Jiang Jingying,Ju Zhaoru,Sun Yinghua,et al.Application of shear wave elastography for diagnosing biliary atresia: a Meta-analysis[J].Journal of Clinical Pediatric Surgery,2021,20(02):126-132.[doi:10.12260/lcxewkzz.2021.02.005]
剪切波弹性成像诊断胆道闭锁价值的Meta分析
- Title:
- Application of shear wave elastography for diagnosing biliary atresia: a Meta-analysis
- 分类号:
- R657.4+4 R445.1
- 摘要:
- 目的 对近年来公开报道的应用剪切波弹性成像诊断胆道闭锁的相关研究做一荟萃分析,初步评估剪切波弹性成像在诊断胆道闭锁中的价值。方法 根据检索式对中英文数据库文献进行检索,按研究纳入排除标准筛选文献,并使用QUADAS-2量表对纳入文献的质量进行评价。提取文献数据,拟合SROC曲线。结果 本荟萃分析共检索到相关文献132篇,按纳入与排除标准,最终纳入数据分析的研究共7项,结果提示剪切波弹性成像诊断胆道闭锁拟合SROC曲线下面积为0.90(95%CI:0.88~0.93),灵敏度为84%(95%CI:72%~92%),特异度为83%(95%CI:70%~91%)。结论 剪切波弹性成像诊断胆道闭锁的临床应用前景可观,但目前尚缺乏前瞻性、高质量的临床诊断试验,各研究间异质性较大,其诊断价值尚有待进一步验证。儿童剪切波弹性成像检测方法目前尚没有统一标准,有待进一步探索、完善。
- Abstract:
- Objective To determine the value of shear wave elastography (SWE) in the diagnosis of biliary atresia (BA) through a meta-analysis of the relevant recent researches.Methods According to the retrieval criteria,the Chinese and English database literature was searched and the articles were screened and selected.The included literature was evaluated by the QUADAS-2 scale.The relevant data were extracted and SROC curve was plotted.Results A total of 132 relevant literatures were retrieved.Based upon the eligibility criteria,7 studies were finally included for data analysis.The results showed that the area under the SROC curve of SWE for diagnosing BA was 0.90(95%CI:0.88-0.93),the combined sensitivity 81% (95%CI:72%-92%) and the combined specificity 85%(95%CI:70%-91%).Conclusion SWE is valuable for diagnosing BA.However,there is still a lack of prospective and high-quality clinical diagnostic tests.The heterogeneity of previous studies is high so that the diagnostic value of SWE should be further verified.Meanwhile the method of SWE in children remains to be further improved and standardized.
参考文献/References:
1 Alagille D.Extrahepatic biliary atresia[J].Hepatology,1984,4(1 Suppl):7S-10S.DOI:10.1002/hep.1840040704.
2 Sun S,Chen G,Zheng S,et al.Analysis of clinical parameters that contribute to the misdiagnosis of biliary atresia[J].J Pediatr Surg,2013,48(7):1490-1494.DOI:10.1016/j.jpedsurg.2013.02.034.
3 Gennisson JL,Deffieux T,Fink M,et al.Ultrasound elastography:principles and techniques[J].Diagn Interv Imaging,2013,94(5):487-495.DOI:10.1016/j.diii.2013.01.022.
4 Sigrist RMS,Liau J,Kaffas AE,et al.Ultrasound elastography:review of techniques and clinical applications[J].Theranostics,2017,7(5):1303-1329.DOI:10.7150/thno.18650.
5 Goldschmidt I,Streckenbach C,Dingemann C,et al.Application and limitations of transient liver elastography in children[J].J Pediatr Gastroenterol Nutr,2013,57(1):109-113.DOI:10.1097/MPG.0b013e31829206a0.
6 Thumar V,Squires JH,Spicer PJ,et al.Ultrasound elastography applications in pediatrics[J].Ultrasound Q,2018,34(4):199-205.DOI:10.1097/RUQ.0000000000000379.
7 Kim S,Kang Y,Lee MJ,et al.Points to be considered when applying FibroScan S probe in children with biliary atresia[J].J Pediatr Gastroenterol Nutr,2014,59(5):624-628.DOI:10.1097/MPG.0000000000000489.
8 Barr RG.Shear wave liver elastography[J].Abdom Radiol (NY),2018,43(4):800-807.DOI:10.1007/s00261-017-1375-1.
9 Taljanovic MS,Gimber LH,Becker GW,et al.Shear-wave elastography:basic physics and musculoskeletal applications[J].Radiographics,2017,37(3):855-870.DOI:10.1148/rg.2017160116.
10 Kim YY,Kim MJ,Shin HJ,et al.Interconversion of elasticity measurements between two-dimensional shear wave elastography and transient elastography[J].Med Ultrason,2018,20(2):127-133.DOI:10.11152/mu-1307.
11 Kim JR,Suh CH,Yoon HM,et al.The diagnostic performance of shear-wave elastography for liver fibrosis in children and adolescents:A systematic review and diagnostic meta-analysis[J].Eur Radiol,2018,28(3):1175-1186.DOI:10.1007/s00330-017-5078-3.
12 Chen S,Liao B,Zhong Z,et al.Supersonic shearwave elastography in the assessment of liver fibrosis for postoperative patients with biliary atresia[J].Sci Rep,2016,6:31057.DOI:10.1038/srep31057.
13 Shen QL,Chen YJ,Wang ZM,et al.Assessment of liver fibrosis by Fibroscan as compared to liver biopsy in biliary atresia[J].World J Gastroenterol,2015,21(22):6931-6936.DOI:10.3748/wjg.v21.i22.6931.
14 Shin NY,Kim MJ,Lee MJ,et al.Transient elastography and sonography for prediction of liver fibrosis in infants with biliary atresia[J].J Ultrasound Med,2014,33(5):853-864.DOI:10.7863/ultra.33.5.853.
15 贺晓,崔可飞,滑少华,等.实时超声弹性成像在婴儿肝炎综合征和胆道闭锁肝纤维化诊断中的应用价值[J].临床超声医学杂志,2016,18(7):456-458. He X,Cui KF,Hua SH,et al.Application value of real-time ultrasound elastography in the diagnosis of liver fibrosis from infantile hepatitis syndrome and biliary atresia[J].J Clin Ultrasound in Med,2016,18(7):456-458.
16 张国英,唐缨,牛宁宁,等.ARFI与RTE评价胆道闭锁患儿肝脏硬度的对比研究[J].中国超声医学杂志,2018,34(3):244-247. Zhang GY,Tang Y,Niu NN,et al.Comparative study of ARFI and RTE technique in evaluating liver stiffness in children with biliary atresia[J].Chinese J Ultrasound Med,2018,34(3):244-247.
17 Leschied JR,Dillman JR,Bilhartz J,et al.Shear wave elastography helps differentiate biliary atresia from other neonatal/infantile liver diseases[J].Pediatr Radiol,2015,45(3):366-375.DOI:10.1007/s00247-014-3149-z.
18 Wu JF,Lee CS,Lin WH,et al.Transient elastography is useful in diagnosing biliary atresia and predicting prognosis after hepatoportoenterostomy[J].Hepatology,2018,68(2):616-624.DOI:10.1002/hep.29856.
19 刘琴,苏英姿,任红雁,等.实时剪切波弹性成像在鉴别胆道闭锁和胆汁淤积的诊断价值[J].中国临床医学影像杂志,2019,30(6):421-424.DOI:10.12117/jccmi.2019.06.011 Liu Q,Su YZ,Ren HY,et al.Application value of real-time shear wave elastography in diagnosing biliary atresia and cholestasis[J].J Chin Clin Med Imag,2019,30(6):421-424.DOI:10.12117/jccmi.2019.06.011
20 秦敏.肝脏超声实时剪切波弹性在早期诊断胆道闭锁中的价值探讨[J].肝脏,2019,24(7):815-816.DOI:10.3969/j.issn.1008-1704.2019.07.032. Qin M.Exploring the value of real-time shear wave elastography in early diagnosing biliary atresia[J].Chinese Hepatology,2019,24(7):815-816.DOI:10.3969/j.issn.1008-1704.2019.07.032.
21 张鑫鑫,李士星,鞠浩,等.剪切波和实时组织超声弹性成像对BA和IHS肝弹性改变探讨[J].中国超声医学杂志,2016,32(9):808-811.DOI:10.3969/j.issn.1002-0101.2016.09.014. Zhang XX,Li SX,Ju H,et al.Changes of BA and IHS hepatic elasticity by shear wave and real-time tissue ultrasound imaging[J].Chinese J Ultrasound Med,2016,32(9):808-811.DOI:10.3969/j.issn.1002-0101.2016.09.014.
22 Dillman JR,DiPaola FW,Smith SJ,et al.Prospective assessment of ultrasound shear wave elastography for discriminating biliary atresia from other causes of neonatal cholestasis[J].J Pediatr,2019,212:60-65.e3.DOI:10.1016/j.jpeds.2019.05.048.
23 Duan XX,Peng Y,Liu WG,et al.Does supersonic shear wave elastography help differentiate biliary atresia from other causes of cholestatic hepatitis in infants less than 90 days old? compared with grey-scale US[J].Biomed Res Int,2019,2019:9036362.DOI:10.1155/2019/9036362.
24 Wang X,Qian L,Jia L,et al.Utility of shear wave elastography for differentiating biliary atresia from infantile hepatitis syndrome[J].J Ultrasound Med,2016,35(7):1475-1479.DOI:10.7863/ultra.15.08031.
25 Zhou LY,Jiang H,Shan QY,et al.Liver stiffness measurements with supersonic shear wave elastography in the diagnosis of biliary atresia:a comparative study with grey-scale US[J].European radiology,2017,27(8):3474-3484.DOI:10.1007/s00330-016-4710-y.
26 段星星,彭娅,刘凌萍,等.超声剪切波弹性成像技术对胆道闭锁筛查与诊断的临床价值分析[J].临床小儿外科杂志,2018,17(11):821-825.DOI:10.3969/j.issn.1671-6353.2018.11.005. Duan XX,Peng Y,Liu LP,et al.Value of shear wave elastography in differentiating biliary atresia from cholestatic hepatitis in infants[J].J Clin Ped Sur,2018,17(11):821-825.DOI:10.3969/j.issn.1671-6353.2018.11.005.
27 Hanquinet S,Courvoisier DS,Rougemont AL,et al.Contribution of acoustic radiation force impulse (ARFI) elastography to the ultrasound diagnosis of biliary atresia[J].Pediatr Radiol,2015,45(10):1489-1495.DOI:10.1007/s00247-015-3352-6.
28 Zhou LY,Wang W,Shan QY,et al.Optimizing the US diagnosis of biliary atresia with a modified triangular cord thickness and gallbladder classification[J].Radiology,2015,277(1):181-191.DOI:10.1148/radiol.2015142309.
29 Shima H,Igarashi G,Wakisaka M,et al.Noninvasive acoustic radiation force impulse (ARFI) elastography for assessing the severity of fibrosis in the post-operative patients with biliary atresia[J].Pediatr Surg Int,2012,28(9):869-872.DOI:10.1007/s00383-012-3140-4.
30 Sintusek P,Siriporn N,Punpanich D,et al.Spleen and liver stiffness to detect esophageal varices in children with biliary atresia[J].J Pediatr Gastroenterol Nutr,2019,69(4):411-415.DOI:10.1097/MPG.0000000000002430.
31 Sohn H,Park S,Kang Y,et al.Predicting variceal bleeding in patients with biliary atresia[J].Scand J Gastroenterol,2019,54(11):1385-1390.DOI:10.1080/00365521.2019.1683225.
32 Uchida H,Sakamoto S,Kobayashi M,et al.The degree of spleen stiffness measured on acoustic radiation force impulse elastography predicts the severity of portal hypertension in patients with biliary atresia after portoenterostomy[J].J Pediatr Surg,2015,50(4):559-564.DOI:10.1016/j.jpedsurg.2014.12.026.
33 Voutilainen S,Kivisaari R,Lohi J,et al.A prospective comparison of noninvasive methods in the assessment of liver fibrosis and esophageal varices in pediatric chronic liver diseases[J].J Clin Gastroenterol,2016,50(8):658-663.DOI:10.1097/MCG.0000000000000532.
34 Yokoyama S,Ishigami M,Honda T,et al.Spleen stiffness by 2-D shear wave elastography is the most accurate predictor of high-risk esophagogastric varices in children with biliary atresia[J].Hepatol Res,2019,49(10):1162-1168.DOI:10.1111/hepr.13381.
35 Yoon H,Shin HJ,Kim MJ,et al.Predicting gastroesophageal varices through spleen magnetic resonance elastography in pediatric liver fibrosis[J].World J Gastroenterol,2019,25(3):367-377.DOI:10.3748/wjg.v25.i3.367.
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备注/Memo
收稿日期:2020-04-20。
基金项目:上海市重点学科(编号:2017ZZ02022);上海市临床重点专科(编号:shslczdzk05703);国家儿童医学中心"海聚"国际联合实验室(编号:EK1125180104);国家儿童医学中心青年临床科学家项目(编号:EK112520180310)
通讯作者:郑珊,Email:szheng@shmu.edu.cn