Noninvasive evaluation of esophageal and gastric varices in liver cirrhosis by shear-wave ultrasound elastography
-
摘要:
食管胃底静脉曲张破裂出血是导致肝硬化患者死亡的主要原因之一,因此早期对食管胃底静脉曲张进行监测有助于改善患者的预后,而目前作为诊断金标准的肝静脉压力梯度和上消化道内镜检查均为侵入性检查,不利于长期随访。现就剪切波超声弹性成像技术对肝硬化门静脉高压食管胃底静脉曲张患者的无创评估进行了介绍。
Abstract:Esophagogastric variceal bleeding is one of the main causes of death in patients with liver cirrhosis,and therefore,early monitoring of esophageal and gastric varices may help to improve the prognosis of patients; however at present,hepatic venous pressure gradient and upper gastrointestinal endoscopy used as the gold standard for diagnosis are invasive examinations,which may not help with long-term follow-up. This article introduces the noninvasive evaluation of esophageal and gastric varices in cirrhotic patients by shear-wave ultrasound elastography.
-
[1] de FRANCHIS R,Baveno VI Faculty. Expanding consensus in portal hypertension:Report of the Baveno VI Consensus Workshop:Stratifying risk and individualizing care for portal hypertension[J]. J Hepatol,2015,63(3):743-752. [2] CREMERS I,RIBEIRO S. Management of variceal and nonvariceal upper gastrointestinal bleeding in patients with cirrhosis[J]. Therap Adv Gastroenterol,2014,7(5):206-216. [3] Chinese Society of Hepatology,Chinese Medical Association;Chinese Society of Gastroenterology,Chinese Medical Association; Chinese Society of Endoscopy,Chinese Medical Association. Guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension[J]. J Clin Hepatol,2016,32(2):203-219.(in Chinese)中华医学会肝病学分会,中华医学会消化病学分会,中华医学会内镜学分会.肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J].临床肝胆病杂志,2016,32(2):203-219. [4] European Association for the Study of the Liver. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis[J]. J Hepatol,2018,69(2):406-460. [5] GARCIA-TSAO G,ABRALDES JG,BERZIGOTTI A,et al.Portal hypertensive bleeding in cirrhosis:Risk stratification,diagnosis,and management:2016 practice guidance by the American Association for the study of liver diseases[J]. Hepatology,2017,65(1):310-335. [6] KIM BK,HAN KH,PARK JY,et al. A liver stiffness measurement-based,noninvasive prediction model for high-risk esophageal varices in B-viral liver cirrhosis[J]. Am J Gastroenterol,2010,105(6):1382-1390. [7] CHEN Y,WANG W,WANG H,et al. Rapamycin attenuates splenomegaly in both intrahepatic and prehepatic portal hypertensive rats by blocking m TOR signaling pathway[J]. PLo S One,2016,11(1):e0141159. [8] MEJIAS M,GARCIA-PRAS E,GALLEGO J,et al. Relevance of the m TOR signaling pathway in the pathophysiology of splenomegaly in rats with chronic portal hypertension[J]. J Hepatol,2010,52(4):529-539. [9] TAKUMA Y,NOUSO K,MORIMOTO Y,et al. Portal hypertension in patients with liver cirrhosis:Diagnostic accuracy of spleen stiffness[J]. Radiology,2016,279(2):609-619. [10] CASTERA L,PINZANI M,BOSCH J. Non invasive evaluation of portal hypertension using transient elastography[J]. J Hepatol,2012,56(3):696-703. [11] SIGRIST R,LIAU J,KAFFAS AE,et al. Ultrasound elastography:Review of techniques and clinical applications[J]. Theranostics,2017,7(5):1303-1329. [12] WANG XK,WANG P,ZHANG Y,et al. A study on spleen transient elastography in predicting the degree of esophageal varices and bleeding[J]. Medicine(Baltimore),2019,98(9):e14615. [13] TSENG Y,LI F,WANG J,et al. Spleen and liver stiffness for noninvasive assessment of portal hypertension in cirrhotic patients with large esophageal varices[J]. J Clin Ultrasound,2018,46(7):442-449. [14] CALVARUSO V,BRONTE F,CONTE E,et al. Modified spleen stiffness measurement by transient elastography is associated with presence of large oesophageal varices in patients with compensated hepatitis C virus cirrhosis[J]. J Viral Hepat,2013,20(12):867-874. [15] STEFANESCU H,MARASCO G,CALS P,et al. A novel spleen-dedicated stiffness measurement by FibroScanimproves the screening of high-risk oesophageal varices[J].Liver Int,2020,40(1):175-185. [16] PATERNOSTRO R,REIBERGER T,BUCSICS T. Elastographybased screening for esophageal varices in patients with advanced chronic liver disease[J]. World J Gastroenterol,2019,25(3):308-329. [17] AUGUSTIN S,PONS M,MAURICE JB,et al. Expanding the Baveno VI criteria for the screening of varices in patients with compensated advanced chronic liver disease[J]. Hepatology,2017,66(6):1980-1988. [18] AUGUSTIN S,PONS M,GENESCA J. Validating the Baveno VI recommendations for screening varices[J]. J Hepatol,2017,66(2):459-460. [19] ABRALDES JG,BUREAU C,STEFANESCU H,et al. Noninvasive tools and risk of clinically significant portal hypertension and varices in compensated cirrhosis:The“Anticipate”study[J]. Hepatology,2016,64(6):2173-2184. [20] GONZLEZ-OJEDA A,CERVANTES-GUEVARA G,CHVEZSNCHEZ M,et al. Platelet count/spleen diameter ratio to predict esophageal varices in Mexican patients with hepatic cirrhosis[J]. World J Gastroenterol,2014,20(8):2079-2084. [21] DING NS,NGUYEN T,ISER DM,et al. Liver stiffness plus platelet count can be used to exclude high-risk oesophageal varices[J]. Liver Int,2016,36(2):240-245. [22] PEAGU R,SRARU R,NECULA A,et al. The role of spleen stiffness using ARFI in predicting esophageal varices in patients with hepatitis B and C virus-related cirrhosis[J]. Rom J Intern Med,2019,57(4):334-340. [23] LUCCHINA N,RECALDINI C,MACCHI M,et al. Point shear wave elastography of the spleen:Its role in patients with portal hypertension[J]. Ultrasound Med Biol,2018,44(4):771-778. [24] PARK Y,KIM SU,PARK SY,et al. A novel model to predict esophageal varices in patients with compensated cirrhosis using acoustic radiation force impulse elastography[J]. PLo S One,2015,10(3):e0121009. [25] JANSEN C,BOGS C,VERLINDEN W,et al. Shear-wave elastography of the liver and spleen identifies clinically significant portal hypertension:A prospective multicentre study[J].Liver Int,2017,37(3):396-405. [26] PETZOLD G,TSAKNAKIS B,BREMER S,et al. Evaluation of liver stiffness by 2D-SWE in combination with non-invasive parameters as predictors for esophageal varices in patients with advanced chronic liver disease[J]. Scand J Gastroenterol,2019,54(3):342-349. [27] YOO HW,KIM YS,KIM SG,et al. Usefulness of noninvasive methods including assessment of liver stiffness by 2-dimensional shear wave elastography for predicting esophageal varices[J]. Dig Liver Dis,2019,51(12):1706-1712. [28] SINGH S,EATON JE,MURAD MH,et al. Accuracy of spleen stiffness measurement in detection of esophageal varices in patients with chronic liver disease:Systematic review and meta-analysis[J]. Clin Gastroenterol Hepatol,2014,12(6):935-945.e4. [29] LIPINSKI M,SABOROWSKI M,HEIDRICH B,et al. Clinical characteristics of patients with liver cirrhosis and spontaneous portosystemic shunts detected by ultrasound in a tertiary care and transplantation centre[J]. Scand J Gastroenterol,2018,53(9):1107-1113. [30] DONG X,HUANG LP. Research advances in the value of ultrasound elastography in the diagnosis of gastroesophageal varices in patients with liver cirrhosis[J]. J Clin Hepatol,2018,34(11):2424-2427.(in Chinese)董雪,黄丽萍.超声弹性成像技术诊断肝硬化食管胃静脉曲张的研究进展[J].临床肝胆病杂志,2018,34(11):2424-2427. 期刊类型引用(7)
1. 苏健,张锋镝,谈志丽,游丽萍,张景豪,郑超,高月求,王灵台,孙学华. 肝硬化门静脉高压血流动力学机制及中医药治疗进展. 中西医结合肝病杂志. 2025(01): 100-103 . 百度学术
2. 王影,胡海峰,李璐,刘慧临,张英慧,邓佳佳. 超声剪切波弹性成像联合血小板计数在肝硬化食管胃底静脉曲张中的应用价值. 影像研究与医学应用. 2024(16): 167-169+173 . 百度学术
3. 张华妮,李嘉颖,周敏辉,陈海波,孙志超. 脾脏影像纹理特征预测肝硬化患者食管静脉曲张严重程度的研究. 浙江医学. 2023(05): 470-474+562 . 百度学术
4. 刘水澎,张国顺. 彩色多普勒超声检测门静脉、脾静脉血流动力学在肝硬化食管胃底静脉曲张患者中的临床应用研究. 中国实验诊断学. 2023(04): 436-439 . 百度学术
5. 刘越,卢学峰. 剪切波弹性成像测量脾脏硬度评估肝硬化食管静脉曲张. 中国介入影像与治疗学. 2022(02): 119-122 . 百度学术
6. 陈丽芬,姚朝光,蓝婧,黄理,覃冬林,欧琴,吴晓云,黄霜湘. MR弹性成像与超声内镜用于肝硬化食管胃底静脉曲张诊断的比较. 肝脏. 2022(04): 447-450 . 百度学术
7. 曾海龙,夏铭,张正坤,王伟,姚建华. 超声内镜弹性成像联合声速匹配技术对上消化道肿瘤和胰腺疾病诊断价值研究. 中华肿瘤防治杂志. 2021(22): 1754-1756 . 百度学术
其他类型引用(1)
-