肝硬化患者肝细胞癌监测适当超声质量的预测因素

StephenW

Predictors of adequate ultrasound quality for hepatocellular carcinoma surveillance in patients with cirrhosis
Authors

    First published: 8 November 2016Full publication history
    DOI: 10.1111/apt.13841View/save citation
    Cited by: 0 articles

    Funding Information

    The Handling Editor for this article was Professor Peter Hayes, and it was accepted for publication after full peer-review.

Summary
Background

Abdominal ultrasound fails to detect over one-fourth of hepatocellular carcinoma (HCC) at an early stage in patients with cirrhosis. Identifying patients in whom ultrasound is of inadequate quality can inform interventions to improve surveillance effectiveness.
Aim

To evaluate and identify predictors of ultrasound quality in patients with cirrhosis.
Methods

We performed a retrospective cohort study among patients who underwent ultrasound examination for a cirrhosis-related indication between April 2015 and October 2015. Three fellowship-trained abdominal radiologists collectively reviewed all ultrasound exams and categorised exam quality as definitely adequate, likely adequate, likely inadequate and definitely inadequate to exclude liver lesions. We performed multivariable logistic regression to determine characteristics associated with inadequate ultrasound quality.
Results

Among 941 patients, 191 (20.3%) ultrasounds were inadequate for excluding HCC- 134 definitely inadequate and 57 likely inadequate. In multivariable analysis, inadequate quality was associated with male gender (OR 1.68, 95% CI 1.14–2.48), body mass index category (OR 1.67, 95% CI 1.45–1.93), Child–Pugh B or C cirrhosis (OR 1.93, 95% CI 1.32–2.81), alcohol-related cirrhosis (OR 2.11, 95% CI 1.33–3.37), NASH cirrhosis (OR 2.87, 95% CI 1.71–4.80), and in-patient status (OR 1.55, 95% CI 1.01–2.37). Ultrasounds were inadequate in over one-third of patients with Child–Pugh C cirrhosis, BMI >35, or NASH cirrhosis.
Conclusions

One in five ultrasounds in patients with cirrhosis are inadequate for exclusion of HCC, which can contribute to surveillance failure. Alternative surveillance modalities are needed in subgroups prone to inadequate ultrasounds including obese patients, those with Child Pugh B or C cirrhosis, and those with alcohol- or NASH-related cirrhosis.

StephenW

肝硬化患者肝细胞癌监测适当超声质量的预测因素
作者

    首次发布：2016年11月8日完整的出版历史
    DOI：10.1111 / apt.13841查看/保存引文
    引用：0文章

    资金信息

    这篇文章的处理编辑是Peter Hayes教授，它在完全同行评审后被接受出版。

概要
背景

腹部超声在肝硬化患者的早期检测不到四分之一的肝细胞癌（HCC）。识别超声的质量不足的患者可以通知干预措施以提高监测效果。
目标

评估和识别肝硬化患者超声质量的预测因子。
方法

我们在2015年4月至2015年10月期间接受了肝硬化相关适应症的超声检查的患者中进行了回顾性队列研究。三位受过研究培训的腹部放射科医师共同审查了所有超声检查，并将检查质量分类为明确足够，可能足够，可能不足，绝对不足以排除肝脏病变。我们进行多变量逻辑回归以确定与不足的超声质量相关的特性。
结果

在941例患者中，191例（20.3％）超声不足以排除HCC-134绝对不足，57例可能不足。在多变量分析中，质量不足与男性性别（OR 1.68,95％CI 1.14-2.48），体重指数类别（OR 1.67,95％CI 1.45-1.93），Child-Pugh B或C肝硬化（OR 1.93， 95％CI 1.32-2.81），酒精相关性肝硬化（OR 2.11,95％CI 1.33-3.37），NASH肝硬化（OR 2.87,95％CI 1.71-4.80）和住院状态（OR 1.55,95％CI 1.01-2.37）。超过三分之一的Child-Pugh C型肝硬化，BMI> 35或NASH肝硬化的患者超声不足。
结论

肝硬化患者中的五分之一超声不足以排除HCC，这可能有助于监视失败。在易发生不适当超声的亚组（包括肥胖患者，患有Child Pugh B或C肝硬化的亚组）和具有酒精或NASH相关性肝硬化的亚组中需要替代的监测模式。