超音波検査技術

ISSN: 1881-4506
一般社団法人日本超音波検査学会
〒162-0801 東京都新宿区山吹町358-5
Japanese Journal of Medical Ultrasound Technology 40(5): 507-514 (2015)
doi:10.11272/jss.40.507

学術賞－研究Researcher's Award - Research Paper

視覚的評価と肝硬度測定機器による非侵襲的肝線維化診断Non-invasive Diagnosis of Liver Fibrosis by Visual Evaluation and Transient Elastography (FibroScan®)

長谷川 聡洋1，和田 智文2，島崎 洋2，大村 卓味3，市原 真4Toshihiro Hasegawa1, Tomofumi Wada2, Hiroshi Shimazaki2, Takumi Oomura3, Shin Ichihara4

1 JA北海道厚生連網走厚生病院医療技術部放射線技術科Department of Radiological Technology, Division of Medical Technology, Abashiri Kosei General Hospital ◇ 〒093-0076 北海道網走市北六条西1丁目9番地Kita-6-Nishi 1-9, Abashiri-shi, Hokkaido 093-0076, Japan

2 JA北海道厚生連札幌厚生病院医療技術部放射線技術科Department of Radiological Technology, Division of Medical Technology, Sapporo Kosei General Hospital ◇ 〒060-0033 北海道札幌市中央区北三条東8丁目5番地Kita-3-Higashi 8-5, Chuo-ku, Sapporo-shi, Hokkaido 060-0033, Japan

3 JA北海道厚生連札幌厚生病院第3消化器内科Department of Gastroenterology 3, Sapporo Kosei General Hospital ◇ 〒060-0033 北海道札幌市中央区北三条東8丁目5番地Kita-3-Higashi 8-5, Chuo-ku, Sapporo-shi, Hokkaido 060-0033, Japan

4 JA北海道厚生連札幌厚生病院病理診断科Department of Pathology, Sapporo Kosei General Hospital ◇ 〒060-0033 北海道札幌市中央区北三条東8丁目5番地Kita-3-Higashi 8-5, Chuo-ku, Sapporo-shi, Hokkaido 060-0033, Japan

受付日：2015年3月24日Received: March 24, 2015
受理日：2015年8月1日Accepted: August 1, 2015
発行日：2015年10月1日Published: October 1, 2015
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非侵襲的肝線維化診断として肝硬度測定機器による肝弾性値とUSのBモード像による視覚的評価をそれぞれ肝生検による肝線維化ステージ分類と対比した．肝弾性値には肝線維化ステージと良好な相関を認めたが，同じ肝線維化ステージ内であっても得られる値にややバラつきがあり，隣り合う肝線維化ステージ間で重複部分も多く存在することを念頭に置き，肝線維化の推定を慎重に行う必要がある．視覚的評価では正常肝から慢性肝炎への移行期や非ウイルス性肝障害で結果に乖離を認める傾向にあり，肝障害原因別に組織性状とそれに由来する画像的特徴をしっかり把握し判定することが重要である．可能であれば，特に正常肝から慢性肝炎への移行期やNASH，PBC，AIHなどの非ウイルス性肝障害に対しては肝弾性値と視覚的評価を併用することで，さらに精度の高い非侵襲的肝線維化診断が可能と考える．

Purpose: We compared liver stiffness by transient elastography and visual evaluation by B-mode image against the liver fibrosis stage of liver biopsy.

Methods: 121 examples which liver biopsy was implemented at the same moment with transient elastography between Oct 2012 and Dec 2013. 61 examples of males and 60 examples of females, average age 57.2±12.4 years old. Breakdown of the cause of hepatic disorder is 12 examples of hepatitis B virus (HBV), 59 examples of hepatitis C virus (HCV), 22 examples of non-alcoholic steatohepatitis (NASH), 11 examples of primary biliary cirrhosis (PBC), 7 examples of autoimmune hepatitis (AIH), 2 examples of alcoholic, 2 examples of drug-induced, 2 examples of fatty liver, 4 examples with no known cause. Breakdown of the classification of liver fibrosis stage by liver biopsy is 11 examples of F0, 44 examples of F1, 35 examples of F2, 16 examples of F3, 15 examples of F4. Examination items are (1) contradistinction of liver stiffness and the result of liver biopsy, (2) contradistinction of visual evaluation and the result of liver biopsy. Visual evaluation was conducted under an agreement of 3 sonographers without any information of each patients, classifying B-mode image into 1 (normal～chronic hepatitis; CH), 2 (CH), 3 (Pre liver cirrhosis; PreLC), 4 (LC).

Results: (1) Respective average value of liver stiffness is F0; 5.5±1.4 kPa (median 5.2 kPa), F1; 5.8±2.3 kPa (median 5.6 kPa), F2; 9.3±5.5 kPa (median 7.7 kPa), F3; 14.8±8.0 kPa (median 13.0 kPa), F4; 26.7±11.3 kPa (median 24.0 kPa) and observed elevation of liver stiffness as liver fibrosis stage elevated. It respectively showed a significant difference between F1–F2, F2–F3, F3–F4 (p<0.005, p<0.05, p<0.05).

(2) 83 examples (68.6%) are accordant results of both visual evaluation and liver fibrosis stage. On the other hand, 38 examples (31.4%) are vastly different results and they tend to be low level of liver fibrosis stage. Especially, we could recognize 12 examples (9.9%) as huger difference and the breakdown of each reason of hepatic disorder is HBV 1 example, HCV 2 examples, AIH 4 examples, PBC 1 example, PBC+AIH 1 example, NASH 2 examples, for unknown reason 1 example and could also recognize lots of non-viral hepatic disorder.

Conclusion: Both liver stiffness and visual evaluation showed high diagnostic accuracy even simple substance. But the score of liver stiffness varied widely even in liver fibrosis stage where is same with liver stiffness. And there existed overlaps between liver fibrosis stages laid side-by-side. With that in mind, we have to estimate liver fibrosis carefully. Transitional period from normal liver to chronic hepatitis and non-viral hepatic disorder tended to show gap with visual evaluation. It is important to determine, grasping that both tissue characterization and image characteristics with respect to each reasons of hepatic disorder. If possible, we are able to realize higher-accuracy non-invasive diagnosis of liver fibrosis, with using liver stiffness and visual evaluation together for transitional period from normal liver to chronic hepatitis and non-viral hepatic disorder.

キーワード：肝弾性値；視覚的評価；肝線維化

Key words: liver stiffness; visual evaluation; liver fibrosis

© 2015 一般社団法人日本超音波検査学会© 2015 Japanese Society of Sonographers

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