青木 智子^{1, 2}, 西口 修平², 飯島 尋子^{1, 2}

Tomoko AOKI^{1, 2}, Shuhei NISHIGUCHI², Hiroko IIJIMA^{1, 2}

¹兵庫医科大学超音波センター, ²兵庫医科大学内科肝胆膵科

¹Ultrasound Imaging Center, Hyogo College of Medicine, Japan, ²Department of Hepatobiliary and Pancreatic Disease, Hyogo College of Medicine, Japan

キーワード :

【AIM】
Many studies have demonstrated risk factors for developing liver cancer in patients with chronic liver disease （CLD）, whereas a few reports are available on the usefulness of shear waves for predicting malignant lesions in the liver. The usefulness of shear waves in the diagnosis of liver fibrosis was studied, and the performance of shear waves in three different modalities was compared. The usefulness of Virtual Touch Quantification （VTQ） for the prediction of liver cancer was evaluated.
【METHODS】
①Total 1088 CLD cases who underwent VTQ （October 2008 to July 2012） were included （564 males, 524 females, mean age 60.4）. ②Of ①, 853 cases had VTQ on the same day of liver biopsy. ③162 cases had an additional Shear Wave Elastography （SWE）, and ④121 cases had an additional Fibroscan on the same day. Fibrosis evaluated with the New Inuyama classification was compared to the measurements by each modality, and the cut off value to distinguish the degree of fibrosis was chosen using the ROC curves. Factors associated with cancer development were identified.
【RESULTS】
Out of ①, 681 cases had no history of cancer （HCVAb（+） n=395, HBsAg（+） n=132, HCVAb（-） and HBsAg（-）［NBNC］: n=154） （CHC n=395, CHB n=132, NBNC n=154）. , but the remaining 407 cases （37.4％） had （n=276, n=39, n=92, respectively）. Fibrosis stages were compared to the liver stiffness measurements by each modality. In ②, the mean VTQ value for each fibrosis stages were F0 （n=72） 1.11 m/s, F1 （n=331） 1.18 m/s, F2 （n=148） 1.46 m/s, F3 （n=162） 1.57 m/s, F4 （n=168） 2.49 m/s. Cut off value （Vs） of 1.61 m/s significantly differentiated between F0-3 and F4 （sensitivity ［Sn］ 0.82, specificity ［Sp］ 0.87）. In ③, cut off value （Vs） of 1.90 m/s significantly differentiated between F0-3 and F4 （Sn 0.98, Sp 0.80）. The Vs value of VTQ were well correlated with the SWE measurement （correlation coefficient ［CC］=0.801）. In ④, cut off value of 9.30kPa significantly differentiated between F0-3 and F4 （Sn 0.91, Sp 0.78）. The Vs value of VTQ was significantly correlated with Fibroscan measurement （CC=0.804） （p＜0.001）. Univariate analysis of 1088 cases for determining the risk factors for carcinogenesis demonstrated significant differences in age, sex, hyaluronic acid, Vs, Plt, PT-INR, γGTP, fasting glucose （p＜0.001）. Logistic regression analysis identified that high Vs values in elderly-males cases were especially associated with cancer development.
【CONCLUSION】
VTQ reflected the degree of fibrosis well, and correlated significantly with SWE and Fibroscan. The elder patients with high liver stiffness value were more associated with cancer development.