目的:肝脏瞬时弹性成像(TE)已被WHO认可为肝脏疾病的一线诊断工具。尽管由肋间空间(ICS)相关因素(包括皮下脂肪过多和相对于换能器尺寸的狭窄ICS)和操作员经验不足引起的不可靠和无效的结果并不少见,目前尚无理想探针放置的标准指南。在这里,我们进行了一项前瞻性观察性研究,通过使用超声B模式和弹性成像表征ICS的解剖和生物力学特性,确定TE的理想测量部位和呼吸状况.
方法:在59例患者的四个特定部位逐点进行肋间超声检查,以同时测量宽度,刚度,和肝脏上ICSs的皮肤-肝囊距离(SCD),在吸气末和呼气末条件下。第8路ICS和前腋窝线的交点,第七ICS和前腋窝线,第八ICS和腋窝中线,和第7个ICS和腋窝中系分别定义为站点1至4。
结果:结果表明,站点2和3的肋间宽度较大;站点3和4的肋间刚度较低;站点2和3的SCD较短。在最终吸气时,ICS明显更宽更硬。此外,在位点1和3更容易看到肝脏。
结论:我们建议将Site3用于TE探针放置,因为它的宽度更大,较低的刚度,腹壁厚度较小。在末端吸气时执行TE是优选的,以最小化换能器-肋骨干扰。这项研究为标准化的TE检查程序铺平了道路。
■首先建立了WHO推荐的肝脏TE的标准化测量方案,以提高检查程序的成功率和效率。
结论:WHO推荐的TE不可靠或由于肋间间隙相关因素而失败。建议在腋下中线上的第8个肋间空间和末端吸气。这种标准化的协议有助于处理具有挑战性的案件,并简化了操作程序。
OBJECTIVE: Liver transient elastography (TE) has been endorsed by the WHO as the first-line diagnostic tool for liver diseases. Although unreliable and invalid results caused by intercostal space (ICS)-associated factors (including excessive subcutaneous fat and a narrow ICS relative to the transducer size) and operator inexperience are not uncommon, no standard guidelines for ideal probe placement are currently available. Herein, we conducted a prospective observational study to identify an ideal measurement site and respiratory condition for TE by characterizing anatomical and biomechanical properties of the ICSs using ultrasound B-mode and elasticity imaging.
METHODS: Intercostal ultrasound was performed pointwise at four specific sites in 59 patients to simultaneously measure the width, stiffness, and skin‒liver capsule distance (SCD) of the ICSs over the liver, under end-inspiratory and end-expiratory conditions. Intersections between the 8th ICS and anterior axillary line, the 7th ICS and anterior axillary line, the 8th ICS and mid-axillary line, and the 7th ICS and mid-axillary line were defined as Sites 1 to 4, respectively.
RESULTS: Results indicated that Sites 2 and 3 presented greater intercostal width; Sites 3 and 4 displayed lower intercostal stiffness; Sites 2 and 3 exhibited a shorter SCD. The ICSs were significantly wider and stiffer at end-inspiration. Additionally, the liver was more easily visualized at Sites 1 and 3.
CONCLUSIONS: We recommend Site 3 for TE probe placement owing to its greater width, lower stiffness, and smaller abdominal wall thickness. Performing TE at end-inspiration is preferred to minimize transducer-rib interferences. This study paves the way toward a standardized TE examination procedure.
UNASSIGNED: A standardized measurement protocol for WHO-recommended liver TE was first established to improve the success and efficiency of the examination procedure.
CONCLUSIONS: WHO-recommended TE is unreliable or fails due to intercostal space-related factors. The 8th intercostal space on the mid-axillary line and end-inspiration are recommended. This standardized protocol aids in handling challenging cases and simplifies operational procedures.