지방간 진단을 위한 간 초음파와 Fibroscan 검사법의 비교 분석

김근희,지태정,김현진 한국방사선학회 2022 한국방사선학회 논문지 Vol.16 No.3

This study retrospectively analyzed the test results of 441 patients who visited Hospital I in Busan from October 2021 to December 2021 and conducted both mid-term ultrasound and fibroscan tests. The purpose of the study was to investigate the usefulness of fibroscan in inter-fat evaluation by conducting correlation analysis and chi-squared test of inter-fat evaluation using liver ultrasound and fibroscan. As a result of analyzing the correlation between the fatty liver reading result of abdominal ultrasound and Fibroscan UAP, the correlation was found to be r=0.600 and p=0.000. In the inter-provincial evaluation, Fibroscan showed high validity in predicting objective results using inter-provincial values. 본 연구는 2021년 10월부터 2021년 12월까지 부산 소재 I 병원을 내원한 환자와 건감검진 대상 중 간 초음파와 Fibroscan 검사를 모두 시행한 441명의 검사 결과지를 후향적으로 분석하였다. 연구 목적은 간 초음파를 이용한 지방간 평가와 Fibroscan을 이용한 지방간 평가의 상관관계분석 및 카이제곱검정을 시행하여 지방간 평가에 있어 Fibroscan의 유용성을 알아보고자 하였다. 복부초음파의 지방간 판독 결과와 Fibroscan UAP의 상관관계 분석 결과 r=0.600, p=0.000으로 나타나 상관관계가 확인되었다. 지방간 평가에 있어서 Fibroscan은 지방간 수치로 하여 객관적인 결과를 예측하는데 높은 타당도를 보였다.

만성 간질환 환자에서 순간 탄성도와 간조직 검사에 의한 간섬유화 비교

정민규 ( Min Kyu Jung ),조한진 ( Han Jin Cho ),이호철 ( Ho Chul Lee ),박관식 ( Kwan Sik Park ),서은희 ( Eun Hee Seo ),전성우 ( Sung Woo Jeon ),조창민 ( Chang Min Cho ),탁원영 ( Won Young Tak ),김성국 ( Sung Kook Kim ),최용환 ( Yon 대한소화기학회 2008 대한소화기학회지 Vol.51 No.4

목적: 최근 새롭게 개발된 순간 탄성도는 간경도를 측정하여 빠르고 간단하면서도 비침습적으로 간섬유화 정도를 측정하는 방법이다. 몇몇 연구 결과들에 의하면 Fibroscan을 이용한 간경도 측정으로 C형 간염 환자의 간섬유화 정도를 비교적 정확히 예측할 수 있었다. 이 연구의 목적은 HCV 외 다양한 병인을 가진 국내 만성 간질환 환자의 간섬유화 정도를 측정하는 데 순간 탄성도의 정확성 및 임상적인 유용성을 간조직 검사 결과와 비교하여 알아보고자 하였다. 대상 및 방법: 최근 6개월 이내에 간조직 검사를 시행한 54명의 만성 간 질환 환자를 대상으로 하였다. 만성 간질환의 원인은 HBV, HCV, 자가면역, 비알코올 지방간염이었다. 간섬유화 등급은 대한병리학회 소화기병리연구회가 제안한 간조직 기술지침에 따라 섬유화 4등급으로 나누어 판독하였다. 결과: Fibroscan의 간경도 측정치는 F0는 5.10 kPa, F1 이 9.72 kPa, F2가 8.48 kPa, F3는 16.96 kPa, F4에서는 19.86 kPa를 보여주었다. 간섬유화 등급이 높아질수록 간경도 측정치도 증가하였으며, 이들의 상관관계는 spearman 상관상수가 0.614로 유의하였다. 결론: Fibroscan을 사용한 간경도 측정법은 통증을 동반하지 않고 검사 시간이 짧으며 합병증이 없다는 점에서 만성 간질환 환자의 간섬유화 정도를 측정하는데 있어 간조직 검사에 비해 간편한 검사법이나 그 진단적 가치를 확인하기 위해서는 다양한 원인질환을 대상으로 다른 섬유화의 혈청표지자들과 함께 많은 수의 환자들을 대상으로 전향적인 연구가 필요할 것으로 생각한다. Background/Aims: Transient elastography (Fibroscan, Echosens, France) is a new, simple, and non-invasive method to assess the degree of hepatic fibrosis by measuring liver stiffness. Recent reports have shown that liver stiffness measurement using Fibroscan allowed accurate prediction of hepatic fibrosis in patient with chronic hepatitis C. The aim of this study was to evaluate accuracy of Fibroscan for the detection of hepatic fibrosis in Korea with various etiologies of chronic liver disease by comparison with fibrosis assessed by histologic examination. Methods: Fifty-four patients with chronic liver diseases, which were histologically confirmed within recent 6 months were enrolled. Etiologies were HBV, HCV infection, autoimmune hepatitis, and non alcoholic steatohepatitis. Hepatic fibrosis was graded on the basis of standard guideline proposed by the Korean Study Group for the Pathology of Digestive Diseases. Results: Fibroscan values were significantly higher in F3 (16.96 kPa) and F4 (19.86 kPa) than others (p=0.003). Liver stiffness measurement was significantly correlated to the fibrosis stage (r=0.614, p<0.0001). Conclusions: Liver stiffness measurement by Fibroscan is a promising method for the assessment of hepatic fibrosis in chronic liver disease because it accompanies no complication. (Korean J Gastroenterol 2008;51:241-247)

Cause of Cirrhosis in Mongolia Evaluated by Non-Invasive Methods Including Fibroscan, FIB4 and APRI

( Oidov Baatarkhuu ),( Munkhchuluun Batzaya ),( D. Enkhutya ),( S. Munkhdemberel ),( S. Ariunaa ),( B. Davaakhuu ),( B. Erkhem ),( G. Egelmaral ),( J. Amarsanaa ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Liver cirrhosis is the one of the most deadly diseases in Mongolia and in rest of the world. To determine the main cause of liver cirrhosis through using methods as AST-to-Platelet Ratio Index (APRI), Fibrosis 4 score (FIB4), and Fibroscan. Methods: We collected 2758 patients who had Fibroscan, then divided them in three groups, HBV positive, HCV positive, and virus negative. Depending on the result of the Fibro scan ,we made a cut-off point of 12kPa to separate patients with F4 stage from F0, F1, F2, and F3 patients. To compare the result of the Fibroscan with other techniques we collected other laboratory results including AST, ALT level, thrombocyte number, viral markers, and viral load. Results: Among 2758 subjects 57.7% (1591) of patients were anti-HCV positive, 35.7% (984) of patients were HBV positive and 6.6% (182) of patients were virus negative. Amongst 1590 patients who were anti-HCV positive, 62.4%(992) of patients diagnosed with F4 stage of fibrosis by Fibroscan. On the other hand, 34.7%(551) of patients with HBV positive has developed cirrhosis and 2.9% (47) of patients had cirrhosis without any evidence of virus. We randomly selected 100 patients from both HBV and HCV positive groups to determine the correlation between Fibroscan, FIB4 and APRI. The correlation between Fibroscan and other non-invasive method including APRI and FIB4 was not strong. In our further study, among 2.9% patients with cirrhosis caused by non-viral etiology, 70% were frequent alcohol consumers and only 15%t admitted that they were addicted to alcohol, and rest of the patients developed liver cirrhosis caused by other factors. Conclusions: The most common cause of liver cirrhosis is HCV, followed by HBV in Mongolia.

Study on Fibrosis Change with Transient Elastography in Chronic Hepatitis B Virus Treatment with Tenofovir

( Ha Phuong Linh ),( Hoang Van Tiep ),( Dinh Cong Dang ),( Nguyen Khac Hung Manh ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Background: Tenofovir disoproxil fumarate (TDF) is one of the first optimal choices to be used in the treatment of chronic hepatitis B. FibroScan is non-invasive methods to assess liver fibrosis. Aims: To evaluate the therapeutic effect of TDF on fibrosis via FibroScan after treatment. Methods: This study was conducted in 63 chronic hepatitis B patients who had the indication of antiviral therapy at 103 Cam Khe Clinic from March 2019 to March 2020. All patients with chronic hepatitis B treated with TDF during 6 months. Liver fibrosis stages was appreciated using transient hepatic elastography by Fibroscan before and after 6 months treatment. Results: The average age of patients was 46 years, with men accounted for 69% of the total. After treatment, normalization of ALT 71.26%, viral response of 90.23%, HBV DNA below the detection level was 66.3%. Liver fibrosis evaluated by FibroScan before and after 6 months treatment were 7.15 ± 1.56 kPa, and 3.58 ± 1.19 kPa eveluated by FibroScan. Conclusions: TDF was effective for patients after treatment on liver fibrosis assessed by FibroScan in chronic hepatitis B patients.

간섬유화스캔을 이용한 선천성 담도 폐쇄증의 최적 수술시기 시험적 제안

이화영,박영아,한석주,고홍,Lee, Hwa-Young,Park, Young-A,Han, Seok-Joo,Koh, Hong 대한소아소화기영양학회 2011 Pediatric gastroenterology, hepatology & nutrition Vol.14 No.1

목 적: 선천성 담도폐쇄증의 일차적 치료로 알려진 Kasai 수술에서의 가장 중요한 예후 인자로 수술 시기가 중요하다는 것은 기존의 연구 결과들을 통해 잘 알려져 있다. 본 연구에서는 선천성 담도 폐쇄증 환아들을 수술 시기별로 분류하고 간섬유화 스캔을 수술 전후에 시행하여 얻어진 간탄성률값을 이용하여 수술 전후의 간 섬유화 변화를 비교함으로서 본 연구에서 도출된 최적의 수술시기가 기존의 연구와 일치하는지 재확인 하고자 한다. 방 법: 2007년 10월부터 2010년 7월까지 단일 기관에서 Kasai 수술을 시행 받은 환자 중, 수술 전후로 간섬유화 스캔을 시행한 환자 34명을 대상으로 수술 시기별 간탄성률 결과값을 비교하였다. 결 과: 환자군의 수술 시기가 빠를수록 수술 전과 후 모두에서 간탄성률 결과값은 좋았고, 특히 8주 이전에 수술을 시행 받은 경우 그 이상에서 수술을 받은 환자군보다 수술 후의 간섬유화가 적게 진행되었고 일부에서는 회복되었다. 또한 8주 수술 전후의 각 탄성률 간의 차이값 또한 통계적으로 유의하였다. 결 론: Kasai 수술의 시기가 이를수록 수술 전 간 섬유화가 적고, 적어도 8주 이전에서 Kasai 수술을 시행하였을 때 수술 이후의 간섬유화가 양호하였으며 수술전후의 간섬유화 진행 정도가 크지 않았다. 따라서 본 연구에서는 간섬유화스캔을 바탕으로 적어도 8주 미만의 연령이 Kasai 수술을 시행 받기에 최적의 시기임을 재확인하였다. Purpose: Based on previous research findings, it is well-known that the timing of surgery is generally considered the most important prognostic factor for a Kasai portoenterostomy, the primary treatment for biliary atresia. This research aimed to identify the optimal timing of a Kasai portoenterostomy and to verify if the proposed optimal timing corresponds to previous studies. All patients were classified by the timing of surgery, and pre- and post-operative fibrotic changes of the liver were measured with the elasticity value from fibroscans. Methods: The stiffness scores of the pre- and post-operative fibroscans in 34 patients who were treated by Kasai portoenterostomy from October 2007 to September 2010 in Severance children's hospital were reviewed. Results: The earlier the patients were treated by Kasai portoenterostomy, the lower the fibroscan scores. When the patients were treated prior to the 8th week, the post-operative scores of the fibroscans were significantly better than those patients who were treated after the 8th week, and some even recovered partially. Moreover, when operated before the 8th week, the differences between each pre- and postoperative fibroscan score also showed statistical relevance (p=0.0002). Conclusion: The earlier the patient was treated by Kasai portoenterostomy, the less liver fibrosis that developed, the lower the level of post-operative fibrosis, and the less the degree of fibrotic progress before and after the operation. Thus, this research proposal reconfirms once more that the 8th week is the optimal timing for a Kasai portoenterostomy.

만성 간질환 환자에서 간 섬유화 평가에 대한 간 탄력도 측정의 유용성

김은선 ( Eun Sun Kim ),서연석 ( Yeon Seok Seo ),이광균 ( Kwang Gyun Lee ),박상훈 ( Sanghoon Park ),권용대 ( Yong Dae Kwon ),금보라 ( Bora Keum ),김용식 ( Yong Sik Kim ),진윤태 ( Yoon Tae Jeen ),전훈재 ( Hoon Jai Chun ),김창덕 ( Ch 대한내과학회 2008 대한내과학회지 Vol.74 No.3

목적: 만성간질환 환자에서 섬유화 진행 정도의 평가는 환자의 치료 및 예후를 결정하는데 매우 중요하다. 섬유화 평가를 위해 간 조직 생검이 가장 좋은 검사법으로 알려져 있으나 비용이 많이 들고 침습적인 검사라는 점 등 몇 가지 문제점이 있어 최근에는 비 침습적 방법을 통한 간 섬유화 측정법들이 시도되고 있다. 본 연구는 이러한 비 침습적 검사법의 하나인 Fibroscan을 통한 liver stiffness measurement(LSM)가 만성간질환 환자에서의 간 섬유화 정도 평가에 유용한가를 평가하기 위해 시행하였다. 방법: 만성간질환으로 간 조직생검을 시행한 93명의 환자를 대상으로 하였다. 간 조직생검 시행 당일 또는 다음날 Fibroscan을 통해 LSM을 측정하였다. 생검 조직의 섬유화 정도는 METAVIR 기준의 간 섬유화 병기에 따라 분류하였다. LSM 결과의 유용성 및 섬유화 정도 평가에 대한 optimal cutoff value를 결정하기 위해 receiver-operating characteristics(ROC) curve 분석을 시행하였다. 결과: 만성간질환으로 간 조직생검을 시행 받은 85명 환자의 연령은 40±13세(중앙값, 40세)였으며 남자가 62명(66.6%)이었다. 만성간질환의 원인은 다음과 같다. 만성 B형 간염, 56명(65.9%) 만성 C형 간염, 19명(22.4%) 지방간질환, 4명(4.7); 자가면역성간염, 3명(3.5%) 기타, 2명(2.4%). 간 조직 생검 결과 F0-1, F2, F3 및 F4에 해당하는 환자는 각각 21명(24.7%), 27명(31.8%), 26명(30.6%) 및 11명(12.9%)이었다. 간조직 생검을 통한 간 섬유화 진행단계는 LSM 결과와 유의한 연관성을 보였다(Kendall`s correlation coefficient: 0.583;p<0.001). 간 조직 생검에서 F2 이상, F3 이상 및 F4 이상에 대한 LSM의 area under ROC curve는 각각 0.871 (95% CI, 0.787-0.956), 0.874 (95% CI, 0.800-0.948) 및 0.894 (95% CI, 0.817-0.970)였다. F2 이상, F3 이상 및 F4 이상에 대한 optimal cutoff value는 각각 6.9, 11.9 및 14.15 kPa였다. 결론: Fibroscan을 통한 LSM 측정은 만성간질환 환자에서 간의 섬유화 정도를 평가할 수 있는 유용한 비 침습적인 방법으로 생각된다. Background/Aims: Accurate assessment of liver fibrosis is very important for predicting the prognosis of patients with chronic liver diseases. Liver biopsy is still considered the gold-standard for assessing liver fibrosis. However, it is an invasive procedure with several limitations such as its questionable outcomes. Recent studies have suggested that liver stiffness measurement (LSM) using Fibroscan is noninvasive and useful for assessing liver fibrosis. This study was performed to evaluate the efficacy of LSM for evaluating liver fibrosis in patients with chronic liver diseases. Methods: We prospectively enrolled 93 patients with chronic liver diseases, as confirmed by liver biopsy. The patients underwent liver biopsy and LSM. The METAVIR liver fibrosis stages of the biopsy specimens were assessed by an experienced pathologist. LSM was performed by Fibroscan. The efficacy of LSM and the optimal cutoff values for assessment of the fibrosis stage were determined by a receiver-operating characteristics (ROC) curve analysis. Results: LSM was well correlated with the fibrosis stage (Kendall correlation coefficient: 0.58; p<0.001). The areas under the ROC curves were 0.871 (95% CI, 0.715-0.924) for the patients with significant fibrosis (F≥2), 0.874 (0.761-0.929) for the patients with severe fibrosis (F≥3) and 0.894 (0.792-0.956) for the patients with cirrhosis (F=4). The optimal LSM cutoff values for F ≥2, F ≥3 and F=4 were 6.9, 11.75 and 14.5 kPa, respectively. Conclusions: LSM was a simple, effective method for assessing liver fibrosis in patients with chronic liver diseases. Its use for the follow up and management of these patients could be of great interest and so further investigation is required. (Korean J Med 74:264-270, 2008)

The Impact of Inflammation Grade of Liver Histology on the Improvement of Liver Stiffness Assessed by Transient Elastography

( Jeong-ju Yoo ),( Yeon Seok Seo ),( Young Seok Kim ),( Soung Won Jeong ),( Jae Young Jang ),( Sang Jun Suh ),( Hyung Joon Yim ),( Ki Tae Suk ),( Dong Joon Kim ),( Kwanh-hyub Han ),( Seung Up Kim ),( 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Transient elastography (TE; Fibroscan) is now almost indispensable tool to estimate liver fibrosis. Although many clinical factors are known as confounding factors of liver stiffness (LS), there is no knowledge of who will achieve an improvement of liver stiffness if they have a similar liver fibrosis stage. The aim of this study is to see whether baseline hepatic inflammation may affect accurate LS measurement and which factors are associated with improvement of LS in Fibroscan. Methods: This retrospective study included consecutive 678 patients who underwent baseline liver biopsy and sequential LS assessment from 2006 to 2016 at 6 tertiary hospitals in Korea. Liver fibrosis and inflammation were graded on the basis of standard guideline proposed by the Korean Study Group for the Pathology of Digestive Diseases. LS measurement was performed at baseline and 1, 3, 5 years. Improvement of LS was defined as decreased LS value compared with baseline. Logistic regression was used to evaluate factors associated with improvement of LS in Fibroscan. Results: Mean age of the patients was 47.12±12.25 years and 48.5% were male. Six hundred 2 patients had viral hepatitis (419 HBV; 183 HCV), 76 non-viral hepatitis. Fibrosis stages 0, 1, 2, 3 and 4 were identified in 13 (1.9%), 96 (14.2%), 132 (19.5%), 186 (27.4%) and 251 (37.0%) patients, inflammation grade 0, 1, 2 and 3 were in 28 (4.1%), 278 (14.0%), 279 (41.2%), and 93 (13.7%), respectively. Baseline inflammation grade was correlated with baseline LSM value, and showed linear correlation with ΔLSM. In addition, as the grade of inflammation increased, the higher percentage of patients showed improvement of LSM. A multivariate analysis showed that higher degree of hepatic inflammation was an independent good predictor for LS improvement (adjusted hazard ratio, 3.33; 95% confidence interval, 1.20-9.26; P=0.021) after adjustment for fibrosis stage, platelet count, total bilirubin and alanine aminotransferase level. The association of LSM and hepatic inflammation was more significant in viral hepatitis compared with non-viral etiology. Conclusions: Baseline hepatic inflammation has significant impact on LS value and improvement of LSM, and should be considered as one of the confounding factors of measuring liver stiffness using Fibroscan.

포스터전시 : Fibroscan에 의한 간탄력도 측정에 영향을 미치는 요인 분석

이다미,김순선,양민재,문은준,조영주,이명희,전수진,정재연,조성원,김영배,김동준,황성규,양진모 대한간학회 2009 Clinical and Molecular Hepatology(대한간학회지) Vol.15 No.3(S)

춘계학술대회 : 구연 ; 간경변증 : 간경변증의 임상적 진단기준을 만족시키지 못하는 만성 B형 간질환 환자에서 Fibroscan의 유용성

김도영,김승업,이주현,윤영준,안상훈,백용한,문병수,이관식,한광협,전재윤 대한간학회 2007 Clinical and Molecular Hepatology(대한간학회지) Vol.13 No.3(S)

간섬유화 진단에서 순간탄성측정법(Transient Elastography)과 간조직검사의 비교 연구

김현진(Hyeon-jin Kim),정양화(Yang-hwa Chung),진미경(Mi-kyeong Jin),이원홍(Won-hong Lee),서대건(Dae-keon Suh) 대한초음파의료영상학회 2015 대한초음파의료영상학회지 Vol.6 No.1

목적 : 순간탄성측정법(Transient elastography, TE)를 통한 간섬유화 결과 값과 간조직 생검의 결과 값을 분석하여 간섬유화 진단에 대한 TE의 정확도와 유용성을 알아보고자 한다. 대상 및 방법 : 2013년 8월부터 2014년 8월까지 간조직생검을 통해 간섬유화 정도를 확인한 환자들 중에서 간조직검사 시행 전후에 TE를 시행한 304명을 대상으로 후향적 분석을 하였다. 간조직검사 결과는 대한병리학회에서 제시한 간조직 기술지침에 의거하여 F0, F1, F2, F3, F4의 단계로 나누었고, TE는 fibroscan을 사용하여 F2≥, 7.2 kPa; F3≥, 9.6 kPa; F=4, 14.5 kPa 단계로 구분하였다. 결과 : 간경화도에 대한 TE의 민감도는 94.80%, 특이도 77.08%, 정확도 90.95%, 양성예측도 93.71%, 음성예측도는 80.43%였다. TE의 근사 95% 신뢰구간은 0.786에서 0.933, cut-off value은 0.859였고, TE의 근사 유의확률은 각각 0.000으로 나타났다(p<0.05). 일치측도 카파 값은 0.730, 유의확률 0.000으로 두 진단법은 유의한 일치성이 있는 것으로 나타났다 (p<0.05). 결론 : 간경화도 진단에 사용되는 침습적인 방법의 간조직검사는 간 일부 조직만을 통한 간경화도 진단의 대표성 문제와 조직검사 과정에서 부작용 등이 발생하므로 조직검사 결과에 일치성을 보이는 TE로 간경화도 측정을 대체하여 사용하는 것이 더욱 효과적이라고 생각한다. Purpose: Transient elastography by analyzing the results of liver fibrosis and liver biopsy to evaluate the results with accuracy and usefulness of the TE for diagnosing liver fibrosis. Materials and Methods: 304 patients who underwent biopsies before and after the TE among patients who underwent liver fibrosis confirmed by liver biopsy between approximately August 2013 to August 2014 was a retrospective analysis in this study. Liver biopsy on the basis of the results presented in liver tissue technical instructions for Pathology F0, F1, F2, F3, divided into steps of F4. TE uses Fibroscan F2≥, 7.2 kPa; F3≥, 9.6 kPa; F = 4, were separated by 14.5 kPa step. Statistical analysis SPSS ver. 18.0 was processed using the software for, the P-value for each statistical significance level was defined as less than 0.05. Results: The sensitivity of the TE to cirrhosis of the liver also is 94.80%, a specificity of 77.08%, 90.95% accuracy, positive predictive value of 93.71% and the negative predictive value was 80.43%. Approximate 95% confidence interval of the TE is 0.933, cut-off value was 0.859 at 0.786, respectively approximate significance probability of TE was 0.000(p<0.05). Match measure kappa value 0.730, 0.000, significant probability of two diagnostic methods was found to have a significant correspondence (p<0.05). Conclusion: cirrhosis of liver biopsy is also used in the diagnosis of invasive methods such side effects occur in the course of representation issues and biopsy diagnosed with cirrhosis of liver, some organizations only. Therefore, the correspondence with TE looks to cirrhosis of the liver biopsy results also think that it would be more effective to use a substitute measure.