Objective To evaluate the feasibility of using two-dimensional shear wave clastography(2D-SWE)based liver and spleen elastic hardness(L/S-SWE)in patients with liver cirrhosis,and to determine the exclusion and diagnostic thresholds for early identification of liver cirrhosis.Methods A total of 574 patients with chronic hepatitis B(hepatitis B for short)were included in this study.The clinical characteristics,L-SWE and S-SWE of the patients were collected,and the differences between cirrhosis group(n=311)and non cirrhosis group(n=263)were analyzed.The success rate and stability of liver and spleen elastic surgery were evaluated in two groups.The receiver operating characteristic(ROC)curve was used to analyze the efficacy of L-SWE,S-SWE,aspartate aminotransferase to platelet ratio index(APRI)alone and in combination in diagnosing liver cirrhosis.By analyzing the ROC curve,the double threshold for excluding and diagnosing liver cirrhosis was determined.Results There was a statistically significant difference in platelet count and APRI between the cirrhosis group and the non cirrhosis group(all P＜0.05).In the feasibility assessment of 2D-SWE technology,the success rate and stability of liver and spleen elastic operation were relatively high(success rate:97.2％vs 81.3％;stability:0.92 vs 0.84),and the success rate and stability of L-SWE operation were slightly better than S-SWE.The success rate of S-SWE operation in the cirrhosis group was higher than that in the non cirrhosis group(P＜0.05).The correlation analysis results showed that L-SWE,S-SWE,APRI were positively correlated with liver tissue pathological grading(r=0.677,0.528,0.149,all P＜0.05).The areas under the ROC curve for identifying liver cirrhosis using L-SWE,S-SWE,and APRI were 0.959,0.896,and 0.706,respectively.When L-SWE and S-SWE were combined,the area under the ROC curve was 0.987,the sensitivity was 92.6％,and the specificity was 96.0％.The Delong test showed that the combined diagnosis of L-SWE and S-SWE had the same diagnostic efficacy as using L-SWE alone for liver cirrhosis(P＞0.05).Further analysis of the ROC curve showed that the likelihood of liver cirrhosis was low when L-SWE was less than 9.4 kPa,and high when L-SWE was greater than 12.0 kPa.Patients between 9.4 and 12.0 kPa can undergo further S-SWE testing;If the S-SWE was between 17.5 and 29.3 kPa,it was classified as 2D-SWE,which was difficult to determine whether there was liver cirrhosis,and further liver puncture and other examinations were needed.Conclusions 2D-SWE technology has high operational feasibility in the diagnosis of liver cirrhosis,and combined with S-SWE,it helps to improve the diagnostic efficiency of early non-invasive identification of liver cirrhosis,enabling more patients to avoid unnecessary liver puncture examinations.
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