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Use of Aixplorer® for Detection of Liver Fibrosis or Cirrhosis in Patients with Hepatitis C
S58
Ultrasound in Medicine and Biology
correlation of ARFI with fibrosis (r 5 0.483 vs. r 5 0.484, p 5 0.12). ARFI values were not correlated with liver fibrosis in case of aminotransferases level .3x normal value. ARFI measurements were correlated with fibrosis in patients with no or mild steatosis (Hepburn I, II, III on LB) (r 5 0.568; p , 0.0001), while in patients with moderate and severe steatosis (Hepburn IV, V) there was no correlation (r 5 0.055; p 5 0.86). Conclusion: Quality technical parameters (IQR and SR) must be introduced to improve the accuracy of ARFI assessment of liver fibrosis. High levels of aminotransferases and severe steatosis can influence the accuracy of ARFI measurements. SS 29.06 Use of AixplorerÒ for Detection of Liver Fibrosis or Cirrhosis in Patients with Hepatitis C oltzsch,2 J. Wiegand,1 V. Keim2 T. Karlas,1 M. Tr€ 1 Medizinische Klinik fu¨r Gastroenterologie, Universit€atsklinikum Leipzig, Leipzig/DE, 2Interdisziplin€are Zentrale Ultraschalleinheit, Universit€ atsklinikum Leipzig, Leipzig/DE Purpose: Different elastographic procedures are available. Here, we explored the usefulness of the AixplorerÒ-technique for the detection of fibrosis/cirrhosis. Material & Methods: In 33 patients with proven hepatitis C (detectable load of hepatitis C virus) shear wave velocities was determined with the following techniques: FibroscanÒ (Echosens, XL probe, 10 valid measurements, right liver lobe), ARFIÒ (Siemens, 10 valid measurements, right and left liver lobe), AixplorerÒ (Supersonic, 4 valid measurements, right and left liver lobe). Results: Successful measurements were obtained with FibroscanÒ and ARFIÒ (right liver lobe) in 100%, ARFI (left liver lobe) in 94%, AixplorerÒ (right liver lobe) in 97% and AixplorerÒ (left liver lobe) in 85%. In the right liver lobe, mean values were as follows. ARFIÒ: 1,30 m/s, FibroscanÒ: 8,57 kPa, AixplorerÒ: 10,05 kPa. The means of left liver lobe were AixplorerÒ: 13,21 kPa, ARFIÒ: 1,73. In the right liver lobe, there was a significant correlation between ARFIÒ and both FibroscanÒ and AixplorerÒ (r2 5 0,6720, r2 5 0,5408, p , 0,0001). There was a moderate but still significant correlation between ARFIÒ and AixplorerÒ measurements in the left liver lobe (r2 5 0,35, p , 0,001). The AixplorerÒ measurements showed that the homogenicity of the tissue decreased with increasing shear wave velocity. Conclusion: AixplorerÒ is an interesting alternative to other elastographic procedures. Increased values in the left liver lobe were found. Different from other techniques, the inhomogenous structure of liver tissue is directly visible and increased with higher shear wave velocity. SS 29.07 ShearWave Elastography for the Evaluation of Diffuse Liver Disease: Determining Normal and Pathological Values in kPa P. S. Zoumpoulis,1 E. Mastorakou,2 I. Theotokas,1 A. Plagou,1 E. Vafeiadis3 1 Ultrasound, Diagnostic Echotomography SA, Kifissia/GR, 2Onaseio Hospital, Kallithea/GR, 3Laiko Hospital, Athens/GR Purpose: To validate the accuracy of SWE in chronic liver disease and evaluate the normal and abnormal values quantifying liver fibrosis. Material & Methods: A total of 72 prospectively recruited patients underwent SWE of the liver with Aixplorer (Ult Im, Aix ,France) and were grouped into normal (N) fatty liver (FL), chronic liver disease (CLD) and liver cirrhosis (LC). All patients with FL, CLD and LC had US-guided liver biopsy and histopathology. SWE and liver function test results of each group were compared using one-way ANOVA test. The performance of SWE in diagnosing FL, LCD and LC was evaluated using ROC analysis.
Volume 37, Number 8S, 2011 Results: The 72 patients were composed of 18 N, 12 FL, 22 CLD and 20 LC. Mean SWE was significantly different among the groups. Normal: 4.1 Kpa, FL: 6.2 Kpa, CLD: 7.9 Kpa, LC: 11.4 kPa. In diagnosing LC, SWE showed 94% sensitivity and 73,3% specificity at a cutoff value of 8.1 kPa. Conclusion: The accuracy of SWE is well validated in diagnosing LCD and LC. SWE performance is better than laboratory test (LFT) and has to be considered as an accurate diagnostic tool. SS 29.08 Technical and Software Adjustments for a Reliable ShearWave Elastography Estimation of Fibrosis in Chronic Liver Disease P. S. Zoumpoulis,1 I. Theotokas,1 E. Mastorakou,2 A. Plagou,1 E. Vafeiadis3 1 Ultrasound, Diagnostic Echotomography SA, Kifissia/GR, 2Onaseio Hospital, Kallithea/GR, 3Laiko Hospital, Athens/GR Purpose: To establish the technical and statistical parameters in order to limit inter- and intra-observer variability using SWE in the liver. Material & Methods: We studied 72 patients with chronic liver disease. All patients had US-guided liver biopsy and histopathology with F-stage for liver fibrosis. We applied two different protocols of examinations with main equipment presets preserved. The position and the size of the SWE ROI were different and an additional SW quality indicator was evaluated. Results: Mean SWE per F stage in kPa were as follows. For protocol 1, F1: 6.2/F2: 6.4/F3: 7.5/F4: 9.8. For protocol 2, F1: 5.6/F2: 6.6/F3: 7.9/ F4: 9.6. The two protocols were compared using Bland-Altman charts and interclass correlation coefficient (ICC). Protocol 2 showed better accuracy in estimating liver fibrosis with both methods. Conclusion: Application of a robust examination protocol with predetermined parameters concerning the position and the size of the SWE ROI and an additional SW quality indicator are prerequisites for a reliable liver fibrosis estimation using SWE. SS 29.09 Usefulness of Virtual Touch Tissue Quantification to Diagnose the Severity of Fibrosis H. Tanaka,1 H. Iijima,1 M. Yoshida,2 T. Iwai,1 T. Takashima,1 Y. Sakai,1 N. Aizawa,1 N. Ikeda,1 Y. Iwata,1 H. Enomoto,1 M. Saito,1 H. Imanishi,1 S. Hirota,3 J. Fujimoto,4 S. Nishiguchi1 1 Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya/JP, 2 Ultrasound Imaging Center, Hyogo College of Medicine, Nishinomiya/JP, 3Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya/JP, 4Division of Hepatobiliary and Pancreatic Disease, Department of Surgery, Hyogo College of Medicine, Nishinomiya/JP Purpose: The diagnosis of liver fibrosis stage is important in predicting progression of the disease. Virtual touch tissue quantification (VTTQ) is an implementation of acoustic radiation force impulse imaging (ARFI) technology that provides numerical measurements using sheer wave velocity (Vs) value for a noninvasive quantitative assessment of tissue stiffness. We evaluated the diagnostic usefulness of VTTQ in assessing liver fibrosis in chronic hepatitis. Material & Methods: A total of 441 chronic hepatitis and cirrhosis patients, proven by liver biopsies, and 25 healthy volunteers were studied (218 male and 248 female; average age 56.0 13.6; 85 hepatitis B, 251 hepatitis C, 9 hepatitis B + C, 95 hepatitis non-B non-C). The degree of hepatitis was evaluated by the New Inuyama classification; staging of fibrosis was F0 (n 5 49), F1 (n 5 174), F2 (n 5 71), F3 (n 5 76), F4 (n 5 9 6). VTTQ using ARFI with Siemens Acuson S2000 was used for the quantitative analysis. Results: The Vs values compared with F0-F4 stage of the fibrosis stage were 1.13 6 0.17, 1.23 6 0.37, 1.35 6 0.36, 1.56 6 0.05 and
Ultrasound in Medicine and Biology
correlation of ARFI with fibrosis (r 5 0.483 vs. r 5 0.484, p 5 0.12). ARFI values were not correlated with liver fibrosis in case of aminotransferases level .3x normal value. ARFI measurements were correlated with fibrosis in patients with no or mild steatosis (Hepburn I, II, III on LB) (r 5 0.568; p , 0.0001), while in patients with moderate and severe steatosis (Hepburn IV, V) there was no correlation (r 5 0.055; p 5 0.86). Conclusion: Quality technical parameters (IQR and SR) must be introduced to improve the accuracy of ARFI assessment of liver fibrosis. High levels of aminotransferases and severe steatosis can influence the accuracy of ARFI measurements. SS 29.06 Use of AixplorerÒ for Detection of Liver Fibrosis or Cirrhosis in Patients with Hepatitis C oltzsch,2 J. Wiegand,1 V. Keim2 T. Karlas,1 M. Tr€ 1 Medizinische Klinik fu¨r Gastroenterologie, Universit€atsklinikum Leipzig, Leipzig/DE, 2Interdisziplin€are Zentrale Ultraschalleinheit, Universit€ atsklinikum Leipzig, Leipzig/DE Purpose: Different elastographic procedures are available. Here, we explored the usefulness of the AixplorerÒ-technique for the detection of fibrosis/cirrhosis. Material & Methods: In 33 patients with proven hepatitis C (detectable load of hepatitis C virus) shear wave velocities was determined with the following techniques: FibroscanÒ (Echosens, XL probe, 10 valid measurements, right liver lobe), ARFIÒ (Siemens, 10 valid measurements, right and left liver lobe), AixplorerÒ (Supersonic, 4 valid measurements, right and left liver lobe). Results: Successful measurements were obtained with FibroscanÒ and ARFIÒ (right liver lobe) in 100%, ARFI (left liver lobe) in 94%, AixplorerÒ (right liver lobe) in 97% and AixplorerÒ (left liver lobe) in 85%. In the right liver lobe, mean values were as follows. ARFIÒ: 1,30 m/s, FibroscanÒ: 8,57 kPa, AixplorerÒ: 10,05 kPa. The means of left liver lobe were AixplorerÒ: 13,21 kPa, ARFIÒ: 1,73. In the right liver lobe, there was a significant correlation between ARFIÒ and both FibroscanÒ and AixplorerÒ (r2 5 0,6720, r2 5 0,5408, p , 0,0001). There was a moderate but still significant correlation between ARFIÒ and AixplorerÒ measurements in the left liver lobe (r2 5 0,35, p , 0,001). The AixplorerÒ measurements showed that the homogenicity of the tissue decreased with increasing shear wave velocity. Conclusion: AixplorerÒ is an interesting alternative to other elastographic procedures. Increased values in the left liver lobe were found. Different from other techniques, the inhomogenous structure of liver tissue is directly visible and increased with higher shear wave velocity. SS 29.07 ShearWave Elastography for the Evaluation of Diffuse Liver Disease: Determining Normal and Pathological Values in kPa P. S. Zoumpoulis,1 E. Mastorakou,2 I. Theotokas,1 A. Plagou,1 E. Vafeiadis3 1 Ultrasound, Diagnostic Echotomography SA, Kifissia/GR, 2Onaseio Hospital, Kallithea/GR, 3Laiko Hospital, Athens/GR Purpose: To validate the accuracy of SWE in chronic liver disease and evaluate the normal and abnormal values quantifying liver fibrosis. Material & Methods: A total of 72 prospectively recruited patients underwent SWE of the liver with Aixplorer (Ult Im, Aix ,France) and were grouped into normal (N) fatty liver (FL), chronic liver disease (CLD) and liver cirrhosis (LC). All patients with FL, CLD and LC had US-guided liver biopsy and histopathology. SWE and liver function test results of each group were compared using one-way ANOVA test. The performance of SWE in diagnosing FL, LCD and LC was evaluated using ROC analysis.
Volume 37, Number 8S, 2011 Results: The 72 patients were composed of 18 N, 12 FL, 22 CLD and 20 LC. Mean SWE was significantly different among the groups. Normal: 4.1 Kpa, FL: 6.2 Kpa, CLD: 7.9 Kpa, LC: 11.4 kPa. In diagnosing LC, SWE showed 94% sensitivity and 73,3% specificity at a cutoff value of 8.1 kPa. Conclusion: The accuracy of SWE is well validated in diagnosing LCD and LC. SWE performance is better than laboratory test (LFT) and has to be considered as an accurate diagnostic tool. SS 29.08 Technical and Software Adjustments for a Reliable ShearWave Elastography Estimation of Fibrosis in Chronic Liver Disease P. S. Zoumpoulis,1 I. Theotokas,1 E. Mastorakou,2 A. Plagou,1 E. Vafeiadis3 1 Ultrasound, Diagnostic Echotomography SA, Kifissia/GR, 2Onaseio Hospital, Kallithea/GR, 3Laiko Hospital, Athens/GR Purpose: To establish the technical and statistical parameters in order to limit inter- and intra-observer variability using SWE in the liver. Material & Methods: We studied 72 patients with chronic liver disease. All patients had US-guided liver biopsy and histopathology with F-stage for liver fibrosis. We applied two different protocols of examinations with main equipment presets preserved. The position and the size of the SWE ROI were different and an additional SW quality indicator was evaluated. Results: Mean SWE per F stage in kPa were as follows. For protocol 1, F1: 6.2/F2: 6.4/F3: 7.5/F4: 9.8. For protocol 2, F1: 5.6/F2: 6.6/F3: 7.9/ F4: 9.6. The two protocols were compared using Bland-Altman charts and interclass correlation coefficient (ICC). Protocol 2 showed better accuracy in estimating liver fibrosis with both methods. Conclusion: Application of a robust examination protocol with predetermined parameters concerning the position and the size of the SWE ROI and an additional SW quality indicator are prerequisites for a reliable liver fibrosis estimation using SWE. SS 29.09 Usefulness of Virtual Touch Tissue Quantification to Diagnose the Severity of Fibrosis H. Tanaka,1 H. Iijima,1 M. Yoshida,2 T. Iwai,1 T. Takashima,1 Y. Sakai,1 N. Aizawa,1 N. Ikeda,1 Y. Iwata,1 H. Enomoto,1 M. Saito,1 H. Imanishi,1 S. Hirota,3 J. Fujimoto,4 S. Nishiguchi1 1 Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya/JP, 2 Ultrasound Imaging Center, Hyogo College of Medicine, Nishinomiya/JP, 3Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya/JP, 4Division of Hepatobiliary and Pancreatic Disease, Department of Surgery, Hyogo College of Medicine, Nishinomiya/JP Purpose: The diagnosis of liver fibrosis stage is important in predicting progression of the disease. Virtual touch tissue quantification (VTTQ) is an implementation of acoustic radiation force impulse imaging (ARFI) technology that provides numerical measurements using sheer wave velocity (Vs) value for a noninvasive quantitative assessment of tissue stiffness. We evaluated the diagnostic usefulness of VTTQ in assessing liver fibrosis in chronic hepatitis. Material & Methods: A total of 441 chronic hepatitis and cirrhosis patients, proven by liver biopsies, and 25 healthy volunteers were studied (218 male and 248 female; average age 56.0 13.6; 85 hepatitis B, 251 hepatitis C, 9 hepatitis B + C, 95 hepatitis non-B non-C). The degree of hepatitis was evaluated by the New Inuyama classification; staging of fibrosis was F0 (n 5 49), F1 (n 5 174), F2 (n 5 71), F3 (n 5 76), F4 (n 5 9 6). VTTQ using ARFI with Siemens Acuson S2000 was used for the quantitative analysis. Results: The Vs values compared with F0-F4 stage of the fibrosis stage were 1.13 6 0.17, 1.23 6 0.37, 1.35 6 0.36, 1.56 6 0.05 and