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VTTQ (Virtual Touch Tissue Quantification) for Evaluation of Liver Tumors
Abstracts Sun, Aug 28, 2011 Hall B SS 11 10:30-12:00 Abdominal 3 - Focal Liver Lesions SS 11.01 Can Acoustic Radiation Force Impulse Elastography Predict the Nature of Focal Liver Lesions? M. Sendroiu, S. Bota, I. Sporea, M. Danila, A. Popescu, R. Sirli Gastroenterology and Hepatology, University of Medicine and Pharmacy, Timisoara/RO Purpose: To assess the feasibility and the value of ARFI technique for the differentiation between focal liver lesions (FLL) and normal liver parenchyma, between malignant and benign FLL. The technique is offered by Siemens and integrated into an ACUSON S2000 ultrasound system. Material & Methods: We evaluated 80 FLL:52 hepatocellular carcinomas (HCCs), 16 liver metastases, 8 hemangiomas, 1 adenoma, 1 focal nodular hyperplasia and 2 focal fatty lesions, diagnosed by other imaging mehods (CEUS,CT,MRI) or biopsy.To evaluate tissue stiffness (TS), we performed 10 ARFI measurements each in the tumor and in the surrounding liver parenchyma. Median values were calculated and expressed in meters/second (m/s). Results: We could not obtain valid ARFI measurements in the tumor in 10 cases (12.5%) and in the liver in 3 cases (3.7%).The mean values of TS were similar in benign versus malignant FLL: 1.8860.99m/s versus 2.2460.97m/s (p 5 0.27), metastases versus hemangiomas: 2.4861.06m/s versus 1.5760.73m/s (p 5 0.05), HCCs versus hemangiomas: 2.1660.94m/s versus 1.5760.73m/s (p 5 0.12), HCCs versus metastases: 2.1660.94m/s versus 2.4861.06m/s (p 5 0.3). TS was statistically significantly lower in HCCs than in the surrounding liver parenchyma: 2.1660.94m/s versus 2.6860.78m/s (p 5 0.005), but statistically significantly higher in metastases than in the liver parenchyma: 2.4861.06m/s versus 1.6360.68m/s (p 5 0.01). Conclusion: Using ARFI we found statistically significant differences between the surrounding liver parenchyma and malignant FLL, but this method cannot predict the nature of the FLL. SS 11.02 Characterization of Focal Liver Lesions (FLL) with ContrastEnhanced Ultrasound (CEUS) and Shear-Wave Elastography (SWE) I. Theotokas, P. S. Zoumpoulis, P. Filis, E. Mastorakou, K. Mpouhra Ultrasound, Diagnostic Echotomography SA, Kifissia/GR Purpose: SWE represents an innovative method for quantification of tissue elasticity. The aim of this study was the evaluation of SWE in the characterization of FLL. Material & Methods: 52 patients with FLL were included in this study (29 females, 23 males; mean age 59 years). All patients were assigned to SWE. Measurement sites were located inside FLL and in the surrounding liver. CEUS/histology served as reference for the characterization of the lesions. Results: 32 (61,5%) FLL were malignant and 20 (38,5%) benign. The SWE findings differed significantly from those of the surrounding liver parenchyma (p,0,001). Of the 32 malignant lesions 19 were metastatic and 13 were HCC. 13/19(70%) of the metastatic lesions appeared stiffer than the liver and 6/19 (30%) had similar or lower stiffness. Of the 13 HCC, 7(54%) were stiffer than the liver and 6 (46 %) had equal or lower stiffness. Of the 20 benign FLL (9 Hemangiomas, 7 FNH and 4 focal fatty sparing), 13 (65%) appeared stiffer, 4 (20%) softer and 3 (15%)
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had the same stiffness. There was a statistical difference in terms of tumor stiffness only with hemangiomas. Conclusion: FLL have varied SWE findings. There is an interest in using SWE in atypical to CEUS hemangiomas. The established value of CEUS is confirmed in this context. SS 11.03 VTTQ (Virtual Touch Tissue Quantification) for Evaluation of Liver Tumors H. Iijima,1 H. Tanaka,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: 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. VTTQ also enables us to assess the stiffness of liver tumors. Thus, we investigated the potential usefulness of VTTQ to evaluate liver tumors. Material & Methods: 62 liver tumors were studied (28 Hepatocellular carcinomas; HCC, 20 hepatic hemangiomas; HEM and 14 metastatic liver tumors; META). Mean tumor sizes of HCC, HEM and META were 30.0617.3, 30.5615.4 and 31.1617.3, respectively. Stiffness of these tumors was evaluated by the VTTQ using ARFI with Siemens Acuson S2000. We also investigated the stiffness of HCC according to the tumor size, B-mode findings, and histological differentiations. Results: Vs values (m/sec) were HCC, 1.63 6 0.63; HEM, 1.37 6 0.61; META, 2.79 6 0.92. META was higher than those of HCC and HEM (both, P , 0.001). Of the HCCs, there were no difference between tumor sizes (,3cm, 1.54 6 0.59; 3cm, 1.78 6 0.68), B-mode findings (hyper echo, 1.62 6 0.28; hypo echo, 1.51 6 0.80; mosaic echo, 1.73 6 0.67) and histological differentiation (well, 1.71 6 0.79; moderately, 1.78 6 0.64; poorly, 1.23). Conclusion: Stiffness measurement of liver tumor could provide additional qualitative information for differential diagnosis of liver tumors. SS 11.04 Contrast-Enhanced Ultrasound (CEUS) for the Characterization of Focal Liver Lesions: A Multicentric Retrospective Study I. Sporea,1 R. Badea,2 M. Socaciu,3 E. Dumitru,4 S. Ioanitescu,5 M. Voiculescu,5 R. Sirli,1 A. Popescu,1 M. Danila,1 A. F. Martie6 1 Gastroenterology and Hepatology, University of Medicine and Pharmacy, Timisoara/RO, 2Department of Ultrasonography, 3rd Medical Clinic, University of Medicine and Pharmacy, Cluj-Napoca/RO, 3Imagistic Department, University of Medicine and Pharmacy ‘‘Iuliu Hatieganu’’, Cluj Napoca/RO, 4Department of Gastroenterology, Medicine University Constanta, Constanta/RO, 5 Fundeni Clinical Institute, Center of Internal Medicine, Bucharest/RO, 6 Department of Gastroenterology, University of Medicine and Pharmacy, Timisoara/RO Purpose: Development of contrast-specific ultrasound techniques and introduction of second-generation ultrasound contrast agents improved the ability of contrast-enhanced ultrasound (CEUS) in detecting and characterizing focal liver lesions (FLLs). The purpose of this study was to present the experience of four Romanian centers in evaluation of FLLs using CEUS.
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had the same stiffness. There was a statistical difference in terms of tumor stiffness only with hemangiomas. Conclusion: FLL have varied SWE findings. There is an interest in using SWE in atypical to CEUS hemangiomas. The established value of CEUS is confirmed in this context. SS 11.03 VTTQ (Virtual Touch Tissue Quantification) for Evaluation of Liver Tumors H. Iijima,1 H. Tanaka,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: 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. VTTQ also enables us to assess the stiffness of liver tumors. Thus, we investigated the potential usefulness of VTTQ to evaluate liver tumors. Material & Methods: 62 liver tumors were studied (28 Hepatocellular carcinomas; HCC, 20 hepatic hemangiomas; HEM and 14 metastatic liver tumors; META). Mean tumor sizes of HCC, HEM and META were 30.0617.3, 30.5615.4 and 31.1617.3, respectively. Stiffness of these tumors was evaluated by the VTTQ using ARFI with Siemens Acuson S2000. We also investigated the stiffness of HCC according to the tumor size, B-mode findings, and histological differentiations. Results: Vs values (m/sec) were HCC, 1.63 6 0.63; HEM, 1.37 6 0.61; META, 2.79 6 0.92. META was higher than those of HCC and HEM (both, P , 0.001). Of the HCCs, there were no difference between tumor sizes (,3cm, 1.54 6 0.59; 3cm, 1.78 6 0.68), B-mode findings (hyper echo, 1.62 6 0.28; hypo echo, 1.51 6 0.80; mosaic echo, 1.73 6 0.67) and histological differentiation (well, 1.71 6 0.79; moderately, 1.78 6 0.64; poorly, 1.23). Conclusion: Stiffness measurement of liver tumor could provide additional qualitative information for differential diagnosis of liver tumors. SS 11.04 Contrast-Enhanced Ultrasound (CEUS) for the Characterization of Focal Liver Lesions: A Multicentric Retrospective Study I. Sporea,1 R. Badea,2 M. Socaciu,3 E. Dumitru,4 S. Ioanitescu,5 M. Voiculescu,5 R. Sirli,1 A. Popescu,1 M. Danila,1 A. F. Martie6 1 Gastroenterology and Hepatology, University of Medicine and Pharmacy, Timisoara/RO, 2Department of Ultrasonography, 3rd Medical Clinic, University of Medicine and Pharmacy, Cluj-Napoca/RO, 3Imagistic Department, University of Medicine and Pharmacy ‘‘Iuliu Hatieganu’’, Cluj Napoca/RO, 4Department of Gastroenterology, Medicine University Constanta, Constanta/RO, 5 Fundeni Clinical Institute, Center of Internal Medicine, Bucharest/RO, 6 Department of Gastroenterology, University of Medicine and Pharmacy, Timisoara/RO Purpose: Development of contrast-specific ultrasound techniques and introduction of second-generation ultrasound contrast agents improved the ability of contrast-enhanced ultrasound (CEUS) in detecting and characterizing focal liver lesions (FLLs). The purpose of this study was to present the experience of four Romanian centers in evaluation of FLLs using CEUS.