Ultraschall Med 2011; 32(2): 167-175
DOI: 10.1055/s-0029-1245948
Originalarbeiten/Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Accuracy of VirtualTouch Acoustic Radiation Force Impulse (ARFI) Imaging for the Diagnosis of Cirrhosis during Liver Ultrasonography

Genauigkeit von VirtualTouch Acoustic Radiation Force Impulse (ARFI) Imaging für die Ultraschalldiagnose einer LeberzirrhoseF. Piscaglia1 , V. Salvatore1 , R. Di Donato2 , M. D’Onofrio3 , S. Gualandi1 , A. Gallotti3 , E. Peri1 , 5 , A. Borghi1 , 2 , F. Conti2 , G. Fattovich4 , E. Sagrini1 , A. Cucchetti5 , P. Andreone3 , L. Bolondi1
  • 1Div. Internal Medicine, Dept. Clinical Medicine, University and General Hospital S. Orsola-Malpighi, Bologna
  • 2Div. Semeiotica Medica, Dept. Clinical Medicine, University and General Hospital S. Orsola-Malpighi, Bologna
  • 3Div. Radiology, University of Verona
  • 4Div. Gastroenterology Dept., Internal Medicine, University of Verona
  • 5Div. Liver and Multivisceral Transplant Surgery Gastroenterology, Surgery, University and General Hospital S. Orsola-Malpighi, Bologna
Further Information

Publication History

received: 3.9.2010

accepted: 18.11.2010

Publication Date:
14 February 2011 (online)

Zusammenfassung

Ziel: VirtualTouch ist eine neue Ultraschalltechnik, mit der die Lebersteifigkeit im Rahmen der B-Mode-Sonografie eingeschätzt werden kann. Ziel der Studie war die Analyse der diagnostischen Genauigkeit von VirtualTouch für die Diagnose einer Leberzirrhose und dessen Korrelation mit transienter Elastografie (Fibroscan). Material und Methoden: Insgesamt wurden 133 Patienten mit chronischer Lebererkrankung eingeschlossen. 90 / 133 wurden mit VirtualTouch und transienter Elastografie untersucht und 70 von den mit VirtualTouch untersuchten Patienten erhielten eine Leberbiopsie. Die Lebersteifigkeit wurde mit beiden Methoden im rechten Leberlappen untersucht. Die diagnostische Genauigkeit für eine Zirrhose wurde zunächst in den 90 mit Fibroscan untersuchten Patienten bestimmt; hierbei wurde ein Wert von 13 kPa (47 % der Patienten) als diagnostisch für eine Zirrhose angesehen. Der beste mittels VirtualTouch ermittelte Cut-off-Wert für Zirrhose wurde dann bei den 70 Patienten, die auch eine Biopsie erhielten (Zirrhose bei 38 % der Patienten) getestet. 41 Patienten wurden mit VirtualTouch durch 2 verschiedene Sonografeure untersucht. Ergebnisse: Die VirtualTouch-Werte bei Kontrollen, chronischer Hepatitis und Zirrhose lagen bei 113,147 und 255 cm/s. Der AUROC-Wert von VirtualTouch für die Diagnose einer Zirrhose (Fibroscan als Referenz) war 0,941 mit 175 cm/s als bestem Cut-off-Wert (Sensitivität 93,0 %; Spezifizität 85,1 %). VirtualTouch zeigte auch gute Ergebnisse bei Patienten mit bioptisch gesicherter Leberzirrhose (AUROC 0,908, Sensitivität 81,5 %, Spezifizität 88,4 %). Die Korrelation von VirtualTouch mit der transienten Elastografie war sehr gut (r = 0,891) und die Korrelation von VirtualTouch-Messungen beider Sonografeure war auch gut (r = 0,874). Schlussfolgerung: VirtualTouch kann das Vorliegen einer Zirrhose mit hoher Genauigkeit detektieren. Die Methode zeigt eine gute Interobserver Reproduzierbarkeit und die Korrelation von VirtualTouch-basierten Werten und Fibroscan-Werten ist gut.

Abstract

Purpose: VirtualTouch is a new technique recently proposed to evaluate liver stiffness during B-mode ultrasonography. The goal of the present study was to analyze the diagnostic accuracy of VirtualTouch in the diagnosis of cirrhosis and its correlation with transient elastography (Fibroscan). Materials and Methods: A total of 133 patients with chronic liver disease were enrolled. 90 of 133 underwent VirtualTouch and transient elastography and 70 patients assessed with VirtualTouch were submitted to liver biopsy. Stiffness was assessed by both techniques in the right liver lobe. The diagnostic accuracy for cirrhosis was first assessed in the 90 patients submitted to transient elastography with > 13 kPa (47 % of patients) as diagnostic for cirrhosis values. The best cut-off for cirrhosis with VirtualTouch was then tested in the 70 patients with biopsy (cirrhosis in 38 % of patients). 41 patients were assessed by VirtualTouch by two different operators. Results: The VirtualTouch values in controls, chronic hepatitis and cirrhosis were respectively 113, 147 and 255 cm/sec. The AUROC of liver VirtualTouch for the diagnosis of cirrhosis (reference Fibroscan) was 0.941 with 175 cm/sec as the best cut-off (sensitivity 93.0 %; specificity 85.1 %). VirtualTouch confirmed good performance also in patients with bioptic diagnosis of cirrhosis (AUROC 0.908, sensitivity 81.5 %, specificity 88.4 %,). The correlation of VirtualTouch with transient elastography was strict (r = 0.891) and the correlation in VirtualTouch measurements between two operators was also good (r = 0.874). Conclusion: VirtualTouch is able to identify the presence of cirrhosis with good accuracy, shows good interobserver reproducibility and the correlation of its values with those obtained by transient elastography with Fibroscan is good.

References

  • 1 Bedossa P, Dargère D, Paradis V. Sampling variability of liver fibrosis in chronic hepatitis C.  Hepatology. 2003;  38 1449-1457
  • 2 Bonekamp S, Kamel I, Solga S et al. Can imaging modalities diagnose and stage hepatic fibrosis and cirrhosis accurately?.  J Hepatol. 2009;  50 17-35
  • 3 Friedrich-Rust M, Wunder K, Kriener S et al. Liver fibrosis in viral hepatitis: noninvasive assessment with acoustic radiation force impulse imaging versus transient elastography.  Radiology. 2009;  252 595-604
  • 4 Coco B, Oliveri F, Maina A M et al. Transient elastography: a new surrogate marker of liver fibrosis influenced by major changes of transaminases.  J Viral Hepat. 2007;  14 360-369
  • 5 Nightingale K, Soo M S, Nightingale R et al. Acoustic radiation force impulse imaging: in vivo demonstration of clinical feasibility.  Ultrasound Med Biol. 2002;  28 227-235
  • 6 Melodelima D, Bamber J C, Duck F A et al. Transient elastography using impulsive ultrasound radiation force: a preliminary comparison with surface palpation elastography.  Ultrasound Med Biol. 2007;  33 959-969
  • 7 Zhai L, Palmeri M L, Bouchard R R et al. An integrated indenter-ARFI imaging system for tissue stiffness quantification.  Ultrason Imaging. 2008;  30 95-111
  • 8 Palmeri M L, Wang M H, Dahl J J et al. Quantifying hepatic shear modulus in vivo using acoustic radiation force.  Ultrasound Med Biol. 2008;  34 546-558
  • 9 Dahl J J, Pinton G F, Palmeri M L et al. A parallel tracking method for acoustic radiation force impulse imaging.  IEEE Trans Ultrason Ferroelectr Freq Control. 2007;  54 301-312
  • 10 Cavalli G, Re G, Casali A M et al. The microvascular architecture of spleen in congestive splenomegaly. A morphological-histometric study.  Pathol Res Pract. 1982;  174 131-146
  • 11 Sickinger K, Kallmann L, Emmrich J. Intrahepatic pressure and splenic pulp pressure. A simple method for the determination of portal vein pressure during laparoscopy.  Med Klin. 1968;  63 247-251
  • 12 Carriaci C, Carboncini G. The first results of transparietal measurements of intrasplenic pressure.  Bull Sci Med. 1954;  126 234-241
  • 13 Sandrin L, Fourquet B, Hasquenoph J M et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis.  Ultrasound Med Biol. 2003;  29 1705-1713
  • 14 Corradi F, Piscaglia F, Flori S et al. Assessment of liver fibrosis in transplant recipients with recurrent HCV infection: usefulness of transient elastography.  Dig Liver Dis. 2009;  41 217-225
  • 15 Friedrich-Rust M, Ong M F, Martens S et al. Performance of transient elastography for the staging of liver fibrosis: a meta-analysis.  Gastroenterology. 2008;  134 960-974
  • 16 Takahashi H, Ono N, Eguchi Y et al. Evaluation of acoustic radiation force impulse elastography for fibrosis staging of chronic liver disease: a pilot study.  Liver Int. 2010;  30 538-545
  • 17 Colli A, Fraquelli M, Andreoletti M et al. Severe liver fibrosis or cirrhosis: accuracy of US for detection – analysis of 300 cases.  Radiology. 2003;  227 89-94
  • 18 Lupsor M, Badea R, Stefanescu H et al. Performance of a new elastographic method (ARFI technology) compared to unidimensional transient elastography in the noninvasive assessment of chronic hepatitis C. Preliminary results.  J Gastrointestin Liver Dis. 2009;  18 303-310
  • 19 Fierbinteanu-Braticevici C, Andronescu D, Usvat R et al. Acoustic radiation force imaging sonoelastography for noninvasive staging of liver fibrosis.  World J Gastroenterol. 2009;  15 5525-5532
  • 20 Sporea I, Sirli R L, Deleanu A et al. Acoustic Radiation Force Impulse Elastography as Compared to Transient Elastography and Liver Biopsy in Patients with Chronic Hepatopathies.  Ultraschall in Med. 2011;  32 S46-S52
  • 21 Regev A, Berho M, Jeffers L J et al. Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection.  Am J Gastroenterol. 2002;  97 2614-2618
  • 22 Goertz R S, Zopf Y, Jugl V et al. Measurement of liver elasticity with acoustic radiation force impulse (ARFI) technology: an alternative non-invasive method for staging liver fibrosis in viral hepatitis.  Ultraschall in Med. 2010;  31 151-155
  • 23 Friedrich-Rust M, Schwarz A, Ong M et al. Real-time tissue elastography versus FibroScan for noninvasive assessment of liver fibrosis in chronic liver disease.  Ultraschall in Med. 2009;  30 478-484
  • 24 Foucher J, Castéra L, Bernard P H et al. Prevalence and factors associated with failure of liver stiffness measurement using FibroScan in a prospective study of 2114 examinations.  Eur J Gastroenterol Hepatol. 2006;  18 411-412
  • 25 Fraquelli M, Rigamonti C, Casazza G et al. Reproducibility of transient elastography in the evaluation of liver fibrosis in patients with chronic liver disease.  Gut. 2007;  56 968-973
  • 26 Arena U, Vizzutti F, Abraldes J G et al. Reliability of transient elastography for the diagnosis of advanced fibrosis in chronic hepatitis C.  Gut. 2008;  57 1288-1293

Dr. Fabio Piscaglia

Div. Internal Medicine

Dept. Clinical Medicine

via Albertoni 15

40138 Bologna

Italy

Phone: ++ 39/0 51/6 36 25 42/5 68

Fax: ++ 39/0 51/6 36 27 25

Email: fabio.piscaglia@unibo.it