Acoustic Radiation Force Impulse (ARFI) and High-Frequency Ultrasound of the Liver Surface for the Diagnosis of Compensated Liver Cirrhosis

Abstract

Purpose: To evaluate the diagnostic value of acoustic radiation force impulse (ARFI) and high-frequency ultrasound of the liver surface, using histology as a gold standard for the diagnosis of compensated liver cirrhosis.

Materials and Methods: 73 patients without ascites undergoing liver biopsy were included in the study. The left and right liver lobes were examined with ARFI and high-frequency ultrasound. Liver surface irregularity was quantified using image analysis software to calculate the difference between the real surface and the approximated physiological surface through a 20 mm standardized line.

Results: There is a significant difference between cirrhotic and non-cirrhotic patients for both quantified liver surface (QLS) and ARFI (p < 0.001). The mean values for QLS of the left lobe were 0.71 ± 0.24 mm and 1.17 ± 0.80 mm, of the right lobe 0.56 ± 0.26 mm and 0.87 ± 0.26 mm for non-cirrhotic and cirrhotic patients, respectively. The mean values of ARFI measurements of the left lobe were 2.04 ± 0.76 m/s and 2.85 ± 0.81 m/s, of the right lobe 1.65 ± 0.61 m/s and 3.02 ± 0.77 m/s for non-cirrhotic and cirrhotic patients, respectively. Diagnostic accuracy (AUROC) was 0.78/0.80 for QLS and 0.77/0.91 for ARFI of the left/right lobe, respectively. ARFI of the right lobe is significantly better than ARFI of the left (p = 0.023) or QLS of the left (p = 0.025)/right (p = 0.046) lobe of the liver.

Conclusion: Assessment of liver surface irregularity by high-frequency ultrasound (QLS) is a useful diagnostic test for the assessment of compensated liver cirrhosis. ARFI of the right liver lobe is significantly better than high-frequency ultrasound (QLS of the left/right lobe of the liver) and ARFI of the left lobe of the liver.

Zusammenfassung

Ziel: Untersuchung der diagnostischen Aussagekraft der Scherwellenelastometrie (ARFI) und des Hochfrequenzultraschalls der Leberoberfläche bei der Diagnose der kompensierten Leberzirrhose mit dem Goldstandard Leberhistologie.

Material und Methoden: Es wurden 73 Patienten ohne Aszites eingeschlossen, bei denen eine Leberbiopsie durchgeführt wurde. Der linke/rechte Leberlappen wurde mittels ARFI und Hochfrequenzultraschall untersucht. Die Quantifizierung der Leberoberflächenirregularität (QLS) erfolgte mithilfe einer Bildanalysesoftware durch Bestimmung der Differenz der tatsächlichen Oberfläche zu einer approximierten physiologischen Oberfläche in Form einer 20 mm langen Geraden.

Ergebnisse: Sowohl QLS als auch ARFI unterscheiden sich signifikant zwischen Zirrhotikern und Nicht-Zirrhotikern (p < 0,001). Mittelwerte für QLS ergaben für den linken Leberlappen 0.71 ± 0.24 mm bzw. 1,17 ± 0,80 mm, und für den rechten Leberlappen 0,56 ± 0,26 mm bzw. 0,87 ± 0,26 mm für Nicht-Zirrhotiker bzw. Zirrhotiker. Mittelwerte für ARFI-Messungen ergaben für den linken Leberlappen 2,04 ± 0,76 m/s bzw. 2,85 ± 0,81 m/s und für den rechten Leberlappen 1,65 ± 0,61 m/s und 3,02 ± 0,77 m/s für Nicht-Zirrhotiker bzw. Zirrhotiker. Die diagnostische Treffsicherheit (AUROC) war 0,78/0,80 für QLS bzw. 0.77/0.91 für ARFI des jeweils linken/rechten Leberlappens. ARFI-Messungen des rechten Leberlappens sind signifikant besser als ARFI-Messungen des linken (p = 0,023) oder QLS des linken (p = 0,25)/rechten (p = 0,046) Leberlappens.

Schlussfolgerung: Die Beurteilung der Leberoberfläche mittels Hochfrequenzsonografie (QLS) ist ein nützlicher Test für die Diagnose der kompensierten Leberzirrhose. Die Scherwellenelastometrie (ARFI) des rechten Leberlappens ist in der Diagnose der kompensierten Leberzirrhose der Hochfrequenzsonographie (QLS des rechten/linken Leberlappens) und der Scherwellenelastometrie des linken Leberlappens überlegen.

Key words

cirrhosis - high-frequency ultrasound - elastometry - liver surface - ARFI

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