Measurement of Shear Wave Velocity Using Acoustic Radiation Force Impulse Imaging is not Hampered by Previous Use of Ultrasound Contrast Agents

Abstract

Purpose: To assess the inter-observer reproducibility of acoustic radiation force impulse imaging (ARFI) between 2 skilled physicians and to evaluate if ultrasound contrast agents (UCA) affect the measurement of shear wave velocity (SWV) using ARFI.

Patients and Methods: 53 patients (29 males, 24 females, 59 ± 15 [22 – 84] years) who underwent contrast enhanced ultrasound (CEUS) examination were included. ARFI was performed on liver segment V by physicians A and B before CEUS, and by physician A within 4 – 6 minutes and 7 – 10 minutes after contrast injection. In a subgroup of 31 patients (15 males, 16 females, 57 ± 18 [22 – 84] years), ARFI was also performed on focal liver lesions (FLL) by physician A before CEUS, and within 4 – 6 minutes and 7 – 10 minutes after contrast injection.

Results: The SWV values obtained by physician A and B before CEUS yielded an intra-class correlation coefficient value of 0.913 (95 % CI, 0.849 – 0.950). No significant differences were shown between the SWV values of liver segment V in all 53 patients and of FLL in the subgroup of 31 patients obtained before CEUS and that of within 4 – 6 minutes and 7 – 10 minutes after contrast injection (all P> 0.05).

Conclusion: ARFI showed excellent inter-observer reproducibility between 2 skilled physicians. UCA did not affect the measurement of SWV in both liver parenchyma and FLL, at least when performed 4 minutes after the contrast injection. ARFI may become an additional tool in the differential diagnosis of FLL.

Zusammenfassung

Zielsetzung: Ziel der Arbeit ist die Erfassung der Interobserver-Variabilität der Acoustic-Radiation-Force-Impulse-Imaging-(ARFI)-Messung zwischen 2 erfahrenen Ärzten sowie die Untersuchung ob die Anwendung von Ultraschallkontrastmitteln (USKM) die Messung der Scherwellengeschwindigkeit (shear wave velocity, SWV) mittels ARFI beeinflusst.

Patienten und Methoden: 53 Patienten (29 männlich, 24 weiblich, 59 ± 15 [22 – 84] Jahre), die mittels Kontrastmittelultraschall (KMUS) untersucht wurden. ARFI wurde im Lebersegment 5 von 2 Ärzten (A und B) vor KMUS und durch einen Arzt (A) innerhalb von 4 – 6 Minuten und 7 – 10 Minuten nach Injektion durchgeführt.

Ergebnisse: Die durch Untersucher A und B vor KMUS gemessenen SWV-Werte ergaben einen Intraklassen-Korrelationskoeffizienten von 0,913 (95 %-KI, 0,849 – 0,950). Es zeigten sich bei keinem der 53 Patienten signifikante Unterschiede bez. der SWV-Werte im Lebersegment 5 sowie bei keinem der 31 Patienten mit fokalen Leberläsion in der Läsion vor, innerhalb von 4 – 6 Minuten und 7 – 10 Minuten nach KMUS.

Schlussfolgerung: ARFI zeigte eine exzellente Interobserver-Reproduzierbarkeit zwischen 2 erfahrenen Untersuchern. Die Anwendung von Ultraschallkontrastmitteln beeinflusste die Messung der SWV weder im Lebergewebe noch in fokalen Leberläsionen, wenn die Untersuchung frühestens 4 Minuten nach KM-Injektion durchgeführt wurde.

Schlüsselwörter

Leber - Elastografie - Leitlinien - Kontrastmittelultraschall - Reproduzierbarkeit - Scherwelle

Key words

liver - elastography - guidelines - contrast enhanced ultrasound - reproducibility - shear waves

• References

• 1 Gebo KA, Herlong HF, Torbenson MS et al. Role of liver biopsy in management of chronic hepatitis C: a systematic review. Hepatology 2002; 36 (05) S161-S172
• 2 Seeff LB, Everson GT, Morgan TR et al. Complication rate of percutaneous liver biopsies among persons with advanced chronic liver disease in the HALT-C trial. Clin Gastroenterol Hepatol 2010; 8 (10) 877-883
• 3 Ratziu V, Charlotte F, Heurtier A et al. Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology 2005; 128: 1898-1906
• 4 Rockey DC. Noninvasive assessment of liver fibrosis and portal hypertension with transient elastography. Gastroenterology 2008; 134: 8-14
• 5 Friedrich-Rust M, Ong MF, Martens S et al. Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology 2008; 134: 960-974
• 6 Dietrich CF. Real-time tissue elastography, multiple clinical applications, multiple clinical solutions. Endo heute 2010; 23: 177-212
• 7 Friedrich-Rust M, Nierhoff J, Lupsor M et al. Performance of acoustic radiation force impulse imaging for the staging of liver fibrosis: a pooled meta-analysis. J Viral Hepat 2012; 19: e212-e219
• 8 Sporea I, Sirli RL, 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 (Suppl. 01) S46-S52
• 9 Grgurevic I, Cikara I, Horvat J et al. Noninvasive assessment of liver fibrosis with acoustic radiation force impulse imaging: increased liver and splenic stiffness in patients with liver fibrosis and cirrhosis. Ultraschall in Med 2011; 32: 160-166
• 10 Ferraioli G, Tinelli C, Dal Bello B et al. Accuracy of real-time shear wave elastography for assessing liver fibrosis in chronic hepatitis C: a pilot study. Hepatology 2012; 56: 2125-2133
• 11 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
• 12 Rizzo L, Calvaruso V, Cacopardo B et al. Comparison of transient elastography and acoustic radiation force impulse for non-invasive staging of liver fibrosis in patients with chronic hepatitis C. Am J Gastroenterol 2011; 106: 2112-2120
• 13 Yu H, Wilson SR. Differentiation of benign from malignant liver masses with Acoustic Radiation Force Impulse technique. Ultrasound Q 2011; 27: 217-223
• 14 Cho SH, Lee JY, Han JK et al. Acoustic radiation force impulse elastography for the evaluation of focal solid hepatic lesions: preliminary findings. Ultrasound Med Biol 2010; 36: 202-208
• 15 Shuang-Ming T, Ping Z, Ying Q et al. Usefulness of acoustic radiation force impulse imaging in the differential diagnosis of benign and malignant liver lesions. Acad Radiol 2011; 18: 810-815
• 16 Kapoor A, Kapoor A, Mahajan G et al. Real-time elastography in differentiating metastatic from nonmetastatic liver nodules. Ultrasound Med Biol 2011; 37: 207-213
• 17 Davies G, Koenen M. Acoustic radiation force impulse elastography in distinguishing hepatic haemangiomata from metastases: preliminary observations. Br J Radiol 2011; 84: 939-943
• 18 Claudon M, Dietrich CF, Choi BI et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver--update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall in Med 2013; 34: 11-29
• 19 Liepsch D, Schmid T, McLean J et al. Do contrast agents affect ultrasound flow measurements?. Technol Health Care 2004; 12: 411-423
• 20 Khan HG, Gailloud P, Bude RO et al. The effect of contrast material on transcranial Doppler evaluation of normal middle cerebral artery peak systolic velocity. AJNR Am J Neuroradiol 2000; 21: 386-390
• 21 Ressner M, Brodin LA, Jansson T et al. Effects of ultrasound contrast agents on Doppler tissue velocity estimation. J Am Soc Echocardiogr 2006; 19: 154-164
• 22 Dietrich CF, Serra C, Jedrzejczyk M. Chapter 2, Ultrasound of the liver. In: Dietrich CF, , editor EFSUMB course book on ultrasound. London: European Federation of Societies for Ultrasound in Medicine and Biology; 2012: 31-90
• 23 Lim AK, Patel N, Eckersley RJ et al. Evidence for spleen-specific uptake of a microbubble contrast agent: a quantitative study in healthy volunteers. Radiology 2004; 231: 785-788
• 24 Landis JR, Koch GG. An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics 1977; 33: 363-374
• 25 Bamber J, Cosgrove D, Dietrich CF et al. EFSUMB Guidelines and Recommendations on the Clinical Use of Ultrasound Elastography. Part 1: Basic Principles and Technology. Ultraschall in Med 2013; 34: 169-184
• 26 Cosgrove D, Piscaglia F, Bamber J et al. EFSUMB Guidelines and Recommendations on the Clinical Use of Ultrasound Elastography. Part 2: Clinical Applications. Ultraschall in Med 2013; 34: 238-253
• 27 Sporea I, Sirli R, Bota S et al. Is ARFI elastography reliable for predicting fibrosis severity in chronic HCV hepatitis?. World J Radiol 2011; 3: 188-193
• 28 Yoneda M, Suzuki K, Kato S et al. Nonalcoholic fatty liver disease: US-based acoustic radiation force impulse elastography. Radiology 2010; 256: 640-647
• 29 Friedrich-Rust M, Romen D, Vermehren J et al. Acoustic radiation force impulse-imaging and transient elastography for non-invasive assessment of liver fibrosis and steatosis in NAFLD. Eur J Radiol 2012; 81: e325-e331
• 30 Crespo G, Fernandez-Varo G, Marino Z et al. ARFI, FibroScan, ELF, and their combinations in the assessment of liver fibrosis: a prospective study. J Hepatol 2012; 57: 281-287
• 31 Dietrich CF, Cui XW, Barreiros AP et al. EFSUMB guidelines 2011: comment on emergent indications and visions. Ultraschall in Med 2012; 33 (Suppl. 01) S39-S47
• 32 Hernot S, Klibanov AL. Microbubbles in ultrasound-triggered drug and gene delivery. Adv Drug Deliv Rev 2008; 60: 1153-1166
• 33 Ying L, Lin X, Xie ZL et al. Clinical utility of acoustic radiation force impulse imaging for identification of malignant liver lesions: a meta-analysis. Eur Radiol 2012; 22: 2798-2805
• 34 D'Onofrio M, Gallotti A, Mucelli RP. Tissue quantification with acoustic radiation force impulse imaging: Measurement repeatability and normal values in the healthy liver. Am J Roentgenol Am J Roentgenol 2010; 195: 132-136
• 35 Piscaglia F, Salvatore V, Di Donato R et al. Accuracy of virtualtouch acoustic radiation force impulse (ARFI) imaging for the diagnosis of cirrhosis during liver ultrasonography. Ultraschall in Med 2011; 32: 167-175
• 36 Karlas T, Pfrepper C, Wiegand J et al. Acoustic radiation force impulse imaging (ARFI) for non-invasive detection of liver fibrosis: examination standards and evaluation of interlobe differences in healthy subjects and chronic liver disease. Scand J Gastroenterol 2011; 46: 1458-1467
• 37 Toshima T, Shirabe K, Takeishi K et al. New method for assessing liver fibrosis based on acoustic radiation force impulse: a special reference to the difference between right and left liver. J Gastroenterol 2011; 46: 705-711