PDF herunterladen
Z Gastroenterol 2020; 58(09): 847-854
DOI: 10.1055/a-1217-7465
Originalarbeit

Preliminary Clinical Experience with Shear Wave Dispersion Imaging for Liver Viscosity in Preoperative Diagnosis of Focal Liver Lesions

Vorläufige klinische Erfahrung mit der Scherwellendispersionsbildgebung für die Leberviskosität bei der präoperativen Diagnose fokaler Leberläsionen
Yi Dong
1   Ultrasound Department, Zhongshan Hospital Fudan University, Shanghai, China
,
Yijie Qiu
1   Ultrasound Department, Zhongshan Hospital Fudan University, Shanghai, China
,
Qi Zhang
1   Ultrasound Department, Zhongshan Hospital Fudan University, Shanghai, China
,
Daohui Yang
1   Ultrasound Department, Zhongshan Hospital Fudan University, Shanghai, China
,
Lingyun Yu
1   Ultrasound Department, Zhongshan Hospital Fudan University, Shanghai, China
,
Wen-Ping Wang
1   Ultrasound Department, Zhongshan Hospital Fudan University, Shanghai, China
,
Christoph F. Dietrich
2   Caritas-Krankenhaus Bad Mergentheim gGmbH, Bad Mergentheim, Germany
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Background The aim of our study is to analyze viscosity characteristics of focal liver lesions (FLLs) and the diagnostic performance of shear wave dispersion (SWD) in differentiating benign and malignant FLLs.

Methods Between January 2018 and April 2018, 58 consecutive patients (median age 57, age range 21–74 years, 37 males) with 58 FLLs located on the right lobe of liver were prospectively studied. The Aplio i900 series diagnostic ultrasound system (Canon Medical systems) equipped with a curvilinear PV1-475BX transducer (1–8 MHz) was used. SWD slope and viscosity measurements were expressed as mean ± standard deviation for both liver tumors and background liver parenchyma. Histopathological results after surgery were regarded as the gold standard for diagnosis.

Results Final diagnosis included 40 cases of malignant and 18 cases of benign FLLs. The mean viscosity value were 14.78 ± 1.86 m/s/kHz for hepatocellular carcinoma (n = 30), 14.81 ± 2.35 m/s/kHz for liver metastasis lesions (n = 10), 13.23 ± 1.31 m/s/kHz for hemangioma (n = 13), and 13.67 ± 2.72 m/s/kHz for focal nodular hyperplasia (n = 5). Malignant FLLs showed higher mean viscosity values (14.79 ± 3.15 m/s/KHz) than benign FLLs (13.36 ± 2.76 m/s/KHz) (p < 0.05). The best performing cut-off value of lesion viscosity was 13.15 m/s/kHz (sensitivity 83.3 %; specificity 56.5 %; area under the curve (AUC) 0.71) for malignancy) (p < 0.05).

Conclusions The analysis of SWD slope and liver viscosity parameters provide additional viscoelastic information about FLLs before operation.

Zusammenfassung

Einleitung Ziel der Studie ist es die Viskosität fokaler Leberläsionen (FLL) zu bestimmen und die Aussagekraft der Scherwellendispersion zur Differenzierung von benignen und malignen Leberraumforderung zu validieren.

Methode Zwischen Januar und April 2018 wurden 58 konsekutive Patienten (medianes Alter der Patienten 57 (21–74) Jahre, 37 Männer) mit FLL im rechten Leberlappen prospektiv untersucht. Die Untersuchungen erfolgten mit einem hochauflösenden Ultraschallgerät Canon Aplio i900, ausgerüstet mit einem kurvilinearen Schallkopf PV1-475BX (1–8 MHz). Die Scherwellendispersion und Viskositätmessungen wurden ausgedrückt als Mittelwert ± Standardabweichung, sowohl für die FLL, als auch für das Leberparenchym. Der Goldstandard war die histopathologische Untersuchung der FLL nach chirurgischer Resektion.

Ergebnisse Die finale Diagnose beinhaltete 40 Patienten mit malignen und 18 Patienten mit benignen FLL. Die mittleren Viskositätswerte lagen bei 14,78 ± 1,86 m/s/kHz für hepatozelluläre Karzinome (n = 30), 14,81 ± 2,35 m/s/kHz für Lebermetastasen (n = 10), 13,23 ± 1,31 m/s/kHz für Hämangiome (n = 13) und 13,67 ± 2,72 m/s/kHZ für fokale noduläre Hyperplasien (n = 5). Maligne fokale Leberläsionen zeigten (14.79 ± 3.15 m/s/KHz) höhere Viskositätswerte als gutartige fokale Leberläsionen (13.36 ± 2.76 m/s/KHz) (P < 0,05). Bei einem angenommenen Wert von 13,15 m/s/kHz betrug die Sensitivität für die richtige Erkennung maligner Raumforderungen 83,3 %, die Spezifität 56,5 %, die Fläche unter der Kurve (area under the curve (AUC) 0,71, p < 0,05).

Schlussfolgerung Die Analyse der Leberviskositätsmessung mittels Scherwellendispersion gibt zusätzliche Informationen zur Charakterisierung fokaler Leberläsionen.

Key words

shear wave dispersion - viscosity - ultrasound - diagnosis - focal liver lesions

Schlüsselwörter

Scherwellendispersion - Viskosität - Ultraschall - Leitlinien - Diagnosen - fokale Leberläsionen


Publikationsverlauf

Eingereicht: 09. Oktober 2019

Angenommen: 06. Juli 2020

Artikel online veröffentlicht:
18. September 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 Dietrich CF, Sharma M, Gibson RN. et al. Fortuitously discovered liver lesions. World J Gastroenterol 2013; 19: 3173-3188
    CrossrefPubMedGoogle Scholar
  • 2 Schellhaas B, Wildner D, Pfeifer L. et al. LI-RADS-CEUS – Proposal for a contrast-enhanced ultrasound algorithm for the diagnosis of hepatocellular carcinoma in high-risk populations. Ultraschall in der Medizin 2016; 37: 627-634
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 3 Chiorean L, Cantisani V, Jenssen C. et al. Focal masses in a non-cirrhotic liver: the additional benefit of CEUS over baseline imaging. Eur J Radiol 2015; 84: 1636-1643
    CrossrefPubMedGoogle Scholar
  • 4 Dietrich CF, Averkiou M, Nielsen MB. et al. How to perform contrast-enhanced ultrasound (CEUS). UIO 2018; 4: E2-E15
    PubMedGoogle Scholar
  • 5 Dietrich CF, Bamber J, Berzigotti A. et al. EFSUMB Guidelines and recommendations on the clinical use of liver ultrasound elastography, Update 2017 (Long Version). Ultraschall in der Medizin 2017; 38: e16-e47
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 6 Dietrich CF, Bamber J, Berzigotti A. et al. EFSUMB guidelines and recommendations on the clinical use of liver ultrasound elastography, Update 2017 (Short Version). Ultraschall in der Medizin 2017; 38: 377-394
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 7 European Association for Study of L, Asociacion Latinoamericana para el Estudio del H. EASL-ALEH Clinical Practice Guidelines: non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol 2015; 63: 237-264
    CrossrefPubMedGoogle Scholar
  • 8 Ferraioli G, Filice C, Castera L. et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 3: liver. Ultrasound Med Biol 2015; 41: 1161-1179
    CrossrefPubMedGoogle Scholar
  • 9 Dong Y, Sirli R, Ferraioli G. et al. Shear wave elastography of the liver – review on normal values. Zeitschrift fur Gastroenterologie 2017; 55: 153-166
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 10 Dong Y, Wang WP, Xu Y. et al. Point shear wave speed measurement in differentiating benign and malignant focal liver lesions. Med Ultrason 2017; 19: 259-264
    CrossrefPubMedGoogle Scholar
  • 11 Ronot M, Di Renzo S, Gregoli B. et al. Characterization of fortuitously discovered focal liver lesions: additional information provided by shearwave elastography. Eur Radiol 2015; 25: 346-358
    CrossrefPubMedGoogle Scholar
  • 12 Brunel T, Guibal A, Boularan C. et al. Focal nodular hyperplasia and hepatocellular adenoma: the value of shear wave elastography for differential diagnosis. Eur J Radiol 2015; 84: 2059-2064
    CrossrefPubMedGoogle Scholar
  • 13 Ling WW, Lu Q, Lu CL. et al. Effects of vascularity and differentiation of hepatocellular carcinoma on tumor and liver stiffness: in vivo and in vitro studies. Ultrasound Med Biol 2014; 40: 739-746
    CrossrefPubMedGoogle Scholar
  • 14 Lu Q, Ling WW, Lu CL. et al. Hepatocellular carcinoma: stiffness value and ratio to discriminate malignant from benign focal liver lesions. Radiol 2015; 275: 880-888
    CrossrefPubMedGoogle Scholar
  • 15 Frulio N, Laumonier H, Carteret T. et al. Evaluation of liver tumors using acoustic radiation force impulse elastography and correlation with histologic data. JUM 2013; 32: 121-130
    PubMedGoogle Scholar
  • 16 Hasab Allah M, Salama RM, Marie MS. et al. Utility of point shear wave elastography in characterisation of focal liver lesions. Expert Rev Gastroenterol Hepatol 2018; 12: 201-207
    CrossrefPubMedGoogle Scholar
  • 17 Grgurevic I, Bokun T, Salkic NN. et al. Liver elastography malignancy prediction score for noninvasive characterization of focal liver lesions. Liver Int 2018; 38: 1055-1063
    CrossrefPubMedGoogle Scholar
  • 18 Heide R, Strobel D, Bernatik T. et al. Characterization of focal liver lesions (FLL) with acoustic radiation force impulse (ARFI) elastometry. Ultraschall in der Medizin 2010; 31: 405-409
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 19 Verlinden W, Francque S, Michielsen P. et al. Successful antiviral treatment of chronic hepatitis C leads to a rapid decline of liver stiffness without an early effect on spleen stiffness. Hepatology 2016; 64: 1809-1810
    CrossrefPubMedGoogle Scholar
  • 20 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 Rad 2012; 22: 2798-2805
    CrossrefPubMedGoogle Scholar
  • 21 Berzigotti A, Ferraioli G, Bota S. et al. Novel ultrasound-based methods to assess liver disease: The game has just begun. Dig Liver Dis 2018; 50: 107-112
    CrossrefPubMedGoogle Scholar
  • 22 Piscaglia F, Salvatore V, Mulazzani L. et al. Ultrasound shear wave elastography for liver disease. A critical appraisal of the many actors on the stage. Ultraschall in der Medizin 2016; 37: 1-5
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 23 Barry CT, Mills B, Hah Z. et al. Shear wave dispersion measures liver steatosis. Ultrasound Med Biol 2012; 38: 175-182
    CrossrefPubMedGoogle Scholar
  • 24 Chen X, Shen Y, Zheng Y. et al. Quantification of liver viscoelasticity with acoustic radiation force: a study of hepatic fibrosis in a rat model. Ultrasound Med Biol 2013; 39: 2091-2102
    CrossrefPubMedGoogle Scholar
  • 25 Chen S, Urban MW, Pislaru C. et al. Liver elasticity and viscosity quantification using shearwave dispersion ultrasound vibrometry (SDUV). Conference proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society IEEE Engineering in Medicine and Biology Society Annual Conference 2009; 2009: 2252-2255
    PubMedGoogle Scholar
  • 26 de Ledinghen V, Vergniol J, Capdepont M. et al. Controlled attenuation parameter (CAP) for the diagnosis of steatosis: a prospective study of 5323 examinations. J Hepatol 2014; 60: 1026-1031
    CrossrefPubMedGoogle Scholar
  • 27 Sugimoto K, Moriyasu F, Oshiro H. et al. Viscoelasticity measurement in rat livers using shear-wave us elastography. Ultrasound Med Biol 2018; DOI: 10.1016/j.ultrasmedbio.2018.05.008.
    CrossrefPubMedGoogle Scholar
  • 28 Barry CT, Hah Z, Partin A. et al. Mouse liver dispersion for the diagnosis of early-stage fatty liver disease: a 70-sample study. Ultrasound Med Biol 2014; 40: 704-713
    CrossrefPubMedGoogle Scholar
  • 29 Deffieux T, Montaldo G, Tanter M. et al. Shear wave spectroscopy for in vivo quantification of human soft tissues visco-elasticity. IEEE Trans Med Imaging 2009; 28: 313-322
    CrossrefPubMedGoogle Scholar
  • 30 Guo YR, Chen X, Lin H. et al. In-vitro quantification of rat liver viscoelasticity with shear wave dispersion ultrasound vibrometry. Conference proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society IEEE Engineering in Medicine and Biology Society Annual Conference 2013; 2013: 1915-1918
    PubMedGoogle Scholar
  • 31 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 der Medizin 2013; 34: 169-184
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 32 Chen S, Sanchez W, Callstrom MR. et al. Assessment of liver viscoelasticity by using shear waves induced by ultrasound radiation force. Radiology 2013; 266: 964-970
    CrossrefPubMedGoogle Scholar
  • 33 Chen S, Urban MW, Pislaru C. et al. Shearwave dispersion ultrasound vibrometry (SDUV) for measuring tissue elasticity and viscosity. IEEE Trans Ultrason Ferroelectr Freq Control 2009; 56: 55-62
    CrossrefPubMedGoogle Scholar
  • 34 Akdogan E, Yilmaz FG. The role of acoustic radiation force impulse elastography in the differentiation of benign and malignant focal liver masses. Turk J Gastroenterol 2018; 29: 456-463
    CrossrefPubMedGoogle Scholar
  • 35 da Silva NPB, Hornung M, Beyer LP. et al. Intraoperative shear wave elastography vs. contrast-enhanced ultrasound for the characterization and differentiation of focal liver lesions to optimize liver tumor surgery. Ultraschall in der Medizin 2019; 40: 205-211
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 36 Iredale JP. Models of liver fibrosis: exploring the dynamic nature of inflammation and repair in a solid organ. J Clin Investig 2007; 117: 539-548
    CrossrefPubMedGoogle Scholar
  • 37 Bioulac-Sage P, Balabaud C, Bedossa P. et al. Pathological diagnosis of liver cell adenoma and focal nodular hyperplasia: Bordeaux update. J Hepatol 2007; 46: 521-527
    CrossrefPubMedGoogle Scholar
  • 38 Deffieux T, Gennisson JL, Bousquet L. et al. Investigating liver stiffness and viscosity for fibrosis, steatosis and activity staging using shear wave elastography. J Hepatol 2015; 62: 317-324
    CrossrefPubMedGoogle Scholar
  • 39 Dong DR, Hao MN, Li C. et al. Acoustic radiation force impulse elastography, FibroScan(R), Forns’ index and their combination in the assessment of liver fibrosis in patients with chronic hepatitis B, and the impact of inflammatory activity and steatosis on these diagnostic methods. Mol Med Rep 2015; 11: 4174-4182
    CrossrefPubMedGoogle Scholar
  • 40 Zeng X, Xu C, He D. et al. Influence of hepatic inflammation on fibroscan findings in diagnosing fibrosis in patients with chronic hepatitis B. Ultrasound Med Biol 2015; 41: 1538-1544
    CrossrefPubMedGoogle Scholar