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Ultraschall Med 2014; 35(1): 44-50
DOI: 10.1055/s-0033-1350170
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

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

Acoustic Radiation Force Impulse (ARFI) und Hochfrequenzultraschall der Leberoberfläche zur Diagnose der kompensierten Leberzirrhose
L. Pfeifer
1   Departement of Internal Medicine 1, University of Erlangen
,
R. S. Goertz
1   Departement of Internal Medicine 1, University of Erlangen
,
J. Sturm
1   Departement of Internal Medicine 1, University of Erlangen
,
D. Wachter
2   Institut of Pathology, Universtiy of Erlangen
,
M. O. Riener
2   Institut of Pathology, Universtiy of Erlangen
,
J. Schwitulla
3   Institut of Medical Informatics, Biometry and Epidemiology, University of Erlangen
,
T. Bernatik
4   Innere Medizin, Kreisklinik Ebersberg
,
M. F. Neurath
1   Departement of Internal Medicine 1, University of Erlangen
,
D. Strobel
1   Departement of Internal Medicine 1, University of Erlangen
› Author Affiliations
Further Information

Publication History

25 July 2012

23 June 2013

Publication Date:
07 February 2014 (online)

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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
 

  • References

  • 1 Mortality database. Switzerland: World Health Organization; 2008 Available from www.who.int
    PubMedGoogle Scholar
  • 2 de Franchis R. Cirrhosis: screening for esophageal varices. Nat Rev Gastroenterol Hepatol 2009; 6: 449-450
    CrossrefPubMedGoogle Scholar
  • 3 Bolondi L. Screening for hepatocellular carcinoma in cirrhosis. J Hepatol 2003; 39: 1076-1084
    CrossrefPubMedGoogle Scholar
  • 4 Castera L, Pinzani M. Biopsy and non-invasive methods for the diagnosis of liver fibrosis: does it take two to tango?. Gut 2010; 59: 861-866
    CrossrefPubMedGoogle Scholar
  • 5 Seitz K, Greis C, Schuler A et al. Frequency of tumor entities among liver tumors of unclear etiology initially detected by sonography in the noncirrhotic or cirrhotic livers of 1349 patients. Results of the DEGUM multicenter study. Ultraschall in Med 2011; 32: 598-603
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Macias RMA, Rendon UP, Navas RC et al. Ultrasonography in patients with chronic liver disease: its usefulness in the diagnosis of cirrhosis. Rev Esp Enferm Dig 2003; 95: 258-264 , 251–257
    PubMedGoogle Scholar
  • 7 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
    CrossrefPubMedGoogle Scholar
  • 8 Berzigotti A, Abraldes JG, Tandon P et al. Ultrasonographic evaluation of liver surface and transient elastography in clinically doubtful cirrhosis. J Hepatol 2010; 52: 846-853
    CrossrefPubMedGoogle Scholar
  • 9 Schacherer D, Schuh C, Strauch U et al. Improvement in the routine diagnostic assessment of the liver by high-resolution sonography: an analysis of 999 cases. Scand J Gastroenterol 2007; 42: 366-373
    CrossrefPubMedGoogle Scholar
  • 10 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 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
    CrossrefPubMedGoogle Scholar
  • 14 Goertz RS, Zopf Y, Jugl V et al. Measurement of liver elasticity with acoustic radiation force impulse (ARFI) technology: an alternative noninvasive method for staging liver fibrosis in viral hepatitis. Ultraschall in Med 2010; 31: 151-155
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Sporea I, Sirli RL. Hepatic elastography for the assessment of liver fibrosis--present and future. Ultraschall in Med 2012; 33: 550-558
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Goertz RS, Egger C, Neurath MF et al. Impact of food intake, ultrasound transducer, breathing maneuvers and body position on acoustic radiation force impulse (ARFI) elastometry of the liver. Ultraschall in Med 2012; 33: 380-385
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Lutz H. Ultraschallfibel Innere Medizin. Berlin, Heidelberg, New York: Springer Verlag; 2007
    Google Scholar
  • 19 Bedossa P. Intraobserver and interobserver variations in liver biopsy interpretation in patients with chronic hepatitis C. The French METAVIR Cooperative Study Group. Hepatology 1994; 20: 15-20
    PubMedGoogle Scholar
  • 20 DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988; 44: 837-845
    CrossrefPubMedGoogle Scholar
  • 21 Benjamini YHY. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J Roy Statist SocSer B (Methodological) 1995; 289-300
    PubMedGoogle Scholar
  • 22 Youden WJ. Index for rating diagnostic tests. Cancer 1950; 3: 32-35
    CrossrefPubMedGoogle Scholar
  • 23 Everitt BS. The analysis of contingency tables. Chapman and Hall; 1977
    CrossrefGoogle Scholar
  • 24 Aube C, Oberti F, Korali N et al. Ultrasonographic diagnosis of hepatic fibrosis or cirrhosis. J Hepatol 1999; 30: 472-478
    CrossrefPubMedGoogle Scholar
  • 25 Simonovsky V. The diagnosis of cirrhosis by high resolution ultrasound of the liver surface. Br J Radiol 1999; 72: 29-34
    PubMedGoogle Scholar
  • 26 Sinniah R. A clinicopathological study of micronodular and macronodular cirrhosis in Belfast, Northern Ireland. Ulster Med J 1972; 41: 121-134
    PubMedGoogle Scholar
  • 27 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
    CrossrefPubMedGoogle Scholar
  • 28 Thein HH, Yi Q, Dore GJ et al. Estimation of stage-specific fibrosis progression rates in chronic hepatitis C virus infection: a meta-analysis and meta-regression. Hepatology 2008; 48: 418-431
    CrossrefPubMedGoogle Scholar