Noninvasive Assessment of Liver Fibrosis with Acoustic Radiation Force Impulse Imaging: Increased Liver and Splenic Stiffness in Patients with Liver Fibrosis and Cirrhosis

Zusammenfassung

Ziel: Bewertung von Acoustic Radiation Force Impulse Imaging (ARFI) von Leber und Milz als neue Methode für die nicht-invasive Bewertung der Leberfibrose (LF). Material und Methoden: Drei Gruppen mit insgesamt 58 Teilnehmern wurden untersucht: (A) 20 gesunde Probanden; (B) 18 Patienten mit chronisch viraler Hepatitis (CVH) B oder C mit Leberfibrose im Stadium F1-4 (beurteilt mittels Leberbiopsie, Ishak Klassifikation); und (C) 20 Patienten mit Leberzirrhose (LC). Alle Teilnehmer wurden mit dem Siemens ACUSON S2000 Ultrasound Virtual Touch Tissue Quantification^TM System untersucht. Zehn Messungen wurden an beiden Leberlappen und drei weitere an der Milz vorgenommen. Die gemessenen Mittelwerte der Transversalwellen Geschwindigkeiten (shear wave velocities (SWV), in m/s) wurden zwischen den Gruppen verglichen. Bei 20 Patienten wurde zudem der Pulsatilitätsindex der Arteria lienalis (SAPI) gemessen und mit dem Leber und Milz ARFI und dem histologischen Stadium der LF korreliert. Ergebnisse: Hepatische ARFI Messungen zeigten eine signifikante Korrelation mit den LB Ergebnissen (Spearman’s ρ = 0.766; p < 0,001) und die SWV Grenzwerte von 1,3 (AUC 0,96) und 1,86 (AUC 0,99) erlaubten eine sichere Unterscheidung von gesunder Leber (A), nicht-zirrhotischer CVH (B) und von LC (C). Für die Milz war der SWV Grenzwert von 2,73 (AUC 0,82) geeignet zur Differenzierung von Patienten mit LC und nicht-zirrhotischer CVH. Zwischen SAPI und den hepatischen ARFI Werten bestand eine signifikante Korrelation (ρ = 0,56; p = 0,013). Schlussfolgerung: Die mit ARFI gemessenen hepatischen und lienalen SWV steigen mit dem Stadium der LF und die hepatische SWV korreliert gut mit SAPI. Diese neue Technologie ermöglicht simultane morphologische, Doppler- und elastometrische Untersuchungen und scheint geeignet, die Genauigkeit der nicht-invasiven Fibrose Beurteilung zu verbessern.

Abstract

Purpose: To evaluate acoustic radiation force impulse imaging (ARFI) of the liver and spleen as a new method for the noninvasive assessment of liver fibrosis (LF). Materials and Methods: Three groups of 58 examinees were studied: (A) 20 healthy volunteers; (B) 18 patients with chronic viral hepatitis (CVH) B or C having liver fibrosis stages F 1 – 4 (assessed by liver biopsy; Ishak classification); and (C) 20 patients with liver cirrhosis (LC). All participants were examined using the Siemens ACUSON S 2000 Ultrasound Virtual Touch Tissue Quantification™ system. Ten measurements were performed on both liver lobes and three measurements on the spleen, and the obtained mean values (shear wave velocities [SWV] expressed in m/s) were compared between the groups. In 20 patients the splenic artery pulsatility index (SAPI) was also measured and correlated to the liver and splenic ARFI and histological stage of LF. Results: Hepatic ARFI measurements demonstrated a significant correlation to LB results (Spearman’s ρ = 0.766; ρ < 0.001) and SWV cut-off values of 1.3 (AUC 0.96) and 1.86 (AUC 0.99) could reliably differentiate between healthy (A) and non-cirrhotic CVH (B), as well as between non-cirrhotic CVH (B) and LC (C). Splenic SWV cut-off value of 2.73 (AUC 0.82) could differentiate between the patients with LC and non-cirrhotic CVH. A significant correlation was also observed between the SAPI and liver ARFI results (ρ = 0.56; p = 0.013). Conclusion: The hepatic and splenic SWV measured by ARFI increase with the LF stage, and the hepatic SWV correlate well with SAPI. This new technology enables simultaneous morphological, Doppler and elastometric examinations and might improve the accuracy of noninvasive liver fibrosis assessment.

Key words

abdomen - ultrasound color Doppler - infection - staging

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