Download PDF
Z Gastroenterol 2014; 52(07): 649-653
DOI: 10.1055/s-0034-1366036
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

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

Die Messung der Scherwellenelastografie (ARFI) wird durch die Kontrastmittelsonografie nicht beeinflusst
X. W. Cui
1   Medizinische Klinik 2, Caritas Krankenhaus, Bad Mergentheim, Germany
,
C. Pirri
1   Medizinische Klinik 2, Caritas Krankenhaus, Bad Mergentheim, Germany
,
A. Ignee
1   Medizinische Klinik 2, Caritas Krankenhaus, Bad Mergentheim, Germany
,
C. De Molo
1   Medizinische Klinik 2, Caritas Krankenhaus, Bad Mergentheim, Germany
,
T. O. Hirche
2   Innere Medizin, Deutsche Klinik für Diagnostik, Wiesbaden, Germany
,
D. G. Schreiber-Dietrich
3   Pädiatrie, Caritas-Krankenhaus, Bad Mergentheim, Germany
,
C. F. Dietrich
1   Medizinische Klinik 2, Caritas Krankenhaus, Bad Mergentheim, Germany
› Author Affiliations
Further Information

Publication History

23 August 2013

21 January 2014

Publication Date:
15 July 2014 (online)

Also available at
    Permissions and Reprints

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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 3 Ratziu V, Charlotte F, Heurtier A et al. Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology 2005; 128: 1898-1906
    CrossrefPubMedGoogle Scholar
  • 4 Rockey DC. Noninvasive assessment of liver fibrosis and portal hypertension with transient elastography. Gastroenterology 2008; 134: 8-14
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 6 Dietrich CF. Real-time tissue elastography, multiple clinical applications, multiple clinical solutions. Endo heute 2010; 23: 177-212
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 13 Yu H, Wilson SR. Differentiation of benign from malignant liver masses with Acoustic Radiation Force Impulse technique. Ultrasound Q 2011; 27: 217-223
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Liepsch D, Schmid T, McLean J et al. Do contrast agents affect ultrasound flow measurements?. Technol Health Care 2004; 12: 411-423
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Hernot S, Klibanov AL. Microbubbles in ultrasound-triggered drug and gene delivery. Adv Drug Deliv Rev 2008; 60: 1153-1166
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar