Comparison of Acoustic Structure Quantification,Transient Elastography (FibroScan) and Histology in Patients with Chronic Hepatitis B and without Moderate to Severe Hepatic Steatosis

The purpose of this study was to compare acoustic structure quantification (ASQ) with transient elastography for staging liver fibrosis. One hundred eighty-two patients with chronic hepatitis B and without moderate to severe hepatic steatosis scheduled for liver biopsy underwent ASQ and transient elastography examinations. All ASQ parameters, including total mode, total average, red mode, red average, red standard deviation, blue mode, blue average, blue standard deviation and focal disturbance (FD) ratio and liver stiffness obtained via transient elastography were found to correlate with fibrosis stage (Spearman's r?=?0.783, 0.791, 0.750, 0.771, 0.544, 0.718, 0.691, 0.439, 0.815 and 0.814, respectively; all p values < 0.001). Among the ASQ parameters, the FD ratio had the highest correlation with the stage of fibrosis. The areas under the receiver operating characteristic curves (AUCs) of FD ratio and liver stiffness were 0.911 and 0.906 for F ≥ F1, 0.918 and 0.882 for F ≥ F2, 0.911 and 0.914 for F ≥ F3 and 0.926 and 0.978 for F?=?F4, respectively. There was no significant difference in AUCs between FD ratio and liver stiffness in predicting different stages of fibrosis (p?=?0.062–0.912). ASQ is a promising technique for assessing liver fibrosis in the absence of moderate to severe hepatic steatosis.     

Non-invasive assessment of liver fibrosis using acoustic structure quantification: comparison with transient elastography in chronic viral hepatitis

Purpose

The purpose of this study was to evaluate the diagnostic efficacy of acoustic structure quantification (ASQ) parameters [mode, average, and focal distribution (FD) ratio] in the staging of hepatic fibrosis in patients with chronic viral hepatitis and to compare it with transient elastography (TE) by using liver biopsy as reference standard.

Methods

We studied 62 patients with chronic viral hepatitis. Each patient underwent ASQ evaluation and liver biopsy; 54 of these patients received TE. Thirty-six participants without any liver disease were enrolled as normal group, who also underwent ASQ evaluation and TE. All three parameters of ASQ were compared with the histologic fibrosis grade according to the METAVIR scoring (F0–F4). Statistical analysis was performed to investigate the correlations and the diagnostic values of ASQ parameters and compare them to TE.

Results

All three ASQ parameters and TE were significantly correlated with liver fibrosis stage. Of the ASQ parameters, the mode parameter showed the best correlation (P < 0.001). On the area under the receiver operating characteristic curve (AUROC), the mode parameter of ASQ analysis showed both significant correlation and good accuracy for diagnosis of F ≥ 1, F ≥ 2, and F ≥ 3. These values were significantly better than those of the average and FD ratio parameters in F ≥ 1 and F ≥ 2 (P < 0.05). There was no statistically significant difference in AUROC between the mode parameter and TE in diagnosis of F ≥ 1, F ≥ 2, or F ≥ 3.

Conclusions

The mode parameter is the most reliable ASQ parameter, comparable to TE, as a non-invasive method for the detection and grading of liver fibrosis in patients with chronic viral hepatitis.

     

Acoustic Structure Quantification Versus Point Shear Wave Speed Measurement for the Assessment of Liver Fibrosis in Viral Hepatitis B

This study was conducted to evaluate the value of acoustic structure quantification (ASQ) technology versus that of point shear wave speed measurement (PSWSM) imaging technology for the assessment of liver fibrosis stage. A total of 104 patients with chronic hepatitis B (CHB) and 30 healthy control patients underwent ASQ and PSWSM examinations. Seven quantitative parameters were obtained from ASQ, and a principal component analysis was used to establish the integrative indicators. A quantitative parameter, known as the shear wave speed (SWS, m/s), was obtained from the PSWSM. The METAVIR scores for the assessment of pathologic liver fibrosis were used as a benchmark. Liver fibrosis stages exhibited a good correlation with the integrative indicators and SWS (r?=?0.682, p?<0.001; r?=?0.651, p?<0.001). The areas under the receiver operating characteristic curves for ASQ and PSWSM were 0.705 and 0.854 for mild liver fibrosis (F?≥?1, p?=?0.045), 0.813 and 0.743 for significant liver fibrosis (F?≥?2, p?=?0.115), 0.839 and 0.857 for severe liver fibrosis (F?≥?3, p?=?0.417) and 0.874 and 0.971 for liver cirrhosis (F?=?4, p?=?0.016), respectively. In conclusion, both ASQ and PSWSM were promising ultrasonic methods for assessing liver fibrosis in patients with CHB; however, PSWSM was more valuable for identifying mild liver fibrosis (F?≥?1) and cirrhosis (F?=?4) than ASQ, and the combination of PSWSM and ASQ improved the accuracy of diagnosing severe liver fibrosis (F?≥?3).     

磁共振T1 mapping、T2 mapping评估大鼠肝纤维化和肝脂肪变性

目的 采用磁共振T1 mapping、T2 mapping评估大鼠肝纤维化和肝脂肪变性，观察其应用价值。方法 将80只大鼠随机分成实验组（n=70）对照组（n=10）， 分别于背部注射四氯化碳橄榄油溶液及生理盐水，制作大鼠肝纤维化模型。于注药后第4、6、8、10和12周，分别随机选取实验组14只和对照组2只大鼠采集MRI，测量肝实质T1值和T2值，并行组织病理检查。根据病理结果将大鼠肝纤维化划分为S₀~S₄期，脂肪变性划分为F₀~F₄度，比较肝纤维化各期T1值和T2值，分析其与肝纤维化及肝脂肪变性相关性。结果 S₀期大鼠肝脏T1值和T2值与肝纤维化各期差异有统计学意义（P均<0.05），S₁期[（402.01±57.14）ms]肝实质T1值较S₃期[（514.83±87.10）ms]和S₄期[（518.72±36.50）ms]短（P均<0.05），S₂期[（417.49±47.00）ms]肝实质T1值较S₄期短（P<0.05）；S₁期[（65.12±9.46）ms]肝实质T2值较S₄期[（55.33±7.30）ms]略延长（P<0.05）。T1值与肝纤维化程度呈正相关（r=0.68，P<0.01），T2值与脂肪变性程度呈正相关（r=0.72，P<0.01）。结论 磁共振T1 mapping可无创评估大鼠肝纤维化，T2 mapping可无创评估大鼠肝脂肪变性，有望为临床诊断肝纤维化和肝脂肪变性提供新的影像学方法。     

Hepatic Elastometry and Glissonian Line in the Assessment of Liver Fibrosis

The aim of this study was to identify a method for staging hepatic fibrosis using a non-invasive, rapid and inexpensive technique based on ultrasound morphologic hepatic features. A total of 215 patients with different liver diseases underwent B-mode (2-D brightness mode) ultrasonography, vibration-controlled transient elastography, 2-D shear wave elastography and measurement of the controlled attenuation parameter with transient elastography. B-Mode images of the anterior margin of the left lobe were obtained and processed with automatic Genoa Line Quantification (GLQ) software based on a neural network for staging liver fibrosis. The accuracy of GLQ was 90.6% during model training and 78.9% in 38 different patients with concordant elastometric measures. Receiver operating characteristic curve analysis of GLQ performance using vibration-controlled transient elastography as a reference yielded areas under the curves of 0.851 for F ≥ F1, 0.793 for F ≥ F2, 0.784 for F ≥ F3 and 0.789 for F ≥ F4. GLQ has the potential to be a rapid, easy-to-perform and tolerable method in the staging of liver fibrosis.     

Ultrasound-Based Quantification of Fibrosis and Steatosis with a New Software Considering Transient Elastography as Reference in Patients with Chronic Liver Diseases

The goal of this study was to evaluate the performance of two new ultrasound-based techniques (ShearWave PLUS elastography [2-D-SWE PLUS], SSp PLUS Imaging [SSp PLUS]) implemented on the Aixplorer Mach 30 ultrasound system (Supersonic Imagine, Aix-en-Provence, France) for the non-invasive assessment of liver steatosis and fibrosis, using transient elastography (TE) with the controlled attenuation parameter (CAP) as reference. This monocentric cross-sectional study included 133 consecutive adult patients with chronic hepatopathies. Liver stiffness and steatosis were evaluated in the same session using the techniques mentioned above. An excellent correlation was observed between liver stiffness measurements obtained with 2-D-SWE PLUS and TE (r = 0.92, p < 0.0001). The best cutoff value of 2-D-SWE PLUS for predicting F≥2 was 6.8 kPa; for F≥3, 8.4 kPa; and for F4, 11 kPa. With respect to steatosis evaluation, a strong negative correlation between CAP and SSp PLUS values (r = –0.70, p < 0.0001) was obtained. The best SSp PLUS cutoff value for predicting steatosis was 1537 m/s.     

Diagnostic Performance of 2-D Shear-Wave Elastography with Propagation Maps and Attenuation Imaging in Patients with Non-Alcoholic Fatty Liver Disease

We aimed to investigate the diagnostic performance of new 2-D shear-wave elastography (SWE) with propagation maps and attenuation imaging (ATI) for quantification of fibrosis and steatosis in non-alcoholic fatty liver disease (NAFLD). Consecutive patients with NAFLD and healthy volunteers underwent liver stiffness measurement and steatosis quantification by means of vibration-controlled transient elastography coupled with the controlled attenuation parameter as the reference and by 2-D shear-wave elastography (2-D-SWE) with propagation maps and ATI as the investigational methods. We included 232 participants (164 in the NAFLD group and 68 in the healthy control group): 51.7%/49.3% women/men; mean age, 54.2 ± 15.2 y; mean body mass index, 29.4 ± 6.5 kg/m². Significant correlations were found between 2-D-SWE and vibration-controlled transient elastography (r = 0.71, p < 0.0001) and between ATI and the controlled attenuation parameter (r = 0.72, p < 0.0001). NAFLD-specific 2-D-SWE liver stiffness measurement cutoffs were as follows—F ≥ 2: 7.9 kPa (area under the curve [AUC] = 0.91); F ≥ 3: 10 kPa (AUC = 0.92); and F = 4: 11.4 kPa (AUC = 0.95). For steatosis, the best cutoffs by ATI were as follows—S1 = 0.73 dB/cm/MHz (AUC = 0.86); S2 = 0.76 dB/cm/MHz (AUC = 0.86); and S3 = 0.80 dB/cm/MHz (AUC = 0.83). According to Baveno VI criteria, the optimal 2-D-SWE liver stiffness measurement for diagnosing liver cirrhosis is 15.5 kPa (AUC = 0.94), and for ruling out compensated advanced chronic liver disease it is 9.2 kPa (AUC = 0.92). To conclude, 2-D-SWE with propagation maps and ATI is reliable for quantification of liver fibrosis and steatosis in patients with NAFLD.     

Accuracy of Controlled Attenuation Parameter and Liver Stiffness Measurement in Patients with Non-alcoholic Fatty Liver Disease

We evaluated the diagnostic accuracy of the controlled attenuation parameter (CAP) and liver stiffness measurements (LSM) measured with either an M or XL probe against liver biopsy (LB) in patients with non-alcoholic fatty liver disease (NAFLD). This study was a cross-sectional prospective study that included 179 NAFLD patients. With a cutoff value for CAP ≥345, we can exclude significant steatosis in 87% (79.4%–92.5%) of our population. With respect to the LSM, the highest accuracy was obtained for F ≥ F3 (area under the receiver operating characteristic curve [AUROC] = 0.98) and F = F4 (AUROC = 0.98). In a multivariable linear regression model, significant predictors influencing LSM were fibrosis stage (β = 2.6, p < 0.001) as a positive predictor and lobular inflammation (β = –0.68, p = 0.04) as a negative predictor, without significant influence after adjustment for CAP and probe type. We found that CAP is a satisfactory method for excluding advanced steatosis, while LSM is a good non-invasive marker for the exclusion of fibrosis.     

Usefulness of Attenuation Imaging with an Ultrasound Scanner for the Evaluation of Hepatic Steatosis

We investigated the diagnostic capability of the proprietary attenuation imaging (ATI) modality found on some Canon Medical Systems Corp. ultrasound scanners to detect histologically diagnosed steatosis in 148 patients. ATI values increased significantly with increasing steatosis grade (p < 0.001). The diagnostic values (area under the receiver operating characteristic curve) of ATI for steatosis grades ≥ 1 (5%–33% of hepatocytes), ≥ 2 (33%–66% of hepatocytes) and 3 (> 66% of hepatocytes) were 0.85, 0.91 and 0.91. In addition, ATI values increased significantly with increasing steatosis grades (p = 0.002) even in obese patients (n = 41). The diagnostic values of ATI for steatosis grades ≥ 1, ≥ 2 and 3 in obese patients were 0.72, 0.72 and 0.78. Furthermore, ATI values increased significantly with increasing steatosis grade (p < 0.001) in patients with non-alcoholic fatty liver disease (NAFLD) (n = 38). The diagnostic values of ATI for steatosis grades ≥ 1, ≥ 2 and 3 in NAFLD patients were 0.77, 0.88 and 0.86. In conclusion, the ATI method showed good diagnostic capability for the detection of hepatic steatosis.     

Acoustic structure quantification (ASQ): a new tool in sonographic examination of liver lesions in hepatic alveolar echinococcosis

Purpose

Qualitative and quantitative acoustic structure quantification (ASQ) is a new, noninvasive sonographic imaging method based on B-mode. This prospective clinical pilot study aims to answer the question whether delineation and measurement of liver lesions in hepatic alveolar echinococcosis (HAE) can be improved by ASQ. Furthermore, this is the first pilot study to explore how ASQ parameters in HAE lesions develop.

Methods

A total of 24 patients (male = 13/female = 11, mean age = 52 years (16–85), mean disease duration = 68 months (1–334)) with HAE were examined with ASQ using a Toshiba Aplio 500 unit. ASQ parameters were measured in HAE liver lesions and in adjacent non-tumor parenchyma. Quantitative analysis was performed offline using ASQ quantification software.

Results

Subjectively parasitic tumors in HAE appear more prominent in color-coded ASQ imaging, but the size of lesions measured in ASQ mode does not differ from size measurements in B-mode. Median focal disturbance ratio (FD ratio) in lesions was 3 (0.1–3), compared with 0.5 (0.1–1.8) in surrounding liver parenchyma (p < 0.0001). Statistical comparison of other ASQ parameters (mode, average, standard deviation) shows results that are similarly significant with p values between p < 0.0001 and p < 0.0018.

Conclusion

ASQ is a promising sonographic method for examination and quantification of structural changes of liver parenchyma in HAE lesions.     

犬肝纤维化模型MR弥散张量成像及其与CT灌注参数、VEGF表达的相关性

目的 利用DTI测定犬肝纤维化模型的ADC值、FA值,评估肝纤维化程度,分析其与CT灌注参数及VEGF表达水平的相关性.方法 健康中华田园犬15只,随机分成实验组(n=10)和对照组(n=5).实验组犬经腹腔注射50％CCl4油溶液,辅以高脂饮食,建立犬肝纤维化模型.对2组犬每隔4周行MR DTI、CT灌注成像及肝穿活检.根据病理分期分组,分析各组MR DTI参数ADC值、FA值,并与CT灌注参数及VEGF表达水平进行对照.结果 成功获得各期肝纤维化模型;随肝纤维化进展,ADC值逐渐降低(P＜0.05),FA值总体呈上升趋势(P＞0.05);ADC值与PVP、TLP呈正相关;VEGF表达水平随肝纤维化进展而明显增高(P＜0.05).结论 对犬行腹腔注射CCl4油溶液辅以高脂饮食可成功模拟人类从肝细胞变性-肝纤维化-肝硬化的全过程;MR DTI能反映肝纤维化各期的血流动力学变化趋势;VEGF可能在慢性肝病所致肝纤维化过程中起重要作用.     

Tissue Doppler Imaging and Tissue Strain Imaging for the Evaluation of Hepatic Fibrosis in Patients with Chronic Hepatitis B

We studied the feasibility of evaluating the stages of liver fibrosis with tissue Doppler imaging (TDI) and tissue strain imaging (TSI) for patients with chronic hepatitis B virus infection. One hundred ten patients were divided into two groups: normal adult group (n = 38) and chronic liver disease group (n = 72, patients infected with HBVs). The chronic liver disease group was divided into three subgroups on the basis of the Scheuer scoring system and clinical evidence: mild fibrosis (S0 and S1, n = 11), moderate fibrosis (S2 and S3, n = 27) and cirrhosis (S4 and clinically typical cirrhosis, n = 34) groups. TDI was performed for a chosen oblique section. Four regions of interest (ROIs), A–D, were chosen in the hepatic parenchyma based on the direction of propagation from the heart to the liver. Strain rate curves were obtained on the basis of TDI and TSI findings. Strain peak rates (SPRs) of all ROIs and the differences in times to SPRs for the four ROIs (T_A-B, T_B-C and T_C-D) in the hepatic parenchyma were measured with TDI and TSI. Strain rate curves were analyzed for each ROI. The strain rate curves for the normal adult group were synchronous, whereas those for the chronic liver disease group were asynchronous. SPRs of the ROIs gradually decreased with the progression of liver fibrosis. The SPRs of ROI B significantly correlated with chronic liver disease severity (r = 0.991, p < 0.05). Areas under the curve (AUCs) of the ROI A and ROI B SPRs at the moderate fibrosis and cirrhosis stages were 0.86 ± 0.06, 0.81 ± 0.56 and 0.90 ± 0.65, 0.92 ± 0.04, respectively. The AUC of the SPRs of ROIs A and B correlated better than the platelet/age/phosphatase/α-fetoprotein/aspartate aminotransferase (PAPAS) index for advanced fibrosis. The differences in time to SPRs among the peaks of the four ROIs (T_A-B, T_B-C and T_C-D) gradually increased with the progression of liver fibrosis. TDI and TSI with quantitative measurements using tissue Doppler analysis software (TDIQ, GE Medical Systems, Horten, Norway) provided reliable information for evaluating non-invasive liver fibrosis in patients with chronic hepatitis B.     

声学结构定量技术无创性评价肝纤维化程度的初步研究

目的：初步探讨声学结构定量技术（ASQ）在无创性评价肝纤维化程度中的应用价值。方法运用装有ASQ软件的超声仪器对100例正常对照组及120例病理明确的慢性乙型肝炎患者进行肝脏扫查,分析肝实质回声的原始回波信号,记录比较并分析其卡方直方图和参数：Mode（众数）、Average（均数）、SD（标准差）、B/R（蓝红曲线下面积之比）。将以上参数与病理肝纤维化程度进行相关性分析,对相关性较好的参数指标分别以肝纤维化程度S≥1及S≥3为不同研究终点分组进行受试者工作特征曲线（ROC）分析并确定最佳界值。结果随着肝纤维化程度的增加,红色曲线及蓝色曲线的走行由平滑、锐利变得粗糙、曲折,蓝色曲线下面积逐渐增大。红色曲线Mode值、Average值在各组之间比较有显著性差异（P＜0.01）,SD值在除中度（S3）与重度（S4）肝纤维化组以外各组之间均有显著性差异（P＜0.01）。蓝色曲线Mode值与Average值在各组之间有显著性差异（P＜0.01）。B/R值在各组之间均有显著性差异（P＜0.01）且与肝纤维化程度有较好正相关（r＝0.77,P＜0.05）,对B/R进行ROC分析,S≥1时受试者特征曲线下面积（AUROC）为0.88,S≥3时AUROC 为0.96。结论声学结构定量技术是一项非侵入性评价肝纤维化程度的新技术,在肝纤维化分期尤其是早期肝硬化的诊断中有广阔的应用前景。     

Trans-portal hepatic infusion of cultured bone marrow-derived mesenchymal stem cells in a steatohepatitis murine model

The incidence of nonalcoholic steatohepatitis-related liver cirrhosis is increasing. We used a steatohepatitis murine model fed a choline-deficient, l-amino acid-defined (CDAA) diet with a single injection of carbon tetrachloride (CCl₄) to evaluate the efficacy of trans-portal hepatic infusion of bone marrow-derived mesenchymal stem cells (BMSCs) for liver fibrosis, liver steatosis, and oxidative stress. Mice were fed a CDAA diet and injected with a single intraperitoneal dose of CCl₄ (0.5 ml/kg) after 4 weeks of CDAA diet. After 12 weeks of CDAA diet, 1 × 10⁶ luciferase-positive syngeneic BMSCs (Luc-BMSCs) were infused into the animal spleen. An in vivo imaging system was used to confirm Luc-BMSC accumulation in the liver via the portal vein, and at 4 weeks after infusion, we compared liver fibrosis, liver steatosis, and oxidative stress. After the BMSC-infusion, serum albumin and serum total bilirubin were significantly improved. Liver fibrosis assessed by Sirius red staining, α-smooth muscle actin protein, and collagen 1A1 mRNA expression was significantly suppressed. Furthermore, liver steatosis area was significantly lower, the 8-hydroxy-2''-deoxyguanosine-positive cells were significantly fewer, and superoxide dismutase 2 protein expression of the liver was significantly increased. In conclusion, our data confirmed the efficacy of trans-portal hepatic infusion of BMSCs in a steatohepatitis murine model.     

Quantification of Liver Viscoelasticity with Acoustic Radiation Force: A Study of Hepatic Fibrosis in a Rat Model

Ultrasound elastography, based on shear wave propagation, enables the quantitative and non-invasive assessment of liver mechanical properties such as stiffness and has been found to be feasible for and useful in the diagnosis of hepatic fibrosis. Most ultrasound elastographic methods use a purely elastic model to describe liver mechanical properties. However, to describe tissue that is dispersive and to obtain an accurate measure of tissue elasticity, the viscoelasticity of the tissue should be examined. The objective of this study was to investigate the shear viscoelastic characteristics, as measured by ultrasound elastography, of liver fibrosis in a rat model and to evaluate the diagnostic accuracy of viscoelasticity for staging liver fibrosis. Liver fibrosis was induced in 37 rats using carbon tetrachloride (CCl₄); 6 rats served as controls. Liver viscoelasticity was measured in vitro using shear waves induced by acoustic radiation force. The measured mean values of liver elasticity and viscosity ranged from 0.84 to 3.45 kPa and from 1.12 to 2.06 Pa·s for fibrosis stages F0–F4, respectively. Spearman correlation coefficients indicated that stage of fibrosis was well correlated with elasticity (0.88) and moderately correlated with viscosity (0.66). The areas under receiver operating characteristic curves were 0.97 (≥F2), 0.91 (≥F3) and 1.00 (F4) for elasticity and 0.91 (≥F2), 0.79 (≥F3) and 0.74 (F4) for viscosity, respectively. The results confirmed that shear wave velocity was dispersive in frequency, suggesting a viscoelastic model to describe liver fibrosis. The study finds that although viscosity is not as good as elasticity for staging fibrosis, it is important to consider viscosity to make an accurate estimation of elasticity; it may also provide other mechanical insights into liver tissues.     

Comparison of 2-D Shear Wave Elastography and Point Shear Wave Elastography for Assessing Liver Fibrosis

Progressive liver fibrosis may result in cirrhosis, portal hypertension and increased risk of hepatocellular carcinoma. We performed a meta-analysis to compare liver fibrosis staging in chronic liver disease patients using 2-D shear wave elastography (2-D SWE) and point shear wave elastography (pSWE). The PubMed, Web of Science and Cochrane Library databases were searched until May 31, 2020 for studies evaluating the diagnostic performance of 2-D SWE and pSWE in assessing liver fibrosis. Pooled sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratios and area under receiver operating characteristic curve were estimated using the bivariate random effects model. As a result, 71 studies with 11,345 patients were included in the analysis. The pooled sensitivities of 2-D SWE and pSWE significantly differed for the detection of significant fibrosis (F ≥ 2; 0.84 vs. 0.76, p < 0.001) and advanced fibrosis (F ≥ 3; 0.90 vs. 0.83, p = 0.003), but not for detection of cirrhosis (F = 4; 0.89 vs. 0.85, p = 0.090). The pooled specificities of 2-D SWE and pSWE did not significantly differ for detection of F ≥ 2 (0.81 vs. 0.79, p = 0.753), F ≥ 3 (0.87 vs. 0.83, p = 0.163) or F = 4 (0.87 vs. 0.84, p = 0.294). Both 2-D SWE and pSWE have high sensitivity and specificity for detecting each stage of liver fibrosis. Two-dimensional SWE has higher sensitivity than pSWE for detection of significant fibrosis and advanced fibrosis.     

Validation of Shear Wave Elastography Cutoff Values on the Supersonic Aixplorer for Practical Clinical Use in Liver Fibrosis Staging

The purpose of this study was to determine the validity of previously established ultrasound shear wave elastography (SWE) cut-off values (≥F2 fibrosis) on an independent cohort of patients with chronic liver disease. In this cross-sectional study, approved by the institutional review board and compliant with the Health Insurance Portability and Accountability Act, 338 patients undergoing liver biopsy underwent SWE using an Aixplorer ultrasound machine (SuperSonic Imagine, Aix-en-Provence, France). Median SWE values were calculated from sets of 10 elastograms. A single blinded pathologist evaluated METAVIR fibrosis staging as the gold standard. The study analyzed 277 patients with a mean age of 48 y. On pathologic examination, 212 patients (76.5%) had F0–F1 fibrosis, whereas 65 (23.5%) had ≥F2 fibrosis. Spearman's correlation of fibrosis with SWE was 0.456 (p < 0.001). A cut-off value of 7.29 kPa yielded sensitivity of 95.4% and specificity of 50.5% for the diagnosis of METAVIR stage ≥F2 liver fibrosis in patients with liver disease using the SuperSonic Imagine Aixplorer SWE system.     

诊断超声介导微泡提高肝纤维化通透性及促进基因传递

目的 探讨诊断超声联合微泡对肝纤维化组织通透性的影响及其介导基因转染肝纤维化大鼠的有效性。方法 采用二甲基亚硝胺(DMN)法建立大鼠肝纤维化模型,80只大鼠在建模第4周末随机分为:模型对照组、单纯微泡组、单纯超声组和诊断超声联合微泡组。分别进行肝纤维化微血管通透性实验和基因转染实验,采用激光共聚焦显微镜观察伊文思蓝(EB)在肝纤维化组织内分布情况,同时定量检测肝纤维化组织内EB的含量,评估不同分组微血管通透性。荧光显微镜下观察含增强型绿色荧光蛋白报告基因的质粒转染大鼠肝纤维化模型的基因表达情况。结果 激光共聚焦显微镜显示诊断超声联合微泡组纤维化肝实质内可见明显的EB红色荧光。诊断超声联合微泡组纤维化肝组织中EB含量明显高于其他3组(P<0.05)。荧光显微镜下观察,相比其余3组,诊断超声联合微泡组增强型绿色荧光蛋白最多,基因转染效率最高。结论 诊断超声联合微泡在提高纤维化肝脏微血管通透性的同时可促进基因传递。     

New Noninvasive Assessment of Liver Fibrosis in Chronic Hepatitis B

Objective. A novel parameter acquired from conventional B‐mode sonographic videos was introduced in this study, and its diagnostic accuracy for evaluation of hepatic fibrosis was investigated. Methods. Twenty‐eight patients with chronic hepatitis B and 8 patients with hepatic cysts in the right lobe (controls) were enrolled. B‐mode sonographic videos of hepatic motion under the ensisternum in the sagittal plane were captured during peaceful breathing. Maximal accumulative respiration strain (MARS) values of hepatic tissue were obtained after image analysis. METAVIR scoring after liver biopsy was considered the standard. First, the relationship between MARS and the fibrotic stage was studied; and second, receiver operating characteristic (ROC) curves were used to assess the accuracy of MARS for evaluation of the fibrotic stage. Results. When the transducer was placed in the sagittal imaging plane under the ensisternum during the whole respiratory period, the hepatic tissue motion was almost in the same plane. The MARS values (mean ± SD) were 29.44% ± 10.44% in the F0 group (no fibrosis; n = 8), 19.30% ± 9.10% in the F1 group (portal fibrosis without septa; n = 8), 18.09% ± 7.36% in the F2–F3 group (portal fibrosis with few septa or numerous septa without cirrhosis; n = 12), and 14.16% ± 4.18% in the F4 group (cirrhosis; n = 8). The Spearman correlation coefficient between MARS and the fibrotic stage was 0.516 (P = .001). The diagnostic accuracy rates, expressed as areas under the ROC curves, were 0.87 for mild fibrosis (F ≥ 1), 0.72 for substantial fibrosis (F ≥ 2), and 0.75 for cirrhosis (F = 4). Conclusions. Maximal accumulative respiration strain attained from B‐mode sonographic videos of hepatic tissue is a new, convenient, economical, and promising noninvasive parameter for assessment of hepatic fibrosis in patients with chronic hepatitis B.     

Could Ultrasound Elastography Reflect Liver Function?

The purpose of this study was to investigate whether ultrasound elastography reflects liver function reserve relative to liver fibrosis histology. Sixty-five New Zealand rabbits were divided into an experimental group (n?=?45) and a control group (n?=?20). In the experimental group, liver fibrosis (F1–F4) was induced by subcutaneous injection of carbon tetrachloride. Point shear wave elastography and the indocyanine green (ICG) elimination test were performed for the two groups at 4-wk intervals for 56?wk. The liver stiffness value (LSV) and the ICG retention rate at 15?min (ICGR15) were obtained, and the correlation between them was investigated. The median LSVs of stages F0–F4 were 3.92?kPa (1.91–8.53?kPa), 5.02?kPa (2.39–8.91?kPa), 7.87?kPa (5.21–12.26?kPa), 12.83?kPa (5.92–16.79?kPa) and 16.64?kPa (9.76–29.50?kPa), respectively. The median ICGR15 values of stages F0–F4 were 8.7% (4.8%–15.6%), 10.8% (5.6%–20.3%), 19.2% (12.3%–26.7%), 31.0% (20.9%–41.0%) and 45.6% (22.1%–60.9%). There were significant differences in LSVs and ICGR15 values among the different stages of liver fibrosis (p?<0.01). A positive correlation was observed between LSV and ICGR15 (r?=?0.7497, p?<?0.0001). A strong correlation was observed between liver stiffness and liver function reserve, indicating ultrasound elastography may reflect liver function reserve in different degrees of liver fibrosis.