Contrast-Enhanced Ultrasonography with Arrival Time Parametric Imaging as a Non-Invasive Diagnostic Tool for Liver Cirrhosis

Abstract

Liver biopsy is the gold standard method for staging liver fibrosis, but it is an invasive procedure that is associated with some complications. There are also non-invasive techniques for assessing liver fibrosis, such as elastography and biological tests, but these techniques can fail in detection or generate false measurements depending on the subject’s condition. This study aimed to determine whether liver fibrosis can be evaluated using contrast-enhanced ultrasonography with arrival time parametric imaging using the ultrasound machine’s parametric image software, the method being called (CEUS-PAT). CEUS-PAT was performed on each subject using SonoVue as a contrast agent, and images showing liver parenchyma and the right kidney on a single screen were used for analysis in parametric imaging, which was performed using the proprietary software of the ultrasound system. The ratio between the kidney and liver arrival times was calculated. The study included 64 predominantly male (56.3%) subjects, 37 cirrhotic patients, and 27 healthy volunteers, with a mean age of 58.98 ± 8.90 years. Significant differences were found between the liver cirrhosis and healthy groups regarding CEUS-PAT, 0.83 ± 0.09 vs. 0.49 ± 0.11, p < 0.0001. The correlation between CEUS-PAT and VCTE was r = 0.81. The optimal cut-off value for detecting liver cirrhosis was >0.7, with an AUC of 0.98, p < 0.001, Se = 89.19%, Sp = 100%, PPV = 100%, and NPV = 87.1%. We demonstrate that CEUS-PAT achieves excellent performance in diagnosing liver cirrhosis and is a fast method for diagnosing liver cirrhosis that can even be applied in situations where the use of other methods is excluded.

Color Mapping using Ultrasound System-integrated Perfusion Software for Evaluation of Focal Liver Lesions: A Possible First Step for More Independent Reading

“…Whether or not there are diagnostic advantages for CEUS with a novel mode of investigation, such as HIFI, must be decided after further studies regarding diagnostic safety, detection, and characterization of solid liver tumors; differentiation of complicated cystic lesions; and dynamic acquisition and digital storage of the dynamics of unclear lesions on CT or MRI from the early arterial phase after 10-15 s to a late phase of 5-6 min [29,30]. Furthermore, CEUS brings an advantage in certain cases of patient with liver cirrhosis, as it provides a non-invasive method for generic cirrhosis of the liver using parametric images (CEUS-PAT) [31].…”

EFSUMB Technical Review – Update 2023: Dynamic Contrast-Enhanced Ultrasound (DCE-CEUS) for the Quantification of Tumor Perfusion

“…An objective and quantitative diagnosis of perfusion characteristics is of particular relevance in the follow-up of cancer patients but can also be used for the diagnostic assessment of other pathological changes associated with alterations in tissue perfusion. This applies, for example, to the noninvasive diagnosis of the progression of parenchymal liver disease, liver cirrhosis, and portal hypertension [10,11,12,13,14,15,16] and for the noninvasive evaluation of chronic kidney disease [17,18,19] and subclinical kidney transplant rejection [17,20,21,22,23,24]. There are partially contradictory data regarding the evaluation of inflammatory activity and response to biologic therapy in inflammatory bowel disease [25,26,27,28,29,30,31,32,33,34].…”