Liver Fibrosis in Patients with Chronic Hepatitis C: Noninvasive Diagnosis by Means of Real-time Tissue Elastography—Establishment of the Method for Measurement

Koizumi, Yohei; Hirooka, Masashi; Kisaka, Yoshiyasu; Konishi, Ichiro; Abe, Masanori; Murakami, Hidehiro; Matsuura, Bunzo; Hiasa, Yoichi; Onji, Morikazu

doi:10.1148/radiol.10100319

Cited by 131 publications

(113 citation statements)

References 23 publications

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“…We analyzed the strain ratio of the ovarian stroma, which we thought to be more objective than the elasticity pattern, because it showed images of relative tissue hardness (18). The strain ratio is a semiquantitative measurement of hardness of the lesion with respect to the adjacent soft tissues, where higher ratios point to harder tissues (9).…”

Section: Discussionmentioning

confidence: 99%

Contribution of real-time elastography in diagnosis of polycystic ovary syndrome

Ciraci

Tan²,

Özcan³

et al. 2015

Diagn Interv Radiol

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ABDOMINAL IMAGINGORIGINAL ARTICLE PURPOSE We aimed to assess the feasibility and reproducibility of real-time elastography (RTE) for displaying the effects of morphological changes in the ovary in polycystic ovary syndrome (PCOS). METHODSForty-eight patients diagnosed with PCOS and 48 healthy women were enrolled in the study. Ultrasonography and RTE were performed on the 3 rd day of the menstrual cycle. Evaluations were performed independently by two radiologists. Ovarian volume, number of follicles, elasticity pattern, and strain ratio were measured. Elasticity patterns were assessed as hard (type 1; blue or blue-green), moderate (type 2; green or green-yellow) or soft (type 3; red or orange-red). RESULTSBoth radiologists determined the elasticity pattern as mostly type 1 in the PCOS group and type 3 in the control group (P < 0.01). The mean strain ratios obtained by the first and second radiologist were 6.1±1.8 (2.7-10.1) and 6.0±1.5 (3.0-9.0) in PCOS and 3.3±1.2 (1.7-7.2) and 3.2±0.9 (1.7-6.8) in the control group, respectively (P < 0.001). Interobserver agreement was moderate for the elasticity pattern (κ=0.48) and good for the strain ratio (intraclass correlation coefficient, 0.77). A strain ratio of 3.8 was determined as the optimized cutoff point by receiver operating curve analysis. Strain ratio was correlated with the ovarian volume and the number of detected follicles (P < 0.001). CONCLUSION Elasticity pattern and strain ratio can help identify morphological changes that make PCOS ovaries stiffer than normal ovaries. In reproductive-aged women, polycystic ovary syndrome (PCOS) is an important cause of infertility and is characterized by menstrual irregularities, hirsutism and signs of hyperandrogenism, and polycystic ovary appearance (1-3). In addition to insulin resistance, serum androgenic hormone levels are increased, causing undesired effects on women's metabolic, reproductive, and cardiovascular health (1-5). PCOS is characterized by enlarged ovaries containing small cysts, for which the syndrome was named (6).Real-time elastography (RTE) is a novel and dynamic imaging technique that is simply based on the hardness or softness of tissues or organs under the appropriate compression and can be used with conventional ultrasonography (US) probes after performing gray-scale and Doppler US. Displacement of soft tissues is greater than hard tissues, and tissue hardness is displayed as a color-coded image that lays over the gray-scale US image translucently (7). Elastography has been used previously for differentiation of pathologies of tissues and organs, such as thyroid, breast, kidneys, and liver (7-9). There are limited studies about the elastographic properties of the ovaries, mostly focused on ovarian neoplasms and, to the best of our knowledge, there is no medical data concerning the elasticity properties of the ovary in PCOS (10, 11). In this study, our purpose was to assess the feasibility and reproducibility of RTE for displaying the effects of morphological changes in the ovary in PCOS and to p...

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Section: Discussionmentioning

confidence: 99%

Contribution of real-time elastography in diagnosis of polycystic ovary syndrome

Ciraci

Tan²,

Özcan³

et al. 2015

Diagn Interv Radiol

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“…Recent studies have evaluated its use in the study of hepatic fibrosis in patients with chronic liver disease (viral in most cases), and the results have shown good concordance with histological data [24,25]. Takahashi et al, for example, found that liver stiffness measured with ARFI correlates with Metavir scores of liver fibrosis.…”

Section: Introductionmentioning

confidence: 95%

ARFI elastography in patients with chronic autoimmune liver diseases: A preliminary study

Righi

Fiorini

Molo

et al. 2012

Journal of Ultrasound

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Objective: Acoustic radiation force impulse (ARFI) is a new software-based technique that evaluates liver stiffness during B-mode ultrasonography. The purpose of this study was to evaluate the accuracy of ARFI in distinguishing patients with chronic autoimmune liver disease from healthy subjects. Material and methods: We enrolled 9 adult patients (8 women, 1 man; age 48.1 AE 12.8 years) with chronic autoimmune disease (primary biliary cirrhosis (PBC, n Z 3), autoimmune hepatitis (AIH, n Z 2), primary sclerosing cholangitis (PSC, n Z 1) and overlap syndromes, (n Z 3) who underwent a liver biopsy and 11 healthy volunteers (age 34.7 AE 10.4 years; 7 women, 4 men). Liver stiffness was evaluated and expressed as the shear wave velocity (SWV) in m/sec. We used a US scanner Siemens-Acuson S2000, evaluating the right liver lobe and the left liver lobe. Results: The SWV was significantly higher in cases (right lobe: 1.51 AE 0.44; left lobe: 1.57 AE 0.40) than in controls (right lobe: 1.08 AE 0.10; left lobe: 1.12 AE 0.13) (right lobe: P Z 0.002; left lobe: P Z 0.013). We found no significant correlation between right and left lobe SWVs in cases (P Z 0.779) or controls (P Z 0.385). The SWV cut-off that best distinguished cases from controls was 1.25 m/sec (accuracy: AUCZ0.885; sensitivity: 70.6%; specificity: 95.5%). Conclusions: ARFI elastography is a noninvasive ultrasonographic technique that can differentiate healthy subjects from patients with fibrotic stages of chronic liver disease.Sommario Introduzione: L'elastografia ARFI è una tecnologia integrata all'ultrasonografia convenzionale B-mode in grado di determinare la rigidità tissutale. L'obiettivo di questo studio è stato valutare se l'elastografia ARFI sia in grado di differenziare pazienti affetti da patologie epatiche croniche autoimmuni e soggetti normali. Materiali e metodi: Sono stati arruolati 9 pazienti affetti da epatopatia cronica autoimmune sottoposti a biopsia epatica (età 48.1 AE 12.8 anni; femmine/maschi: 8/1; 3 PBC, 2 AIH, 1 PSC e 3 overlap) e 11 volontari sani (età 34.7 AE 10.4 anni; F/M: 7/4). La rigidità epatica è stata valutata mediante l'elastografia ARFI ed espressa come "shear wave velocity" (SWV) in m/sec. È stato utilizzato un ecografo Siemens-Acuson S2000 valutando entrambi i lobi epatici. Le * Corresponding author. Ospedale S. Orsola Malpighi, Via Massarenti, 9, St. Orsola Malpighi, Bologna, Italy.E-mail address: fiorini.erica@gmail.com (E. Fiorini). misurazioni sono state eseguite a respiro bloccato, ad una profondità compresa tra 2 e 5 cm. Risultati: La SWV è risultata significativamente più elevata nei casi (Dx: 1.51 AE 0.44; Sn: 1.57 AE 0.40) rispetto ai controlli (Dx: 1.08 AE 0.10; Sn: 1.12 AE 0.13) (Dx: P Z 0.002; Sn: P Z 0.013). Sia nei pazienti con epatopatia cronica (P Z 0.779) che nei controlli (P Z 0.385) non è stata rilevata una differenza statisticamente significativa della SWV fra i due lobi. Il valore ottimale di SWV per discriminare i casi dai controlli è risultato 1.25 m/sec (accuratezza: AUC Z 0.885; sensibilità...

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“…Because many diseases correlate with changes in the mechanical properties of tissues, this technique has been successfully applied in detecting and assessing various pathologies of thyroid gland, breast, lymph nodes, major salivary gland, prostate, kidney, and liver [1][2][3][11][12][13][14][15][16][17]. However, to our knowledge, no study has been reported previously in the medical literature using real time sonoelastography to assess gallbladder polyps.…”

Section: Discussionmentioning

confidence: 99%

“…B-mode and real-time elastographic images were simultaneously presented as a twopanel image, and the elastogram was displayed in a color scale that ranged from red (greatest strain, softest component), to green (average strain, intermediate component), to blue (no strain, hardest component) [10]. Elastography scans were performed according to a standard protocol as follows: after identification of a gallbladder polyp on a gray scale ultrasound image, real-time elastography was performed using the same probe while applying minimal pressure to the probe, since the gallbladder itself receives pressure from the heartbeat [11]; images were obtained only when optimal compression was in the 5-7-bar range [3]; the scanning protocol was completed after confirming that several stable and reproducible images depicted almost the same color map of the polyp; static and moving images were also recorded for later review; elasticity properties were decided in consensus by two radiologists.…”

Section: Equipment and Scanningmentioning

confidence: 99%

The use of real-time elastography in the assessment of gallbladder polyps: preliminary observations

Teber¹,

Tan²,

Dönmez³

et al. 2014

Med Ultrason

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Aims: Gallbladder polyps often have a benign nature. Current guidelines suggest surgical removal of polyps greater than 10 mm. However, the accuracy of the size criteria is limited because neoplasia can be found in gallbladder polyps less than 10 mm. The aim of this study was to evaluate the feasibility of real time elastography for gallbladder polyps and to demonstrate the elasticity properties of the polyps. Material and method: Fifty-three polypoid lesions of the gallbladder were prospectively examined with real-time elastography. Of these patients, 52 had a diagnosis of benign gallbladder polyps and one patient was accepted as a gallbladder carcinoma due to its clinical and radiological findings. B-mode and real-time elastographic images were simultaneously presented as a two-panel image, and the elastogram was displayed in a color scale that ranged from red (greatest strain, softest component), to green (average strain, intermediate component), to blue (no strain, hardest component). Results: The mean size for benign gallbladder polyps was 7.2 ± 3 mm (range, 5-21 mm). All benign gallbladder polyps on consecutive real-time elastographic images appeared as having a high-strain elastographic pattern. Only one patient who was accepted with gallbladder carcinoma had a gallbladder polyp with low elasticity properties. Conclusions: Our study showed that real time elastography of gallbladder polyps is feasible. This novel approach may be useful for the characterization of polypoid lesions of the gallbladder.

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Liver Fibrosis in Patients with Chronic Hepatitis C: Noninvasive Diagnosis by Means of Real-time Tissue Elastography—Establishment of the Method for Measurement

Abstract: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100319/-/DC1.

Cited by 131 publications

References 23 publications

Contribution of real-time elastography in diagnosis of polycystic ovary syndrome

Contribution of real-time elastography in diagnosis of polycystic ovary syndrome

ARFI elastography in patients with chronic autoimmune liver diseases: A preliminary study

The use of real-time elastography in the assessment of gallbladder polyps: preliminary observations

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