ARFI and FibroScan in Fibrosis Liver Evaluation on 554 cases

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ARFI and FibroScan in Fibrosis Liver Evaluation on 554 cases

  1. 1. Noninvasive Liver Fibrosis Evaluation by Acuson S2000 and FibroScan on 554 cases: Comparison ARFI to Transient Elastography LIEM THANH LE, LINH HONG BUI, NHAT THONG LE, HAI THANH PHAN DEPARTMENT OF ULTRASONOGRAPHY MEDIC MEDICAL CENTER, HCMC, VIETNAM
  2. 2. INTRODUCTION <ul><li>In Viet Nam, the incidence of hepatitis B and C is more than 20% of the population (about 18 million people). </li></ul><ul><li>Liver biopsy is still gold standard for assessment of liver fibrosis staging. However, this is an invasive procedure. </li></ul><ul><li>Since 2003, transient elastography [TE] - FibroScan) is an alternative procedure for chronic liver diseases. However, TE, a sonoelastography technique, using ultrasound A mode. </li></ul><ul><li>Recently, ARFI technique emerged as a new elastographic quantification of non-invasive of liver fibrosis, and integrated in conventional ultrasound. ARFI not yet widely used in clinical practice. </li></ul><ul><li>We have conducted a study comparing the correlation between ARFI and TE technique in order to find out whether ARFI could replace TE or not. </li></ul>
  3. 3. MATERIALS AND METHODS <ul><li>It is a descriptive cross sectional stud y </li></ul><ul><li>554 patients (353 men and 201 women, age from 17 to 85 yo (mean = 44+/-13.28), BMI=14.8 to 32.4 (mean= 22.19+/-2.85), 366 patients with chronic HBV or HCV </li></ul><ul><li>FibroScan failed in measurement (one patient was overweight (BMI=29.13, VS=3.47m/s) and one patient was cirrhosis with ascites, (BMI=21.11, VS=1.83m/s)) </li></ul><ul><li>2 sonologists measured ARFI (3 times) and TE techniques (6 or 10 times), in the same site and the same day. </li></ul><ul><li>ARFI values are compared to TE values by MedCalc statistical software, and serologic markers tests are the standard reference. </li></ul>G:ARFI&FS-Acuson 2000-SiemensHÌNH CHUẨNhinhFS.bmp G:ARFI&FS-Acuson 2000-SiemensHÌNH CHUẨNhinhuntitled.bmp G:ARFI&FS-Acuson 2000-SiemensHÌNH CHUẨNH1.jpg
  4. 4. RESULTS <ul><li>Fig 4: Correlation between ARFI and TE, r=0.8319, p<0.0001 </li></ul><ul><li>ARFI and TE techniques are close correlation with statistical significance of fibrosis staging (correlative coefficient r = 0.83 with P <0.0001) </li></ul><ul><li>ARFI range from 0.79 to 3.53 m/sec. </li></ul><ul><li>TE range from 2.2 to 75kPa. </li></ul><ul><li>Fig 5: Scatter Diagram with regression line </li></ul>2 Tuongquanduong
  5. 5. The regressive equation  y = 0.9458 + 0.04266 x (where x = FS_kPa and y = VS_m/s) <ul><li>Mean value of the stage V0  V4 (Mean+/-Standard deviation): </li></ul><ul><li>V0=1.037+/- 0.084 m/s (247cases) </li></ul><ul><li>V1=1.203+/-0.025 m/s (96cases) </li></ul><ul><li>V2=1.276+/- 0.022 m/s (53cases) </li></ul><ul><li>V3=1.417+/-0.067 m/s (68cases) </li></ul><ul><li>V4=2.093+/-0.480 m/s (90cases) </li></ul>1
  6. 6. - Statistical differences between V0-V1, V1-V2, V2-V3, V3-V4 (t range from 12.34 to 33.9, p <0.0001). - Close clinical agreement between FibroScan F4 and ARFI V4 for cirrhosis, kappa=0.8 <ul><li>Fig 8: Independent samples t-test: V0-V1 </li></ul>BDV0-V1.emf <ul><li>Fig 10: Inter-rater agreement (kappa), between F4 and V4 </li></ul>BD.emf
  7. 8. ROC CURVE <ul><li>Cut -off Value=1.25m/ s,Sensibility = 83.7%, Specificity =87.3%, </li></ul><ul><li>AUROC=0.918, p<0.0001 </li></ul>ROC F0,1-F2,3,4.jpg
  8. 9. DISCUSSION <ul><li>ARFI measurements have a close correlation with TE ( r = 0.083, p>0.0001). In addition, there are a good clinical agreement between ARFI and TE in cirrhosis F4 stage and V4 stage (kappa = 0.8). Thus the accuracy of diagnosing of cirrhosis of ARFI and TE is similar. </li></ul><ul><li>the value of correlative coefficient r in the present study (r=0.8319, 554 cases) is higher than another study, r=0.532 – 71cases of Ioan Sporea (Romania, 2010). </li></ul><ul><li>From the builded regressive equation, we propose a reference for staging of liver fibrosis (Fig 6) in using of ARFI technique, for applying in clinical practice. </li></ul><ul><li>From which we determine the mean value of each stage, and the value t test showed significant statistical differences between stages ( t = 1.34-33.9, p < 0.0001) </li></ul>
  9. 10. DISCUSSION <ul><li>The integration of ARFI technique in conventional ultrasound system (B mode and Doppler) is an advantage of workflow for assessment liver fibrosis and other diseases in an ultrasound examination. </li></ul><ul><li>In this study TE did not measure for 2 cases, but all can be measured with ARFI </li></ul><ul><li>The weak point of this research is lack of microscopic data of liver biopsy for analysis. </li></ul><ul><li>We think ARFI technique is a potential assessment for liver fibrosis evaluation and strain imaging in clinical practice. </li></ul>
  10. 11. CONCLUSION <ul><li>FibroScan </li></ul><ul><li>ARFI of liver fibrosis assessment in chronic viral hepatitis has accurate diagnosis which is close correlation with TE </li></ul><ul><li>ARFI techniques of ACUSON S2000 may substitute for TE of FibroScan. </li></ul><ul><li>Acuson S2000 </li></ul>G:Untitled.png G:20090905-Fibro_800.jpg
  11. 12. References <ul><li>Roee Lazebnik S., MD Ph.D., Tissue Strain Analytics - Virtual Touch Tissue Imaging and Quantification, Siemens ACUSON S2000 Utrasound System, Siemens Medical Solutions, USA, Inc, Mountain View, CA USA, 2008. </li></ul><ul><li>Florentina Guzmán-Aroca, MD, Manuel Reus, MD, Juan D. Berná-Serna, MD, Laura Serrano, MD, Cristina Serrano, MD, Amparo Gilabert, MD and Angela Cepero, MD: Reproducibility of Shear Wave Velocity Measurements by Acoustic Radiation Force Impulse Imaging of the Liver: A Study in Healthy Volunteers, Department of Radiology, Virgen de la Arrixaca University Hospital, El Palmar, Spain, JUM July 1, 2011 vol. 30 no. 7, pp: 975-979. </li></ul><ul><li>Ioan Sporea, Roxana Şirli, Alina Popescu, Mirela Danilă, Department of Gastroenterology and Hepatology, „Victor Babeş” University of Medicine and Pharmacy Timişoara, Romania , Acoustic Radiation Force Impulse (ARFI) – a new modality for the evaluation of liver fbrosis , Medical Ultrasonography, 2010 , Vol. 12, No 1, 26-31. </li></ul><ul><li>Simona Bota, Ioan Sporea, Roxana Şirli, Alina Popescu, Mirela Dănilă, Mădălina Şendroiu: Factors that influence the correlation of Acoustic Radiation Force Impulse (ARFI) elastography with liver fibrosis , Med Ultrson,Feb. 2011, Vol.13, No 2, 135-140. </li></ul><ul><li>Monica Lupsor, Radu Badea, Horia Stefanescu, Zeno Sparchez, Horaţiu Branda, Alexandru Serban, Anca Maniu: Performance of a New Elastographic Method (ARFI technology) Compared to Unidimensional Transient Elastography in the Noninvasive Assessment of Chronic Hepatitis C . Preliminary Results , J Gastrointestin Liver Dis, Sep.2009, Vol 18, No 3, 303-310. </li></ul>
  12. 13. References <ul><li>Carmen Fierbinteanu-Braticevici, Dan Andronescu, Radu Usvat, Dragos Cretoiu, Cristian Baicus, and Gabriela Marinoschi , Acoustic radiation force imaging sonoelastography for noninvasive staging of liver fibrosis , Medical Clinic II and Gastroenterology, University Hospital, 050094 Bucharest, Romania. World J Gastroenterol. 2009 November 28; 15(44): 5525–5532. </li></ul><ul><li>Ioan Sporea, Roxana Şirli, Simona Bota, Carmen Fierbinţeanu-Braticevici, Ana Petrişor, Radu Badea, Monica Lupşor, Alina Popescu, Mirela Dănilă, Is ARFI elastography reliable for predicting fibrosis severity in chronic HCV hepatitis? World J Radiol 2011 July 28; 3(7): 188-193. </li></ul><ul><li>Mireen Friedrich-Rust,MD, KatrinWunder,MD, Susanne Kriener,MD, Liver Fibrosis in Viral Hepatitis: Noninvasive Assessment with Acoustic Radiation Force Impulse Imaging versus Transient Elastography , Radiology: Volume 252: Number 2,August 2009, radiology.rsnajnls.org. </li></ul><ul><li>Carmen Fierbinteanu-Braticevici, Dan Andronescu, Radu Usvat, Dragos Cretoiu, Cristian Baicus, and Gabriela Marinoschi, Acoustic radiation force imaging sonoelastography for noninvasive staging of liver fibrosis , World J Gastroenterol. 2009 November 28; 15(44): 5525–5532. </li></ul>
  13. 14. Thank you for your attention!

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