Skip to main content
Log in

New method for assessing liver fibrosis based on acoustic radiation force impulse: a special reference to the difference between right and left liver

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

Virtual touch tissue quantification (VTTQ) based on acoustic radiation force impulse (ARFI) imaging has been developed as a noninvasive bedside method for the assessment of liver stiffness. In this study, we examined the diagnostic performance of ARFI imaging in 103 patients, focusing on the difference in VTTQ values between the right and left liver lobes.

Methods

We evaluated VTTQ values of the right and left lobes in 79 patients with chronic liver disease who underwent histological examination of liver fibrosis and in 24 healthy volunteers. The diagnostic accuracy of VTTQ was compared with several serum markers, including hyaluronic acid, type 4 collagen, and aspartate transaminase to platelet ratio index.

Results

The VTTQ values (meters per second) in the right and left lobes were 1.61 ± 0.51 and 1.90 ± 0.68, respectively, and the difference was statistically significant (P < 0.0001). The VTTQ values in both liver lobes were correlated significantly with histological fibrosis grades (P < 0.001). The standard deviations of the VTTQ values in the right lobe were significantly lower than those in the left lobe (P < 0.001). The area under the receiver-operating characteristic curve for the diagnosis of fibrosis (F ≥ 3) using VTTQ values in both liver lobes was superior to serum markers, especially in the right lobe.

Conclusions

VTTQ is an accurate and reliable tool for the assessment of liver fibrosis. VTTQ of the right lobe was more accurate for diagnosing liver fibrosis than in the left lobe.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

VTTQ:

Virtual Touch™ tissue quantification

ARFI:

Acoustic radiation force impulse

ROC:

Receiver operating characteristic

ALT:

Alanine aminotransferase

LDLT:

Living donor liver transplantation

APRI:

Aspartate transaminase-to-platelet ratio index

HCVAb:

Hepatitis C virus antibody

HBsAg:

Hepatitis B virus surface antigen

m/s:

Meters per second

AST:

Aspartate aminotransferase

PPV:

Positive predictive value

NPV:

Negative predictive value

HBV:

Hepatitis B virus

HCV:

Hepatitis C virus

References

  1. Mazzagferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334:693–9.

    Article  Google Scholar 

  2. National Institutes of Health. NIH consensus statement on management of hepatitis C. Hepatology. 2002;36:S3–20.

    Google Scholar 

  3. Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med. 2001;344:495–500.

    Article  PubMed  CAS  Google Scholar 

  4. Maharaj B, Maharaj RJ, Leary WP, Cooppan RM, Naran AD, Pirie D, et al. Sampling variability and its influence on the diagnostic yield of percutaneous needle biopsy of the liver. Lancet. 1986;1:523–5.

    Article  PubMed  CAS  Google Scholar 

  5. Regev A, Berho M, Jeffers LJ, Milikowski C, Molina EG, Pyrsopoulos NT, et al. Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol. 2002;97:2614–8.

    Article  PubMed  Google Scholar 

  6. Bedossa P, Dargere D, Paradise V. Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology. 2003;38:1449–57.

    PubMed  Google Scholar 

  7. Imbert-Bismut F, Ratziu V, Pieroni L, Charlotte F, Benhamou Y, Poynard T, et al. Biochemical markers of liver fibrosis in patients with hepatitis C virus infection: a prospective study. Lancet. 2001;357:1069–75.

    Article  PubMed  CAS  Google Scholar 

  8. Forns X, Ampurdanes S, Llovet JM, Aponte J, Quinto L, Martinez-Bauer E, et al. Identification of chronic hepatitis C patients without hepatic fibrosis by a simple predictive model. Hepatology. 2002;36:986–92.

    PubMed  Google Scholar 

  9. Guechot J, Laudat A, Loria A, Serfaty L, Poupon R, Giboudeau J. Diagnostic accuracy of hyaluronans and type III procollagen aminoterminal peptide serum assays as markers of liver fibrosis in chronic viral hepatitis C evaluated by ROC curve analysis. Clin Chem. 1996;42:558–63.

    PubMed  CAS  Google Scholar 

  10. Nightingale KR, Zhai L, Dahl JJ, Frinkley KD, Palmeri ML. Shear wave velocity estimation using acoustic radiation force impulsive excitation in liver in vivo. In: Proceedings of institute of electrical and electronics engineers (IEEE) ultrasonics symposium, 2006. Vancouver: IEEE; 2006. p. 1156–60.

  11. Friedrich-Rust M, Wunder K, Kriener S, Sotoudeh F, Richter S, Bojunga J, et al. Liver fibrosis in viral hepatitis: noninvasive assessment with acoustic radiation force impulse imaging versus transient elastography. Radiology. 2009;252:595–604.

    Article  PubMed  Google Scholar 

  12. Takahashi H, Ono N, Eguchi Y, Eguchi T, Kitajima Y, Kawaguchi Y, et al. Evaluation of acoustic radiation force impulse elastography for fibrosis staging of chronic liver disease: a pilot study. Liver Int. 2010;30:538–45.

    Article  PubMed  Google Scholar 

  13. Palmeri ML, Frinkley KD, Zhai L, Gottfried M, Bentley RC, Ludwig K, et al. Acoustic radiation force impulse (ARFI) imaging of the gastrointestinal tract. IEEE. 2004;1:23–7.

    Google Scholar 

  14. Dahl JJ, Pinton GF, Palmeri ML, Agrawal V, Nightingale KR, Trahey GE. A parallel tracking method for acoustic radiation force impulse imaging. IEEE Trans Ultrason Ferroelectr Freq Control. 2007;54:301–12.

    Article  PubMed  Google Scholar 

  15. Garra BS. Imaging and estimation of tissue elasticity by ultrasound. Ultrasound Q. 2007;23:255–68.

    Article  PubMed  Google Scholar 

  16. Castera L, Vergniol J, Foucher J, Le Bail B, Chanteloup E, et al. Prospective comparison of transient elastography, fibrotest, APRI and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterology. 2005;128:343.

    Article  PubMed  Google Scholar 

  17. Harada N, Soejima Y, Taketomi A, Yoshizumi T, Ikegami T, Yamashita Y, et al. Assessment of graft fibrosis by transient elastography in patients with recurrent hepatitis C after living donor liver transplantation. Transplantation. 2008;85:69–74.

    Article  PubMed  Google Scholar 

  18. Ziol M, Handra-Luca A, Kettaneh A, Christidis C, Mal F, Kazemi F, de Ledinghen V, et al. Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C. Hepatology. 2005;41:48.

    Article  PubMed  Google Scholar 

  19. Foucher J, Chanteloup E, Vergniol J, Castera L, Le Bail B, Adhoute X, et al. Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study. Gut. 2006;55:403–8.

    Article  PubMed  CAS  Google Scholar 

  20. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the area under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44:837–45.

    Article  PubMed  CAS  Google Scholar 

  21. Yoshida H, Shiratori Y, Moriyama M, Arakawa Y, Ide T, Sata M, et al. Interferon therapy reduces the risk for hepatocellular carcinoma: national surveillance program of cirrhotic and noncirrhotic patients with chronic hepatitis C in Japan. Ann Intern Med. 1999;131:174–81.

    PubMed  CAS  Google Scholar 

  22. Ikeda K, Saitoh S, Suzuki Y, Kobayashi M, Tsubota A, Koida I, et al. Disease progression and hepatocellular carcinogenesis in patients with chronic viral hepatitis: a prospective observation of 2215 patients. J Hepatol. 1998;28:930–8.

    Article  PubMed  CAS  Google Scholar 

  23. Ingiliz P, Chhay KP, Munteanu M, Lebray P, Ngo Y, Roulot D, et al. Applicability and variability of liver stiffness measurements according to probe position. World J Gastroenterol. 2009;15:3398–404.

    Article  PubMed  Google Scholar 

  24. Sandrin L, Fourquet B, Hasquenoph JM, Yon S, Fournier C, Mal F, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol. 2003;29:1705–13.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors wish to thank Siemens Medical Solutions USA, Inc., for the use of the Acuson S2000 device, Mochida Siemens Medical Systems Co., Ltd., in Japan for assisting in the setup of the device, and Ms. Natsumi Yamashita for her valuable advice with the statistical analysis. We have no financial interests linked to this work.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Takeo Toshima.

Rights and permissions

Reprints and permissions

About this article

Cite this article

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 46, 705–711 (2011). https://doi.org/10.1007/s00535-010-0365-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00535-010-0365-7

Keywords

Navigation