Role of acoustic radiation force impulse elastography, aminotransferase to platelet ratio index and fibrotest for the assessment of significant fibrosis and cirrhosis in chronic liver disease

Background: Accurate grading of hepatic fibrosis is important for the application of appropriate intervening strategy. Liver biopsy is the golden standard of fibrotic grading, however wide clinical application is hindered by its inherent drawbacks. Biomechanical-based ultrasonic elastography has received mass attention. However, several clinical studies found that the sole application of ultrasonic elastography may bring evident errors in diagnosing hepatic fibrosis. It is suggested that a combination of ultrasonic elastography and serum liver functions tests holds the potential to overcome those disadvantages. Aims and objectives was to study the diagnostic accuracy of ultrasonography elastography, APRI, fibrotest for significant fibrosis and cirrhosis in patients with chronic liver disease and established the correlation between ARFI elastography, APRI, Fibrotest in grading of liver fibrosisMethods: Sixty three patients with chronic liver disease were studied.  Liver stiffness was evaluated with ARFI elastography. Histologic staging of liver fibrosis served as the reference standard except a very few cirrhotic patients who were graded as cirrhotic on the basis of clinical examination. The required APRI, Fibrotest parameters and relevant clinical history was recorded.  Fibrosis stage was assessed according to the METAVIR classification.Results: ARFI, APRI, and Fibrotest demonstrated a significant correlation with the histological stage. According to ARFI and APRI for evaluating fibrotic stages more than F2, ARFI showed an enhanced diagnostic accuracy than APRI. The combined measurement of ARFI and APRI exhibited better accuracy than ARFI alone when evaluating ≥ F2 fibrotic stage that showed  significant concordance  i.e. 79.3% cases,  out of which 69.8% of total cases were correctly diagnosed on comparison with the gold standard. Fibrotest and ARFI elastography show significant concordance in grading of fibrosis i.e. 82.5%. Cases out of which 68.3% of total cases were correctly diagnosed on comparison with the gold standard.Conclusions: APRI, ARFI, and fibrotest are novel tools among non-invasive modalities to rule out significant fibrosis and cirrhosis in patients with chronic liver disease. ARFI with APRI and ARFI with fibrotest showed enhanced diagnostic accuracy than ARFI or APRI or fibrotest alone for significant liver fibrosis.

Application of acoustic radiation force impulse elastography combined with serum markers in Child-Pugh grading

OBJECTIVES: Acoustic radiation force impulse (ARFI) elastography, the aspartate aminotransferase-to-alanine aminotransferase ratio (AAR), aspartate aminotransferase-to-platelet ratio index (APRI), and the fibrosis-4 (FIB-4) index are widely used to assess liver fibrosis. However, efficacies of these methods in the evaluation of hepatic functional reserve remain unclear. In this study, we investigated the relationship between ARFI elastography combined with either AAR, APRI, or FIB-4 index and Child-Pugh (CP) class for the evaluation of hepatic functional reserve in patients with chronic hepatitis B (CHB)-related cirrhosis. METHODS: The shear wave velocities of 104 patients with clinically confirmed CHB-related cirrhosis were determined using the ARFI; and clinical serum markers (e.g. ALT, AST, PLT) were used to calculate the AAR, APRI, and FIB-4 index. Cirrhosis patients were scored according to their CP class. The ARFI, AAR, APRI, and FIB-4 index were compared with the CP class. The efficacy of each indicator in diagnosis was analyzed using the receiver operating characteristic (ROC) curve and the ARFI combined with either the AAR, APRI, or FIB-4 index, which is used to predict decompensated cirrhosis. RESULTS: No significant differences were observed in gender and age among CP classes A, B, and C patients (p>0.05). The ARFI values and the AAR, APRI, and FIB-4 index of patients with CP classes A, B, and C were significantly different (p<0.05). With an increasing CP class, the ARFI, AAR, APRI, and FIB-4 values increased. The correlation between the ARFI and the CP class was stronger than that between the AAR, APRI, and FIB-4 index and the CP class. The area under the ROC curve for the diagnosis of decompensated cirrhosis using the ARFI was 0.841, which was higher than that for the AAR, APRI, and FIB-4 index. According to the area under the curve results, no significant differences were found when the ARFI was combined with either the AAR, APRI, or FIB-4 index and when the ARFI alone was used. CONCLUSIONS: The ARFI value has a strong correlation with the CP class. Therefore, ARFI elastography complements CP class in the assessment of the hepatic functional reserve in patients with CHB-related cirrhosis.

Clinical utility of TIRADS and ultrasound elastography in characterization of thyroid nodules

Background: Thyroid nodules are a common entity in an iodine deficient population, however malignant nodules are relatively uncommon with excellent prognosis. Ultrasound elastography is a useful tool for characterization of nodules and allows selection of tumors for FNAC. This study aimed to evaluate the diagnostic value of strain elastography and acoustic radiation force impulse (ARFI) imaging in differentiating malignant from benign thyroid nodules.Methods: This study included 100 thyroid nodules evaluated using ultrasound TIRADS classification. Strain elastography evaluated the nodules using the elasticity score and strain ratio followed by VTI and shear wave velocity generated from ARFI data to characterize the nodules. Final diagnoses were obtained from cytological and/or histological evaluation. The diagnostic performance of the two elastography methods was analyzed and compared by multiple receiver operating characteristic curve analysis.Results: Of the 100 thyroid nodules observed in 100 patients (82 females and 18 males), 22% were malignant nodules and 78% were benign. The cut off values for elasticity scores, mean SR, VTI grade and mean SWV for predicting malignant thyroid nodules were greater than or equal to score 2, 2.4, grade 3, 2.5m/s respectively. The area under the receiver operating characteristic curve for elasticity score, mean SR, VTI grade and mean SWV was 0.79, 0.78, 0.89 and 0.84, respectively (P>0.05) and the accuracy was 74, 81.6, 88 and 87.5%, respectively (P>0.05). The accuracy of the combined use of conventional sonography, strain elastography and ARFI imaging was 85.6% respectively, which was higher than that of conventional sonography (P>0.05).Conclusions: Strain elastography and ARFI imaging have high sensitivity and specificity for differentiating malignant from benign thyroid nodules and therefore have good clinical utility in evaluating these lesions.

Multicenter Retrospective Risk Assessment of Esophageal Variceal Bleeding in Patients with Cirrhosis: An Acoustic Radiation Force Impulse Elastography-Based Prediction Model

BACKGROUND/AIMS: Acoustic radiation force impulse (ARFI) elastography predicts the presence of esophageal varices (EVs). We investigated whether an ARFI-based prediction model can assess EV bleeding (EVB) risk in patients with cirrhosis. METHODS: The records of 262 patients with cirrhosis who underwent ARFI elastography and endoscopic surveillance at two institutions in 2008 to 2013 were retrospectively reviewed, and ARFI spleen diameter-to-platelet ratio scores (ASPS) were calculated. RESULTS: The median patient age (165 men, 97 women) was 56 years. The median ARFI velocity, spleen diameter, platelet count, and ASPS were 1.7 m/sec, 10.1 cm, 145×10⁹/L, and 1.16, respectively. During the median 38-month follow-up, 61 patients experienced EVB. Among all patients (179 without EVs and 83 with EVs), the cutoff value that maximized the sum of the sensitivity (73.1%) and specificity (78.4%) (area under receiver operating characteristic curve [AUROC], 0.824) for predicting EVB was 2.60. The cumulative EVB incidence was significantly higher in patients with ASPS ≥2.60 than in those with ASPS <2.60 (p<0.001). Among patients with EVs (n=83), 49 had high-risk EVs (HEVs), and 22 had EVB. The cumulative EVB incidence was significantly higher in HEV patients than in low-risk EV patients (p=0.037). At an ASPS of 4.50 (sensitivity, 66.7%; specificity, 70.6%; AUROC, 0.691), the cumulative EVB incidence was significantly higher in patients with a high ASPS than in those with a low ASPS (p=0.045). A higher ASPS independently predicted EVB (hazard ratio, 4.072; p=0.047). CONCLUSIONS: ASPS can assess EVB risk in patients with cirrhosis. Prophylactic management should be considered for patients with HEVs and ASPS ≥4.50.

Value of contrast - enhanced ultrasonography and acoustic radiation force impulse elastography in identification of boundary range and viability of hepatic alveolar echinococcosis / 中国血吸虫病防治杂志

Objective To investigate the biologic viability and boundary range of hepatic alveolar echinococcosis (HAE) by the contrast-enhanced ultrasonography (CEUS) and acoustic radiation force impulse elastography (ARFI). Methods Totally 27 HAE patients confirmed by pathology underwent CEUS and ARFI examinations. Results Gray scale sonography of HAE showed unclear boundary, inhomogeneous, and middle hyperechoic nodules, and the maximum area was (6.08 ± 4.47) cm2 in 27 lesions. CEUS of HAE showed non-enhancement in three phases and black hole sign. Circumferential enhancement on the pe riphery of the lesion was synchronized with the liver parenchyma and showed “fast in and slow out”. The maximum area was (8.87 ± 4.83) cm2. The area of ECUS was larger than gray scale sonography in HAE (t = 2.20, P = 0.03). The mean shear wave velocities (SWVs) of the interior, the boundary range, and the surrounding liver tissues of HAE were statistically different by ARFI (F = 84.538, P < 0.001), and the interior had the highest values. Conclusions CEUS and ARFI examinations can detect the biologic viability and boundary range of migrating zone around HAE, which is valuable for guiding treatment, judging curative effect, and predicting prognosis.

Diagnostic value of acoustic radiation force impulse imaging combined with contrast-enhanced ultrasound in patients with acute cerebral ischemia / 中国中西医结合急救杂志

Objective To investigate the value of acoustic radiation force impulse imaging (ARFI) combined with contrast-enhanced ultrasound (CEUS) in diagnosis of acute cerebral ischemia (ACI) in patients with carotid artery vulnerable plaque (VP). Methods One hundred and ten patients with carotid artery VP diagnosed by routine ultrasound admitted to Renhe Hospital Affiliated to Three Gorges University from October 2017 to January 2019 were selected as subjects, including 59 patients with ACI (ACI group) and 51 patients with non-ACI (non-ACI group) confirmed by magnetic resonance imaging (MRI). All patients underwent routine ultrasound, CEUS and ARFI examinations, the differences in sizes of VP, shear wave velocity (SWV) and enhancement intensity (EI) were compared, and the diagnostic values of SWV and EI were evaluated by the analyses of receiver operating characteristic curve (ROC). Results Two hundred and ten VPs were found in 110 patients, including 112 grade 1 plaques, 53 grade 2 plaques, and 45 grade 3 plaques, compared with grade 1 plaques, the proportion of mixed echo (MP) and strong echo (SP) in grade 2 plaques, and the proportion of all echo types in grade 3 plaques were all significantly different from that of grade 1 plaques (all P < 0.05); compared with grade 1 plaques, the proportion of grade 2 plaques with thickness ≤ 2.0 mm, and the proportion of grade 3 plaques with thickness ≤ 2.0 mm and more than 3.1 mm were all significantly different from that of grade 1 plaques (all P < 0.05). SWV in ACI group was obviously lower than that in non-ACI group (m/s: 1.91±0.54 vs. 2.41±0.57), and EI in ACI group was significantly higher than that in non-ACI group (dB: 3.62±1.13 vs. 2.81±1.05), the difference being statistically significant (both P < 0.05). The area under the ROC curve (AUC) of SWV was 0.681 and the cutoff value was 2.21 m/s, sensitivity, specificity, positive predictive value and negative predictive value were 83.05%, 80.39%, 83.05%, 80.39%; the AUC of EI was 0.638, and the cutoff value was 3.71 dB, sensitivity, specificity, positive predictive value and negative predictive value were 79.66%, 74.51%, 78.33%, 76.00%. AUC of SWV combined with EI was 0.812, sensitivity, specificity, positive predictive value and negative predictive value were 93.22%, 94.12%, 94.83%, 92.31%, significantly higher than those of SWV or EI alone (all P < 0.05). Conclusion In ACI patients, the SWV of VP decreases and EI of VP increases, the detection efficacy of SWV combined with EI for diagnosis of ACI has relatively high clinical value, as the combined diagnostic efficiency is significantly higher than that of either SWV or EI alone.

Evaluation of acoustic radiation force impulse in diagnosing non-surgical complications after liver transplantation / 中华超声影像学杂志

Objective To evaluate the clinical significance of acoustic radiation force impulse ( ARFI) technique in the assessment of non-surgical complications after liver transplantation . Methods Three hundred and seventy-two patients with abnormal liver function after liver transplantation undergone ARFI exam before liver biopsy ( excluding surgical complications) . The shear wave velocity ( SWV ) between different groups divided according pathological results after biopsy was compared ,and SWV of 23 patients with normal liver function after liver transplantation was compared too . Moreover , 26 normal people were random selected as control group . Results ① Among the 372 patients ,there were 100 cases of rejection ,82 cases of biliary complications ,52 cases of hepatitis virus infection ,49 cases of drug induced liver injury ,56 cases of non-specific manifestation ,9 cases of steatosis ,3 cases of hypoxic-ischemic ,2 cases of inappropriate preserve injury and 19 cases of diagnosis were not clear . ② SWV of control group was ( 1 .49 ± 0 .66) m/s ,of normal liver function group was ( 1 .64 ± 0 .68) m/s ,of abnormal liver function group was ( 2 .08 ± 0 .66) m /s . Abnormal liver function group had higher SWV than normal liver function group and control group ( P < 0 .01) . There was no significant difference between normal liver function group and control group ( P > 0 .05) . ③ In the specific pathology manifestation patients ,hepatitis virus infection group had the highest SWV[ ( 2 .29 ± 0 .72) m /s] ,drug induced liver injury group had the lowest SWV [ ( 1 .94 ± 0 .57) m /s] ,and there were significant differences between two groups ( P < 0 .01) . ④ The ROC results showed that the area under curve of ARFI was 0 .688 for patients with abnormal liver function after liver transplantation , and 0 .655 for differential diagnosis between drug induced liver injury and hepatitis virus infection .Conclusions As a noninvasive technique ,ARFI is correlated with histopathology and has clinical value in the differential diagnosis of non-surgical complications after transplantation .

Diagnostic value of two liver imaging techniques combined with serological models for hepatitis B virus-related liver fibrosis / 中华传染病杂志

Objective@#To compare the diagnostic efficacy of transient elastography (TE) FibroScan and acoustic radiation force impulse imaging (ARFI) combined with serological models including aspartate aminotransferase-to-platelet ratio (APRI) and fibrosis-4 (FIB-4) in hepatitis B virus-related fibrosis.@*Methods@#Sixty-seven patients with chronic HBV infection from October 2014 to May 2017 in Department of Infectious Diseases, Putuo Hospital were enrolled. Both FibroScan and ARFI were conducted in all patients together with serological tests. According to the golden standard of pathology results, the diagnosis values of FibroScan, ARFI combined with APRI or FIB-4 were compared as noninvasive assessment for liver fibrosis. Data with homogeneity of variance were tested by t test, and data with heterogeneity of variance were tested by Mann-Whitney U test.@*Results@#Based on the pathology results, the receiver operating characteristic (ROC) areas under the curve (AUC) of APRI, FIB-4, FibroScan and ARFI in diagnosis of hepatic fibrosis ≥S2 were 0.752, 0.612, 0.885, and 0.850, respectively. The AUC of ROC curve in diagnosis of hepatic fibrosis ≥S3 were 0.746, 0.733, 0.851, and 0.863, respectively. The AUC of ROC curve in diagnosis of hepatic fibrosis ≥S4 were 0.782, 0.705, 0.962 and 0.981, respectively. Combined liver imaging technique and serological tests, such as APRI with FibroScan, APRI with ARFI, FIB-4 with FibroScan or FIB-4 with ARFI, the AUC of ROC curve in the 4 groups in diagnosis of hepatic fibrosis ≥S2 were 0.887, 0.861, 0.893, and 0.853, respectively; in the diagnosis of hepatic fibrosis ≥S3 were 0.873, 0.871, 0.900, and 0.875, respectively; and in diagnosis of hepatic fibrosis ≥S4 were 0.952, 0.981, 0.969, and 0.981, respectively. FibroScan and ARFI were positively correlated with liver inflammation (r=0.467, P=0.000; r=0.371, P=0.002) and jaundice (r=0.424, P=0.000; r=0.0.312, P=0.01), while negatively correlated with platelet (r=-0.331, P=0.006; r=-0.312, P=0.01). The AUC of ROC curve of FibroScan, ARFI and their combination with serological model were significantly increased compared with the single serological model (all P<0.05).@*Conclusions@#Serological models such as APRI and FIB-4 as well as liver imaging techniques such as FibroScan and ARFI are all valuable in assessment of hepatic fibrosis, while FibroScan and ARFI have better diagnostic value. ARFI is convenient to application for its integration with the ordinary ultrasound system. The sensitivity and specificity for diagnosis of hepatic fibrosis could be improved by combining serological model with FibroScan or ARFI. Combination of APRI and ARFI show the highest accuracy in diagnosis of hepatic fibrosis. Combination of serological models and transient elastic liver imaging is recommended for assessment and follow-up of HBV-related fibrosis.

Shear wave elastography and acoustic radiation force impulse imaging in differential diagnosis of benign and malignant thyroid nodules / 中国介入影像与治疗学

Objective To compare the diagnostic value of shear wave elastography (SWE) and acoustic radiation force impulse imaging (ARFI) in benign and malignant thyroid nodules (TNs).Methods A total of 43 patients with 51 thyroid nodules were included.According to the diameter,all nodules were divided into small nodules (diameter ≤1 cm) and large nodules (1 cm＜diameter≤3 cm).All patients underwent both SWE and ARFI examinations at the same time.SWE (Emax,Emean,Emin),virtual touch tissue quantification (VTQ) and virtual touch tissue imaging (VTI) area ratio were obtained.The optimal cut-off values of SWE,VTQ,VTI area ratio were calculated with ROC curve to identify malignant thyroid nodules from benign ones,and the sensitivity,specificity,accuracy of Emax,VTQ and VTI area ratio were calculated respectively.Results The cut-off value of Emax,VTQ,VTI area ratio in differential diagnosis of benign and malignant TNs was 37.74 kPa,2.19 m/s and 1.24,respectively.The sensitivity was 85.30％ (29/34),76.50％ (26/ 34),64.71％ (22/34),the specificity was 100％ (17/17),94.10％ (16/17),88.20％ (15/17),the accuracy was 90.20％ (46/51),90.20％ (46/51),72.55％ (37/51) of E VTQ and VTI area ratio in diagnosis of malignant thyroid nodules,respectively.The sensitivity of Emax and VTQ in the diagnosis of malignant large NTs was 92.31％ (12/13) and 100％ (13/13),respectively,while the sensitivity of VTI area ratio and Emax in the diagnosis of malignant small NTs were both 80.95％ (17/21).Conclusion Either SWE or ARFI has good diagnostic performance in distinguishing malignant thyroid nodules from benign ones.Emax is of equal value in diagnosing thyroid benign and malignant nodules.VTQ has advantage for diagnosing large NTs,while VTI area ratio shows better diagnostic performance for small NTs.

Comparison of acoustic radiation force impulse and supersonic shear imaging in diagnosis of liver fibrosis in patients with chronic hepatitis B / 中国医师进修杂志

Objective To compare acoustic radiation force impulse(ARFI)and supersonic shear imaging (SWE) in diagnosis of liver fibrosis in patients with chronic hepatitis B. Methods Eighty patients with chronic hepatitis B having underwent ARFI and SWE examination were enrolled in this study.The elastic modulus E value(EI)was measured by SWE.The liver shear wave velocity(VTQ)was measured by ARFI.All patients underwent liver biopsy.The diagnostic values of SWE and ARFI for liver fibrosis were analyzed with Sperman correlation and the ROC curve.Results The values of EI and VTQ were increased with the pathological stage determined by liver biopsy and there were significantly differences(P<0.01).The correlation coefficient of SWE and ARFI was 0.651,P<0.01.The correlation coefficient of SWE, ARFI and pathological stage determined by liver biopsy were 0.784 and 0.683 and there were significant differences(P<0.01).The areas under ROC for diagnosing liver fibrosis≥S2,≥S3 and =S4 by using SWE were 0.912, 0.934 and 0.955 respectively and those by using ARFI were 0.870, 0.892 and 0.884. The sensitivity of ARFI in diagnosing liver fibrosis was similar with SWE, but SWE showed higher specificity (Z=8.756,P < 0.01; Z=10.802,P < 0.01; Z=15.871,P < 0.01). Conclusions Both SWE and ARFI can be effectively used in the evaluation of liver fibrosis in patients with chronic hepatitis B.The SWE technology has more advantages.

Elastography In Head And Neck Region - A Review

Sonographic elastography is a new technique for measurement of the tissue stiffness, and is currently under investigation for tissue characterization in several anatomic sites. In recent years, real-time Ultrasonography elastography (USE) modes have appeared on commercially available clinical ultrasound machines, stimulating an explosion of research into potential oncologic and non-oncologic clinical applications of USE. Preliminary evidence suggests that USE can differentiate benign and malignant conditions accurately in several different tissues. The principles underlying elastography are that tissue compression produces strain (displacement) within the tissue – which is lower in harder tissues than in softer tissues and that malignant tissues are generally harder than normal surrounding tissue. Therefore, elastography might yield clinical information useful in diagnosing cervical metastasis and improving prognosis in oral cancer .The purpose of this review is to highlight a promising new ultrasound technique, known as elastography, which measures the characteristics of tissue compliance.

Clinical value of acoustic radiation force impulse imaging in assessing the therapeutic effect of acupuncture on trapezius myofascial pain syndrome / 医学研究生学报

Objective Myofascial pain syndrome (MPS) is a common muscle function disturbance.This study was to investigate the clinical value of acoustic radiation force impulse (ARFI) imaging in assessing the therapeutic effect of acupuncture for patients with trapezius MPS.Methods A total of 116 patients diagnosed with trapezius MPS received acupuncture therapy once a day for 10 days in Pudong Hospital from August 2015 to June 2016.Using ARFI imaging, we recorded the shear wave velocity (SWV) of the trapezius and obtained the short-form McGill Pain Questionnaire (SF-MPQ) scores of the patients before, at the end of, and at 7, 15 and 30 days after treatment.Then, we analyzed the interaction and correlation between the SWV values and SF-MPQ scores of the patients at different time points.Results Both the SF-MPQ scores and SWV values were first decreased, falling to lowest values (5.19 points and 1.43 m/s) at 7 days after treatment, and then increased again.The interaction between the SF-MPQ scores and SWV values were significantly different at different time points (Finteraction=2.553, Pinteraction=0.038), and there was a strong linear correlation between the two indexes (r=0.755, P=0.000).Conclusion ARFI imaging combined with SF-MPQ has a certain clinical value in assessing the effect of acupuncture on trapezius MPS.

Acoustic radiation force impulse imaging in differential diagnosis of small solid thyroid nodules coexisting with Hashimoto's thyroiditis / 中国介入影像与治疗学

Objective To investigate the application value of acoustic radiation force impulse imaging (ARFI) in differential diagnosis of small solid thyroid nodules coexisting with Hashimoto's thyroiditis (HT).Methods A total of 136 patients with 155 small solid nodules (≤1 cm in diameter) confirmed by pathology were included.The small solid nodules were divided into HT group and normal group.All patients underwent virtual tissue imaging (VTI) and virtual touch tissue quantification (VTQ).The stiffness of small solid thyroid nodules in two groups was respectively scored based on VTI images,and the area ratios of nodules in VTI images to gray scale images were calculated.Taking pathological diagnosis as the gold standard,the ROC curve were performed to explore the optimal points and efficacy of area ratio and shear wave velocity (SWV) in the diagnosis of malignant nodules in two groups respectively.Results Regarding VTI score≥4 as the diagnostic standard of malignant nodules,the sensitivity of HT group and normal group in diagnosis of malignant nodules had significant difference (64.29％[27/42] vs 81.69％[58/71],P＜0.05).In two groups,the area ratio and SWV of malignant nodules were significantly higher than those of benign nodules (all P＜0.05).The area ratio and SWV of thyroid benign nodules and malignant nodules had no significantly difference between two groups (all P＞0.05).Taking 1.41 as the cutoff point of area ratio,the sensitivity and specificity in diagnosis of malignant nodules in HT group were 85.7％ and 88.9％.Taking 2.87 m/s as the cutoff point of SWV,sensitivity and specificity in diagnosis of malignant nodules in HT group were 85.7％ and 94.4％.Taking 1.40 as the cutoff point of area ratio,the sensitivity and specificity in diagnosis of malignant nodules in normal group were 91.5％ and 95.8％.Taking 2.67 m/s as the cutoff point of SWV,the sensitivity and specificity in diagnosis of malignant nodules in normal group were 88.7％ and 95.8％.Conclusion ARFI technology can evalu-ate the hardness of the small solid thyroid nodules through the intuitive VTI images and objective SWV values in HT,which is helpful in diagnosis of malignant nodules in HT backgroud.

Association of VTQ value of spleen with staging of liver fibrosis in hepatitis B / 实用医学杂志

Objective To investigate the feasibility of VTQ value of spleen in noninvasive assessment of staging of liver fibrosis in patients with hepatitis B.Methods VTQ values of spleen were measured in 56 patients with hepatitis B by using ARFI technique and liver biopsy was performed.The patients were then grouped according to the stages of liver fibrosis stage.The results were analyzed by the intergroup comparison,Pearson Correlation analysis,and receiver operating characteristic curve (ROC curve).Results There was positive association of the VTQ value with the stages of liver fibrosis,whose correlation coefficient was 0.83 (P ＜ 0.05);There was no significant difference between the spleen VTQ value and the liver fibrosis S1 and SO (P ＞ 0.05),whereas there were significant differences among other groups (P ＜ 0.05).The area under the ROC curve was 0.95,the cut-off value was 2.79m/s,and the specificity and sensitivity were 81.8％ and 91.7％ respectively.Conclusions The VTQ value measured by ARFI technique has a better value in noninvasive diagnosis of stages of hepatitis B liver fibrosis.

Correlation analysis between liver and spleen stiffness measured by acoustic radiation force impulse and hepatic venous pressure gradient / 中华消化杂志

Objective To investigate the correlation between liver and spleen stiffness measured by acoustic radiation force impulse (ARFI) and hepatic venous pressure gradient (HVPG),and to evaluate its efficiency in the diagnosis of portal hypertension.Methods From April 2014 to March 2016,20 cases underwent HVPG measurement because of liver cirrhosis were enrolled.Before HVPG measurement,liver and spleen stiffness were assessed with ARFI.The correlation between HVPG and age,alanine aminotransferase (ALT),aspartate aminotransferase (AST),total hilirubin,serum albumin,platelet count,prothrombin time,aspartate aminotransferase to platelet ratio index (APRI) score,Child-Pugh score,model for end-stage liver disease (MELD) score,liver stiffness and spleen stiffness were analyzed.Pearson correlation and Spearman rank correlation were performed for statistical analysis.Results HVPG,liver and spleen stiffness were successfully measured in all 20 patients.The mean liver stiffness was (1.78±0.29) m/s,the mean spleen stiffness was (3.37±0.44) m/s and HVPG was (16.10±5.14) mmHg (1 mmHg=0.133 kPa).Age,ALT,AST,total bilirubin,serum albumin,platelet count,prothrombin time,APRI score,Child-Pugh score and MELD score were all not correlated with HVPG (all P＞0.05).But HVPG was positively correlated with liver and spleen stiffness (r=0.449,P=0.047;r=0.487,P=0.030).In the diagnosis of HVPG≥12 mmHg,the area under curve (AUC) of liver stiffness was 0.875,the optimal cut-off value was 1.77 m/s,the sensitivity was 68.6 ％ and the specificity was 100.0％.In the diagnosis of HPVG≥20 mmHg,the AUC of liver stiffness was 0.798,the optimal cut off value was 1.85 m/s,the sensitivity was 100.0％ and the specificity was 68.8％.The AUC of spleen stiffness was 0.820,the optimal cut-off value was 3.23 m/s,the sensitivity was 100.0 ％ and the specificity was 56.3％.Conclusion In patients with liver cirrhosis,liver stiffness and spleen stiffness assessed by ARFI are positively correlated with HVPG and therefore ARFI has certain application value in the noninvasive diagnosis of portal hypertension.

Acoustic radiation force impulse imaging in preoperative assessment of liver cirrhosis in infants with biliary atresia / 中国医学影像技术

Objective To investigate the diagnostic performance of acoustic radiation force impulse (ARFI) imaging in assessing liver cirrhosis preoperatively in infants with biliary atresia (BA).Methods A total of 64 consecutive infants with BA who underwent ARFI imaging in 3 days before Kasai surgery were recruited.Virtual Touch Quantification mode was used to measure shear wave speed (SWS),All infants with BA underwent liver biopsy during the surgery.The mean SWS of infants with and without liver cirrhosis were compared and analyzed.The diagnostic efficacy of SWS was observed using ROC curves.Results Liver cirrhosis was found in 8 of 64 infants.The mean SWS in infants with cirrhosis was significant-ly higher than that in infants without cirrhosis ([2.51±0.50]m/s vs [1.74±0.31]m/s,t=6.039,P＜0.001).The cutoff value of SWS for predicting liver cirrhosis was 2.16 m/s,the area under ROC curve was 0.930 (P＜0.001),and the diagnostc sensitivity and specificity was 87.50％ and 92.86％,respectively.Conclusion ARFI imaging is helpful to predic tion of liver cirrhosis in infants with BA preoperatively.It may be an effective method for clinical management and prognosis prediction in infants with BA.

Differential diagnostic value of acoustic radiation force impulse imaging and contrast-enhanced ultrasound in benign and malignant thyroid nodules / 重庆医学

Objective To evaluate the differentiating diagnostic value of single use and combined use of contrast-enhanced ultrasound(CEUS)and acoustic radiation force impulse imaging(ARFI) in TI-RADS class 3 and 4 thyroid nodules.Methods A total of 68 inpatients with thyroid nodules treated by operation in the First Affiliated Hospital of Henan University of Science and Technology (according with TI-RADS class 3 and 4 thyroid nodules suggested by Ji-Young Park in 99 cases) were collected and their imaging data were retrospectively analyzed.All cases simultaneously conducted ARFI and CEUS examinations before operation.The pathogenic results served as the golden standard.The differentiating diagnostic values of single use and combined use of CEUS and ARFI in TI-RADS class 3 and 4 thyroid nodules were comparatively analyzed by using the statistical method.Results Both ARFI and CEUS had high differential diagnosis value in TI-RADS class 3 and 4 thyroid nodules,however,the single use of ARFI and CEUS no statistically significant difference in diagnosis value (P＞0.05),the combination use of ARFI and CEUS significantly improved the sensitivity and accuracy of diagnosis.Conclusion The combination of CEUS and ARFI can be applied to differentiate TI-RADS class 3 and 4 thyroid nodules.

Acoustic radiation force impulse imaging in preoperative assessment of liver cirrhosis in infants with biliary atresia / 中国医学影像技术

Objective To investigate the diagnostic performance of acoustic radiation force impulse (ARFI) imaging in assessing liver cirrhosis preoperatively in infants with biliary atresia (BA).Methods A total of 64 consecutive infants with BA who underwent ARFI imaging in 3 days before Kasai surgery were recruited.Virtual Touch Quantification mode was used to measure shear wave speed (SWS),All infants with BA underwent liver biopsy during the surgery.The mean SWS of infants with and without liver cirrhosis were compared and analyzed.The diagnostic efficacy of SWS was observed using ROC curves.Results Liver cirrhosis was found in 8 of 64 infants.The mean SWS in infants with cirrhosis was significant-ly higher than that in infants without cirrhosis ([2.51±0.50]m/s vs [1.74±0.31]m/s,t=6.039,P＜0.001).The cutoff value of SWS for predicting liver cirrhosis was 2.16 m/s,the area under ROC curve was 0.930 (P＜0.001),and the diagnostc sensitivity and specificity was 87.50％ and 92.86％,respectively.Conclusion ARFI imaging is helpful to predic tion of liver cirrhosis in infants with BA preoperatively.It may be an effective method for clinical management and prognosis prediction in infants with BA.

Differential diagnostic value of acoustic radiation force impulse imaging and contrast-enhanced ultrasound in benign and malignant thyroid nodules / 重庆医学

Objective To evaluate the differentiating diagnostic value of single use and combined use of contrast-enhanced ultrasound(CEUS)and acoustic radiation force impulse imaging(ARFI) in TI-RADS class 3 and 4 thyroid nodules.Methods A total of 68 inpatients with thyroid nodules treated by operation in the First Affiliated Hospital of Henan University of Science and Technology (according with TI-RADS class 3 and 4 thyroid nodules suggested by Ji-Young Park in 99 cases) were collected and their imaging data were retrospectively analyzed.All cases simultaneously conducted ARFI and CEUS examinations before operation.The pathogenic results served as the golden standard.The differentiating diagnostic values of single use and combined use of CEUS and ARFI in TI-RADS class 3 and 4 thyroid nodules were comparatively analyzed by using the statistical method.Results Both ARFI and CEUS had high differential diagnosis value in TI-RADS class 3 and 4 thyroid nodules,however,the single use of ARFI and CEUS no statistically significant difference in diagnosis value (P＞0.05),the combination use of ARFI and CEUS significantly improved the sensitivity and accuracy of diagnosis.Conclusion The combination of CEUS and ARFI can be applied to differentiate TI-RADS class 3 and 4 thyroid nodules.

Evaluation of application value of acoustic radiation force impulse imaging of transplant liver in early recovery after transplantation / 器官移植

Objective To evaluate the application value of acoustic radiation force impulse imaging (ARFI) in the early recovery of transplant liver.Methods Nineteen patients undergoing orthotopic liver transplantation were assigned into the study group and 12 healthy adults were recruited in the control group.In the study group,patients received bedside conventional ultrasound and ARFI examination at 1,2,3,5 and 7 d after liver transplantation to observe the change of transplant liver elasticity,and those in the control group underwent once conventional ultrasound and ARFI examination.Two-dimensional liver ultrasound,color Doppler ultrasound and ARFI findings were statistically compared between the study and control groups.Results Conventional ultrasound demonstrated that the liver graft was properly recovered within 1 week after liver transplantation.ARFI revealed that the shear ware velocity (SWV) at 1,2,3,5 and 7 d after liver transplantation was significantly higher than that in the control group (all P＜0.05).The SWV at postoperative 1 d was significantly higher than that at postoperative 7 d (P＜0.05).Conclusions ARFI can distinguish the liver stiffness between patients early after liver transplantation and healthy controls,and reflect the early variation of liver stiffness with good clinical application value.