Accuracy of VirtualTouch Acoustic Radiation Force Impulse (ARFI) Imaging for the Diagnosis of Cirrhosis during Liver Ultrasonography

 

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Zusammenfassung

Ziel: VirtualTouch ist eine neue Ultraschalltechnik, mit der die Lebersteifigkeit im Rahmen der B-Mode-Sonografie eingeschätzt werden kann. Ziel der Studie war die Analyse der diagnostischen Genauigkeit von VirtualTouch für die Diagnose einer Leberzirrhose und dessen Korrelation mit transienter Elastografie (Fibroscan). Material und Methoden: Insgesamt wurden 133 Patienten mit chronischer Lebererkrankung eingeschlossen. 90 / 133 wurden mit VirtualTouch und transienter Elastografie untersucht und 70 von den mit VirtualTouch untersuchten Patienten erhielten eine Leberbiopsie. Die Lebersteifigkeit wurde mit beiden Methoden im rechten Leberlappen untersucht. Die diagnostische Genauigkeit für eine Zirrhose wurde zunächst in den 90 mit Fibroscan untersuchten Patienten bestimmt; hierbei wurde ein Wert von 13 kPa (47 % der Patienten) als diagnostisch für eine Zirrhose angesehen. Der beste mittels VirtualTouch ermittelte Cut-off-Wert für Zirrhose wurde dann bei den 70 Patienten, die auch eine Biopsie erhielten (Zirrhose bei 38 % der Patienten) getestet. 41 Patienten wurden mit VirtualTouch durch 2 verschiedene Sonografeure untersucht. Ergebnisse: Die VirtualTouch-Werte bei Kontrollen, chronischer Hepatitis und Zirrhose lagen bei 113,147 und 255 cm/s. Der AUROC-Wert von VirtualTouch für die Diagnose einer Zirrhose (Fibroscan als Referenz) war 0,941 mit 175 cm/s als bestem Cut-off-Wert (Sensitivität 93,0 %; Spezifizität 85,1 %). VirtualTouch zeigte auch gute Ergebnisse bei Patienten mit bioptisch gesicherter Leberzirrhose (AUROC 0,908, Sensitivität 81,5 %, Spezifizität 88,4 %). Die Korrelation von VirtualTouch mit der transienten Elastografie war sehr gut (r = 0,891) und die Korrelation von VirtualTouch-Messungen beider Sonografeure war auch gut (r = 0,874). Schlussfolgerung: VirtualTouch kann das Vorliegen einer Zirrhose mit hoher Genauigkeit detektieren. Die Methode zeigt eine gute Interobserver Reproduzierbarkeit und die Korrelation von VirtualTouch-basierten Werten und Fibroscan-Werten ist gut.

Abstract

Purpose: VirtualTouch is a new technique recently proposed to evaluate liver stiffness during B-mode ultrasonography. The goal of the present study was to analyze the diagnostic accuracy of VirtualTouch in the diagnosis of cirrhosis and its correlation with transient elastography (Fibroscan). Materials and Methods: A total of 133 patients with chronic liver disease were enrolled. 90 of 133 underwent VirtualTouch and transient elastography and 70 patients assessed with VirtualTouch were submitted to liver biopsy. Stiffness was assessed by both techniques in the right liver lobe. The diagnostic accuracy for cirrhosis was first assessed in the 90 patients submitted to transient elastography with > 13 kPa (47 % of patients) as diagnostic for cirrhosis values. The best cut-off for cirrhosis with VirtualTouch was then tested in the 70 patients with biopsy (cirrhosis in 38 % of patients). 41 patients were assessed by VirtualTouch by two different operators. Results: The VirtualTouch values in controls, chronic hepatitis and cirrhosis were respectively 113, 147 and 255 cm/sec. The AUROC of liver VirtualTouch for the diagnosis of cirrhosis (reference Fibroscan) was 0.941 with 175 cm/sec as the best cut-off (sensitivity 93.0 %; specificity 85.1 %). VirtualTouch confirmed good performance also in patients with bioptic diagnosis of cirrhosis (AUROC 0.908, sensitivity 81.5 %, specificity 88.4 %,). The correlation of VirtualTouch with transient elastography was strict (r = 0.891) and the correlation in VirtualTouch measurements between two operators was also good (r = 0.874). Conclusion: VirtualTouch is able to identify the presence of cirrhosis with good accuracy, shows good interobserver reproducibility and the correlation of its values with those obtained by transient elastography with Fibroscan is good.

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Dr. Fabio Piscaglia

Div. Internal Medicine

Dept. Clinical Medicine

via Albertoni 15

40138 Bologna

Italy

Phone: ++ 39/0 51/6 36 25 42/5 68

Fax: ++ 39/0 51/6 36 27 25

Email: fabio.piscaglia@unibo.it