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Diagnosis of liver cirrhosis by transit-time analysis at contrast-enhanced ultrasonography

Analisi del tempo di transito del mezzo di contrasto ecografico nella diagnosi di cirrosi

  • Abdominal Radiology/Radiologia Addominale
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

The aims of this prospective study were to evaluate analysis of sulfur-hexafluoride-filled microbubble contrast agent (Sonovue) transit times as a tool for differentiating liver cirrhosis from the noncirrhotic stage of liver disease and to compare its performance with that of conventional B-mode and Doppler ultrasonography (US).

Materials and methods

Contrast-enhanced hepatic ultrasonography with the US contrast agent Sonovue was performed on 38 patients with diagnoses of hepatic cirrhosis based on unequivocal clinical signs or liver biopsy findings (Child-Pugh classes A in 19, B in 16 and C in three), 31 patients with noncirrhotic diffuse liver disease (biopsy confirmed) and 14 controls without diffuse liver disease. Time curves of hepatic-vein signal intensity were analysed using objective criteria to determine the time of enhancement onset (hepatic-vein arrival time) and peak enhancement (hepatic-vein peak enhancement). Accuracy in diagnosing cirrhosis was compared with that based on B-mode and Doppler data.

Results

Hepatic-vein arrival time in cirrhotic patients was significantly shorter (p<0.01) than in noncirrhotic (chronic liver disease and controls) patients. Peak enhancement times in these three groups were not significantly different. An arrival-time cutoff of 17 s distinguished cirrhotic from noncirrhotic patients with high accuracy (100% sensitivity, 93.3% specificity, positive and negative predictive values 92.6% and 100%, respectively) and excellent reproducibility (kappa coefficients of 1.0 and 0.93 for intraand interobserver agreement). Contrast-enhanced US showed better sensitivity than the B-mode and Doppler data.

Conclusions

Analysis of the time of onset of US contrast enhancement of the hepatic vein appears to be a potentially useful noninvasive supplement to conventional sonography and Doppler in the follow-up of patients with chronic diffuse liver disease.

Riassunto

Obiettivo

Lo scopo di questo studio prospettico è stato quello di valutare l’analisi del tempo di transito delle microbolle di mezzo di contrasto costituito da esafluoruro di zolfo (Sonovue) come mezzo per differenziare la cirrosi epatica dagli stadi non cirrotici di malattia e di comparare la sua performance con quella dell’esame B-mode standard e Doppler.

Materiali e metodi

È stato effettuato l’esame ecografico del fegato con mezzo di contrasto Sonovue in 38 pazienti con diagnosi di cirrosi basata su segni clinici inequivocabili o su biopsia epatica (Child-Pugh A in 19 pazienti, B in 16 e C in 3). Sono stati analizzati inoltre 31 pazienti con patologia cronica diffusa non cirrotica (confermata dalla biopsia), e 14 pazienti di controllo senza patologia epatica. Sono stati analizzati i diagrammi tempo/intensità di segnale della vena sovraepatica utilizzando criteri oggettivi per determinare il tempo di inizio dell’enhancement (tempo di arrivo della vena sovraepatica) e il picco di enhancement (tempo di picco della vena sovraepatica). L’accuratezza nella diagnosi di cirrosi è stata confrontata con quella basata sui dati B-mode e Doppler.

Risultati

Il tempo di arrivo della vena sovraepatica nei pazienti cirrotici è risultato significativamente pi`u breve (p<<0,01) rispetto ai pazienti non cirrotici (patologia epatica cronica e controlli). Il tempo di picco di enhancement in questi tre gruppi non è risultato significativo. Un tempo cut-off di arrivo di 17 secondi ha distinto pazienti cirrotici da quelli non cirrotici con elevata accuratezza (100% sensitività, 93,3% specificità, valore predittivo positivo e negativo: 92,6% e 100%, rispettivamente) ed eccellente riproducibilità (coefficiente κ di 1,0 e 0,93 per l’accordo intra-ed interosservatore). L’ecografia con mezzo di contrasto ha mostrato una migliore sensibilità rispetto all’esame B-mode e Doppler.

Conclusioni

L’analisi del tempo di inizio dell’enhancement contrastografico della vena sovraepatica appare un potenziale e non invasivo supplemento all’ecografia convenzionale e all’esame Doppler nel follow-up di pazienti con patologia epatica cronica diffusa.

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Authors and Affiliations

  1. Unità di Radiologia, SIUMB Ultrasound School, Ospedale Civile di Senigallia, Via Cellini 1, Senigallia, Italy

    T. Abbattista, E. Ciabattoni & P. Busilacchi

  2. Unità di Gastroenterologia, Ospedale Civile di Senigallia, Via Cellini 1, Senigallia, Italy

    F. Ridolfi, F. Marini, E. Bendia & E. Brunelli

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  1. T. Abbattista
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  2. F. Ridolfi
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  7. P. Busilacchi
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Correspondence to P. Busilacchi.

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Abbattista, T., Ridolfi, F., Ciabattoni, E. et al. Diagnosis of liver cirrhosis by transit-time analysis at contrast-enhanced ultrasonography. Radiol med 113, 860–874 (2008). https://doi.org/10.1007/s11547-008-0292-3

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  • DOI: https://doi.org/10.1007/s11547-008-0292-3

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