Journal of Gastroenterology

, Volume 46, Issue 3, pp 350–358 | Cite as

Real-time tissue elastography as a tool for the noninvasive assessment of liver stiffness in patients with chronic hepatitis C

  • Hiroyasu Morikawa
  • Katsuhiko Fukuda
  • Sawako Kobayashi
  • Hideki Fujii
  • Shuji Iwai
  • Masaru Enomoto
  • Akihiro Tamori
  • Hiroki Sakaguchi
  • Norifumi Kawada
Original Article—Liver, Pancreas, and Biliary Tract

Abstract

Background

Although histopathological examination by “invasive” liver biopsy remains the gold standard for evaluating disease progression in chronic liver disease, noninvasive tools have appeared and have led to great progress in diagnosing the stage of hepatic fibrosis. The aim of this study was to assess the value of real-time tissue elastography, using an instrument made in Japan, for the visible measurement of liver elasticity; in particular, comparing the results with those of transient elastography (Fibroscan).

Methods

Real-time tissue elastography (RTE), transient elastography (Fibroscan), liver biopsy, and routine laboratory analyses were performed in 101 patients with chronic hepatitis C. The values for tissue elasticity obtained using novel software (Elasto_ver 1.5.1) connected to RTE were transferred to four image features, Mean, Standard Deviation (SD), Area, and Complexity. Their association with the stage of fibrosis at biopsy and with liver stiffness (kPa) obtained by Fibroscan was analyzed.

Results

Colored images obtained by RTE were classified into diffuse soft, intermediate, and patchy hard patterns and the calculated elasticity differed significantly between patients according to and correlated with the stages of fibrosis (p < 0.0001). Mean, SD, Area, and Complexity showed significant differences between the stages of fibrosis (Tukey–Kramer test, p < 0.05). In discriminating patients with cirrhosis, the areas under the receiver operating characteristic curves (AUC) were 0.91 for Mean, 0.84 for SD, 0.91 for Area, 0.93 for Complexity, and 0.95 for Fibroscan.

Conclusions

RTE is a noninvasive instrument for the colored visualization of liver elasticity in patients with chronic liver disease.

Keywords

Liver fibrosis Transient elastography Ultrasound Liver biopsy 

References

  1. 1.
    Global surveillance and control of hepatitis C. Report of a WHO Consultation organized in collaboration with the Viral Hepatitis Prevention Board, Antwerp, Belgium. J Viral Hepat. 1999;6:35–47.CrossRefGoogle Scholar
  2. 2.
    Manns MP, McHutchison JG, Gordon SC, Rustgi VK, Shiffman M, Reindollar R, et al. Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial. Lancet. 2001;358:958–65.PubMedCrossRefGoogle Scholar
  3. 3.
    Sporea I, Popescu A, Sirli R. Why, who and how should perform liver biopsy in chronic liver diseases. World J Gastroenterol. 2008;14:3396–402.PubMedCrossRefGoogle Scholar
  4. 4.
    Manning DS, Afdhal NH. Diagnosis and quantitation of fibrosis. Gastroenterology. 2008;134:1670–81.PubMedCrossRefGoogle Scholar
  5. 5.
    Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003;38:518–26.PubMedCrossRefGoogle Scholar
  6. 6.
    Sandrin L, Tanter M, Gennisson JL, Catheline S, Fink M. Shear elasticity probe for soft tissues with 1D transient elastography. IEEE Trans Ultrason Ferroelectr Freq Control. 2002;49:436–46.PubMedCrossRefGoogle Scholar
  7. 7.
    Ganne-Carrié N, Ziol M, de Ledinghen V, Douvin C, Marcellin P, Castera L, et al. Accuracy of liver stiffness measurement for the diagnosis of cirrhosis in patients with chronic liver diseases. Hepatology. 2006;44:1511–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Pinzani M, Vizzutti F, Arena U, Marra F. Technology Insight: noninvasive assessment of liver fibrosis by biochemical scores and elastography. Nat Clin Pract Gastroenterol Hepatol. 2008;5:95–106.PubMedCrossRefGoogle Scholar
  9. 9.
    Yeh WC, Li PC, Jeng YM, Hsu HC, Kuo PL, Li ML, et al. Elastic modulus measurements of human liver and correlation with pathology. Ultrasound Med Biol. 2002;28:467–74.PubMedCrossRefGoogle Scholar
  10. 10.
    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.PubMedCrossRefGoogle Scholar
  11. 11.
    Castéra L, Vergniol J, Foucher J, Le Bail B, Chanteloup E, Haaser M, et al. Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterology. 2005;128:343–50.PubMedCrossRefGoogle Scholar
  12. 12.
    Ziol M, Handra-Luca A, Kettaneh A, Christidis C, Mal F, Kazemi F, et al. Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C. Hepatology. 2005;41:48–54.PubMedCrossRefGoogle Scholar
  13. 13.
    Friedrich-Rust M, Ong MF, Martens S, Sarrazin C, Bojunga J, Zeuzem S, et al. Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology. 2008;134:960–74.PubMedCrossRefGoogle Scholar
  14. 14.
    Arena U, Vizzutti F, Corti G, Ambu S, Stasi C, Bresci S, et al. Acute viral hepatitis increases liver stiffness values measured by transient elastography. Hepatology. 2008;47:380–4.PubMedCrossRefGoogle Scholar
  15. 15.
    Nitta N, Yamakawa M, Shiina T. Tissue elasticity imaging based on combined autocorrelation method and 3D tissue model. In: Proceedings of the IEEE Ultrasonics Symposium. Savoy, III: Institute of Electrical and Electronics Engineers Ultrasonics, Ferroelectrics, and Frequency Control Digital Archive 1998, vol. 2, p. 1447–50.Google Scholar
  16. 16.
    Yamakawa M, Shiina T. Strain estimation using the extended combined autocorrelation method. Jpn J Appl Phys. 2001;40:3872–6.CrossRefGoogle Scholar
  17. 17.
    Itoh A, Ueno E, Tohno E, Kamma H, Takahashi H, Shiina T, et al. Breast disease: clinical application of US elastography for diagnosis. Radiology. 2006;239:341–50.PubMedCrossRefGoogle Scholar
  18. 18.
    Tohno E, Ueno E. Current improvements in breast ultrasound, with a special focus on elastography. Breast Cancer. 2008;15:200–4.PubMedCrossRefGoogle Scholar
  19. 19.
    Tsutsumi M, Miyagawa T, Matsumura T, Kawazoe N, Ishikawa S, Shimokama T, et al. The impact of real-time tissue elasticity imaging (elastography) on the detection of prostate cancer: clinicopathological analysis. Int J Clin Oncol. 2007;12:250–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Uchida H, Hirooka Y, Itoh A, Kawashima H, Hara K, Nonogaki K, et al. Feasibility of tissue elastography using transcutaneous ultrasonography for the diagnosis of pancreatic diseases. Pancreas. 2009;38:17–22.PubMedCrossRefGoogle Scholar
  21. 21.
    Friedrich-Rust M, Ong MF, Herrmann E, Dries V, Samaras P, Zeuzem S, et al. Real-time elastography for noninvasive assessment of liver fibrosis in chronic viral hepatitis. AJR Am J Roentgenol. 2007;188:758–64.PubMedCrossRefGoogle Scholar
  22. 22.
    Desmet VJ, Gerber M, Hoofnagle JH, Manns M, Scheuer PJ. Classification of chronic hepatitis: diagnosis, grading and staging. Hepatology. 1994;19:1513–20.PubMedCrossRefGoogle Scholar
  23. 23.
    The French Metavir Cooperative Study Group. Intraobserver and interobserver variations in liver biopsy interpretation in patients with chronic hepatitis C. Hepatology. 1994;20:15–20.CrossRefGoogle Scholar
  24. 24.
    Bonekamp S, Kamel I, Solga S, Clark J. Can imaging modalities diagnose and stage hepatic fibrosis and cirrhosis accurately? J Hepatol. 2009;50:17–35.PubMedCrossRefGoogle Scholar
  25. 25.
    Muthupillai R, Lomas DJ, Rossman PJ, Greenleaf JF, Manduca A, Ehman RL. Magnetic resonance elastography by direct visualization of propagating acoustic strain waves. Science. 1995;269:1854–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Huwart L, Sempoux C, Vicaut E, Salameh N, Annet L, Danse E, et al. Magnetic resonance elastography for the noninvasive staging of liver fibrosis. Gastroenterology. 2008;135:32–40.PubMedCrossRefGoogle Scholar
  27. 27.
    Săftoiu A, Gheonea DI, Ciurea T. Hue histogram analysis of real-time elastography images for noninvasive assessment of liver fibrosis (letter). AJR Am J Roentgenol. 2007;189:W232–3.PubMedCrossRefGoogle Scholar
  28. 28.
    Ferraioli G, Gulizia R, Filice C. Real-time elastography in the assessment of liver fibrosis (letter). AJR Am J Roentgenol. 2007;189:W170.PubMedCrossRefGoogle Scholar
  29. 29.
    Friedrich-Rust M, Schwarz A, Ong M, Dries V, Schirmacher P, Herrmann E, et al. Real-time tissue elastography versus FibroScan for noninvasive assessment of liver fibrosis in chronic liver disease. Ultraschall Med. 2009;30:478–84.PubMedCrossRefGoogle Scholar
  30. 30.
    Gulizia R, Ferraioli G, Filice C. Open questions in the assessment of liver fibrosis using real-time elastography. AJR Am J Roentgenol. 2008;190:W370–1.PubMedCrossRefGoogle Scholar
  31. 31.
    Tatsumi C, Kudo M, Ueshima K, Kitai S, Ishikawa E, Yada N, et al. Non-invasive evaluation of hepatic fibrosis for type C chronic hepatitis. Intervirology. 2010;53:76–81.PubMedCrossRefGoogle Scholar
  32. 32.
    Obara N, Ueno Y, Fukushima K, Nakagome Y, Kakazu E, Kimura O, et al. Transient elastography for measurement of liver stiffness measurement can detect early significant hepatic fibrosis in Japanese patients with viral and nonviral liver diseases. J Gastroenterol. 2008;43:720–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Ogawa E, Furusyo N, Toyoda K, Takeoka H, Otaguro S, Hamada M, et al. Transient elastography for patients with chronic hepatitis B and C virus infection: non-invasive, quantitative assessment of liver fibrosis. Hepatol Res. 2007;37:1002–10.PubMedCrossRefGoogle Scholar
  34. 34.
    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.PubMedCrossRefGoogle Scholar
  35. 35.
    Forns X, Ampurdanès S, Llovet JM, Aponte J, Quintó L, Martínez-Bauer E, et al. Identification of chronic hepatitis C patients without hepatic fibrosis by a simple predictive model. Hepatology. 2002;36:986–92.PubMedGoogle Scholar
  36. 36.
    Foucher J, Chanteloup E, Vergniol J, Castéra L, Le Bail B, Adhoute X, et al. Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study. Gut. 2006;55:403–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2010

Authors and Affiliations

  • Hiroyasu Morikawa
    • 1
  • Katsuhiko Fukuda
    • 2
  • Sawako Kobayashi
    • 1
  • Hideki Fujii
    • 1
  • Shuji Iwai
    • 1
  • Masaru Enomoto
    • 1
  • Akihiro Tamori
    • 1
  • Hiroki Sakaguchi
    • 1
  • Norifumi Kawada
    • 1
  1. 1.Department of Hepatology, Graduate School of MedicineOsaka City UniversityAbenoJapan
  2. 2.Department of GastroenterologyPL HospitalTondabayashiJapan

Personalised recommendations