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Analysis of intrahepatic vascular morphological changes of chronic liver disease for assessment of liver fibrosis stages by micro-flow imaging with contrast-enhanced ultrasound: preliminary experience

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Abstract

Objective

To assess morphological vascular changes due to an increase in liver fibrosis by using micro-flow imaging (MFI) of contrast-enhanced ultrasound.

Methods

MFI was performed in 47 patients who underwent liver biopsy, and in 10 normal cases. For 27/57 cases, we performed MFI twice in order to assess the reproducibility of the examination, thus yielding a total of 84 examinations. Seven physicians interpreted each case individually by assigning confidence levels for the presence or absence of three imaging features that were related to alteration of portal vein morphology: angle widening, tapering/interruption and tortuosity.

Results

Pearson’s correlation coefficient between the average rating scores based on tortuosity and the histological fibrosis stage was 0.806 (p < 0.001). The diagnostic accuracy of the average area under the ROC curve, which was estimated by use of the confidence levels of tapering/interruption, tortuosity and angle widening, was 0.964 for F1 vs. F2–4, 0.968 for F1–2 vs. F3–4 and 0.910 for F1–3 vs. F4. The average correlation coefficient between the ratings on different images from the same patients was 0.838.

Conclusion

Assessment of morphological intrahepatic vascular changes on MFI may be useful for grading liver fibrosis.

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Acknowledgments

The authors are grateful to Tomihiko Hirokawa, MD, Liu Guang-Jian, MD, Yasuharu Imai, MD, Junich Taira, MD, and Takatomo Sano, MD, for participating as observers; and to Mrs. Elisabeth Lanzl for improving the manuscript.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan

    Katsutoshi Sugimoto, Fuminori Moriyasu, Shigeki Ichimura & Ryo Metoki

  2. Kurt Rossmann Laboratories for Radiologic Imaging Research, Department of Radiology, The University of Chicago, Chicago, IL, USA

    Katsutoshi Sugimoto, Junji Shiraishi & Kunio Doi

  3. School of Health Sciences, Kumamoto University, Kumamoto, Japan

    Junji Shiraishi

Authors
  1. Katsutoshi Sugimoto
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  2. Junji Shiraishi
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  3. Fuminori Moriyasu
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  4. Shigeki Ichimura
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  5. Ryo Metoki
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  6. Kunio Doi
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Corresponding author

Correspondence to Katsutoshi Sugimoto.

Electronic supplementary material

Contrast-enhanced US images with MFI in a 39-year-old healthy man. The cine loop shows regularly and continuously branching portal veins and the regularity of the blood-flow speed of the portal vein branches immediately after the flash, and also shows the spatial and temporal homogeneity of the enhancement of the liver parenchyma a few seconds after the flash. (MPG 1372 kb)

Contrast-enhanced US images with MFI in a 68-year-old woman with F2 disease. MFI cine loop shows slight tortuosity and meandering of the portal vein branches and the irregularity of the blood-flow speed of the portal vein branches immediately after the flash compared with normal liver (S1), and also shows the spatial and temporal heterogeneity of the enhancement of the liver parenchyma a few seconds after the flash. The cine loop also shows dilatation of the hepatic arterial branches immediately after the flash. (MPG 1149 kb)

Contrast-enhanced US images with MFI in a 65-year-old woman with F4 disease. MFI cine loop shows chaotic vascular changes, and also shows the severe spatial and temporal heterogeneity of the liver’s parenchymal enhancement compared with normal liver and F2 disease (S1–S2). (MPG 1384 kb)

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Sugimoto, K., Shiraishi, J., Moriyasu, F. et al. Analysis of intrahepatic vascular morphological changes of chronic liver disease for assessment of liver fibrosis stages by micro-flow imaging with contrast-enhanced ultrasound: preliminary experience. Eur Radiol 20, 2749–2757 (2010). https://doi.org/10.1007/s00330-010-1852-1

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  • DOI: https://doi.org/10.1007/s00330-010-1852-1

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