Original Contribution
Impact Factors and the Optimal Parameter of Acoustic Structure Quantification in the Assessment of Liver Fibrosis

https://doi.org/10.1016/j.ultrasmedbio.2015.05.006Get rights and content

Abstract

The aims of the present study are to assess the impact factors on acoustic structure quantification (ASQ) ultrasound and find the optimal parameter for the assessment of liver fibrosis. Twenty healthy volunteers underwent ASQ examinations to evaluate impact factors in ASQ image acquisition and analysis. An additional 113 patients with liver diseases underwent standardized ASQ examinations, and the results were compared with histologic staging of liver fibrosis. We found that the right liver displayed lower values of ASQ parameters than the left (p = 0.000–0.021). Receive gain experienced no significant impact except gain 70 (p = 0.193–1.000). With regard to different diameter of involved vessels in regions of interest, the group ≤2.0 mm differed significantly with the group 2.1–5.0 mm (p = 0.000–0.033) and the group >5.0 mm (p = 0.000–0.062). However, the region of interest size (p = 0.438–1.000) and depth (p = 0.072–0.764) had no statistical impact. Good intra- and inter-operator reproducibilities were found in both image acquisitions and offline image analyses. In the liver fibrosis study, the focal disturbance ratio had the highest correlation with histologic fibrosis stage (r = 0.67, p < 0.001). In conclusion, the testing position, receive gain and involved vessels were the main factors in ASQ examinations and focal disturbance ratio was the optimal parameter in the assessment of liver fibrosis.

Section snippets

Patients

From January to February 2013, 20 healthy volunteers, which included hospital staff and college students, visiting the hospital for a medical checkup were recruited. The volunteers had no significant medical history of liver disease and systemic disease. They also had no history of chronic drug abuse or excessive alcohol consumption (defined as >30 g/d for men and >20 g/d for women).

From March to August 2013, 161 consecutive adult patients scheduled for liver biopsy or partial liver resection

Results

In this study, 20 healthy volunteers (17 men, 3 women) were enrolled. The mean age was 25.7 y old (SD, 2.0; range, 24–32 y old). The mean body mass index (BMI) was 21.4 kg/m2 (SD, 2.2; range, 17.6–25.5 kg/m2). Another 113 patients were included. Patient characteristics, epidemiologic data and biochemical tests are summarized in Table 1. When taking the clinical setting into account, hepatitis B, hepatitis C and alcoholic diseases had an effect in 58.4%, 3.5% and 1.8% of patients, respectively.

Discussion

The morphologic ASQ directly analyzes the heterogeneity of echotexture scattering in the liver parenchyma, which becomes more and more significant with the progression of liver fibrosis. For the application of ASQ, the integration into a conventional US system makes it more available during standard US examinations of the liver. As in the study by Kramer et al. (2014), no technique limitations were found on the application of ASQ and valid ASQ measurements were achieved for all participants in

Conclusions

According to the results of the present study, testing position of the liver, receive gain and involved vessels in ROIs were important factors affecting ASQ examinations, whereas the ROI size and depth had no effect on ASQ results. Good intra- and inter-operator reproducibility for both images acquisitions and offline images analyses were found. ASQ in its present form might be an effective way to evaluate liver fibrosis severity with significant positive correlation between them. Further

Acknowledgments

Thanks for the financial support of the National Natural Science Foundation of China (No: 81271576 and No: 81471672).

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    Not every study supports the clinical usefulness of ASQ; for example, it has been reported to characterize liver diseases imprecisely (Krämer et al. 2014). The lack of standardized methodology may be one of the causes of imprecise characterization; therefore, Huang et al. (2015) suggested a standardized measurement protocol for ASQ of liver tissues, as follows: (i) imaging data should be acquired using a right intercostal approach; (ii) the receive gain should be set at ≥75; and (iii) the region of interest (ROI) for data analysis should be devoid of large vessels. Nevertheless, a recent clinical study on patients with hepatic steatosis did not agree with the aforementioned protocol and reported that ASQ measurement is independent of the ultrasound scanning approach (Son et al. 2016).

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    The focal disturbance (FD) ratio is defined as the ratio of the areas under the blue and red lines. The FD ratio increases in tissue with higher focal inhomogeneity and lower global homogeneity (Huang et al. 2015, 2016; Karlas et al. 2015; Keller et al. 2015; Nam et al. 2016; Park et al. 2016; Toyoda et al. 2009; Tsui et al. 2016; Yamada et al. 2006). Transient elastography was performed using FibroScan (Echosens, Paris, France) to assess liver stiffness.

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    Acoustic structure quantification (ASQ) is a technique that has recently been employed to characterize liver parenchyma by measuring the difference between backscattered statistics and the Rayleigh distribution. The ASQ technique has been used to assess liver fibrosis (Huang et al. 2015, 2016) and to determine the stage of NAFLD (Karlas et al. 2015; Kuroda et al. 2012; Lee et al. 2017; Shen et al. 2016; Son et al. 2016); however, it was argued that it is an imprecise tool (Krämer et al. 2014). One study suggested using the shape parameter of the Nakagami statistical model to more precisely quantify liver tissue echo amplitude statistics (Tsui et al. 2016a).

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