Katsutoshi Sugimoto, Presenter: Nothing to Disclose

Junji Shiraishi, Abstract Co-Author: Nothing to Disclose

Fuminori Moriyasu MD, PhD, Abstract Co-Author: Nothing to Disclose

Shigeki Ichimura, Abstract Co-Author: Nothing to Disclose

Ryou Metoki MD, Abstract Co-Author: Nothing to Disclose

Kunio Doi PhD, Abstract Co-Author: Shareholder, Hologic, Inc License agreement, Hologic, Inc License agreement, Deus Technologies, LLC License agreement, Riverain Medical License agreement, Mitsubishi Corporation License agreement, MEDIAN Technologies License agreement, General Electric Company License agreement, Toshiba Corporation Research support, Deus Technologies, LLC Research support, DuPont Research support, Elbit Medical Imaging Ltd Research support, Fuji Photo Film Co, Ltd Research support, General Electric Company Research support, Hitachi, Ltd Research support, Eastman Kodak Company Research support, Konica Minolta Group Research support, Mitaya Manufacturing Co, Ltd Research support, Mitsubishi Corporation Research support, Koninklijke Philips Electronics NV Research support, Hologic, Inc Research support, Riverain Medical Research support, Seiko Corporation Research support, Siemens AG Research support, 3M Company Research support, Toshiba Corporation

To assess prospectively the vascular morphologic changes and parenchymal enhancement patterns of chronic liver disease with increasing liver fibrosis by using micro flow imaging (MFI) of sonazoid-enhanced sonography (US), based on histopathologic examination as the reference standard.

The study was approved by the ethics committee. All patients gave written informed consent. MFI is a technique for processing real-time sonazoid-enhanced US images by integrating the path of moving bubbles to depict the vascular morphology. This technique was performed in 47 patients who underwent liver biopsy because of suspicion of chronic liver disease, and in 10 healthy volunteers. For 27 patients, we performed MFI twice in order to assess the reproducibility of the examination, thus yielding a total of 84 examinations. At histologic study, the fibrosis stage was assessed according to the New Inuyama scores (fibrosis scores F0 [no fibrosis] to F4 [cirrhosis]). All scanning data were archived with digital cine clips. A windows-PC-based review system, which can display cine clips for MFI, was developed for off-site observer study. Seven radiologists interpreted each case individually by assigning confidence levels for the presence or absence of nine image features which were related to the vascular morphology and parenchymal enhancement patterns of the liver.

The Pearson’s correlation coefficient between the average rating scores with use of the best image feature and the histologic fibrosis stage was 0.806, which is highly significant (p<0.01). The diagnostic accuracy based on the best image feature, which was expressed as the average area under the ROC curve was 0.920 for the diagnosis of significant fibrosis (F≥F2), 0.973 for severe fibrosis (F≥F3), and 0.931 for cirrhosis. The average correlation coefficient between the ratings of the same cases, but different images was 0.811, which seems to be adequate agreement.

MFI can be useful for prediction of the presence of liver fibrosis.

The high accuracy of sonazoid-enhanced US with MFI suggests that this noninvasive method has the potential to replace liver biopsy for the diagnosis of liver fibrosis.

Sugimoto, K, Shiraishi, J, Moriyasu, F, Ichimura, S, Metoki, R, Doi, K, Micro Flow Imaging of Chronic Liver Disease for Assessment of Liver Fibrosis with Contrast-enhanced Sonography: Preliminary Experience.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8001879.html