Lauren Rosenblum BSc, Abstract Co-Author: Nothing to Disclose

Priscilla Machado MD, Abstract Co-Author: Nothing to Disclose

Patrick L. O'Kane MD, Abstract Co-Author: Research Consultant, NPS Pharmaceuticals Research Consultant, Johnson & Johnson

Andrej Lyshchik MD, Abstract Co-Author: Nothing to Disclose

Flemming Forsberg PhD, Presenter: Equipment support, Toshiba Corporation Equipment support, Siemens AG Research collaboration, General Electric Company Research collaboration, Ultrasonix Medical Corporation Research collaboration, Toshiba Corporation Advisory Board, Siemens AG Advisory Board, Toshiba Corporation

To determine if M-mode or Shear Wave Elasticity (SWE) imaging (independently or combined) provide quantitative markers of liver fibrosis compared to conventional grayscale ultrasound (US) imaging and pathology (the reference standard).

Twelve subjects scheduled for an US-guided liver biopsy and 5 healthy volunteers were scanned with a broad bandwidth curvi-linear array using an IU22 (Philips Medical Systems, Bothell, WA; for grayscale and M-mode imaging) and an Aixplorer scanner (SuperSonic Imagine, Aix-en-Provence, France; for SWE imaging). The M-mode images were quantified using the scanners’ existing calculation software package and by a novel algorithm (implemented in Matlab; Mathworks, Natick, MA) extracting distances between lines of similar intensities (L2LD) as a quantitative biomarker of liver status. Liver stiffness (in kPa) was recorded from the SWE images, while a radiologist (blinded to the other results) scored the grayscale US for degree of fibrosis (on a 0-4 scale). ANOVA and Wilcoxon‘s sign rank tests were used to compare the classification of liver fibrosis by SWE, M-mode (i.e., L2LD) and radiologists scoring with fibrosis determined by pathology as the reference standard.

In this pilot study, the radiologist was correct in 53% of assessments, which was not different from pathology when using a non-parametric test (p=0.3). SWE did not differentiate between degrees of fibrosis (p > 0.71), while the new L2LD biomarker was able to perform a correct classification (p = 0.044). The best differentiation was achieved between normal subjects (fibrosis score = 0) and the subjects with fibrosis scores greater than or equal to 1 (0.30 ± 0.041 vs. 0.43 ± 0.085; p < 0.005).

A new biomarker for noninvasive US evaluation of liver status, based on extracting distances between lines of similar intensities from M-mode images, have been developed. Initial results indicate this parameter can correctly classify degree of fibrosis; albeit based on a limited sample size.

If these results are reproducible in a larger patient population, it may be possible to replace some liver biopsies with evaluations based on noninvasive, quantitative US biomarkers.

Rosenblum, L, Machado, P, O'Kane, P, Lyshchik, A, Forsberg, F, Quantitative Biomarkers for the Assessment of Fibrosis Using M-Mode US and Shear Wave Elastography.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13025987.html