Retrospective Cohort Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2016; 22(26): 6057-6064
Published online Jul 14, 2016. doi: 10.3748/wjg.v22.i26.6057
Visualizing the hepatic vascular architecture using superb microvascular imaging in patients with hepatitis C virus: A novel technique
Hidekatsu Kuroda, Tamami Abe, Keisuke Kakisaka, Yudai Fujiwara, Yuichi Yoshida, Akio Miyasaka, Kazuyuki Ishida, Hideaki Ishida, Tamotsu Sugai, Yasuhiro Takikawa
Hidekatsu Kuroda, Tamami Abe, Keisuke Kakisaka, Yudai Fujiwara, Yuichi Yoshida, Akio Miyasaka, Yasuhiro Takikawa, Division of Hepatology, Department of Internal Medicine, Iwate Medical University, School of Medicine, Morioka, Iwate 020-8505, Japan
Kazuyuki Ishida, Tamotsu Sugai, Department of Molecular Diagnostic Pathology, Iwate Medical University, Morioka, Iwate 020-8505, Japan
Hideaki Ishida, Center of Diagnostic Ultrasound, Akita Red Cross Hospital, Akita 010-1495, Japan
Author contributions: All the authors contributed to this paper.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Reviewer.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrollment.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at hikuro@iwate-med.ac.jp.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hidekatsu Kuroda, MD, PhD, Division of Hepatology, Department of Internal Medicine, Iwate Medical University, School of Medicine, Uchimaru19-1, Morioka, Iwate 020-8505, Japan. hikuro@iwate-med.ac.jp
Telephone: +81-19-6515111 Fax: +81-19-6526664
Received: March 2, 2016
Peer-review started: March 3, 2016
First decision: April 1, 2016
Revised: April 5, 2016
Accepted: April 20, 2016
Article in press: April 20, 2016
Published online: July 14, 2016
Abstract

AIM: To identify the hepatic vascular architecture of patients with hepatitis C virus (HCV) using superb microvascular imaging (SMI) and investigate the use of SMI in the evaluation of liver fibrosis.

METHODS: SMI was performed in 100 HCV patients. SMI images were classified into five types according to the vascular pattern, and these patterns were compared with the fibrosis stage. Moreover, the images were analyzed to examine vascularity by integrating the number of SMI signals in the region of interest ROI [number of vascular trees (VT)]. The number of VT, fibrosis stage, serum parameters of liver function, and CD34 expression were investigated.

RESULTS: There was a significant difference between SMI distribution pattern and fibrosis stage (P < 0.001). The mean VT values in each of the fibrosis stages were as follows: 26.69 ± 7.08 in F0, 27.72 ± 9.32 in F1, 36.74 ± 9.23 in F2, 37.36 ± 5.32 in F3, and 58.14 ± 14.08 in F4. The VT showed excellent diagnostic ability for F4 [area under the receiver operator characteristic (AUROC): 0.911]. The VT was significantly correlated with the CD34 labeling index (r = 0.617, P < 0.0001).

CONCLUSION: SMI permitted the detailed delineation of the vascular architecture in chronic liver disease. SMI appears to be a reliable tool for noninvasively detecting significant fibrosis or cirrhosis in HCV patients.

Keywords: Superb microvascular imaging, Number of vascular trees, Chronic liver disease, Ultrasound, Liver fibrosis, CD34

Core tip: Superb microvascular imaging (SMI) is an innovative Doppler ultrasound technology that employs a unique algorithm to allow for the visualization of minute vessels with slow blood flow. In the present study, we identified the hepatic vascular architecture of patients with hepatitis C virus (HCV) using SMI and investigated the use of SMI in the evaluation of liver fibrosis. SMI allowed for the detailed delineation of the vascular architecture in chronic liver disease patients. Significant differences were found in the SMI pattern distribution and the fibrosis stage. SMI appears to be a reliable tool for noninvasively detecting significant fibrosis or cirrhosis in patients with HCV.