Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2015; 21(32): 9648-9655
Published online Aug 28, 2015. doi: 10.3748/wjg.v21.i32.9648
Liver reserve function assessment by acoustic radiation force impulse imaging
Xiao-Lan Sun, Li-Wei Liang, Hui Cao, Qiong Men, Ke-Zhu Hou, Zhen Chen, Ya-E Zhao
Xiao-Lan Sun, Department of Ultrasound in Medicine, Shanghai Shidong Hospital, Shanghai 200438, China
Li-Wei Liang, Department of Gastroenterology, Shanghai Shidong Hospital, Shanghai 200438, China
Hui Cao, Department of Ultrasound in Medicine, Shanghai Second Military Medical University Affiliated Changhai Hospital, Shanghai 200433, China
Qiong Men, Department of Oncology, Shanghai Shidong Hospital, Shanghai 200438, China
Ke-Zhu Hou, Department of Surgery, Shanghai Shidong Hospital, Shanghai 200438, China
Zhen Chen, Department of Pathology, Shanghai Shidong Hospital, Shanghai 200438, China
Ya-E Zhao, Department of Radiology, Shanghai Shidong Hospital, Shanghai 200438, China
Author contributions: Sun XL and Liang LW contributed equally to this work; Sun XL and Liang LW designed the research; Sun XL, Liang LW, Cao H, Men Q, Hou KZ, Chen Z and Zhao YE performed the research; Cao H, Men Q, Hou KZ, Chen Z and Zhao YE contributed new reagents/analytic tools; Sun XL and Liang LW analyzed the data; Sun XL, Liang LW and Cao H wrote the paper.
Clinical trial registration statement: This study is not registered at Clinical trial because all data are gained from an ultrasound system.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: We declare that there are no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
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: Li-Wei Liang, BE, Department of Gastroenterology, Shanghai Shidong Hospital, No. 999, Shi Guang Road, Shanghai 200438, China. 1533516615@qq.com
Telephone: +86-21-2506636
Received: March 15, 2015
Peer-review started: March 15, 2015
First decision: April 13, 2015
Revised: May 28, 2015
Accepted: June 26, 2015
Article in press: June 26, 2015
Published online: August 28, 2015
Processing time: 166 Days and 6.9 Hours
Abstract

AIM: To evaluate the utility of liver reserve function by acoustic radiation force impulse (ARFI) imaging in patients with liver tumors.

METHODS: Seventy-six patients with liver tumors were enrolled in this study. Serum biochemical indexes, such as aminotransferase (ALT), aspartate aminotransferase (AST), serum albumin (ALB), total bilirubin (T-Bil), and other indicators were observed. Liver stiffness (LS) was measured by ARFI imaging, measurements were repeated 10 times, and the average value of the results was taken as the final LS value. Indocyanine green (ICG) retention was performed, and ICG-K and ICG-R15 were recorded. Child-Pugh (CP) scores were carried out based on patient’s preoperative biochemical tests and physical condition. Correlations among CP scores, ICG-R15, ICG-K and LS values were observed and analyzed using either the Pearson correlation coefficient or the Spearman rank correlation coefficient. Kruskal-Wallis test was used to compare LS values of CP scores, and the receiver-operator characteristic (ROC) curve was used to analyze liver reserve function assessment accuracy.

RESULTS: LS in the ICG-R15 10%-20% group was significantly higher than in the ICG-R15 < 10% group; and the difference was statistically significant (2.19 ± 0.27 vs 1.59 ± 0.32, P < 0.01). LS in the ICG-R15 > 20% group was significantly higher than in the ICG-R15 < 10% group; and the difference was statistically significant (2.92 ± 0.29 vs 1.59 ± 0.32, P < 0.01). The LS value in patients with CP class A was lower than in patients with CP class B (1.57 ± 0.34 vs 1.86 ± 0.27, P < 0.05), while the LS value in patients with CP class B was lower than in patients with CP class C (1.86 ± 0.27 vs 2.47 ± 0.33, P < 0.01). LS was positively correlated with ICG-R15 (r = 0.617, P < 0.01) and CP score (r = 0.772, P < 0.01). Meanwhile, LS was negatively correlated with ICG-K (r = -0.673, P < 0.01). AST, ALT and T-Bil were positively correlated with LS, while ALB was negatively correlated with LS (P < 0.05). The ROC curve revealed that the when the LS value was 2.34 m/s, the Youden index was at its highest point, sensitivity was 69.2% and specificity was 92.1%.

CONCLUSION: For patients with liver tumors, ARFI imaging is a useful tool for assessing liver reserve function.

Keywords: Acoustic radiation force impulse; Liver reserve function; Liver tumor; Receiver-operator characteristic

Core tip: Seventy-six patients with liver tumors were assessed by acoustic radiation force impulse (ARFI) imaging. We found that liver stiffness (LS) was positively correlated with Indocyanine green (ICG)-R15 and the Child-Pugh score, but was negatively correlated with ICG-K. Aspartate aminotransferase, aminotransferase and total bilirubin were positively correlated with LS, while albumin was negatively correlated with LS. The receiver-operator characteristic curve revealed that when LS value was 2.34 m/s, the Youden index was at its highest point. For patients with liver tumors, ARFI imaging is a useful tool to assess liver reserve function.