acoustic radiation force impulse arfiigakukai.marianna-u.ac.jp/idaishi/www/3734/3,4-37-4gaku... ·...

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臠腫腬腤腯腪腴膃臰膌膶膸 Vol. 37, pp. 203211, 2009 Acoustic Radiation Force Impulse ARFI腇腗腀腁 腔腍腌腒腊腏腈腉腐腑腕腂腆腅腃腖腗腎腄腋腓 膦臄腈腋 1 腘腑腥腚 腟腣 2 腢腘腥腚 臑膮 腜腠腧腉 1 膖膴 腣腦腏腉 膤臚 腢腎腒腣 3 腄腌 腃腘 4 腽臫 腆腇腤腩 腵腇 腕腇腜腪 5 膵腵 腎腋腩腄 臞膺 腢腎腫 5 腆腇腥腚 腙腋腟 1 腄腌 腧腅 1 膯膘 腕腇腝腐 腞腙腃腉 1 臌腸 腢腘腛腈 腍腅 腬腅 1 腇腕腋腩 腨腐 1 腆腋 腃腉 1 臊臣 腍腄腓腣 腋腓腌 3 臵臦 腃腎腋腩 腕腌 3 腛腇 腘腡腌 3 腕腇 腢腎腧腉 4 腛腇腑腢 腦腒 6 臒腽 腜腠腆腇 腭腔 腎腗腞腍 2 臰臸 腆腆腘腡 膓臖 腕腌腞腚 3 腒腓 腣腗腞腬 1 腚腅 腟腣 1 : 21 8 20 膥膳膏臟膣腗膏臤腳膀腧腨腀腦臔臱腕臗腓腋腠腑腂腟腌腆腌膏臟膣腗臓臃臺腔膣膱 腒腁腞腊腠腕臯腢腟臓臃臺腔膏臤腳膀臔臱腙腠腑腂腟臶腾腕腜腟臓臃 臺腔膬臩臹腢腣腓腌腑 Acoustic Radiation Force Impulse ARFI膕臅腇膇腋腠腐腇腖膕臅腗腴腻臺腕臥膏腖膬腣臩臹腍腟腊腓腇膂腒腁腟腌腆腌腊腠腙腒腕 ARFI 膕臅 腣膏臤腳膀腕腼腌腐膰腗腔腂腗膏臤腳膀臔臱腕腅腉腟 ARFI 腬腲臜腣腎腖臩 腢腣腓腓腛腕膣腌腐臮臎腗 20 腖膢臏腔腥腯腩腮腀腭膜腓膏臟膣腙腐腗膏臡臈臅腒 臤腳膀臔臱腖膊臹腌腐 42 臜膏膽膎膎膿腓腌腐膏膬臩臹腢腣S2-8 腖膉腰膛腶 腕腅腂腑腎腠腏腠 3 自腌腑臩臹腌 ARFI Vs 臲腣腝腠腐 ARFI Vs 臲腗臞膔腌腑腂腔腂腐腚致腺臲腣腂腑膉腰膛腶臯臲腓腌腐膉腰膛腶腖臤腳膀腗腷腒腗腔腂 腓膭腄腝腠腟腐腚臥膏膛腶 ARFI Vs 臲腗S2-S8 腖臧膁膙腓腌腐膠腹臟膀膌膣膱腓腖 膋膣腒腗 Pearson 腖臇腲臧膐膝臙腣腂膣腌腐膠腹膣膱膟膄腒腗膲腛膗腂臧膐腣腚腐 PT-INR r0.571p0.001腜腞ARFI Vs 臲腗 r0.766p0.001 腓腜腞膗腂臧膐 膐膝腣腚腐臥膏膛腶腒腖 ARFI 臩臹腗膏臤腳膀腧腨腀腦腓膯腂臧膐腣膼腍臓臃臺臩 腢腣腒腁腟膹腇膼腋腠腐ῐῌ῏ Acoustic Radiation Force Impulse Imaging, ARFI Imaging, Elasticity Imaging Techniques, Liver Fibrosis 膥膳臬腈腖臜膏膽膎腕腅腂腑臔臱腓腶腢臕膞臹腕腐腞膏臟膣腣膮腃腊腓腇臘 臉腋腠腑腂腟 14膏臟膣腒腝腠腟臐腖腔腆腒1 臠腫腬腤腯腪腴膃臰膌 膃膌 臍膀膒膏臨2 臋膣膱腴膌 3 膈膃膌 臍膀膒腷膈膃4 腗腴5 臋膣膱6 膾臤腴膌 203 27

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Page 1: Acoustic Radiation Force Impulse ARFIigakukai.marianna-u.ac.jp/idaishi/www/3734/3,4-37-4Gaku... · 2009. 11. 20. · Acoustic Radiation Force Impulse Imaging, ARFI Imaging, Elasticity

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Page 2: Acoustic Radiation Force Impulse ARFIigakukai.marianna-u.ac.jp/idaishi/www/3734/3,4-37-4Gaku... · 2009. 11. 20. · Acoustic Radiation Force Impulse Imaging, ARFI Imaging, Elasticity

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��QR�L��H� ��]Z���'�Y)r�:fgSiT�X'<hi�� ��i�ji���� ��<k$&b�� �� � �������l�m�T�n�<_�!�O��:�k�<�_!�� O ��:� B-})~�QR�L`�� ARFI �������k�_�,.���20��ARFI �e<H� ������<��UV������ ARFI �e<H��op��k�_���� qr,s��t& �������� ARFI <H� �k�_�!����:� �Eop�_���� UV,��u�� ��GH�<�����

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����� ������� ARFI Vs �Velocityshearwave� �� ����������������� ������� F0�F4������������ � F1 ! 11 �� F2 ! 17 �� F3 ! 5�� "�# F4 ! 9�$%&�� '()*+ �,-.-/0/1234�5� �prothrombin timeInternational normalized ratio, PT-INR�� indo-cyanine green �ICG� R15� 678-/9� ':��Platelet, Plt�� ,-;<=>/ III?N�@,AB�type III procollagen N side peptide, PIIINP��IV ?;<=>/� a2- CD-E-FG/ �a2-macro-globulin, a2M�� �9HIJ�KL �zinc sulfateturbidity test, ZTT�� M0G80/ �total bilirubin,T-Bil�� 7NO<P/97QR.</NST<=U�aspartate Amino Transferase, AST�� 7<V/.</N7Q<=U �alanine transaminase, ALT�� 78FQ/ �albumen, Alb�� AW=8J�KL �thy-mol turbidity test, TTT�� X,.E-0/ �Hapto-globin� �Y�� Z[�N\=]��^_��ARFI Vs ���`���ARFI Vs�Y�� Siemens Acuson S2000 �Sie-mens medical systems, Germany� ver1.0 a�b�ver1.5 ��c���d������&�� Cou-inaud �Hef����g�hijkl* �S2�S3�� m�hijnl* �S4� S5� S8�� m�2l*�S6� S7��� ARFI Vs ��Y��� �o�Y���� � S2-8 �pHef�"��� ��q� 3r�s��Y� ARFI Vs����� t�� ARFIVs ��Y$uvw�x�� 5.5 cm �y���"�� S1�Y$u��z�!�{&��|� }r�) {��~������,-.;=8�� �����!"�������# ��1407�����v� ������$���%���v�/S�=�B�;/�/.��&����'(���)�*+��)� Student � t )� Pear-

son �^_������ )�*+��5� 0.05����

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��������� IQR�M � SD ��`�� +��,�$%&��

�Fig. 1� �&�� -����!^�.����a������� �¡¢���� £� ��a��¤

j�) $�� -���pHef/0�����

����������������� ARFI Vs �pHef-���Z[�N\=]�� Fig. 2 �¥��� ;/.-=8¦�pHef-���w�1.4� w: 1.1$%�� �§f-��� 1.22$%&�� )�*+�������{&�!� S4 !-�� 1.4��b� S6!-�� 1.1�,�¨©!#|���� S4 !�b� S6 !,�¨©�� Z[�N\=]!ª���a�«��¨©!#|����¬�� pHef/0�{��§f/0��­��� ��) ��� ���1®�"���Z[�N\=]��! 1 N\=]¤¯%va�! 33�38�2°±v��3²7�8�!%�� ³��) $apHef$ ARFI Vs ��´�v¨©�#|� �Fig. 2��£����o��Hefµ��´�&��v�¡¢��� pHef/0�{���§f/0��^�.�$¶·±v£�����

������������������ ��Z[�N\=]��" vpHef/0���¸�� Fig. 3 �¹±� ��-���� ;/.-=8¦� 0.29� F1 ¦� 0.11� F2 ¦� 0.12� F3 ¦�0.12� F4 ¦� 0.09$%&�� )�*+���;/.-=8¦� F1 ¦ �p�0.007�� F3 ¦� F4 ¦2�p�0.046�$#|�!�;/.-=8¦$� F1�F4��º�¦���¸!�u� �!�����

Fig. 1. Comparison between dispersion SD and IQR�Mof 3ARFI Vs values obtained from total of 434 hepatic

segments.

SD and IQR�M have a di#erence for dispersion by

Student[s t-test. �p0.001�

ARFI ����4»¼*�Z[�Y� 205

29

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ARFI Vs ���������� ������������������� ARFI Vs �� Fig.5 ���� Control ����� 1.22m�s� F1 ����� 1.56m�s� F2 ����� 1.92m�s� F3 ����� 2.20 m�s� F4 ����� 2.56m�s ��� Stage �� 0.3�0.4m�s ��������� !� "#$%&'(� Control)F1 �* �p�0.009�� F1 ) F2 �* �p�0.026���� � F2 ) F3 �* �p�0.123�� F3 ) F4 �*�p�0.060��&'�+,-./!� 0123�4��F4 � Pearson 5678�9:�;)r�0.766 �p�0.001� 5667���� !� <!� =�� ARFI Vs �����>?�@A;&BC�DE�;!�� FGH�$9IJK�)�H9�L;����>?56�MNO9:,!� "#$%�&'�/!� PT-INR� ICG R15� Plt�

Fig. 2. ARFI Vs value on each fibrosis stage.

ARFI Vs value of each hepatic segment

distinguished by fibrosis stages.

ARFI Vs values vary among di#erent hepatic

segments even fibrosis stage.

�a� Control �b� F1 �c� F2 �d� F3 �e� F4

Fig. 3. Diversification of the ARFI Vs value.

Comparison of dispersion levels of ARFI Vs values

obtained from hepatic segments distinguished by fibro-

sis stage.

PQRS �TUV �206

30

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Fig. 4. Correlative comparison between ARFI Vs values and blood data.

The laboratory blood tests, which showed statistically significant correlation to fibrosis staging by

Pearson[s correlation coe$cient, were PT-INR �r�0.57, p�0.001�, ICGR15�r�0.497, p�0.001�,hyaluronic acid �r�0.416, p�0.01�, and Platelet �r��0.436, p�0.01�.�a� PT-INR �b� ICG R15 �c� hyaluronic acid �d� Plt

Fig. 5. Correlation between ARFI Vs values and fibrosis stages.

The ARFI Vs value correlated remarkably with the fibrosis stage. ARFI Vs value showed the

best correlation �r�0.766, p�0.001� compared to blood tests.

ARFI ���������� �� 207

31

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hyaluronic acid� PIIINP� g-Glb ���� typeIV col-lagen� a2M� T-Bil� ZTT ���� �Table. 1�� ���� PT-INR� ICG R15� Plt� hyaluronic acid �p�0.01 ��� ������������������� ���� �� !"#�$���%����� PT-INR �����&� r�0.571 '�()� ARFI Vs *�+,-.�����/01-234��

� �

5���67'8��� ARFI 9:����;<=>?'@);�� AB�C,'��)� D�$�EF�>?�'G���HI'"J/K���'� D���%'G��LM��� NO�"J��� Couinaud �PQR��' 3O� ARFI Vs

*>?�C��� SPQR��>?01'��T-UV34�� D��T-WX��Y,��Z�'�>?O&�[\]^K_�-�)� [\]^K+Y`aI'WX�'b,c-defg? �Z�]4��K� ���� �Hh� �_�'>?O&�[\]^Ki��jk��K� SPQR'8lK>?01��T-mn�WX���K�o?/K�� SD� IQR�M �mn'pq��rst'�K����� uv'� Fig. 1 'w���@,' SD �IQR�M -pq��rst'��3x� yp�z�3� 3O>?'�WX������{|K� b��� SPQR}w*�d~*�������/Kc���� i�c� ARFI *>?'��)� SPQR 3Oh�>?-_���Kc�����K� ���� ;nPQR�>?���'/K�� SPQR@)�>?� 3 O-E���K�5���|��

K�(�� ���IAB������;�� �LM/K'��)� pPQR�"#01�;n��LM���@���� �&�PQR�>?-_���K���"J��������� �67��� ;�S�z� ARFI Vs *� S4 ������ S6 ������UV� ;n���� -p������%-�]4� �Fig. 2�� Di�5��� �� ����'SPQR}w*��T'G��"J�� �Fig. 3��;��SPQR�<='�-�4�� SPQR�ARFI Vs*���)��T�����K�i�"J��� �� ��='@3x ARFI Vs*- 0.2m�sh�T/K��-UV34�� �� ������C���' ARFI Vs *�� 0.3m�s xG[\/Kc�3� i43�����PQR'@)�� ��=- 1����`������K��%-��]4K� (�� 234�SPQR}w*� ARFI Vs

�T*���� �¡¢�£@)�3�'������ i� ����� �� ����;���<=>?���¤;¥��Y¦%����§¨��©ª�«l¤/�� �� ���;u¬���- ­Kc'@)�T-����K��|34�� ®'� �H¯�'8��;nR}w*�_�%����� SPQR}w*�3;nR}w*�°?��'G��"J��� ;���z'8��;�� ������- 1 ����h�K��- 33�38�±²/K����-�)7�8�� 5��"J��SPQR�ARFI Vs*���K���UV� �Fig. 2�� yp³´�SPQR� ARFI Vs *�µ ¶�/K�WX�'��3��c-·?]4K� WX��������3d~*���/K�¸4*-¹¸]4�

Table. 1 Correlations between blood data and fibrosis stages.

º»�¼ ���� 3208

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����������� ��������������� ��� ���� ������ !"#$%&�'()*+����,�-./0����� ��� ��12� 3����()�4����5+�6�78-9�1�:;�<=->�?� �"%?@�AB#CDEF��4 ARFI Vs���GH-I�1� �Fig. 5�F2 � F3 J� F3 � F4 J�3KJL�� CDEF�M�N ARFI Vs � M�OP Q2)�1 RST?�U0�(�1� VN� Pearson �6WXY?@�%ZL[\]^E_K�F4 KL`�6W-Q21a�()� RSL�(�1a�� F3 K�bcY d�(�1e �n�5� ?fg0����hi)�1� jk� F3 K�bcYl�?m�no$pRST-q)����� M��hi�� r1�js�%ZL�� �AB#CDEF�`�6W-t01 !"#$%& �PT-INR� ICGR15� @u�Fig. 4�� ARFI Vs ��v)(?`�6W-t01� ���� ARFI Vs ���AB#wx?R9L���yi�� jk� z{|^DC]� APRI� Fib4}�J~p�AB#C[�� ARFI Vs ������GH%Z-I��� ������L�� 3�� ARFI Vs �()�4� ARFI Vs �-�2�e�����R9�-��01 � jk� ��������-��i� 3AB#CDEF�bcY-l��e?@u� �o�E����P; q)���hi)��� �? C �����?������\�Ez�^\ � ¡¢ \£9¤¥?¦���� AB#§¨� ©¤ª=?����e «¬�����1221�� ARFI Vs � ©¤ª=­®?R9L����� ���

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ARFI ¯°-9��q)�1���®+� ARFIVs ����AB#�RS?6W0� ±²³p��AB#wx¥�0�R9L���

����

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Abstract

Utility of Non-invasive Method Using Acoustic Radiation Force

Impulse �ARFI� Imaging for Measurement of Liver Fibrosis

Gaku Igarashi, Fumio Tsujimoto, Nobuyuki Matsumoto, Masasumi Miyazaki,

Atsuki Koike, Takanori Okamura, Masaru Sakurai, Masaru Okamoto,

Yuuki Ikeda, Hideaki Takahashi, Koutarou Matsunaga, Yoshiki Katakura,

Chiaki Okuse, Satoshi Koizumi, Takeshi Asakura, Hiroshi Nakano,

Masayuki Takagi, Yasuo Nakajima, Sachihiko Nobuoka, Takehito Otsubo,

Michihiro Suzuki, and Fumio Ito

The accurate diagnosis of fibrosis related to chronic liver diseases is crucial for prognostication and

treatment decisions. Although liver biopsy is the gold standard, it has limitations because of its invasive

nature. Thus development of new non-invasive methods is desired to diagnose hepatic fibrosis. Recently,

acoustic radiation force impulse �ARFI� imaging has been developed as a non-invasive modality to evaluatesti#ness of tissues. ARFI imaging theoretically measures liver sti#ness of all the segments independently.

However, there are no reports for the attempt to diagnose liver fibrosis with ARFI imaging. The aim of this

study is to assess the applicability of ARFI imaging for the diagnosis of liver fibrosis. The study enrolled 20

healthy volunteers as a control group 42 patients diagnosed as chronic liver disease. From these patients, we

classified 11 patients with F1, 17 with F2, 5 with F3, 9 with F4 accouding to pathological fibrosis staging by

the new Inuyama classification. ARFI Vs values were acquired with a Siemens Acuson S2000 �SiemensMedical Systems, Germany�, which has been modified to obtain ARFI images. We obtained ARFI Vsvalues from S2 to S8 of Cuinaud[s segmentation system by 3 consecutive measurements. ARFI Vs values of

S1 was excluded from the study, because of the location with di$culty for the measurement. We calculated

interquartile range�median �IQR�M� and standard deviation �SD� of these 3 data from a total of 434segments of 62 patients. The dispersion of IQR�M �1.1� was smaller than that of SD �2.4�, suggesting theexistence of outlier in ARFI Vs values. And to reject those outliers, we chose median to represent ARFI Vs

values of each segments. The average of ARFI Vs value of all segments was calculated as the ARFI Vs value

of whole liver.

The laboratory blood tests, which showed statistically a significant correlation to fibrosis staging by

Pearson[s correlation coe$cient, were PT-INR �r�0.57, p�0.001�, ICGR15 �r�0.497, p�0.001�, hyalu-ronic acid �r�0.416, p�0.01�, and Platelet �r��0.436, p�0.01�. ARFI Vs value showed the bestcorrelation �r�0.766, p�0.001� compared to blood results. In this study we showed that fibrosis staging issignificantly a correlate with whole liver sti#ness which was obtained by ARFI, a newly developed

non-invasive imaging technique, which enables us to quantitatively estimate sti#ness of liver.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School ofMedicine.

ARFI ���������� �� 211

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