acoustic radiation force impulse arfiigakukai.marianna-u.ac.jp/idaishi/www/3734/3,4-37-4gaku... ·...
TRANSCRIPT
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����Acoustic Radiation Force Impulse Imaging, ARFI Imaging,
Elasticity Imaging Techniques, Liver Fibrosis
FG+ ®q*{H��TyXW+ RS33¯3k+ °4 ±²lT5pa+ HBIs�³b3e´µ"VWX#1�4�, HBI_,�V#¶&q]Y_+
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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
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
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$cient, were PT-INR �r�0.57, p�0.001�, ICGR15�r�0.497, p�0.001�,hyaluronic acid �r�0.416, p�0.01�, and Platelet �r��0.436, p�0.01�.�a� PT-INR �b� ICG R15 �c� hyaluronic acid �d� Plt
Fig. 5. Correlation between ARFI Vs values and fibrosis stages.
The ARFI Vs value correlated remarkably with the fibrosis stage. ARFI Vs value showed the
best correlation �r�0.766, p�0.001� compared to blood tests.
ARFI ���������� �� 207
31
hyaluronic acid� PIIINP� g-Glb ���� typeIV col-lagen� a2M� T-Bil� ZTT ���� �Table. 1�� ���� PT-INR� ICG R15� Plt� hyaluronic acid �p�0.01 ��� ������������������� ���� �� !"#�$���%����� 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.
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32
����������� ��������������� ��� ���� ������ !"#$%&�'()*+����,�-./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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"#$% �&'( )210
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Abstract
Utility of Non-invasive Method Using Acoustic Radiation Force
Impulse �ARFI� Imaging for Measurement of Liver Fibrosis
Gaku Igarashi, Fumio Tsujimoto, Nobuyuki Matsumoto, Masasumi Miyazaki,
Atsuki Koike, Takanori Okamura, Masaru Sakurai, Masaru Okamoto,
Yuuki Ikeda, Hideaki Takahashi, Koutarou Matsunaga, Yoshiki Katakura,
Chiaki Okuse, Satoshi Koizumi, Takeshi Asakura, Hiroshi Nakano,
Masayuki Takagi, Yasuo Nakajima, Sachihiko Nobuoka, Takehito Otsubo,
Michihiro Suzuki, and Fumio Ito
The accurate diagnosis of fibrosis related to chronic liver diseases is crucial for prognostication and
treatment decisions. Although liver biopsy is the gold standard, it has limitations because of its invasive
nature. Thus development of new non-invasive methods is desired to diagnose hepatic fibrosis. Recently,
acoustic radiation force impulse �ARFI� imaging has been developed as a non-invasive modality to evaluatesti#ness of tissues. ARFI imaging theoretically measures liver sti#ness of all the segments independently.
However, there are no reports for the attempt to diagnose liver fibrosis with ARFI imaging. The aim of this
study is to assess the applicability of ARFI imaging for the diagnosis of liver fibrosis. The study enrolled 20
healthy volunteers as a control group 42 patients diagnosed as chronic liver disease. From these patients, we
classified 11 patients with F1, 17 with F2, 5 with F3, 9 with F4 accouding to pathological fibrosis staging by
the new Inuyama classification. ARFI Vs values were acquired with a Siemens Acuson S2000 �SiemensMedical Systems, Germany�, which has been modified to obtain ARFI images. We obtained ARFI Vsvalues from S2 to S8 of Cuinaud[s segmentation system by 3 consecutive measurements. ARFI Vs values of
S1 was excluded from the study, because of the location with di$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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