Correlation between acoustic radiation force impulse (ARFI)-based tissue elasticity measurements and perfusion parameters acquired by perfusion CT in cirrhotic livers: a proof of principle

• Published in: Journal of medical ultrasonics (2001) 2019-01, Vol.46 (1), p.81-88
• Main Authors: Esser, Michael, Bitzer, Michael, Kolb, Manuel, Fritz, Jan, Kurucay, Mustafa, Ruff, Christer, Horger, Marius
• Format: Article
• Language: English
• Subjects: Acoustic properties; Acoustics; Aged; Aged, 80 and over; Biopsy; Contrast agents; Contrast media; Correlation; Elasticity; Elasticity Imaging Techniques - methods; Female; Flow velocity; Histology; Humans; Hypertension; Imaging; Liver; Liver - blood supply; Liver - diagnostic imaging; Liver - physiopathology; Liver cancer; Liver cirrhosis; Liver Cirrhosis - diagnostic imaging; Liver Cirrhosis - pathology; Liver diseases; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Parameters; Patients; Portal Vein - diagnostic imaging; Portal Vein - physiopathology; Povidone; Proof of Concept Study; Radiation; Radiology; Reproducibility of Results; Review boards; Sound waves; Statistical analysis; Stiffness; Surveillance; Tomography, X-Ray Computed - methods; Ultrasonic imaging; Ultrasound; Veins & arteries; Wave propagation; Wave velocity
• ISSN: 1346-4523; 1613-2254
• DOI: 10.1007/s10396-018-0886-x

Purpose To investigate whether liver stiffness measured by acoustic radiation force impulse (ARFI) sonoelastography always correlates with the liver perfusion parameters quantified by perfusion CT in patients with known liver cirrhosis. Methods Sonoelastography and perfusion CT were performed in 50 patients (mean age 65.5; range 45–87 years) with liver cirrhosis, who were classified according to Child–Pugh into class A (30/50, 60%), B (17/50, 34%), and C (3/50, 6%). For standardized ARFI measurements in the left liver lobe at a depth of 4 cm, a convex 6-MHz probe was used. CT examinations were performed using 80 kV, 100 mAs, and 50 ml of iodinated contrast agent injected at 5 ml/s. Using standardized region-of-interest measurements, we quantified arterial, portal venous, and total liver perfusion. Results There was a significant linear correlation between tissue stiffness and arterial liver perfusion ( p  = 0.015), and also when limiting the analysis to patients with histology ( p  = 0.019). In addition, there was a positive correlation between the total blood supply (arterial + portal-venous liver perfusion) to the liver and tissue stiffness ( p  = 0.001; with histology, p  = 0.027). Shear wave velocity increased with higher Child–Pugh stages ( p  = 0.013). Conclusion The degree of tissue stiffness in cirrhotic livers correlates expectedly—even if only moderately—with the magnitude of arterial liver perfusion and total liver perfusion. As such, liver elastography remains the leading imaging tool in assessing liver fibrosis.