1.
Patients
The subjects were drawn from a consecutive series of 64 ptients who underwent ARFI because of hepatitis by viral,
alchol,
autoimmune at our
institution with serial follow up after 3~9 months studied between August 2011 and November 2012.
All patients had underlying chronic hepatitis including liver cirrhosis.
Of the 64 patinets (21 women,
43 men,
mean age:53.2 years),
49 patients had viral hepatitis (hepatitis B and or C),
and 15 patients had non-viral cause.
2.Ultrasound image acqusition
B-mode ultrasound and Real-time elastography on an Acuson S2000TM system (Siemens,
Mountain View,
CA,
USA) were performed on the all patients for evaluation of elasticity of liver.
In B-mode image,
we devided patients by cirrosis group and non-cirrhotic group.
Liver cirrhosis was suspected when two of the following cirteria were present: (1) nodular aspect of liver surface,
(2) portal vein diameter>12mm,
(3) collateral circulation,
and (4) hypertrophy of segment 4 (quadrate lobe) by reference (Cirrhosis: diagnosis with sonographic study of liver surface.
Radiology 1989;172:389-392)
In the case of all the patinets,
Acuson S2000TM US system with a curved array 4~1 MHz was used.
According to a previous study,
the intercostal approach had the highest rate of success (97.2%),
and left liver lobe measurement yielded significantly high ARFI SWV and value variance (p=0.0016 and p=0.0198) owing to cardiac motion,
when compared with the intercostal approach in the right liver lobe.
Therefore,
Measurement of SWV in liver parenchyma was performed in the right lobe of the liver through the intercostal space after deep expiration to avoid breathing motion with minimal scanning pressure applied by the operation.
The patients were examined in left lateral decubitus position with the right arm in maximum abduction.
A measurement depth of 2 cm below the liver capsule was chosen to standardize the examination,
and the depth ranged between 30 and 80 mm.
Five successful acquisitions in hepatic parenchyma were performed in each patient.
The highest and lowest values were excluded,
and the mean value was obtained with the other 3 numerical values.
Shear wave velocity in liver using ARFI was graded by Metavir score.
Fig. 4: Metavir Scoring system using ARFI by summary of pubulished reports
References: JY Lee et al. 2011, Liver elastography, median cut off value for dignosis in published reports.2011
And all of the patients were follwed up with same method after 3~9months. We evaluated serial change of Metavir score and devided two groups as decreasing group of Metavir score and not-decresing group and also correlated the relationship between degrees of cirrhosis in ultrasonography & change of biochemical activity.
3.
Statistical analysis
Data were entered into SPSS version 11.0 (SPSS,
Inc.,
Munich,
Germany).
A Χ2 or Fisher's exact test (F test ) was used for the comparsion of categorial variables,
and a Mann-Whitney test was used for the comparison of continuous variables.
The significance level was set at 0.05,
and all p values were two tried.
All stastitical analysis were performed with SPSS.