The Application Value In Early Cirrhosis By Acoustic Structure Quantification Technology

Objective Liver Cirrhosis is a chronic progressive liver disease often found clinically,which is the final outcome of many chronic liver disease.Livercirrhosisrefers to the diffuse liver fibrosis,often accompanied by formed abnormal nodules.And it’s frequently accompanied by clinical symptoms, including liver failure, portal hypertension, which will lead to esophageal varices, hepatic encephalopathy, splenomegaly, ascites, cancer and other complications.So it is easy to diagnose. Due to the lack of specificity of clinical symptoms, early liver cirrhosis is not easy for early detection and diagnosis. Recent research shows that it’s possible to achieve earlier intervention and avoid the progression to cirrhosis by early effective detection and assessment. The gold standard for quantitative assessment of early liver cirrhosis is liver biopsy. However, liver biopsy shows various limitations, such as potential sampling error, difficulties repeating the procedure and complications. Non‐invasive alternatives to liver biopsy thus need to be established. The study aimed to validate the application value for acoustic structure quantification(ASQ) technology to be applied in the diagnosis of early liver cirrhosis, meanwhile combined with the receiver operating characteristic(ROC) curve, thus to accurately assess the distinctive index and the critical value of early liver cirrhosis.Between June 2013 and March 2015, we enrolled 40 early liver cirrhosis patients, who were confirmed by liver biopsy,except those hepatitis as with fatty liver, or fatty liver resulted from excessive drinking, drugs or genetic diseases. The ultrasounic images and laboratory parameters areabnormal.(The level of serum protein decreased, but the level is more than 35g/L, bilirubin is less than 35 mol/L, prothrombin activity is greater than 60% and ALT and AST increased slightly) We also enrolled 60 healthy volunteerswithout history of liver disease and related clinical manifestations,whose blood biochemistry parameters are in the normal range and viral infection markers are negative. There is no statistically significant difference between the gender and age of the two groups which are matched. Instrument use Toshiba Aplio500 ultrasonic diagnostic instrument, convex array probe, THI5.0MHz, built in ASQ software. Put the inspected person in the left lateral decubitus,abdomen fully expose, hands are placed on the head. First,we checked 2D ultrasound of liver, avoiding the obvious blood vessels and bile duct structures as far as possible.Then,selected the region of interest(ROI) for liver biopsy, which usually located in the right lobe, the fifth and sixth intercostal space, told subjects to hold breath. then position the ROI on the acquired images free of great vascular structures, and open the ASQ detection to store 3 or 4 seconds dynamic images. Export the dynamic image, and do offline analysis. Position the region of interest at a depth of 4~6 cm depending on the organ dimensions. The area of ROI is more than 30*30cm2. Analysis the dynamic images to obtain the chi‐square histogram of red and blue curves and the related parameters(include mode, average, SD and FD ratio). Repeated for 6 times, removed the extremum, and averaged.At last, according to the ROC curve to judge which is the best to predict the degree of liver fibrosis in early liver cirrhosis patients among the seven ASQ parameters above. Materials and MethodsResults 1.The characteristics of ASQ’s χ2 histogram The red curve is smooth in normal control group, in the horizontal axis, there is a narrow distribution and the peak is slightly larger than or less than 100%, the area under the blue curve is smaller. In early cirrhosis group,red curve is not smooth, the peak is after the normal, which is much higher than 100%, on the horizontal, there is a wide distribution, height and width of the blue curve are increased, the area under the curve was significantly increased. 2. The related parameters of ASQ technology Redmode,redave,red SD,bluemode,blueave,blue SD and FD ratio:There is a significant difference between normal control group and early cirrhosis group.(99.93±2.02 VS 108.25±6.70,103.72±2.05 VS 112.24±6.48,14.94±1.58 VS 17.25±1.91,116.66±9.94 VS 126.45±6.34,124.30±10.11 VS 137.26±7.99, 20.62±9.15 VS 27.97±7.93, 0.0529±0.0260 VS 0.2694±0.1737,P<0.05)。 3. The area under the ROC curve(AUC) Draw the ROC curve,calculated AUC, determined cut‐off values, and compared the sensitivity and specificity of the different parameters.When the AUC beyond 0.7, the parameter diagnose early liver cirrhosis was valuable. Among the above seven parameters, the AUC values of redmode,redave,red SD,bluemode,blueave,blue SD and FD ratio were 0.878(95%CI:0.807~0.948),0.858(95%CI:0.782~0.934),0.824(95%CI:0.744~0.904),0.876(95%CI:0.803~0.949),0.837(95%CI:0.755~0.919),0.782(95%CI:0.693~0.872),0.934(95%CI:0.890~0.978) respectively. Compared with AUC equals 0.5, statistically significant differences were found between them(P<0.01).When the AUC value is beyond 0.9,the accuracy of diagnosis is high.So FD ratio is more valuable in diagnosing early liver cirrhosis. The best cut‐off value of FD ratio for diagnosing early liver cirrhosis was 0.1033,with sensitivity and specificity of 76% and 98.2% respectively.Conclusion 1. ASQ is sonographic software that performs a quantitative analysis to assess fibrosis with statistical information from ultrasound echo signals. 2. ASQ measures the difference between a theoretical distribution of echo amplitudes obtained by the statistical analysis and that real of echo amplitudes recorded in the case under examination. This technology has overcome the inherent subjectivity of judging experience, making clinical ultrasound diagnosis of early liver cirrhosis more objective and more scientific,improving high accuracy of diagnosis. 3. In the 7 parameters of ASQ, the AUC for diagnosis of early liver cirrhosis with FD ratio was 0.934(95%CI : 0.890~0.978), with the best cut‐off value equals to 0.1033. The sensitivity and specificity respectively equal to 76% and 98.2%. Compared with other parameters of ASQ, there is a close correlation between FD ratio and the degree of histologically evaluated early cirrhosis. 4. ASQ technology is expected to become a new method to diagnose early liver cirrhosis noninvasively.