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Limitations and artifacts in shear-wave elastography of the liver

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Abstract

Recent studies have shown that real-time, two-dimensional shear-wave elastography (2D-SWE) can monitor liver fibrosis by measuring tissue elasticity (i.e., elastic modulus). Two clinical studies of 2D-SWE in the liver have shown that there are several practical issues that can compromise quantitation of liver tissue elasticity. Both general ultrasound (US) limitations and limitations in the 2D-SWE method itself resulted in significant variability in estimated liver elasticity. The most common US limitations were: poor acoustic window, limited penetration, and rib/lung shadows. The most common 2D-SWE limitations were: reverberations under the liver capsule, respiratory/cardiac motion, and vessel pulsation/loss of SWE signal. Based on these studies, scan protocols have been optimized to minimize the influence of these limitations on liver elasticity quantification. These refined protocols should move non-invasive SWE closer to becoming the preferred tool to diagnose and manage many chronic diseases of the liver.

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References

  1. Ghany MG, Strader DB, Thomas DL, Seeff LB, American Association for the Study of Liver Diseases. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology. 2009;49(4):1335–74.

    Article  Google Scholar 

  2. American Association for the Study of Liver Diseases; Infectious Diseases Society of America. [Accessed 16 Feb 2017]; Recommendations for testing, managing, and treating hepatitis C. http://www.hcvguidelines.org. Published 2016.

  3. Bedossa P, Dargere D, Paradise V. Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology. 2003;38:1449–57.

    Article  Google Scholar 

  4. Castera L, Pinzani M, Bosch J. Noninvasive evaluation of portal hypertension using transient elastography. J Hepatol. 2012;56:696–703.

    Article  Google Scholar 

  5. Ferraioli G, Tinelli C, Dal Bello B, Zicchetti M, Lissandrin R, Filice G, Filice C. Performance of liver stiffness measurements by transient elastography in chronic hepatitis. World J Gastroenterol. 2013;19(1):49–56.

    Article  Google Scholar 

  6. Castera Laurent. Noninvasive methods to assess liver disease in patients with hepatitis B or C. Gastroenterology. 2012;142(6):1293–302.

    Article  Google Scholar 

  7. Barr RG, Ferraioli G, Palmeri ML, Ehmans RL, Goodman ZD, Myers R, Rubin J, Garra B, Garcia-Tsao G, Wilson SR, Rubens D, Levine D. Elastography assessment of liver fibrosis: Society of Radiologists in Ultrasound consensus conference statement. Radiology. 2015;276(3):845–61.

    Article  Google Scholar 

  8. Ferraioli G, Tinelli C, Dal Bello B, Zicchetti M, Filice G, Filice C, on behalf of the Liver Fibrosis Study Group. Accuracy of real-time shear wave elastography for assessing liver fibrosis in chronic hepatitis C: a pilot study. Hepatology. 2012;56(6):2125–33.

    Article  Google Scholar 

  9. Ferraioli G, Filice C, Castera L, Choi BI, Sporea I, Wilson S, Cosgrove D, Dietrich CF, Amy D, Bamber JC, Barr R, Chou YH, Ding H, Farrokh A, Friedrich-Rust M, Hall TJ, Nakashima K, Nightingale KR, Palmeri ML, Schafer F, Shiina T, Suzuki S, Kudo M. WFUMB guidelines and recommendations on the clinical use of ultrasound elastography PART 3: liver. Ultrasound Med Biol. 2015;41(5):1161–79.

    Article  Google Scholar 

  10. Petitclerc L, Sebastiani G, Gilbert G, Cloutier G, Tang A. Liver fibrosis: review of current imaging and MRI quantification techniques. J Magn Reson Imaging. 2017;45(5):1276–95.

  11. Bert F, Stahmeyer JT, Rossol S. Ultrasound elastography used for preventive non-invasive screening in early detection of liver fibrosis. J Clin Med Res. 2016;8(9):650–5.

    Article  Google Scholar 

  12. Ferraioli G, Parekh P, Levitov AB, Filice C. Shear wave elastography for evaluation of liver fibrosis. J Ultrasound Med. 2014;33(2):197–203.

    Article  Google Scholar 

  13. Friedrich-Rust M, Poynard T, Castera L. Critical comparison of elastography methods to assess chronic liver disease. Nat Rev Gastroenterol Hepatol. 2016;13(7):402–11.

  14. Bercoff J, Muller M, Tanter M, Fink M. Study of viscous and elastic properties of soft tissues using supersonic shear imaging. IEEE Ultrason Symp. 2003;1:925–8.

    Google Scholar 

  15. Deffieux T, Montaldo G, Tanter M, Fink M. Shear wave spectroscopy for in vivo quantification of human soft tissues visco-elasticity. IEEE TMI. 2009;28(3):313–22.

    Google Scholar 

  16. Gennisson JL, Deffieux T, Fink M, Tanter M. Ultrasound elastography: principles and techniques. Diagn Interv Imaging. 2013;94:487–95.

    Article  Google Scholar 

  17. Bercoff J, Chaffai S, Tanter M, Sandrin L, Catheline S, Fink M, Gennisson JL, Meunier M. In vivo breast tumor detection using transient elastography. Ultrasound Med Biol. 2003;29(10):1387–96.

    Article  Google Scholar 

  18. Sarvazyan AP, Rudenko OV, Swanson SD, Fowlkes JB, Emelianov SY. Shear wave elasticity imaging: a new ultrasonic technology of medical diagnostics. Ultrasound Med Biol. 1998;24(9):1419–35.

    Article  Google Scholar 

  19. Nightingale K, McAleavey S, Trahey G. Shear-wave generation using acoustic radiation force: in vivo and ex vivo results. Ultrasound Med Biol. 2003;29(12):1715–23.

    Article  Google Scholar 

  20. Bercoff J, Tanter M, Fink M. Supersonic shear imaging: a new technique for soft tissue elasticity mapping. IEEE Trans Ultrason Ferroelectr Freq Control. 2004;51(4):396–409.

    Article  Google Scholar 

  21. Hall TJ, Milkowski A, Garra B, Carson PL, Palmeri M, Nightingale K, Lynch T, Alturki A, Andre M, Audiere S, Bamber J, Barr RG, Bercoff J, Bercoff J, Bernal M, Brum J, Chan HW, Chen S, Cohen-Bacrie C, Couade M, Daniels AU, deWall RJ, Dillman JR, Ehman RL, Franchi-Abella SF, Fromageau J, Gennisson JL, Henry JP, Ivancevich N, Kalin J, Kohn S, Kugel JL, Lee KS, Liu NL, Loupas T, Mazernik J, McAleavey S, Miette V, Metz S, Morel BM, Nelson T, Nordberg E, Oudry J, Padwal M, Rouze N, Samir A, Sandrin L, Schaccitti J, Schmitt C, Shamdasani V, Song P, Switalski P, Wang M, Wear K, Xie H, Zhao H. RSNA/QIBA: Shear wave speed as a biomarker for liver fibrosis staging. Prague: IEEE International Ultrasonics Symposium; 2013.

    Google Scholar 

  22. Song P, et al. Two-dimensional shear-wave elastography on conventional ultrasound scanners with time-aligned sequential tracking (TAST) and comb-push ultrasound shear elastography (CUSE). IEEE Trans Ultrason Ferroelectr Freq Control. 2015;62(2):290–302.

    Article  Google Scholar 

  23. Zhao H, Song P, Urban MW, Kinnick RR, Yin M, Greenleaf JF, Chen S. Bias observed in time-of-flight shear wave speed measurements using radiation force of a focused ultrasound beam. Ultrasound Med Biol. 2011;37(11):1884–92.

    Article  Google Scholar 

  24. Cassinotto C, Boursier J, de Ledinghen V, Lebigot J, Lapuyade B, Cales P, Hiriart J-B, Michalak S, Le Bail B, Cartier V, Mouries A, Oberti F, Fouchard-Hubert I, Vergniol J, Aube C. Liver stiffness in nonalcoholic fatty liver disease: a comparison of supersonic shear imaging, FibroScan, and ARFI with liver biopsy. Hepatology. 2016;63(6):1817–27.

    Article  Google Scholar 

  25. European Federations of Societies for Ultrasound in Medicine and Biology; [Accessed 28 March 2017]; EFSUMB Guidelines and Recommendations on the Clinical Use of Ultrasound Elastography. http://www.efsumb.org/guidelines/guidelines-elastography.asp. Published 2017.

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Acknowledgements

This work was supported in part by NIH RO1EB016034, R01CA170734, R01HL121226, RO1HL125339, R01EY026532, and Life Sciences Discovery Fund 3292512. We also thank Jeff Thiel and Manjiri Dighe of the University of Washington, for assistance in capturing clinical data.

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Authors and Affiliations

  1. Applied Physics Lab, University of Washington, Seattle, WA, 98195, USA

    Matthew Bruce

  2. Department of Radiology, University of Washington, Seattle, WA, 98195, USA

    Orpheus Kolokythas

  3. Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100, Pavia, Italy

    Giovanna Ferraioli & Carlo Filice

  4. Department of Bioengineering, University of Washington, Seattle, WA, 98195, USA

    Matthew O’Donnell

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  1. Matthew Bruce
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  2. Orpheus Kolokythas
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  3. Giovanna Ferraioli
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  4. Carlo Filice
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Correspondence to Matthew O’Donnell.

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Bruce, M., Kolokythas, O., Ferraioli, G. et al. Limitations and artifacts in shear-wave elastography of the liver. Biomed. Eng. Lett. 7, 81–89 (2017). https://doi.org/10.1007/s13534-017-0028-1

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  • DOI: https://doi.org/10.1007/s13534-017-0028-1

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