iu22 Liver Shear Wave ElastPQ

Transcription

1 iu22 Liver Shear Wave ElastPQ Clinical Case Study Lucy Wang Clinical Application Specialist ASEAN

2 Case Study: History: 58-year-old male patient, hepatitis B virus (HBV) carrier, with non clinical symptoms presented, with normal Alpha fetoprotein (AFP) test result Patient is monitored with abdominal liver ultrasound scan every six months System information: Philips iu22 xmatrix ultrasound system, C5-1 transducer Findings: Coarsen liver echotexture, with nodular liver surface is observed, No evidence of portal venous hypertension, No focal liver lesions are seen ElastPQ value showed slightly elevated liver stiffness kpa values Suggesting mild liver fibrotic changes 2

3 2D Imaging Liver appears coarsen echotexture Nodular liver surface is observed The nodularity corresponds to the presence of regenerating modules and fibrosis 3

4 Color Doppler Hepatic artery runs parallel with the portal vein in the same direction Smooth fill in of portal vein color Portal vein shows bright, echogenic borders, no intraluminal echoes Normal main portal vein diameter (normal: <13mm) 4

5 Pulse Wave Doppler Normal hepatopedal flow is observed (toward the liver) Normal monophasic portal venous flow with some fluctuation due to respiratory and cardiac activity No evidence of portal venous hypertension 5

6 Shear Wave Point Quantification (ElastPQ) 10 effective ElastPQ samples are taken Average liver stiffness value: 8.66kPa, standard deviation of 0.60kPa, Slightly elevated kpa, suggesting mild fibrotic changes 6

7 ElastPQ Scanning Tips: Inter-costal approach, sample the right lobe, avoid left lobe Avoid breathing or any motion Sample an area free of blood vessels, ligaments or scar tissue; segment 5 is the easiest location Leave ROI box a margin of about 2cm on the sides Avoid liver/kidney interface Store values of effective acquisitions Don t measure the elasticity of fluid, it will create bad reading 7

8 iu22 Liver Shear Wave ElastPQ Preliminary Result Euroson 2012, by Prof Ferraioli, Pavia, Italy (The results were presented as preliminary as the study is still going on, final results will be publically available later this year) The ElastPQ shear wave is a highly reproducible tool for assessing liver elasticity Respect to TE, there is a trend of better performance of ElastPQ shear wave in the diagnosis of significant fibrosis (F>2) in chronic viral hepatitis 8

9 Hitachi Philips iu22 Hitachi Preirus Liver Elastography Shear Wave Point Quantification (ElastPQ) Hitachi Real-time Tissue Elastography (HI-RTE) How it works Shear Wave quantification Strain Data (distributions of Special push pulse is sent out, generates shear waves in the body elasticity in tissue are marked by various colors, Blue sclerosis; Red softness) Additional detection pulse are generated, speed of shear waves is calculated, displayed Does not demonstrate physical elasticity directly, but shows the relative degree of tissue strain on screen and converted into tissue stiffness (an absolute quantification of tissue stiffness) The required liver distortion for future analysis achieved from the rhythmic pulsations of the heart or abdominal aorta Transducers PureWave transducer C5-1, lower frequency transducer for deeper Linear transducer frequency of 4-9 MHz abdominal type of work Measurement Depth 2 8 cm 2 5 cm Measurement Unit kpa or m/s Scoring, Strain histogram measurement Workflow Competitive Offers increased diagnostic confidence absolute stiffness values can be categorized Strain & relocation can vary greatly due to different pressures and frequencies of pressure 9

10 FibroScan Philips FibroScan Remarks Liver Elastography Transducers C5-1 A range of transducers with different frequency Measurement Unit Combined conventional ultrasound imaging with elastography imaging Qualitative Elastography map kpa or m/s /amplitude kpa iu22 Liver ElastPQ has Res/Pen options to assist with challenging patients, Pen for deeper or cirrhotic livers FibroScan for different patient sizes, need to choose different transducer iu22 has the flexibility to meet users preference by choosing kpa (Global standard stiffness measurement unit), or m/s Using the same conventional transducer, a routine liver abdominal scan can be Competitive performed With ultrasound 2D imaging, user is able to identify liver segments, and be able to avoid any vascular structure to be included in the ROI. With ultrasound 2D imaging,, user is able to identify ascites and to avoid sampling the area FibroScan CANNOT be used for patients with ascites 10

11 Conclusion Philips iu22 xmatrix ultrasound system provides integrated & validated offering for liver imaging, including C5-1 Purewave technology, excellent 2D image quality even on most challenging patients, excellent color, Doppler sensitivity ElastPQ can help detect fibrosis and monitor changes over time, increased diagnostic confidence absolute stiffness values can be categorized ElastPQ is user independent and delivers immediate results without a steep learning curve ElastPQ helps increase patient safety and comfort earlier diagnosis, less invasive continual assessment 11

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