The Application Of Contrast-enhanced Ultrasonography Parameters In Evaluation Liver Reserve Function Of Cirrhosis

Purpose:This study was aimed to explore the application value of contrast-enhanced ultrasound(CEUS)parameters in liver reserve function of cirrhosis.Materials and methods:Fifty subjects were enrolled from June 2019 to February 2020,of which 20 were healthy and 30 were cirrhosis(Child-Pugh A: 20,Child-Pugh B: 10).All subjects underwent two-dimensional ultrasound(2D)scan of the liver,and selected the best scan sections showing portal vein,hepatic artery,and hepatic vein at the same time.Then injected the second-generation ultrasound contrast agent(SonoVue)2.4ml through the anterior cubital vein,acquisition of the best dynamic image for offline analysis by GE LOGIQ E9 ultrasound diagnostic instrument.Two physicians independently observed the entire process of contrast-enhanced ultrasound and recorded the arriving time of hepatic artery,portal vein,hepatic vein(HAAT、PVAT、HVAT)and wash-out time of hepatic vein(HVWT),then calculated the transit time of hepatic artery to hepatic vein(HA-HVTT)and portal vein to hepatic vein(PV-HVTT).Take the average of each parameter as the final result.The difference analyses of all parameters between normal and cirrhosis and the correlation analyses of the indocyanine green retention rate at 15 min(ICG-R15)with HVAT、HVWT、HA-HVTT、PV-HVTT were performed,and the diagnostic ability as well as optimal cut-off values of HVAT and HVWT for differentiating patients with ICG-R15>14% from ICG-R15≤14% were analyzed.HAAT 、PVAT 、HVAT and HVWT were measured by directly visualization of contrast enhanced ultrasound.Results:(1)Comparison of parameters between control and cirrhosis: The time of HVAT 、HVWT 、HA-HVTT 、PV-HVTT between normal and cirrhosis were 24.90±3.73s(21.60±1.63s)、 131.10±16.37s(192.60±52.33s)、 13.45±2.58s(9.73±2.03s)、 9.70±2.33s(5.27±1.89s),the difference was statistically significant(P= 0.001,0.00,0.00,0.00),and HAAT 、 PVAT were not statistically different between the two groups(2)Correlation between parameters(HVAT,HVWT,HA-HVTT,PV-HVTT)and ICG-R15: There were significant correlations of ICG-R15 with HVAT and HVWT,and the correlation coefficients were-0.444(P=0.014)and 0.554(P = 0.001),respectively.No correlation of ICG-R15 with HA-HVTT and PV-HVTT was found in this study.(3)Receiver operating characteristic curve were performed to evaluate the cutoff values and diagnosibility of parameters to diagnose ICG-R15 > 14%.a)HVAT: when HVAT < 21.51 s,the sensitivity,specificity,positive predictive value,negative predictive value,Youden and area under the ROC curve are 70.6%,76.9%,80.0%,66.67%,0.475,0.77,respectively.b)HVWT: when HVWT > 158 s,the sensitivity,specificity,positive predictive value,negative predictive value,Youden and area under the ROC curve are 88.2%,53.8%,71.43%,77.78%,0.42,0.76,respectively.(4)Comparison of sensitivity and specificity between HVAT and HVWT in the diagnosis of ICG-R15 > 14%: no statistical difference(P = 0.25,0.25).Conlusion:Contrast-enhanced ultrasound parameters(HVAT,HVWT)are significantly correlated with cirrhosis ICG-R15,which can be used as new indicators to evaluate liver reserve function of cirrhosis.