title: Acoustic radiation force impulse imaging predicts postoperative ascites resulting from curative hepatic resection for hepatocellular carcinoma.
abstract: BACKGROUND
  Measurement of liver stiffness using Virtual Touch Tissue Quantification (VTTQ) based on acoustic radiation force impulse imaging reflects the degree of hepatic fibrosis and reserve. This prospective study investigated how well the VTTQ value predicts the development of postoperative complications before curative hepatic resection for hepatocellular carcinoma (HCC).
  
  
  METHODS
  The study enrolled 50 consecutive patients between February 2009 and October 2010 whose preoperative VTTQ values were determined before they underwent curative hepatic resection for HCC. We assessed the relationship between postoperative complications and VTTQ values.
  
  
  RESULTS
  The study included 41 (82%) patients with chronic hepatitis and 9 (18%) with nonviral cirrhosis. The mean VTTQ value was 1.60 (m/sec), which correlated with the fibrosis stage (P = .0058). The VTTQ value was the only variable correlated with postoperative ascites that did not respond to pharmacologic treatment and required invasive management. Univariate and subsequent multivariate analyses revealed that the preoperative VTTQ value was the only independent risk factor for predicting the development of postoperative ascites (cutoff, 1.68 cm/sec; P = .007; odds ratio, 76.481). The area under the receiver operating characteristic curve for the diagnosis of postoperative ascites using VTTQ values was 0.90, whereas those using the aspartate transaminase-to-platelet ratio index and indocyanine green retention rate at 15 minutes values were 0.68 and 0.55, respectively.
  
  
  CONCLUSIONS
  These data suggest that the VTTQ value is a reliable surrogate marker for predicting postoperative ascites before curative hepatic resection for HCC.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Harada
authors.forename: Ken
authors.initials: K
authors.lastname: Shirabe
authors.forename: Hideki
authors.initials: H
authors.lastname: Ijichi
authors.forename: Rumi
authors.initials: R
authors.lastname: Matono
authors.forename: Hideaki
authors.initials: H
authors.lastname: Uchiyama
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Yoshizumi
authors.forename: Akinobu
authors.initials: A
authors.lastname: Taketomi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Soejima
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000368:Aged; D001201:Ascites / Q000175:diagnosis* / Q000473:pathology; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D004548:Elasticity; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology / Q000601:surgery*; D008103:Liver Cirrhosis / Q000473:pathology; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010865:Pilot Projects; D011183:Postoperative Complications / Q000175:diagnosis* / Q000473:pathology; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014110:Touch; D014584:User-Computer Interface