title: Relationship between the liver tissue shear modulus and histopathologic findings analyzed by intraoperative shear wave elastography and digital microscopically assisted morphometry in patients with hepatocellular carcinoma.
abstract: OBJECTIVE
  Shear wave elastography is a novel noninvasive method for assessing liver fibrosis by measuring liver stiffness. This study was conducted to evaluate how pathologic changes could have an impact on measured elasticity values in both resected hepatocellular carcinomas and adjacent liver tissue.
  
  
  METHODS
  Intraoperative shear wave elastography was performed in 7 patients who underwent liver resection at our institution; 7 hepatocellular carcinomas and adjacent liver tissue were subjected to elastographic measurements. A total of 48 circular regions of interest (ROIs; 3-8 mm in diameter) were located in the hepatocellular carcinomas (n = 37) and adjacent liver tissue (n = 11), and mean stiffness values were obtained from each ROI. All of the histologic images corresponding to the 48 ROIs after surgery were transformed into digital microscopic images by a scanning system, and histologic parameters, such as the proportions of nuclear areas, fatty areas, fibrous areas, and vessel areas, were quantitatively assessed. Relationships between the mean stiffness and the histologic parameters were investigated by the mixed effects model.
  
  
  RESULTS
  By univariate analysis, the proportions of collagen fiber areas (P = .039), fibrous areas (P = .045), hepatocellular nuclear areas (P = .045), and nuclear areas other than hepatocellular and lymphoplasmacytic areas (P = .039) showed statistically positive associations with mean stiffness values. Multivariate analysis indicated that the proportion of collagen fiber areas was the strongest pathologic determinant of mean stiffness (P = .008), with hepatocellular nuclear areas also having a significant effect (P = .010).
  
  
  CONCLUSIONS
  Fibrosis predictably affects elastographic estimation, but hepatocellular density (ie, hepatocellular nuclear areas) also alters elastographic assessment.
authors.affiliation: Department of Gastro enterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan. sugimoto@tokyo-med.ac.jp.
authors.forename: Mitsuyoshi
authors.initials: M
authors.lastname: Honjo
authors.forename: Fuminori
authors.initials: F
authors.lastname: Moriyasu
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Sugimoto
authors.forename: Hisashi
authors.initials: H
authors.lastname: Oshiro
authors.forename: Kentaro
authors.initials: K
authors.lastname: Sakamaki
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Kasuya
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nagai
authors.forename: Akihiko
authors.initials: A
authors.lastname: Tsuchida
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Imai
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000503:physiopathology*; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology* / Q000503:physiopathology*; D008113:Liver Neoplasms / Q000473:pathology* / Q000503:physiopathology*; D008297:Male; D008853:Microscopy / Q000379:methods; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted
keywords: digital microscopy; elastography; gastrointestinal ultrasound; hepatocellular carcinoma; shear wave imaging; sonography