title: Comparison of Acoustic Structure Quantification (ASQ), shearwave elastography and histology in patients with diffuse hepatopathies.
abstract: BACKGROUND
  Objective of the study was to evaluate the diagnostic value of novel ultrasonographic modalities in comparison with simultaneously performed liver biopsy.
  
  
  METHODS
  The results of simultaneously performed examinations using Acoustic Structure Quantification (ASQ), Virtual Touch Imaging and Quantification (VTIQ) and Virtual Touch Tissue Quantification (VTTQ) were compared with the findings of liver biopsy in patients with a wide variety of diffuse hepatopathies (n = 51). The histologically determined fibrosis stage according to Desmet and Scheuer was compared with quantitative measurements returned by the ultrasonographic imaging modalities.
  
  
  RESULTS
  No statistically significant correlation with histologically determined fibrosis stage could be identified for any measurements returned using ASQ. Increasing severity of hepatic steatosis, however, was associated with a reduction in the focal disturbance (FD) ratio (r = -0.55; p < 0.0001). The shearwave velocities measured using VTTQ satisfyingly correlated with fibrosis stage (r = 0.56; p > 0.0001). Fibrosis stages > F2 were associated with an area under the curve (AUC) of 0.94 (95%-CI:0.84-0.99). A cut-off value for shearwave velocity of 1.66 m/s was determined with a sensitivity of 100% and a specificity of 84 %. VTIQ showed a less pronounced but acceptable correlation with fibrosis stage (r = 0.35; p = 0.0154). For fibrosis stages > F2 analysis showed an AUC of 0.84 (95%-CI:0.70-0.93). The cut-off value was 1.82 m/s with a sensitivity of 100% and a specificity of 58 %.
  
  
  CONCLUSIONS
  While ASQ showed no diagnostic advantage in our patient collective, VTTQ showed high reliability for determining severe liver fibrosis in a group of patients with diffuse liver diseases of different etiology.
authors.affiliation: Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany. jan.keller@uni-ulm.de.
authors.forename: Jan
authors.initials: J
authors.lastname: Keller
authors.affiliation: Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany. tanja.kaltenbach@uniklinik-ulm.de.
authors.forename: Tanja Eva-Maria
authors.initials: TE
authors.lastname: Kaltenbach
authors.affiliation: Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany. mark.hanele@uniklinik-ulm.de.
authors.forename: Mark Martin
authors.initials: MM
authors.lastname: Haenle
authors.affiliation: Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany. suemeyra.oeztuerk@uniklinik-ulm.de.
authors.forename: Suemeyra
authors.initials: S
authors.lastname: Oeztuerk
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany. tilmann.graeter@uniklinik-ulm.de.
authors.forename: Tilmann
authors.initials: T
authors.lastname: Graeter
authors.affiliation: Louis Stokes Cleveland Department of Veterans Affairs Medical Center, 10601 East Boulevard, Cleveland, OH, 44106, USA. richard.Mason2@va.gov.
authors.forename: Richard Andrew
authors.initials: RA
authors.lastname: Mason
authors.affiliation: Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany. thomas.seufferlein@uniklinik-ulm.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Seufferlein
authors.affiliation: Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany. wolfgang.Kratzer@uniklinik-ulm.de.|Universitätsklinikum Ulm, Zentrum für Innere Medizin, Klinik für Innere Medizin I, Albert-Einstein-Allee 23, D-89081, Ulm, Germany. wolfgang.Kratzer@uniklinik-ulm.de.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Kratzer
mesh_terms: D001706:Biopsy; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index