Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan.
Eur J Radiol. 2013 Jun;82(6):929-34. doi: 10.1016/j.ejrad.2013.01.015. Epub 2013 Feb 28.
To examine the potential utility of 3D-reconstructed sonograms to distinguish cirrhotic from non-cirrhotic livers by demonstrating hepatic surface characteristics.
A preliminary phantom study was performed to examine the potential resolution of 3D images, recognizing surface irregularities as a difference in height. In a prospective clinical study of 31 consecutive patients with ascites (21 cirrhosis, 10 non-cirrhosis), liver volume data were acquired by transabdominal mechanical scanning. The hepatic surface features of cirrhotic and non-cirrhotic patients were compared by 2 independent reviewers. Intra- and inter-operator/reviewer agreements were also examined.
The phantom study revealed that 0.4mm was the minimum recognizable difference in height on the 3D sonograms. The hepatic surface image was successfully visualized in 74% patients (23/31). Success depended on the amount of ascites; visualization was 100% with ascites of 10mm or more between the hepatic surface and abdominal wall. The images showed irregularity of the hepatic surface in all cirrhotic patients. The surface appearance was confirmed as being very similar in 3 patients who had both 3D sonogram and liver resection for transplantation. The ability to distinguish cirrhotic liver from non-cirrhotic liver improved with the use of combination of 2D- and 3D-imaging versus 2D-imaging alone (sensitivity, p=0.02; accuracy, p=0.02) or 3D-imaging alone (sensitivity, p=0.03). Intra-/inter-operator and inter-reviewer agreement were excellent (κ=1.0).
3D-based sonographic visualization of the hepatic surface showed high reliability and reproducibility, acting as a virtual laparoscopy method, and the technique has the potential to improve the diagnosis of cirrhosis.
通过显示肝脏表面特征，研究 3D 重建超声对区分肝硬化和非肝硬化肝脏的潜在应用价值。
初步的体模研究旨在检查 3D 图像的潜在分辨率，通过高度差异识别表面不规则性。在一项连续 31 例腹水患者（21 例肝硬化，10 例非肝硬化）的前瞻性临床研究中，通过经腹机械扫描获取肝脏体积数据。由 2 位独立的观察者对肝硬化和非肝硬化患者的肝脏表面特征进行比较。还检查了内部和外部操作者/观察者之间的一致性。
体模研究表明，3D 超声上可识别的最小高度差异为 0.4mm。在 74%的患者（23/31）中成功地可视化了肝脏表面图像。成功取决于腹水的量；当肝脏表面和腹壁之间的腹水为 10mm 或更多时，可视化率为 100%。图像显示所有肝硬化患者的肝脏表面不规则。在 3 位同时进行 3D 超声和肝移植切除手术的患者中，确认了肝脏表面的外观非常相似。与单独使用 2D 成像相比，使用 2D-和 3D 成像的组合（敏感性，p=0.02；准确性，p=0.02）或单独使用 3D 成像（敏感性，p=0.03）可提高区分肝硬化肝脏和非肝硬化肝脏的能力。内部/外部操作者和观察者之间的一致性非常好（κ=1.0）。
基于 3D 的肝脏表面超声可视化具有高度的可靠性和可重复性，可作为一种虚拟腹腔镜方法，该技术有可能改善对肝硬化的诊断。
