Attenuation Measuring Ultrasound Shearwave Elastography (AMUSE) as Noninvasive Imaging Biomarker for Liver Acute Cellular Rejection

IF 2.4 3区医学 Q2 ACOUSTICS Ultrasound in Medicine and Biology Pub Date : 2024-10-16 DOI:10.1016/j.ultrasmedbio.2024.09.018

Luiz Vasconcelos , John Grady , Sara Aristizabal , Rebeca Oliveira , Matthew W. Urban , Shigao Chen , William Sanchez , James F. Greenleaf , Ivan Nenadic

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Abstract

Objective

There are over 9000 liver transplants in the United States per year, with acute cellular rejection (ACR) being a prevalent early post-transplant complication (20%–40%) treated using corticosteroids. Ischemia-reperfusion injury (IRI), another early post-transplant pathology, has similar laboratory results but typically resolves without therapy. ACR confirmation requires invasive liver biopsy, bearing risks like hemorrhage and pneumothorax. Attenuation Measuring Ultrasound Shearwave Elastography (AMUSE) assesses shear wave velocity (c) and attenuation (α) without rheological models and have shown potential for noninvasive tissue characterization.

Methods

We analyzed 58 transplanted livers suspected for ACR by comparing AMUSE measurements to biopsy findings. Thirteen patients underwent longitudinal tracking from ACR diagnosis on day 7 to therapy initiation and repeat biopsy on day 14. Statistical methods and support vector machine (SVM) were used for performance analysis.

Results

AMUSE measurements at 100, 200, and 300 Hz showed statistical significance (p < 0.001) for ACR presence, with 200 Hz exhibiting the highest Spearman correlation coefficients for c and α (0.68 and -0.83). High c (> 2.2 m/s) and low α (< 130 Np/m) at 200 Hz correlated with ACR diagnostic, while low c and high α indicated no ACR. Combining c and α into a single biomarker α/c improved patient differentiation, yielding an F1-score of 0.97. SVM was used to evaluate AMUSE ACR staging capabilities using all available frequencies, reaching 0.95 F1-score for categorical classification, with an AUROC of 0.99. When evaluating the presence of ACR the SVM reached 0.99 F1-score, with 1.00 sensitivity/recall.

Conclusion

These findings support the use of AMUSE potential for detection and staging of liver ACR.

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衰减测量超声剪切波弹性成像（AMUSE）作为肝脏急性细胞排斥反应的无创成像生物标记。

目的：美国每年有 9000 多例肝脏移植手术，急性细胞排斥反应（ACR）是移植后早期并发症的常见病（20%-40%），使用皮质类固醇进行治疗。缺血再灌注损伤（IRI）是另一种移植后早期病理现象，其实验室结果类似，但通常无需治疗即可缓解。ACR 确认需要进行侵入性肝活检，存在出血和气胸等风险。衰减测量超声剪切波弹性成像（AMUSE）无需流变学模型即可评估剪切波速度（c）和衰减（α），已显示出无创组织特征描述的潜力：我们通过比较 AMUSE 测量值和活检结果，对 58 例疑似 ACR 的移植肝进行了分析。13 名患者接受了从第 7 天确诊 ACR 到开始治疗和第 14 天重复活检的纵向追踪。采用统计方法和支持向量机（SVM）进行性能分析：100、200 和 300 Hz 的 AMUSE 测量结果显示 ACR 存在的统计学意义（p < 0.001），其中 200 Hz 的 c 和 α 的 Spearman 相关系数最高（0.68 和 -0.83）。200 赫兹的高 c（> 2.2 m/s）和低 α（< 130 Np/m）与 ACR 诊断相关，而低 c 和高α则表示没有 ACR。将 c 和 α 合并为单一生物标志物 α/c 可提高患者分辨能力，其 F1 分数为 0.97。使用 SVM 评估 AMUSE ACR 分期能力时，使用了所有可用的频率，分类分类的 F1 分数为 0.95，AUROC 为 0.99。在评估是否存在 ACR 时，SVM 的 F1 分数为 0.99，灵敏度/召回率为 1.00：这些研究结果支持使用 AMUSE 电位对肝脏 ACR 进行检测和分期。

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来源期刊

Ultrasound in Medicine and Biology 医学-核医学

CiteScore

6.20

自引率

6.90%

发文量

325

审稿时长

70 days

期刊介绍： Ultrasound in Medicine and Biology is the official journal of the World Federation for Ultrasound in Medicine and Biology. The journal publishes original contributions that demonstrate a novel application of an existing ultrasound technology in clinical diagnostic, interventional and therapeutic applications, new and improved clinical techniques, the physics, engineering and technology of ultrasound in medicine and biology, and the interactions between ultrasound and biological systems, including bioeffects. Papers that simply utilize standard diagnostic ultrasound as a measuring tool will be considered out of scope. Extended critical reviews of subjects of contemporary interest in the field are also published, in addition to occasional editorial articles, clinical and technical notes, book reviews, letters to the editor and a calendar of forthcoming meetings. It is the aim of the journal fully to meet the information and publication requirements of the clinicians, scientists, engineers and other professionals who constitute the biomedical ultrasonic community.

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