Liver disease
A global health concern
With increasing prevalence, Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) is the most common cause of chronic liver disease worldwide and a growing public health concern. It is a silent condition that can progress from steatohepatitis into fibrosis, and eventually cirrhosis – a major factor for liver transplants and mortality.
Liver analysis package
Diffuse liver disease represents a significant burden on the global health community. Non Alcoholic Fatty Liver Disease (NAFLD) is one of the most important causes of liver disease globally, creating an increasing burden on health systems. Globally NAFLD affects upwards of 20% of the world’s population, reaching as high as 35% in some regions. With concerning trends in childhood obesity, creating an increased risk of NAFLD in later life. Fatty liver disease is related to life-style factors, such as diet, exercise and alcohol consumption and can lead to cirrhosis and liver failure.
The Aplio series diagnostic ultrasound system incorporates the latest generation architecture and advanced transducer technology to deliver a new level of image quality. The newly developed liver tools aim to support clinicians to evaluate diffuse liver disease easier and faster.
Liver disease imaging is one of the major challenges faced by clinicians due to a wide range of pathologies that have overlapping appearances on medical imaging. To provide the diagnostic confidence and clarification needed, new and unique imaging tools have been developed to allow visualisation of changes in liver status.
Ultrasound diagnosis of the fatty liver using B-mode is difficult to reproduce and has a high degree of inter observer error. The ability to accurately and non-invasively grade the degree of “fatty” will help clinicians diagnose this condition more accurately and earlier.
The Aplio series diagnostic ultrasound system incorporates the latest generation architecture and advanced transducer technology to deliver a new level of image quality. The newly developed liver tools aim to support clinicians to evaluate diffuse liver disease easier and faster.
Liver disease imaging is one of the major challenges faced by clinicians due to a wide range of pathologies that have overlapping appearances on medical imaging. To provide the diagnostic confidence and clarification needed, new and unique imaging tools have been developed to allow visualisation of changes in liver status.
Ultrasound diagnosis of the fatty liver using B-mode is difficult to reproduce and has a high degree of inter observer error. The ability to accurately and non-invasively grade the degree of “fatty” will help clinicians diagnose this condition more accurately and earlier.
Aplio i-series liver Analysis
Covering the full range of liver disease
Liver disease is one of the major challenges in imaging today, with a wide range of pathologies. To provide the diagnostic confidence needed, new and unique imaging tools have been developed to allow visualisation of changes in liver status.
Attenuation Imaging (ATI)
Quantify and color-code changes in the liver composition (e.g. fat content)
Using statistical analysis of the attenuation throughout the region of interest, the system is able to quantify the accuracy of the sample. This provides information regarding the uniformity of the attenuation which is important for accuracy.
- As the ultrasound wave is transmitted though tissue, it is attenuated through the process of scatter, absorption and heat.
- The amount of attenuation is proportional to the frequency.
Shear Wave Dispersion (SWD)
Adds tissue viscosity to the routine stiffness assessment of Shear Wave Elastography
Tissue stiffness changes are common in liver disease, but any viscosity changes associated with disease processes such as fatty infiltration were not able to be assessed until now. The combination of SWE and SWD adds both stiffness and viscosity information for a more complete liver assessment.
In cases of liver inflammation, the liver becomes more viscous. It is these changes that SWD is quantifying.
In cases of liver inflammation, the liver becomes more viscous. It is these changes that SWD is quantifying.
Shear Wave Elastography (SWE)
Non-invasive, quantitative assessment of tissue stiffness
Canon's shear wave technology provides a quantitative measure and dynamic visual display of tissue stiffness in a variety of clinical settings.
Shear waves are generated by means of an ultrasonic burst (left). Depending on tissue properties, shear waves travel at varying speed. Canon's unique propagation mode can be used to confirm the quality of the shear wave generation (right).
- Overcoming complications / limitations of biopsy
- 5 smart maps to visualise and quantify shear wave propagation in real time, including a variance map
- Canon unique propagation maps actually show shearwave propagation through the tissue
- This assists in measurement placement ensuring accuracy, reproducibility and best practice
- One shot or continuous mode scanning allowing multiple measurements from one acquisition and quicker examination times
- Push pulse optimised for deeper regions
Shear waves are generated by means of an ultrasonic burst (left). Depending on tissue properties, shear waves travel at varying speed. Canon's unique propagation mode can be used to confirm the quality of the shear wave generation (right).
Multi-Parametric Report
Reporting for liver applications
Multi-parametric report which can combine results from both ultrasound as well as external exams (such as blood tests) for a combined result. This unique ability to bring multiple test results and combine into a single report can allow a more comprehensive understanding of liver status.
Results can be viewed in tabular format or as a spider plot (where the shape of the combined result mapping can give information on relationships between results in a visual way).
Multi-parametric report for the following liver applications:
- Shear Wave Elastography
- Shear Wave Dispersion map
- Attenuation Imaging
- User-registered label measurement
Transducer technology
Wideband multi-frequency iDMS convex: i8CX1 (PVI-475BX)
Covers the same bandwidth as two conventional transducers
Aplio i-series provides superior sensitivity and resolution for both near and far field. The ability to use one transducer across a wider range of patient types can potentially reduce cost, while providing better imaging.
Features:
- Up to 50 cm penetration
Multi-frequency slim-face convex: i8C1 (PVI-475BT)
Enables easy intercostal scanning and more
This narrow face transducer features:
- Improved shape for easy grip
- Super lightweight transducer head
- Light weight, thin and highly flexible cable
Multi-frequency micro-convex: 8MC1 (PVT-482BT)
The advantages of a curved array in a small footprint
Aplio i-series' thin micro-convex provides enhanced maneuverability and ease of access.
New Features:
- Single crystal technology
- Lightweight and maneuverable
- New CIVCO® Verza™ Guidance System
Clinical Applications:
- Abdominal
- Pediatric
- OB
- Biopsy Guidance
White Papers
Approaches to liver tumours
Shear Wave Elastography (SWE) and the needle navigation system are indispensable technologies not only for diagnosis but also for monitoring and assessing local treatment. Read the paper to hear Dr. Fuminori Moriyasu from Tokyo Medical University explain the SWE approach to liver tumors, including the differential diagnosis of tumors and the applications of SWE in local treatment.
Laparoscopic liver resection as a less invasive treatment option for hepatocellular carcinoma
In this white paper, Dr. Satoru Seo, Department of Surgery from the Graduate School of Medicine, Kyoto University, shared his clinical impressions of the PET-805LA transducer used in combination with the Aplio series diagnostic ultrasound system and discussed the clinical usefulness of intraoperative contrast-enhanced ultrasound.
» “The Aplio's shear wave application supplies the user with multiple indicators of the reliability of the shear wave propagation. These tools should be used in all cases. The operator should consider using a combination of continuous and one-shot modes, especially when working with a non-compliant patient” «
»“The most outstanding feature was the newly developed abdominal curve transducer 8C1. This transducer has the penetration and contrast resolution to scan through my bariatric patients with liver depths of 23 cm.” «
Education & resources
Our Product
Canon's product range is designed to meet the daily demands from small, mobile clinic machines to university hospital systems with research needs. In this section, you can review each individual product and see the technology that makes a difference, every day.
New WFUMB guidelines - Liver Ultrasound Elastography: An Update to the World Federation for Ultrasound in Medicine and Biology Guidelines and Recommendations. (Page 2422 table 2)
SWE
SWE acquisition. Propagation lines in the far field represent how the shear wave has been affected by the vessels in the ROI and loss of data is shown here as lack of colour fill in the speed map. This indicates an area where calliper placement should not be performed but rather in areas of homogeneity on the colour map and continuous parallel propagation lines
SWE using dual mode together with speed and propagation maps. We use both maps to help with accuracy and reproducibility in our calliper placement, extremely important when undertaking SWE. We can use the speed map (or an elastography map), to look for uniformity in data collection, areas of black indicate no data acquired and callipers should not be placed here. Propagation maps are used to look at continuous parallel lines to also indicate good quality data and correct calliper placement.
A case of liver fibrosis. Different colours are seen within the speed map indicating areas of increased stiffness. Propagation lines are also thicker and further apart – another indication of increased stiffness. Both correlate to an increase in number, suggestive of fibrosis.
New WUFUMB guidelines* recommend only one measurement be taken from each Shear Wave acquisition. With continuous wave acquisition, the Canon systems can acquire a ‘cine loop’ of Shear Waves to make multiple measurements quicker and easier.
ATI
A good acquisition using ATI. Values are shown in white representing a good quality acquisition.
A good acquisition using ATI. Values are shown in white representing a good quality acquisition.
A good acquisition using ATI. Values are shown in white representing a good quality acquisition.
Another ATI acquisition, this time showing values in yellow representing a mediocre acquisition.
ATI showing values in red representing a poor acquisition
Liver analysis shear wave quad view
Liver analysis using quad view shows four displays during the one acquisition. Top row is SWE using speed and propagation maps to help correct calliper placement. We also have a b-mode representation of the area being interrogated and lastly we have a dispersion map. We can now use this information to obtain accurate quantification of both liver stiffness and viscosity to assess for fibrosis and inflammation, with one simple acquisition.
