The value of virtual touch quantification in assessment of liver function reserve in hepatocellular carcinoma patients: a clinical study

Abstract Purpose: Quantitative assessment of liver function reserve (LFR) plays an important role in clinical management of hepatocellular carcinoma (HCC) patients. Reduced LFR is closely related to increased level of liver fibrosis. Virtual Touch Quantification (VTQ) is a non-invasive ultrasonic imaging technique. In this study, we aimed to explore the correlation between VTQ parameters and LFR levels in different stages of liver fibrosis.Methods: From January 2016 to October 2018, 145 hepatocellular carcinoma patients (114 males and 31 females) scheduled for hepatectomy were enrolled in this study. All patients were histopathologically diagnosed and classified into five groups. The VTQ measurement and indocyanine green (ICG) clearance tests were performed following standard presurgical procedures. VTQ parameters and ICG retention values at 15min (ICG-R15) after ICG injection were compared among all staging groups using non-parametric Kruskal-Wallis test. Correlation between VTQ parameters and ICG-R15 was analyzed for all patients and patients within each staging group. We further divide patients into 3 groups by ICG-R15 values: Group 1 (ICG-R15 < 10%), Group 2 (ICG-R15 10%-20%) and Group 3 (ICG-R15 > 20%). The receiver operating characteristic (ROC) in detection of Group 3 patients using VTQ parameters was analyzed.Results: (1) The ICG R15 values are significantly different among the five-liver fibrosis staging groups (F =7.149, P < 0.001). Moderate correlation was observed between VTQ and ICG R15 values (r = 0.575, p < 0.001) among all patients. (2) VTQ value of Group 2 was significantly higher than that of Group 1 (P = 0.013) and VTQ value of Group 3 was significantly higher than in Group 1 and 2 (P < 0.001; p = 0.005). Classifying a patient to have ICG R15 value greater than 20% (Group 3) given his/her VTQ value is above 1.8 m/s has 100% sensitivity and 78.1% specificity. The area under the ROC is 0.946 (95%CI: 0.895, 0.976, p <0.0001).Conclusions: Non-invasive measurement of VTQ using ultrasound elastography techniques is a valuable tool for clinician to quantify liver fibrosis and assess liver functional reserve in HCC patients, in vivo, which, in turn, helps for the better preoperative planning of HCC patients.