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2092110 Correlation Between Controlled Attenuation Parameter(CAP) and Liver Steatosis Quantification
S170
Ultrasound in Medicine and Biology
2092099 The Quality of Liver Tissue Specimen in Echo-Assisted Liver Biopsy Ioan Sporea, Felix Bende, Roxana Sirli, Alina Popescu, Silviu Nistorescu Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy ‘‘Victor Babe’’ Timioara, Romania, Timisoara, Choose a State or Province, Romania Objectives: Liver biopsy is the reference method for staging chronic hepathopathies. There are 3 techniques for performing liver biopsy: percutaneous, trans-jugular and laparoscopic. The percutaneous liver biopsy can be performed: blinded, echo-guided and echo-assisted. The purpose of this study is to evaluate the quality of liver tissue specimen in echo-assisted liver biopsy. Methods: We performed a retrospective study of the last 10 years of experience in echo-assisted liver biopsy in our Department. 1520 patients (41.5% male, 58.5% female), mean age of 46 612 years old, underwent a total of 1557 liver biopsies. The following parameters were evaluated: number of inconclusive biopsies, number of passages through liver, length of tissue specimen and number of portal tracts. Specimens with less than 10 portal tracts were considered inconclusive by the anatomopathologist. The biopsy was performed using Menghini modified needles, 1.4 and 1.6 mm in diameter (Hepafix – Braun kits for LB) and was ultrasound-assisted. Results: From the total of 1520 liver tissue specimens, a low rate of 1% were inconclusive. 89.9% of the total procedures were performed using a 2 liver passage technique, while 10.1% were performed with a single liver passage. The mean length of tissue specimen was 3.2 61.4cm and the mean number of portal tracts was 20 610. While comparing the two liver biopsy techniques we noticed that the size of tissue specimens obtained with 2 passages is bigger than the one obtained with 1 passage (3.2 61.4cm vs. 2.4 61.2cm, P , 0.0001). The correlation between the length of tissue specimen and the number of portal tracts was r5 0.54, P , 0.0001. Conclusions: Echo-assisted liver biopsy is a very good method for obtaining high quality tissue specimens. By using a 2 liver passage technique, a larger tissue sample is obtained. 2092110 Correlation Between Controlled Attenuation Parameter(CAP) and Liver Steatosis Quantification Ruxandra Mare, Ioan Sporea, Alina Popescu, Alexandra Deleanu, Isabel Dan Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy ‘‘Victor Babe’’ Timioara, Romania, Timisoara, Choose a State or Province, Romania Objectives: The CAP based on FibroscanÒ has been recently developed for liver steatosis assessment. This study was designed to evaluate the utility of CAP using the diagnostic cut-offs proposed by the Shi meta-analysis (1). Methods: Steatosis was evaluated using CAP and ultrasound in 570 subjects. CAP was calculated if valid liver stiffness measurements were obtained by M probe, expressed in decibel per meter (dB/m). CAP failure was defined as zero valid shots. For quantification between different stages of steatosis we used the following cut-off values: S15232.5 db/m, S25255 db/m, S35290 db/m(1). The severity of liver steatosis was evaluated by ultrasound as according to the subjective assessment of the ‘‘brightness’’ of the liver and the intensity of ‘‘posterior attenuation’’. A semi-quantitative scale was used, ranging from 0 to 3 (0, no steatosis; 1, mild steatosis; 2, moderate steatosis; 3, severe steatosis). The US examination was performed by expert ultrasonographists (level III according to the EFSUMB classification), blinded to CAP quantification.
Volume 41, Number 4S, 2015 Results: 38,9% (222 subjects), were excluded due to failure/unrealiable liver stiffness measurements with M probe. In ultrasound, liver steatosis was graded as follows: S0- 144 cases (41.4%), S1 - 94 cases (27%), moderate – 85 cases (24.5%) and severe - 27 cases (7.2%). By using the proposed cut-off values, there were no significant differences in percentages between CAP values and quantification of steatosis by means of US in patients without steatosis (36.8% vs 41.4% p50.4), in patients with mild ( 11.5% vs 24.4 % p50.08) or with moderate steatosis (18.7% vs 24,5% p50.2). Only severe steatosis was observed in a significantly higher percentage by means of CAP than by ultrasound (33% vs 7.2 % p,0.001). CAP showed good correlation with steatosis estimated by ultrasound (r50.6072, p,0.0001). Conclusions: CAP seems to be a promising tool for screening and quantification of steatosis in the general population. Larger studies are needed for validation. 1. Shi KQ, et al. Controlled attenuation parameter for the detection of steatosis severity in chronic liver disease: A meta-analysis of diagnostic accuracy. J. Gastroenterol Hepatol 2014 Jan 29. http://dx. doi.org/10.1111/jgh.12519 2092113 Non-Cystic Cervical Mass: How to Make the Differential Diagnosis Sandra Monica Tochetto, Osmar Saito, Julia Zavariz, Renata Cavalcane Lima Coelho, Maria Cristina Chammas Radiology, University of S~ao Paulo, S~ao Paulo, SP, Brazil Objectives: - To review the ultrasonographic findings (gray-scale, color Doppler and elastography) of non-cystic cervical masses. - To describe the ultrasonographic and anatomical findings that can be helpful in their diagnosis. Methods: The exhibit will review the ultrasonographic findings of the most common non-cystic cervical masses according to an algorithm base on their location: midline, anterior neck triangle and posterior neck triangle. Results: The exhibit will show examples of: inflammatory, infectious and neoplastic adenopathy, salivary gland tumors, complicated (infectious and neoplastic) thyroglossal duct cyst, ectopic thyroid tissue, thyroid enlargement, parathyroid masses, cervical thymus, laryngocele, paragangliomas, lipoma, osseous tumor and tumor of neural origin. The discussion will emphasize the differential diagnosis with anatomopathological correlation. Conclusions: A neck mass might come to attention as either a symptomatic abnormality or an additional finding identified at radiological imaging for other reasons. These masses may represent a variety of conditions having a congenital, acquired inflammatory, neoplastic or vascular origin. An approach based on anatomical location associated with the knowledge of the ultrasonographic appearance may help to achieve an accurate diagnosis. 2092142 Shear Wave Elastographic Methods and Liver Biopsy for The Evaluation of Liver Fibrosis – Preliminary Experience Oana Gradinaru-Tascau, Ioan Sporea, Alina Popescu, Roxana Sirli, Ruxandra Mare, Madalina Popescu Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy ‘‘Victor Babe’’ Timioara, Romania, Timisoara, Choose a State or Province, Romania Objectives: The aim of this study was to evaluate the shear wave elastographic methods available in our department (2D-SWE, TE and ARFI) for the evaluation of liver fibrosis.
Ultrasound in Medicine and Biology
2092099 The Quality of Liver Tissue Specimen in Echo-Assisted Liver Biopsy Ioan Sporea, Felix Bende, Roxana Sirli, Alina Popescu, Silviu Nistorescu Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy ‘‘Victor Babe’’ Timioara, Romania, Timisoara, Choose a State or Province, Romania Objectives: Liver biopsy is the reference method for staging chronic hepathopathies. There are 3 techniques for performing liver biopsy: percutaneous, trans-jugular and laparoscopic. The percutaneous liver biopsy can be performed: blinded, echo-guided and echo-assisted. The purpose of this study is to evaluate the quality of liver tissue specimen in echo-assisted liver biopsy. Methods: We performed a retrospective study of the last 10 years of experience in echo-assisted liver biopsy in our Department. 1520 patients (41.5% male, 58.5% female), mean age of 46 612 years old, underwent a total of 1557 liver biopsies. The following parameters were evaluated: number of inconclusive biopsies, number of passages through liver, length of tissue specimen and number of portal tracts. Specimens with less than 10 portal tracts were considered inconclusive by the anatomopathologist. The biopsy was performed using Menghini modified needles, 1.4 and 1.6 mm in diameter (Hepafix – Braun kits for LB) and was ultrasound-assisted. Results: From the total of 1520 liver tissue specimens, a low rate of 1% were inconclusive. 89.9% of the total procedures were performed using a 2 liver passage technique, while 10.1% were performed with a single liver passage. The mean length of tissue specimen was 3.2 61.4cm and the mean number of portal tracts was 20 610. While comparing the two liver biopsy techniques we noticed that the size of tissue specimens obtained with 2 passages is bigger than the one obtained with 1 passage (3.2 61.4cm vs. 2.4 61.2cm, P , 0.0001). The correlation between the length of tissue specimen and the number of portal tracts was r5 0.54, P , 0.0001. Conclusions: Echo-assisted liver biopsy is a very good method for obtaining high quality tissue specimens. By using a 2 liver passage technique, a larger tissue sample is obtained. 2092110 Correlation Between Controlled Attenuation Parameter(CAP) and Liver Steatosis Quantification Ruxandra Mare, Ioan Sporea, Alina Popescu, Alexandra Deleanu, Isabel Dan Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy ‘‘Victor Babe’’ Timioara, Romania, Timisoara, Choose a State or Province, Romania Objectives: The CAP based on FibroscanÒ has been recently developed for liver steatosis assessment. This study was designed to evaluate the utility of CAP using the diagnostic cut-offs proposed by the Shi meta-analysis (1). Methods: Steatosis was evaluated using CAP and ultrasound in 570 subjects. CAP was calculated if valid liver stiffness measurements were obtained by M probe, expressed in decibel per meter (dB/m). CAP failure was defined as zero valid shots. For quantification between different stages of steatosis we used the following cut-off values: S15232.5 db/m, S25255 db/m, S35290 db/m(1). The severity of liver steatosis was evaluated by ultrasound as according to the subjective assessment of the ‘‘brightness’’ of the liver and the intensity of ‘‘posterior attenuation’’. A semi-quantitative scale was used, ranging from 0 to 3 (0, no steatosis; 1, mild steatosis; 2, moderate steatosis; 3, severe steatosis). The US examination was performed by expert ultrasonographists (level III according to the EFSUMB classification), blinded to CAP quantification.
Volume 41, Number 4S, 2015 Results: 38,9% (222 subjects), were excluded due to failure/unrealiable liver stiffness measurements with M probe. In ultrasound, liver steatosis was graded as follows: S0- 144 cases (41.4%), S1 - 94 cases (27%), moderate – 85 cases (24.5%) and severe - 27 cases (7.2%). By using the proposed cut-off values, there were no significant differences in percentages between CAP values and quantification of steatosis by means of US in patients without steatosis (36.8% vs 41.4% p50.4), in patients with mild ( 11.5% vs 24.4 % p50.08) or with moderate steatosis (18.7% vs 24,5% p50.2). Only severe steatosis was observed in a significantly higher percentage by means of CAP than by ultrasound (33% vs 7.2 % p,0.001). CAP showed good correlation with steatosis estimated by ultrasound (r50.6072, p,0.0001). Conclusions: CAP seems to be a promising tool for screening and quantification of steatosis in the general population. Larger studies are needed for validation. 1. Shi KQ, et al. Controlled attenuation parameter for the detection of steatosis severity in chronic liver disease: A meta-analysis of diagnostic accuracy. J. Gastroenterol Hepatol 2014 Jan 29. http://dx. doi.org/10.1111/jgh.12519 2092113 Non-Cystic Cervical Mass: How to Make the Differential Diagnosis Sandra Monica Tochetto, Osmar Saito, Julia Zavariz, Renata Cavalcane Lima Coelho, Maria Cristina Chammas Radiology, University of S~ao Paulo, S~ao Paulo, SP, Brazil Objectives: - To review the ultrasonographic findings (gray-scale, color Doppler and elastography) of non-cystic cervical masses. - To describe the ultrasonographic and anatomical findings that can be helpful in their diagnosis. Methods: The exhibit will review the ultrasonographic findings of the most common non-cystic cervical masses according to an algorithm base on their location: midline, anterior neck triangle and posterior neck triangle. Results: The exhibit will show examples of: inflammatory, infectious and neoplastic adenopathy, salivary gland tumors, complicated (infectious and neoplastic) thyroglossal duct cyst, ectopic thyroid tissue, thyroid enlargement, parathyroid masses, cervical thymus, laryngocele, paragangliomas, lipoma, osseous tumor and tumor of neural origin. The discussion will emphasize the differential diagnosis with anatomopathological correlation. Conclusions: A neck mass might come to attention as either a symptomatic abnormality or an additional finding identified at radiological imaging for other reasons. These masses may represent a variety of conditions having a congenital, acquired inflammatory, neoplastic or vascular origin. An approach based on anatomical location associated with the knowledge of the ultrasonographic appearance may help to achieve an accurate diagnosis. 2092142 Shear Wave Elastographic Methods and Liver Biopsy for The Evaluation of Liver Fibrosis – Preliminary Experience Oana Gradinaru-Tascau, Ioan Sporea, Alina Popescu, Roxana Sirli, Ruxandra Mare, Madalina Popescu Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy ‘‘Victor Babe’’ Timioara, Romania, Timisoara, Choose a State or Province, Romania Objectives: The aim of this study was to evaluate the shear wave elastographic methods available in our department (2D-SWE, TE and ARFI) for the evaluation of liver fibrosis.