- Email: [email protected]
[109] VALIDATION OF MAGNETIC RESONANCE ELASTOGRAPHY IN PATIENTS WITH CHRONIC LIVER DISEASE
Suturduy, I 4 April
S48
The aim of this study is to identify factors associated with development of HCC in patients after spontaneous e-seroconversion in a large population. Methods: All patients seen at the Hepatitis Clinic, Queen Mary Hospital, Hong Kong, with documented spontaneous e-seroconversion was identified and included. Patients were monitored 3-6 monthly for acute exacerbations and the development of HCC. Results: A total of 602 patients were included with a median follow-up of 8.8 years (range, 0.6-23.8 years), of which 349 (58%) were males. Nineteen patients developed HCC diagnosed at a median interval of 4.3 years after e-seroconversion (range, 1.4-14.4 years). Significant risk factors for HCC development by log-rank test included the age of e-seroconversion, presence of underlying cirrhosis at the time ofe-seroconversion, peak AFP levels before and after e-seroconversion, and post-seroconversion median ALT levels. Using multivariate analysis by Cox regression analysis, both cirrhosis (OR 4.128, 95% C1 1.283-13.276) and age of seroconversion (OR 1.099, 95% CI 1.055-1.146) remained significant factors associated with risk of HCC, (p=0.017 and p i O . O O 1 respectively). In patients aged between 40 and 65 years with HCC, the time of e-seroconversion was compared to age-matched controls at a ratio of 1.4. There was a significantly higher median age of e-seroconversion in HCC patients compared with controls (46 vs 42 years respectively, p = 0.049). The cumulative HCC incidence at 5 and 10 years from the time of e-seroconversion for different age groups is shown below. The 15-year cumulative incidence of HCC in patients with cirrhosis after spontaneous HBeAg seroconversion was 32% compared with 2% in patients without cirrhosis (p 0.001).
( 1 I%), and PBC ( 1 1%). Fibrosis stage was 0-1 (34%), 2-3 (l5%), and 4 (51%). The mean liver stiffness in CLD patients was significantly higher (6.0+2.7 lcPa vs 2.2+0.3 kPa, p i O . O O O 1 ) when compared to healthy volunteers. Mean stiffness for cirrhosis was higher compared to lower fibrosis stages (8.0f2.3 kPa vs 4.2&1.4kPa, p iO.OOO1). Degree of steatosis was not correlated with mean liver stiffness (r=-0.3, p > 0.05). Spleen elastograms were obtained in all patients. Mean liver and spleen stiffness values were significantly correlated in all subjects (Figure).
Age of seroconversion (years)
11101 THE SPECTRUM OF AUTOIMMUNE CHOLANGITIS IN
Cuinulative incidence 5-year
1 0-year
<30
I%
I%
31-40 41-50 >50
0% 8Yo 10%
0% 13% 51%
Conclusion: In patients undergoing spontaneous HBeAg seroconversion, older age of seroconversion and underlying cirrhosis were significant factors associated with increase nsk of HCC development
11091 VALIDATION OF MAGNETIC RESONANCE ELASTOGRAPHY IN PATIENTS WITH CHRONIC LIVER DISEASE J.A. Talwallcar', M. Yin2, R.C. Grimm2, P.J. Rossman2, A. Manduca2, R.L. Ehman2. 'Depurtment of Medicine, Muyo Clinic College of Medicine, Rochexter, MN; 2MR Luhorutory und Rudiology, Muyo Clinic College of' Medicine, Rochester, MI?( 7JSA E-mail: [email protected]
Background: Preliminary studies confirm the feasibility of magnetic resonance elastography (MRE) for detecting hepatic fibrosis. Aim: 1 ) To report the prospective validation of liver stiffness measurement by MRE in human subjects. 2) To describe the feasibility and significance of spleen stiffness assessed by MRE. Methods: Patients with CLD (n=35) and/or liver histology (within 1 yr) and healthy volunteers ( n = 12) were studied. All MRE examinations used a I .5 T whole-body MR imager (GE Medical System, U.S.A). In the supine position, a 19 cm cylindrical passive pneumatic driver was placed against the anterior abdominal wall. Shear waves at 60 Hz were generated by the driver from an active speaker. Axial wave images of liver and spleen were obtained by GRE-based sequences. Quantitative images of shear stiffness (elastograms) were obtained by LFE inversion algorithms. Steatosis was quantified by the Dixon method. Results: Mean age of CLD patients was 54 yrs with 50% women. Major etiologies were hepatitis C (20%), NASH (20%), alcohol (1 l%), AIH
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Conclusions: ( I ) M R E is a valid method for non-invasively diagnosing hepatic fibrosis (2) Steatosis does not appear to influence liver stiffness (3) Given the strong correlation between liver and spleen stiffness, MRE could serve as a quantitative method for assessing portal hypertension
CHILDHOOD M. Sciveres', G. Maggiorel, N. Giurici2, A. Ventura2, 0. Bernard3. 'Depurtment of Pediutrics, Uniuer~xit?,of Pisu, Italy; 'IRCSS; 'Seruice d'H4putologie Pediutrique, Hfipitul de Le Kremlin-Bicetre, Frunce E-mail: [email protected]
Background: Autoimmune Cholangitis (AC) is debated as a distinct clinical entity. In childhood autoimmune liver disease (ALD), biliary damage occurs frequently, independently to the evidence of large bile ducts changes, however, a systematic description of a large series of children with AC has never been attempted to date. Patients and Methods: We followed 55 pediatric patients with ALD and histological and/or imaging evidence of bile duct damage by transhepatic and/or RM cholangiography, referred to one of the 3 institutions participating to the study in the last two decades. Results: There were 32 males (M:F 1.4: I), median age at onset was 10.3 years. In 42 (77%), an Inflammatory Bowel Disease (IBD) was associated and was symptomatic in all but 6. Mean ALT activity was 5.48xN, mean gGT 5.95 x N and all but 7 patients presented hypergammaglobulinemia. Autoantibodies were present in 87% of patients (SMA 61%, ANA 45%, plc-ANCA 4 I %, LC 1 5%, LKM I none). Histological examination showed Autoimmune Hepatitis (AIH) with minimal biliary damage in 5 , an overlap of cholangitisihepatitis in 14, and an Autoimmune Sclerosing Cholangitis (ASC) in 20. Signs of acute and chronic cholangitis were equally present; 50% showed ductular fibrosis and 12% biliary granulomas. Cirrhosis was histologically evident in 14% at onset. Imaging of biliary tree at onset showed a normal picture in 36% of patients, dilatation of intra-/extrahepatic ducts without obstacles in 27% and a typical picture of ASC in 37%. Median follow-up was 10.6 years. At histological re-evaluation evidence of disease progression to F314 fibrosis was present in 50% and of radiological evidence of sclerosing lesions in 64%. In 8 patients imaging follow up documented evolution from normal or dilated bile duct to sclerosing cholangitis. However, fully recovery on immunosuppressive treatment of dilated bile ducts was documented in 3 out of 6. Two patients underwent Orthotopic Liver Trasplantation. Conclusions: AC in childhood is a slowly progressive disease, strictly associated to IBD. Progression toward ASC is frequent but not mandatory.
S48
The aim of this study is to identify factors associated with development of HCC in patients after spontaneous e-seroconversion in a large population. Methods: All patients seen at the Hepatitis Clinic, Queen Mary Hospital, Hong Kong, with documented spontaneous e-seroconversion was identified and included. Patients were monitored 3-6 monthly for acute exacerbations and the development of HCC. Results: A total of 602 patients were included with a median follow-up of 8.8 years (range, 0.6-23.8 years), of which 349 (58%) were males. Nineteen patients developed HCC diagnosed at a median interval of 4.3 years after e-seroconversion (range, 1.4-14.4 years). Significant risk factors for HCC development by log-rank test included the age of e-seroconversion, presence of underlying cirrhosis at the time ofe-seroconversion, peak AFP levels before and after e-seroconversion, and post-seroconversion median ALT levels. Using multivariate analysis by Cox regression analysis, both cirrhosis (OR 4.128, 95% C1 1.283-13.276) and age of seroconversion (OR 1.099, 95% CI 1.055-1.146) remained significant factors associated with risk of HCC, (p=0.017 and p i O . O O 1 respectively). In patients aged between 40 and 65 years with HCC, the time of e-seroconversion was compared to age-matched controls at a ratio of 1.4. There was a significantly higher median age of e-seroconversion in HCC patients compared with controls (46 vs 42 years respectively, p = 0.049). The cumulative HCC incidence at 5 and 10 years from the time of e-seroconversion for different age groups is shown below. The 15-year cumulative incidence of HCC in patients with cirrhosis after spontaneous HBeAg seroconversion was 32% compared with 2% in patients without cirrhosis (p 0.001).
( 1 I%), and PBC ( 1 1%). Fibrosis stage was 0-1 (34%), 2-3 (l5%), and 4 (51%). The mean liver stiffness in CLD patients was significantly higher (6.0+2.7 lcPa vs 2.2+0.3 kPa, p i O . O O O 1 ) when compared to healthy volunteers. Mean stiffness for cirrhosis was higher compared to lower fibrosis stages (8.0f2.3 kPa vs 4.2&1.4kPa, p iO.OOO1). Degree of steatosis was not correlated with mean liver stiffness (r=-0.3, p > 0.05). Spleen elastograms were obtained in all patients. Mean liver and spleen stiffness values were significantly correlated in all subjects (Figure).
Age of seroconversion (years)
11101 THE SPECTRUM OF AUTOIMMUNE CHOLANGITIS IN
Cuinulative incidence 5-year
1 0-year
<30
I%
I%
31-40 41-50 >50
0% 8Yo 10%
0% 13% 51%
Conclusion: In patients undergoing spontaneous HBeAg seroconversion, older age of seroconversion and underlying cirrhosis were significant factors associated with increase nsk of HCC development
11091 VALIDATION OF MAGNETIC RESONANCE ELASTOGRAPHY IN PATIENTS WITH CHRONIC LIVER DISEASE J.A. Talwallcar', M. Yin2, R.C. Grimm2, P.J. Rossman2, A. Manduca2, R.L. Ehman2. 'Depurtment of Medicine, Muyo Clinic College of Medicine, Rochexter, MN; 2MR Luhorutory und Rudiology, Muyo Clinic College of' Medicine, Rochester, MI?( 7JSA E-mail: [email protected]
Background: Preliminary studies confirm the feasibility of magnetic resonance elastography (MRE) for detecting hepatic fibrosis. Aim: 1 ) To report the prospective validation of liver stiffness measurement by MRE in human subjects. 2) To describe the feasibility and significance of spleen stiffness assessed by MRE. Methods: Patients with CLD (n=35) and/or liver histology (within 1 yr) and healthy volunteers ( n = 12) were studied. All MRE examinations used a I .5 T whole-body MR imager (GE Medical System, U.S.A). In the supine position, a 19 cm cylindrical passive pneumatic driver was placed against the anterior abdominal wall. Shear waves at 60 Hz were generated by the driver from an active speaker. Axial wave images of liver and spleen were obtained by GRE-based sequences. Quantitative images of shear stiffness (elastograms) were obtained by LFE inversion algorithms. Steatosis was quantified by the Dixon method. Results: Mean age of CLD patients was 54 yrs with 50% women. Major etiologies were hepatitis C (20%), NASH (20%), alcohol (1 l%), AIH
16
1
14
UvmrPntienth
HealIhy Volunteer
- Llnear1All VoIuIIIpws)
--
/;*'
,
-,
y=0.9947*+1.9231
.
-2-
0.7713
04 0
2
4
6
B
1
0
1
Z
l
d
Llver StRne88 #Pa)
Conclusions: ( I ) M R E is a valid method for non-invasively diagnosing hepatic fibrosis (2) Steatosis does not appear to influence liver stiffness (3) Given the strong correlation between liver and spleen stiffness, MRE could serve as a quantitative method for assessing portal hypertension
CHILDHOOD M. Sciveres', G. Maggiorel, N. Giurici2, A. Ventura2, 0. Bernard3. 'Depurtment of Pediutrics, Uniuer~xit?,of Pisu, Italy; 'IRCSS; 'Seruice d'H4putologie Pediutrique, Hfipitul de Le Kremlin-Bicetre, Frunce E-mail: [email protected]
Background: Autoimmune Cholangitis (AC) is debated as a distinct clinical entity. In childhood autoimmune liver disease (ALD), biliary damage occurs frequently, independently to the evidence of large bile ducts changes, however, a systematic description of a large series of children with AC has never been attempted to date. Patients and Methods: We followed 55 pediatric patients with ALD and histological and/or imaging evidence of bile duct damage by transhepatic and/or RM cholangiography, referred to one of the 3 institutions participating to the study in the last two decades. Results: There were 32 males (M:F 1.4: I), median age at onset was 10.3 years. In 42 (77%), an Inflammatory Bowel Disease (IBD) was associated and was symptomatic in all but 6. Mean ALT activity was 5.48xN, mean gGT 5.95 x N and all but 7 patients presented hypergammaglobulinemia. Autoantibodies were present in 87% of patients (SMA 61%, ANA 45%, plc-ANCA 4 I %, LC 1 5%, LKM I none). Histological examination showed Autoimmune Hepatitis (AIH) with minimal biliary damage in 5 , an overlap of cholangitisihepatitis in 14, and an Autoimmune Sclerosing Cholangitis (ASC) in 20. Signs of acute and chronic cholangitis were equally present; 50% showed ductular fibrosis and 12% biliary granulomas. Cirrhosis was histologically evident in 14% at onset. Imaging of biliary tree at onset showed a normal picture in 36% of patients, dilatation of intra-/extrahepatic ducts without obstacles in 27% and a typical picture of ASC in 37%. Median follow-up was 10.6 years. At histological re-evaluation evidence of disease progression to F314 fibrosis was present in 50% and of radiological evidence of sclerosing lesions in 64%. In 8 patients imaging follow up documented evolution from normal or dilated bile duct to sclerosing cholangitis. However, fully recovery on immunosuppressive treatment of dilated bile ducts was documented in 3 out of 6. Two patients underwent Orthotopic Liver Trasplantation. Conclusions: AC in childhood is a slowly progressive disease, strictly associated to IBD. Progression toward ASC is frequent but not mandatory.