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1297: Detection of Recurrent Lesions in HCC Patients Treated with Radiofrequency Ablation (RFA): A Comparison of Contrast Enhanced Ultrasonography with CT
S180
Ultrasound in Medicine and Biology
Results: There were 4 types of enhancement patterns observed in the 113 lesions on CEUS. Type I, 49 (43.4%) nodules demonstrated simultaneous enhancement with the liver parenchyma and, therefore, the nodules appeared isoechoic to the liver throughout the arterial, portal and parenchymal phases; Type II, 27 (23.9%) nodules demonstrated delayed enhancement in the portal phase and then became isoechoic to the liver in parenchymal phase; Type III, 28 (24.8%) nodules presented delayed or simultaneous enhancement with the liver and then slight wash-out causing a hypoechoic appearance in the parenchymal phase; Type IV, 9 (8.0%) nodules presented slight enhancement with hyperechoic during arterial phase and slight wash-out with hypoechoic to the liver during the parenchymal phase. The ratio of hepatocellular dysplasia were significantly higher in type III/IV enhancement patterns than in type I/II (P⬍0.05). There were no significant statistical differences in hepatocellular regeneration, degeneration, necrosis, fibrous tissue hyperplasia, inflammatory cellular infiltration between type III/IV and type I/II enhancement patterns (P⬎0.05). Conclusions: The analysis of hemodynamics and the degree of hepatocellular atypia of RNs can help to monitor the development of RNs, and CEUS is useful in the clinical practice for the study of nodular lesions in cirrhotic patients. Key Words: Ultrasonography; Contrast agent; Cirrhosis; Regenerative nodule 1295 Portal Hyperperfusion in Living Donor Liver Transplantation Yu Fan Cheng, Chang Gung Memorial Hospital, Taiwan Portal hyperperfusion in a small-size liver graft is one cause of posttransplant graft dysfunction. We retrospectively analyzed the potential risk factors predicting the development of portal hyperperfusion in 43 adult living donor liver transplantation recipients. The following were evaluated: age, body weight, native liver disease, spleen size, graft size, graft-torecipient weight ratio (GRWR), total portal flow, recipient portal venous flow per 100 g graft weight (RPVF), graft-torecipient spleen size ratio (GRSSR) and portosystemic shunting. Spleen size was directly proportional to the total portal flow (p⫽0.001) and RPVF (p⫽0.014). Graft hyperperfusion (RPVF flow ⬎250 mL/min/ 100 g graft) was seen in eight recipients. If the GRSSR was ⬍0.6, 5 of 11 cases were found to have graft hyperperfusion (p ⫽ 0.017). The presence of portosystemic shunting was significant in decreasing excessive RPVF (p ⫽ 0.059). A decrease in portal flow in the hyperperfused grafts was achieved by intraoperative splenic artery ligation or splenectomy. Spleen size is a major factor contributing to portal flow after transplant. The GRSSR is associated with posttransplant graft hyperperfusion at a ratio of ⬍0.6.
Volume 35, Number 8S, 2009 CDUS were also performed during the 1st week of postoperative days. Postoperative enhanced CT studies were performed on cases of hyperbilirubinemia Results: The MHV vein grafts reconstructed were including 15 V5s, 18 V8s and 13 of V5 ⫹V8 in one anastomosis. CDUS had detected normal outflow in 52% (24/46), poor flow velocity (⬍10cm/sec) or flat waveform in 37% (17/46) and no flow in 11% (5/46). Postoperative complications with marked ascites, pleural effusion and/or persisted hyperbilirubinemia were noted in 7 cases including 3 cases of marginal graft-recipient weight ratio (⬍1.0). CT scans was performed for complications with significant venous congestion. Conclusion: Poor outflow of the reconstructed MHV graft detected by CDUS is significant to the graft dysfunction. CDUS is the best modality for evaluation of the outflow patency during and post LDLT. 1297 Detection of Recurrent Lesions in HCC Patients Treated with Radiofrequency Ablation (RFA): A Comparison of Contrast Enhanced Ultrasonography with CT Ying Dai, Beijing Cancer Hospital & Institute, China Objective: To investigate the diagnostic value of ultrasonography combined with contrast enhanced ultrasonography (CEUS) in detection of recurrent lesions in HCC patients treated with radiofrequency ablation (RFA) compared with Compute Tomography (CT). Methods: One hundred and seventy-three patients with HCC treated with curative RFA were enrolled in this study. All patients received both CEUS with SonoVue and CT at regular intervals. Nodules with contrast enhancement during the arterial phase (hypervascular) on CEUS were diagnosed as malignant. Biopsy and pathological confirmation or enlargement during follow-up were regarded to be the reference standard. Results: Altogether 102 hypervascular nodules were detected in 50 patients. Of them, 102 nodules in 41 patients were confirmed as malignant. The other nodules were confirmed as benign including 14 regenerative nodules, 3 abnormal perfusion, 2 vascular malformation, 1 hemangioma and 1 vessel cross-section. The sensitivity, specificity and accuracy rate for CEUS in the detection of recurrent nodules were 85.2% (69/81), 38.1% (8/21) and 75.5% (77/102). The sensitivity, specificity and accuracy rate for CT were 85.2% (69/81), 80.1% (17/21) and 84.3% (86/102). There was no statistical significance between the two method (X2⫽2.473, P⫽0.116). Conclusion: CEUS was helpful to detect recurrent nodules in HCC patients treated with RFA, comparable with CT. Keywords: contrast enhanced ultrasonography; hepatocellular carcinoma, radiofrequency ablation, recurrence
1296 1298 Doppler Ultrasound of the Venous Graft (Middle Hepatic Vein) in Adult Living Donor Liver Transplantation Yu Fan Cheng, Chang Gung Memorial Hospital, Taiwan T L Huang, Kaohsiung Medical Center, Taiwan Objective: To assess the patency of the reconstructed middle hepatic vein (MHV) with cryopreserved vein graft in adult living Donor liver transplantation (LDLT) Materials and Methods: From 2006 to 2008 Mar, there were 46 adult LDLT cases included with the MHV reconstructed by cryopreserved vein grafts. The branches drained segment 5 (V5) and/or segment 8 (V8) were reconstructed by size ⬎ 5 mm. Color Doppler ultrasound (CDUS) was performed to make sure of patency immediately after reperfusion of the graft. If no flow or poor flow velocity and /or monophasic waveform was abnormal, readjust of venous flow or re-do anastomosis may be done under CDUS recheck.
Additional Application of Interferon-Apha After Complete Destruction (CD) of Hepatocellular Carcinoma (HCC): Influence on Local Tumor Progression (LTP) Jordan G Genov, Clinic of Gastroenterology, University Hospital “Queen Joanna”, Bulgaria Nikola G Grigorov, Clinic of Gastroenterology, University Hospital “Queen Joanna”, Bulgaria Rumiana G Mitova, Clinic of Gastroenterology, University Hospital “Queen Joanna”, Bulgaria Branimir S Golemanov, Clinic of Gastroenterology, University Hospital “Queen Joanna”, Bulgaria Ljudmil R Dinkov, Clinic of Gastroenterology, University Hospital “Queen Joanna”, Bulgaria Marin P Donov, Clinic of Gastroenterology, University Hospital “Queen Joanna”, Bulgaria
Ultrasound in Medicine and Biology
Results: There were 4 types of enhancement patterns observed in the 113 lesions on CEUS. Type I, 49 (43.4%) nodules demonstrated simultaneous enhancement with the liver parenchyma and, therefore, the nodules appeared isoechoic to the liver throughout the arterial, portal and parenchymal phases; Type II, 27 (23.9%) nodules demonstrated delayed enhancement in the portal phase and then became isoechoic to the liver in parenchymal phase; Type III, 28 (24.8%) nodules presented delayed or simultaneous enhancement with the liver and then slight wash-out causing a hypoechoic appearance in the parenchymal phase; Type IV, 9 (8.0%) nodules presented slight enhancement with hyperechoic during arterial phase and slight wash-out with hypoechoic to the liver during the parenchymal phase. The ratio of hepatocellular dysplasia were significantly higher in type III/IV enhancement patterns than in type I/II (P⬍0.05). There were no significant statistical differences in hepatocellular regeneration, degeneration, necrosis, fibrous tissue hyperplasia, inflammatory cellular infiltration between type III/IV and type I/II enhancement patterns (P⬎0.05). Conclusions: The analysis of hemodynamics and the degree of hepatocellular atypia of RNs can help to monitor the development of RNs, and CEUS is useful in the clinical practice for the study of nodular lesions in cirrhotic patients. Key Words: Ultrasonography; Contrast agent; Cirrhosis; Regenerative nodule 1295 Portal Hyperperfusion in Living Donor Liver Transplantation Yu Fan Cheng, Chang Gung Memorial Hospital, Taiwan Portal hyperperfusion in a small-size liver graft is one cause of posttransplant graft dysfunction. We retrospectively analyzed the potential risk factors predicting the development of portal hyperperfusion in 43 adult living donor liver transplantation recipients. The following were evaluated: age, body weight, native liver disease, spleen size, graft size, graft-torecipient weight ratio (GRWR), total portal flow, recipient portal venous flow per 100 g graft weight (RPVF), graft-torecipient spleen size ratio (GRSSR) and portosystemic shunting. Spleen size was directly proportional to the total portal flow (p⫽0.001) and RPVF (p⫽0.014). Graft hyperperfusion (RPVF flow ⬎250 mL/min/ 100 g graft) was seen in eight recipients. If the GRSSR was ⬍0.6, 5 of 11 cases were found to have graft hyperperfusion (p ⫽ 0.017). The presence of portosystemic shunting was significant in decreasing excessive RPVF (p ⫽ 0.059). A decrease in portal flow in the hyperperfused grafts was achieved by intraoperative splenic artery ligation or splenectomy. Spleen size is a major factor contributing to portal flow after transplant. The GRSSR is associated with posttransplant graft hyperperfusion at a ratio of ⬍0.6.
Volume 35, Number 8S, 2009 CDUS were also performed during the 1st week of postoperative days. Postoperative enhanced CT studies were performed on cases of hyperbilirubinemia Results: The MHV vein grafts reconstructed were including 15 V5s, 18 V8s and 13 of V5 ⫹V8 in one anastomosis. CDUS had detected normal outflow in 52% (24/46), poor flow velocity (⬍10cm/sec) or flat waveform in 37% (17/46) and no flow in 11% (5/46). Postoperative complications with marked ascites, pleural effusion and/or persisted hyperbilirubinemia were noted in 7 cases including 3 cases of marginal graft-recipient weight ratio (⬍1.0). CT scans was performed for complications with significant venous congestion. Conclusion: Poor outflow of the reconstructed MHV graft detected by CDUS is significant to the graft dysfunction. CDUS is the best modality for evaluation of the outflow patency during and post LDLT. 1297 Detection of Recurrent Lesions in HCC Patients Treated with Radiofrequency Ablation (RFA): A Comparison of Contrast Enhanced Ultrasonography with CT Ying Dai, Beijing Cancer Hospital & Institute, China Objective: To investigate the diagnostic value of ultrasonography combined with contrast enhanced ultrasonography (CEUS) in detection of recurrent lesions in HCC patients treated with radiofrequency ablation (RFA) compared with Compute Tomography (CT). Methods: One hundred and seventy-three patients with HCC treated with curative RFA were enrolled in this study. All patients received both CEUS with SonoVue and CT at regular intervals. Nodules with contrast enhancement during the arterial phase (hypervascular) on CEUS were diagnosed as malignant. Biopsy and pathological confirmation or enlargement during follow-up were regarded to be the reference standard. Results: Altogether 102 hypervascular nodules were detected in 50 patients. Of them, 102 nodules in 41 patients were confirmed as malignant. The other nodules were confirmed as benign including 14 regenerative nodules, 3 abnormal perfusion, 2 vascular malformation, 1 hemangioma and 1 vessel cross-section. The sensitivity, specificity and accuracy rate for CEUS in the detection of recurrent nodules were 85.2% (69/81), 38.1% (8/21) and 75.5% (77/102). The sensitivity, specificity and accuracy rate for CT were 85.2% (69/81), 80.1% (17/21) and 84.3% (86/102). There was no statistical significance between the two method (X2⫽2.473, P⫽0.116). Conclusion: CEUS was helpful to detect recurrent nodules in HCC patients treated with RFA, comparable with CT. Keywords: contrast enhanced ultrasonography; hepatocellular carcinoma, radiofrequency ablation, recurrence
1296 1298 Doppler Ultrasound of the Venous Graft (Middle Hepatic Vein) in Adult Living Donor Liver Transplantation Yu Fan Cheng, Chang Gung Memorial Hospital, Taiwan T L Huang, Kaohsiung Medical Center, Taiwan Objective: To assess the patency of the reconstructed middle hepatic vein (MHV) with cryopreserved vein graft in adult living Donor liver transplantation (LDLT) Materials and Methods: From 2006 to 2008 Mar, there were 46 adult LDLT cases included with the MHV reconstructed by cryopreserved vein grafts. The branches drained segment 5 (V5) and/or segment 8 (V8) were reconstructed by size ⬎ 5 mm. Color Doppler ultrasound (CDUS) was performed to make sure of patency immediately after reperfusion of the graft. If no flow or poor flow velocity and /or monophasic waveform was abnormal, readjust of venous flow or re-do anastomosis may be done under CDUS recheck.
Additional Application of Interferon-Apha After Complete Destruction (CD) of Hepatocellular Carcinoma (HCC): Influence on Local Tumor Progression (LTP) Jordan G Genov, Clinic of Gastroenterology, University Hospital “Queen Joanna”, Bulgaria Nikola G Grigorov, Clinic of Gastroenterology, University Hospital “Queen Joanna”, Bulgaria Rumiana G Mitova, Clinic of Gastroenterology, University Hospital “Queen Joanna”, Bulgaria Branimir S Golemanov, Clinic of Gastroenterology, University Hospital “Queen Joanna”, Bulgaria Ljudmil R Dinkov, Clinic of Gastroenterology, University Hospital “Queen Joanna”, Bulgaria Marin P Donov, Clinic of Gastroenterology, University Hospital “Queen Joanna”, Bulgaria