- Email: [email protected]
405 THE CLINICAL CHARACTERISTICS OF ACUTE KIDNEY INJURY AFTER TRANSARTERIAL CHEMOEMBOLIZATION IN PATIENTS WITH HEPATOCELLULAR CARCINOMA
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POSTERS
Aims of the present study were to assess incidence and risk factors of HCC recurrence and to compare it with the incidence of first HCC in cirrhotics. Methods: Retrospective analysis of cirrhotic patients with HCC submitted to resection (n = 205) and cirrhotics undergoing surveillance with ultrasonography (n = 150). Results: Resected patients showed higher prevalence of male gender and higher alpha-fetoprotein (AFP) (P < 0.05). Risk factors for early (<2 years) recurrence (incidence = 21.8%/year) were higher AFP, poorly tumor differentiation and presence of microvascular invasion (P < 0.05), all suggesting a metastatic cause for recurrence. Risk factors for both late recurrence (18.4%/year) and first HCC occurrence (3.3%/year) were male gender, older age and higher serum transaminase (suggesting de novo HCC postresection); multiple primary tumors and higher AFP were additional risk factors for respectively late recurrence and first HCC (P < 0.05). Resected patients with 1 risk factors for late recurrence showed similar annual incidence of HCC (6.2%/year) to controls with >1 risk factors (6.3%/year; P = 0.919). Conclusion: HCC annual incidence remains higher than in cirrhosis even after two years from resection. However, in low risk resected HCC cirrhotic patients the incidence is similar to that of cirrhotic controls. The assessment of such characteristics in resected patients could address tailored post-operative follow-up schedules or, in the liver transplantation setting, modify allocation priority in HCC patients (maintaining or discarding priority). 403 TO RULE OUT HEPATOCELLULAR CARCINOMA IN HIGH RISK PATIENTS: A NOVEL INDEX FOR EXCLUDING HEPATOCELLULAR CARCINOMA IN CENTRAL EUROPEAN IN-PATIENTS WITH LIVER DISEASE M. Quante1 , A. Erhardt2 , V. Schmitz1 , W. Caselmann3 , T. Sauerbruch1 , C. Rabe1 . 1 Department of Internal Medicine I, University of Bonn, Bonn, Germany; 2 Department of Internal Medicine, University of D¨usseldorf, D¨usseldorf, Germany; 3 Bavarian State Ministry for the Environment, Health, and Consumer Protection, Germany E-mail: [email protected] Introduction: Diagnostic tests for hepatocellular carcinoma (HCC) have less than optimal sensitivity and specificity. Lack of resources precludes the use of more sensitive procedures (MRI) in all patients. In this study, we develop and validate a risk index to discriminate patients with HCC from cirrhotics without HCC before performing further diagnostic evaluation. Patients and Methods: 409 in-patients with liver cirrhosis and/or HCC were included. Stepwise logistic regression was performed to construct an index to differentiate between HCC patients and cirrhotics. This index was validated using another unrelated cohort of 558 consecutive in-patients with liver cirrhosis and/or HCC. 237 patients with HCC from the German national HCC registry served as a further independent control group. Results: The risk index includes age, sex, ALT, the presence of ascites, portal vein thrombosis, markers of hepatitis B or C, and performance status. This index detected HCC patients (n = 111) among the total validation cohort of 558 patients with a sensitivity of 96% (95%-confidence interval (CI): 91−99%). The negative predictive value was 98% (CI 94−99%) while the positive predictive value was 28%. Testing the score on another 237 HCC patients from the HCC registry yielded a sensitivity of HCC detection of 94% (CI 89−96%). Conclusions: A simple score derived from seven readily available variables distinguishes between in-patients with HCC or cirrhosis. The index could be used to identify patients with a high likelihood for HCC who could then be examined by more expensive tests. Conversely, low risk individuals in whom costly procedures may not be indicated could be identified.
404 HEPATIC NODULE HEMODYNAMICS USING CONTRASTENHANCED ULTRASONOGRAPHY (CEUS): A COMPARISON OF SONAZOID AND LEVOVIST A. Saito, M. Chiba, Y. Yoneda, T. Komiya, S. Patel, K. Shiratori, S. Katagiri, M. Yamamoto. Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan E-mail: [email protected] Background and Aim: Levovist, which has a diagnostic rate for individual hepatic nodules superior to those of CT and MRI, has been the only intravenous contrast agent available in Japan for the last 9 years. We analyzed hepatic nodule hemodynamics using CEUS with Sonazoid, a new contrast agent, to clarify possible differences from Levovist. Methods: Among 304 hepatic nodules examined using Sonazoid CEUS since February 2007, 38 in 36 cases were selected for this study because Levovist CEUS and pathological findings were also available. There were 27 hepatocellular carcinoma (HCC) nodules (21 moderately differentiated: 5 well-differentiated: 1 mixed), 10 hyperplastic nodules, including 5 focal nodular hyperplasia (FNH), and 1 angiomyolipoma. The Levovist (1 vial; 300 mg/ml) and Sonazoid (0.01 ml/kg) were administered intravenously. Arterial phase imaging from 1 to 40 seconds after injection, and subsequent enhancement (up to 7 minutes for Levovist and up to 30 minutes for Sonazoid) was observed. ADI (Sequoia 512) was used for Levovist and mainly ePHD (Prosound a10) for Sonazoid. Results: 1) In the arterial phase, feeding arteries were better visualized with Levovist, while nodule enhancement was more clearly seen and realtime images were easily obtained with Sonazoid. Capture-mode is useful for analyzing feeding arteries in Sonazoid CEUS. 2) Approximately 80% of nodules showed washout during subsequent phases. These findings appeared within the first 5 min. in all nodules with Levovist, but were delayed for up to 30 min. with Sonazoid. 3) Most HCC nodules, other than the well-differentiated type, showed washout during the subsequent phase, while 70% of the benign nodules remained iso-enhanced. Conclusion: Sonazoid CEUS allowed clear and real-time, though somewhat delayed, visualization of hepatic nodule hemodynamics. Using capture-mode, vascular structure was observed in detail, possibly reducing the need for tumor biopsy. 405 THE CLINICAL CHARACTERISTICS OF ACUTE KIDNEY INJURY AFTER TRANSARTERIAL CHEMOEMBOLIZATION IN PATIENTS WITH HEPATOCELLULAR CARCINOMA J.W. Shin1 , J. Park1 , D.M. Kim1 , J.C. Hwang2 , M.W. Cho3 , H.C. Chung1 , J.S. Lee1 , N.H. Park1 . 1 Department of Internal Medicine, 2 Department of Radiology, Ulsan University Hospital, University of Ulsan, College of Medicine Ulsan, Ulsan, Korea, 3 Department of Epidemiology, Dongguk University College of Medicine, Gyeongju, Korea E-mail: [email protected] Background and Aims: Transarterial chemoembolization (TACE) is effective and commonly used treatment modality for hepatocellular carcinoma (HCC). But clinical characteristics of acute kidney injury (AKI) after TACE have not been known well. We investigated clinical characteristics and outcomes of AKI after TACE in patients with HCC. Methods: A total of 236 HCC patients with 442 TACE sessions were analyzed. Diagnostic criteria for AKI were defined as an increase of serum creatinine 0.3 mg/dl or 1.5 fold above baseline within 48 hours after TACE. Results: AKI developed in 29 (6.6%) TACE sessions of 24 (10.2%) patients. The estimated risk of developing AKI was 5.6% in each session. Twenty-four episodes (82.8%) of AKI were completely recovered within 1 months but 5 episodes (17.2%) showed prolonged renal insufficiency. In multivariate analysis, hypertension (OR: 3.24, p = 0.02), serum albumin (OR: 0.29, p < 0.01) and baseline serum creatinine (OR: 12.02, p < 0.01) were revealed as an independent risk factors of developing AKI. The
03B. LIVER TUMORS – B) CLINICAL (EPIDEMIOLOGY, DIAGNOSIS, MANAGEMENT) occurrence of AKI did not affect survival of patients (median survival time: 14 months vs. 17 months in patients with and without AKI, p = 0.2). Conclusion: AKI was developed in quite a number of HCC patients after TACE and was associated with hypertension, baseline levels of serum albumin and creatinine. Although the majority of AKI was transient and seemed not to affect survival, we should have pay attention to prevention and early recognition of AKI occurrence in high risk patients. 406 IMAGING HEPATOCELLULAR CARCINOMA WITH 18F-DEOXY-GALACTOSE PET HAS A HIGH SENSITIVITY M. Sørensen1,2 , D. Bender1 , S. Keiding1 . 1 PET Centre, Aarhus University Hospital, Aarhus, Denmark; 2 Department of Medicine V (Hepatology), Aarhus University Hospital, Aarhus, Denmark E-mail: [email protected] Background and Aims: Hepatocellular carcinoma, HCC, is a common malignant complication to liver cirrhosis. Early diagnosis is important, but difficult because of difficulties in distinguishing benign cirrhotic liver tissue from malignant tissue using common diagnostic imaging modalities. The aim of this project was to study the feasibility of imaging HCC by PET after injection of the hepatocyte-specific tracer 18F-deoxy-galactose, FDGal. Galactose is very specifically taken up by hepatocytes and an increased uptake is expected in malignant cells. FDG PET using the sugar analogue 18F-deoxy-glucose (FDG) is widely used in oncology to detect malignant tissue but for HCC it only detects about 2/3 of the nodules. Methods: Ten patients with liver cirrhosis and newly diagnosed HCC were included. Diagnosis was based on contrast enhanced dual-phase CT (ceCT), MRI, ultrasound, and/or biopsies. After overnight fasting the patients underwent a static PET scan from base of the skull to mid-thighs one hour after injection of 200 MBq FDGal. Six patients also had a FDG PET scan. All patients had a ceCT. Results: All patients had several HCC nodules in the liver and two patients had extrahepatic disease. All nodules were detected by FDGal, except in one case where there was a small hyper dense lesion on ceCT. FDG PET was only positive in 2/3 of the cases in accordance with previous findings. All FDG negative cases were detected by FDGal PET. In one case both FDG and FDGal revealed a metastasis in the axilla that was not found by ceCT. In two cases FDGal PET revealed HCC not otherwise detected by conventional ceCT nor by FDG PET. Conclusions: FDGal PET seems promising as a novel imaging modality in detecting HCC with better results than both FDG PET and ceCT. 407 EVALUATION OF AN ULTRASOUND TELESCREENING NETWORK FOR HEPATOCELLULAR CARCINOMA H. Stefanescu1,2 , M. Lupsor1 , O. Dancea3 , T. Marita4 , T. Suteu1 , D. Capatana3 , R. Cazan3 , D. Mitrea4 , R. Badea1 . 1 Medical Imaging Dept., University of Medicine and Pharmacy, 3rd Medical Clinic, 2 Hepatology Dept., University of Medicine and Pharmacy, 3rd Medical Clinic, 3 IPA-CIFATT Cluj-Napoca, Romania, 4 Computer Science Dept., Technical University, Cluj-Napoca, Romania E-mail: [email protected] Background and Aims: Ultrasonography (US) is recognized as a sensitive and accurate tool that is used in hepatocellular carcinoma (HCC) screening in chronic liver diseases (CLD) patients. Telemedicine and e-health solutions became valuable tools for optimizing health-care infrastructure in remote areas. The aim of this study was to evaluate the diagnostic accuracy of an ultrasound telescreening network for HCC. Methods: The tele-sonography network consists in many internet connected ultrasound remote terminals situated in the general practitioner’s office and a core located in a tertiary health care facility. The communication system (web based, completely digitalized) is developed using ASP.NET technology. The telescreening protocol consist in completion medical data
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and recording 17 still ultrasound images (.bmp format) and 2 videos (.avi format) of the liver. Medical data and US images are transmitted over the network and stored in a database that is managed using Microsoft SQL Server 2005. A dedicated software that pre-classifies the images on the normal-abnormal criteria is linked to the server and the database. Only abnormal images will be furthermore evaluated by human experts. The evaluation takes into account the BCLC criteria, and estimates the nodules, portal invasion and the global liver parenchyma. 90 listed CLD (all etiologies) patients (mean age 52.7 years, 57.84% males) from a 12000 population from a remote area in northern Romania were evaluated according to protocol. All 90 sets of 17 US images and 2 videos could be transmitted without any inconveniences over the network. All 1530 US images were analyzed comparatively by human experts and by the software. Results: Image interpretation was similar in the two sets. The image analysis software correctly classified all liver cirrhosis US images (p = 0.00) and 97.8% of chronic hepatitis images (p < 0.001). In our group, both the experts and the software could identify only one focal liver lesion (incidence = 1.11%). Conclusion: Telesonography assisted by image analysis seems to be a reliable tool for HCC screening, especially in remote areas. This method needs further internal and external validation. Acknowledgments: These data are part of the PCD-M1-CEEX grant nr 3/2005 from the Romanian Ministry of Education and Scientific Research. 408 HIGH METABOLISM THROMBUS OF THE PORTAL VEIN: 18F FLUORODEOXYGLUCOSE POSITRON EMISSION TOMOGRAPHY/COMPUTER TOMOGRAPHY DEMONSRATION AND CLINICAL SIGNIFICANCE IN HEPATOCELLULAR CARCINOMA L. Sun. Minnan PET Center, The First Hospital of Xiamen, Fujian Medical University, Xiamen, China E-mail: [email protected] Background and Aims: This study assessed the ability of FDG PET/CT to differentiate between benign and malignant portal vein thrombosis in HCC patients. Methods: Five consecutive patients who had HBV cirrhosis, biopsyproved HCC, and thrombosis of the main portal vein and/or left/right
POSTERS
Aims of the present study were to assess incidence and risk factors of HCC recurrence and to compare it with the incidence of first HCC in cirrhotics. Methods: Retrospective analysis of cirrhotic patients with HCC submitted to resection (n = 205) and cirrhotics undergoing surveillance with ultrasonography (n = 150). Results: Resected patients showed higher prevalence of male gender and higher alpha-fetoprotein (AFP) (P < 0.05). Risk factors for early (<2 years) recurrence (incidence = 21.8%/year) were higher AFP, poorly tumor differentiation and presence of microvascular invasion (P < 0.05), all suggesting a metastatic cause for recurrence. Risk factors for both late recurrence (18.4%/year) and first HCC occurrence (3.3%/year) were male gender, older age and higher serum transaminase (suggesting de novo HCC postresection); multiple primary tumors and higher AFP were additional risk factors for respectively late recurrence and first HCC (P < 0.05). Resected patients with 1 risk factors for late recurrence showed similar annual incidence of HCC (6.2%/year) to controls with >1 risk factors (6.3%/year; P = 0.919). Conclusion: HCC annual incidence remains higher than in cirrhosis even after two years from resection. However, in low risk resected HCC cirrhotic patients the incidence is similar to that of cirrhotic controls. The assessment of such characteristics in resected patients could address tailored post-operative follow-up schedules or, in the liver transplantation setting, modify allocation priority in HCC patients (maintaining or discarding priority). 403 TO RULE OUT HEPATOCELLULAR CARCINOMA IN HIGH RISK PATIENTS: A NOVEL INDEX FOR EXCLUDING HEPATOCELLULAR CARCINOMA IN CENTRAL EUROPEAN IN-PATIENTS WITH LIVER DISEASE M. Quante1 , A. Erhardt2 , V. Schmitz1 , W. Caselmann3 , T. Sauerbruch1 , C. Rabe1 . 1 Department of Internal Medicine I, University of Bonn, Bonn, Germany; 2 Department of Internal Medicine, University of D¨usseldorf, D¨usseldorf, Germany; 3 Bavarian State Ministry for the Environment, Health, and Consumer Protection, Germany E-mail: [email protected] Introduction: Diagnostic tests for hepatocellular carcinoma (HCC) have less than optimal sensitivity and specificity. Lack of resources precludes the use of more sensitive procedures (MRI) in all patients. In this study, we develop and validate a risk index to discriminate patients with HCC from cirrhotics without HCC before performing further diagnostic evaluation. Patients and Methods: 409 in-patients with liver cirrhosis and/or HCC were included. Stepwise logistic regression was performed to construct an index to differentiate between HCC patients and cirrhotics. This index was validated using another unrelated cohort of 558 consecutive in-patients with liver cirrhosis and/or HCC. 237 patients with HCC from the German national HCC registry served as a further independent control group. Results: The risk index includes age, sex, ALT, the presence of ascites, portal vein thrombosis, markers of hepatitis B or C, and performance status. This index detected HCC patients (n = 111) among the total validation cohort of 558 patients with a sensitivity of 96% (95%-confidence interval (CI): 91−99%). The negative predictive value was 98% (CI 94−99%) while the positive predictive value was 28%. Testing the score on another 237 HCC patients from the HCC registry yielded a sensitivity of HCC detection of 94% (CI 89−96%). Conclusions: A simple score derived from seven readily available variables distinguishes between in-patients with HCC or cirrhosis. The index could be used to identify patients with a high likelihood for HCC who could then be examined by more expensive tests. Conversely, low risk individuals in whom costly procedures may not be indicated could be identified.
404 HEPATIC NODULE HEMODYNAMICS USING CONTRASTENHANCED ULTRASONOGRAPHY (CEUS): A COMPARISON OF SONAZOID AND LEVOVIST A. Saito, M. Chiba, Y. Yoneda, T. Komiya, S. Patel, K. Shiratori, S. Katagiri, M. Yamamoto. Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan E-mail: [email protected] Background and Aim: Levovist, which has a diagnostic rate for individual hepatic nodules superior to those of CT and MRI, has been the only intravenous contrast agent available in Japan for the last 9 years. We analyzed hepatic nodule hemodynamics using CEUS with Sonazoid, a new contrast agent, to clarify possible differences from Levovist. Methods: Among 304 hepatic nodules examined using Sonazoid CEUS since February 2007, 38 in 36 cases were selected for this study because Levovist CEUS and pathological findings were also available. There were 27 hepatocellular carcinoma (HCC) nodules (21 moderately differentiated: 5 well-differentiated: 1 mixed), 10 hyperplastic nodules, including 5 focal nodular hyperplasia (FNH), and 1 angiomyolipoma. The Levovist (1 vial; 300 mg/ml) and Sonazoid (0.01 ml/kg) were administered intravenously. Arterial phase imaging from 1 to 40 seconds after injection, and subsequent enhancement (up to 7 minutes for Levovist and up to 30 minutes for Sonazoid) was observed. ADI (Sequoia 512) was used for Levovist and mainly ePHD (Prosound a10) for Sonazoid. Results: 1) In the arterial phase, feeding arteries were better visualized with Levovist, while nodule enhancement was more clearly seen and realtime images were easily obtained with Sonazoid. Capture-mode is useful for analyzing feeding arteries in Sonazoid CEUS. 2) Approximately 80% of nodules showed washout during subsequent phases. These findings appeared within the first 5 min. in all nodules with Levovist, but were delayed for up to 30 min. with Sonazoid. 3) Most HCC nodules, other than the well-differentiated type, showed washout during the subsequent phase, while 70% of the benign nodules remained iso-enhanced. Conclusion: Sonazoid CEUS allowed clear and real-time, though somewhat delayed, visualization of hepatic nodule hemodynamics. Using capture-mode, vascular structure was observed in detail, possibly reducing the need for tumor biopsy. 405 THE CLINICAL CHARACTERISTICS OF ACUTE KIDNEY INJURY AFTER TRANSARTERIAL CHEMOEMBOLIZATION IN PATIENTS WITH HEPATOCELLULAR CARCINOMA J.W. Shin1 , J. Park1 , D.M. Kim1 , J.C. Hwang2 , M.W. Cho3 , H.C. Chung1 , J.S. Lee1 , N.H. Park1 . 1 Department of Internal Medicine, 2 Department of Radiology, Ulsan University Hospital, University of Ulsan, College of Medicine Ulsan, Ulsan, Korea, 3 Department of Epidemiology, Dongguk University College of Medicine, Gyeongju, Korea E-mail: [email protected] Background and Aims: Transarterial chemoembolization (TACE) is effective and commonly used treatment modality for hepatocellular carcinoma (HCC). But clinical characteristics of acute kidney injury (AKI) after TACE have not been known well. We investigated clinical characteristics and outcomes of AKI after TACE in patients with HCC. Methods: A total of 236 HCC patients with 442 TACE sessions were analyzed. Diagnostic criteria for AKI were defined as an increase of serum creatinine 0.3 mg/dl or 1.5 fold above baseline within 48 hours after TACE. Results: AKI developed in 29 (6.6%) TACE sessions of 24 (10.2%) patients. The estimated risk of developing AKI was 5.6% in each session. Twenty-four episodes (82.8%) of AKI were completely recovered within 1 months but 5 episodes (17.2%) showed prolonged renal insufficiency. In multivariate analysis, hypertension (OR: 3.24, p = 0.02), serum albumin (OR: 0.29, p < 0.01) and baseline serum creatinine (OR: 12.02, p < 0.01) were revealed as an independent risk factors of developing AKI. The
03B. LIVER TUMORS – B) CLINICAL (EPIDEMIOLOGY, DIAGNOSIS, MANAGEMENT) occurrence of AKI did not affect survival of patients (median survival time: 14 months vs. 17 months in patients with and without AKI, p = 0.2). Conclusion: AKI was developed in quite a number of HCC patients after TACE and was associated with hypertension, baseline levels of serum albumin and creatinine. Although the majority of AKI was transient and seemed not to affect survival, we should have pay attention to prevention and early recognition of AKI occurrence in high risk patients. 406 IMAGING HEPATOCELLULAR CARCINOMA WITH 18F-DEOXY-GALACTOSE PET HAS A HIGH SENSITIVITY M. Sørensen1,2 , D. Bender1 , S. Keiding1 . 1 PET Centre, Aarhus University Hospital, Aarhus, Denmark; 2 Department of Medicine V (Hepatology), Aarhus University Hospital, Aarhus, Denmark E-mail: [email protected] Background and Aims: Hepatocellular carcinoma, HCC, is a common malignant complication to liver cirrhosis. Early diagnosis is important, but difficult because of difficulties in distinguishing benign cirrhotic liver tissue from malignant tissue using common diagnostic imaging modalities. The aim of this project was to study the feasibility of imaging HCC by PET after injection of the hepatocyte-specific tracer 18F-deoxy-galactose, FDGal. Galactose is very specifically taken up by hepatocytes and an increased uptake is expected in malignant cells. FDG PET using the sugar analogue 18F-deoxy-glucose (FDG) is widely used in oncology to detect malignant tissue but for HCC it only detects about 2/3 of the nodules. Methods: Ten patients with liver cirrhosis and newly diagnosed HCC were included. Diagnosis was based on contrast enhanced dual-phase CT (ceCT), MRI, ultrasound, and/or biopsies. After overnight fasting the patients underwent a static PET scan from base of the skull to mid-thighs one hour after injection of 200 MBq FDGal. Six patients also had a FDG PET scan. All patients had a ceCT. Results: All patients had several HCC nodules in the liver and two patients had extrahepatic disease. All nodules were detected by FDGal, except in one case where there was a small hyper dense lesion on ceCT. FDG PET was only positive in 2/3 of the cases in accordance with previous findings. All FDG negative cases were detected by FDGal PET. In one case both FDG and FDGal revealed a metastasis in the axilla that was not found by ceCT. In two cases FDGal PET revealed HCC not otherwise detected by conventional ceCT nor by FDG PET. Conclusions: FDGal PET seems promising as a novel imaging modality in detecting HCC with better results than both FDG PET and ceCT. 407 EVALUATION OF AN ULTRASOUND TELESCREENING NETWORK FOR HEPATOCELLULAR CARCINOMA H. Stefanescu1,2 , M. Lupsor1 , O. Dancea3 , T. Marita4 , T. Suteu1 , D. Capatana3 , R. Cazan3 , D. Mitrea4 , R. Badea1 . 1 Medical Imaging Dept., University of Medicine and Pharmacy, 3rd Medical Clinic, 2 Hepatology Dept., University of Medicine and Pharmacy, 3rd Medical Clinic, 3 IPA-CIFATT Cluj-Napoca, Romania, 4 Computer Science Dept., Technical University, Cluj-Napoca, Romania E-mail: [email protected] Background and Aims: Ultrasonography (US) is recognized as a sensitive and accurate tool that is used in hepatocellular carcinoma (HCC) screening in chronic liver diseases (CLD) patients. Telemedicine and e-health solutions became valuable tools for optimizing health-care infrastructure in remote areas. The aim of this study was to evaluate the diagnostic accuracy of an ultrasound telescreening network for HCC. Methods: The tele-sonography network consists in many internet connected ultrasound remote terminals situated in the general practitioner’s office and a core located in a tertiary health care facility. The communication system (web based, completely digitalized) is developed using ASP.NET technology. The telescreening protocol consist in completion medical data
S157
and recording 17 still ultrasound images (.bmp format) and 2 videos (.avi format) of the liver. Medical data and US images are transmitted over the network and stored in a database that is managed using Microsoft SQL Server 2005. A dedicated software that pre-classifies the images on the normal-abnormal criteria is linked to the server and the database. Only abnormal images will be furthermore evaluated by human experts. The evaluation takes into account the BCLC criteria, and estimates the nodules, portal invasion and the global liver parenchyma. 90 listed CLD (all etiologies) patients (mean age 52.7 years, 57.84% males) from a 12000 population from a remote area in northern Romania were evaluated according to protocol. All 90 sets of 17 US images and 2 videos could be transmitted without any inconveniences over the network. All 1530 US images were analyzed comparatively by human experts and by the software. Results: Image interpretation was similar in the two sets. The image analysis software correctly classified all liver cirrhosis US images (p = 0.00) and 97.8% of chronic hepatitis images (p < 0.001). In our group, both the experts and the software could identify only one focal liver lesion (incidence = 1.11%). Conclusion: Telesonography assisted by image analysis seems to be a reliable tool for HCC screening, especially in remote areas. This method needs further internal and external validation. Acknowledgments: These data are part of the PCD-M1-CEEX grant nr 3/2005 from the Romanian Ministry of Education and Scientific Research. 408 HIGH METABOLISM THROMBUS OF THE PORTAL VEIN: 18F FLUORODEOXYGLUCOSE POSITRON EMISSION TOMOGRAPHY/COMPUTER TOMOGRAPHY DEMONSRATION AND CLINICAL SIGNIFICANCE IN HEPATOCELLULAR CARCINOMA L. Sun. Minnan PET Center, The First Hospital of Xiamen, Fujian Medical University, Xiamen, China E-mail: [email protected] Background and Aims: This study assessed the ability of FDG PET/CT to differentiate between benign and malignant portal vein thrombosis in HCC patients. Methods: Five consecutive patients who had HBV cirrhosis, biopsyproved HCC, and thrombosis of the main portal vein and/or left/right