- Email: [email protected]
631 HEPATOCELLULAR CARCINOMA (HCC) AND METABOLIC SYNDROME: CLINICAL, BIOLOGICAL, PATHOLOGICAL FEATURES AND PROGNOSIS. ANALYSIS OF A PROSPECTIVE COHORT OF 925 HCC
POSTERS for HCC are available only for patients with early stage tumors, so it is necessary to discover a precise method for detecting early stage HCC. MicroRNAs (miRNAs) play important roles in gene regulatory networks, and aberrant miRNA expression has been observed in human hepatocarcinogenesis. This study compared the expression of miRNA in surgically resected HCC tissues and surrounding nontumor tissue from 23 patients with early stage HCC. We also compared the expression of miRNA in serial stages of HCC in a mouse HCC model. This study looked for miRNAs that can be used as biomarkers of HCC. Methods: miRNAs were isolated from mouse liver tissues, surgically resected HCC tissues, and surrounding non-tumor tissues from 23 HCC patients and used to synthesize cDNA. We designed primers for 50 miRNAs, which were selected based on published microarray studies. We used SYBR Green quantitative RT-PCR (qRT-PCR) assays to compare the expression of miRNAs in HCC and surrounding non-HCC tissues in humans and in the mouse HCC model. Results: Six miRNAs were highly up-regulated in early stage HCC; miR-17–5p, 24, 25, 107, 221, and 222 were significantly up-regulated in 65, 61, 74, 65, 83, and 78% of the HCC samples, respectively. In more than 90% of the HCC samples (21 of 23 samples), at least one of miR-221 and miR-25 was up-regulated, as compared with adjacent non-tumor tissues. miR-17–5p, 24, 25, 221, and 222 were also significantly up-regulated in the mouse HCC model. In addition, miR-222 was progressively up-regulated with the stage of HCC in this model. Conclusions: We identified miRNAs that are significantly upregulated in early HCC. More than 90% of the patients with an early stage HCC had elevated expression of either miR-221 or miR25, suggesting that the combination of these the two microRNAs might be an effective biomarker for detecting early HCC. In addition, miR-222 is suitable for determining the stage of HCC. 629 ANALYSIS OF AFP, CYTOGENETIC ABERRATIONS AND MTHFR GENE POLYMORPHISM IN HEPATOCELLULAR CARCINOMA (HCC) PATIENTS V. Balachandar, K. Sasikala. Human Genetics Laboratory, School of Life Sciences, Bharathiar University, Coimbatore, India E-mail: [email protected] Background and Aims: Hepatocellular carcinoma (HCC) is one of the most prevalent human cancers, ranking the fifth most common worldwide, with a high incidence in developing country. The usefulness of alpha-fetoprotein (AFP) as a tumor marker is well known. Conventional cytogenetic studies have demonstrated frequent abnormalities of specific chromosomes in HCC. A single nucleotide polymorphism (SNP) C677T in the methylenetetrahydrofolate reductase (MTHFR) gene has been identified. The present study aims to analyze the AFP levels, the Cytogenetic abnormalities and the MTHFR C677T polymorphism in HCC patients to assess whether peripheral blood had non-random genetic alterations. Methods: The study was conducted on the peripheral blood of 55 HCC patients (aged 30 to 85 years male) undergoing hepatic resection of liver tumour with curative intent and compared with equal number of controls. AFP was quantitatively determined using a commercial ELISA. Both the subjects were analysed for chromosomal alterations using conventional G-banging. The presence of the MTHFR C677T SNP was determined via polymerase chain reaction amplification. Results: In the present investigation, HCC patients had significantly increased AFP levels and aberrant metaphases compared to controls. HCC samples revealed frequent aberrations in chromosomes 1, 8, 17, 13, 16 and 20. Chromatid breaks were seen on chromosomes 1, 2 and 4 while chromatid gaps were on chromosomes 1, 2 and 3. Among the 55 patients with HCC, 15 had
the CC genotype, 26 the CT, and 10 the TT genotype. Only in patients with alcoholic liver disease has a significant association detected between the TT genotype and the presence of HCC (p < 0.05). The present study suggests that TT carriers with alcoholic cirrhosis bear an increased risk of developing HCC. Conclusion: The identified altered chromosomal regions may harbour tumour suppressor genes or Oncogenes that are involved in the multistep process of carcinogenesis or disease pathology. Identification of molecular pathways that drive the proliferation of neoplastic hepatocytes may enable development of drugs that can specifically target and kill those cells. 630 HIGH SERUM LEVELS OF THE INTERLEUKIN 33 RECEPTOR SOLUBLE ST2 AS A NEGATIVE PROGNOSTIC FACTOR IN HEPATOCELLULAR CARCINOMA D. Bergis1 , V. Kassis2 , A. Ranglack2 , V. Koeberle1 , A. Piiper1 , B. Kronenberger1 , S. Zeuzem1 , O. Waidmann1 , H.H. Radeke2 . 1 Department of Internal Medicine 1, 2 Pharmazentrum, J.W.Goethe University Hospital, Frankfurt/Main, Germany E-mail: [email protected] Background: Hepatocellular carcinoma (HCC) is the most common primary malignant liver tumor, usually arises in the setting of liver cirrhosis and has a poor prognosis. Cytokines like IL-6 or IL-10 are known to play an important role in hepatic carcinogenesis. The recently discovered Th2-cytokine interleukin (IL)-33 is a possible mediator in pancreatic and gastric carcinogenesis. IL-33 binds to its receptor soluble ST2 (sST2) which thereby acts as a regulator. The role of IL-33 and sST2 in HCC has not been elucidated yet. Methods: We conducted a case control study with 130 patients and 50 healthy controls. 65 patients suffered from HCC (HCC group), 65 patients had liver cirrhosis without HCC (LC group). We aimed to assess serum IL-33- and sST2 levels and their association with established prognostic scores such as MELD- and CLIP score, liver function parameters and overall survival (OS). Results: The concentration of the soluble IL-33 receptor sST2 significantly differed between the 3 cohorts with highest levels in patients with liver cirrhosis without HCC (p < 0.0001) and lowest levels in healthy controls (p < 0.0001). Patients with liver cirrhosis without HCC showed almost twice as high sST2 levels as patients with HCC. In contrast, IL-33 levels were similar between the cohorts. In patients with HCC sST2 levels were significantly associated with OS (p = 0.002) and significantly correlated with the CLIP- and the MELD-score, AFP, AST and CRP. IL-33 levels did not correlate with OS, the CLIP- or the MELD-score or liver function parameters in either of the groups. Conclusion: In the present study the serum concentration of the soluble IL-33 receptor sST2 was associated with prognosis of HCC indicating a potential role of the IL-33−/sST2 signal transduction in HCC pathogenesis. We therefore consider sST2 a new prognostic marker in HCC. 631 HEPATOCELLULAR CARCINOMA (HCC) AND METABOLIC SYNDROME: CLINICAL, BIOLOGICAL, PATHOLOGICAL FEATURES AND PROGNOSIS. ANALYSIS OF A PROSPECTIVE COHORT OF 925 HCC A. Le Cleac’h1 , L. Possenti1 , C. Blanc-Bisson1 , C. Laurent2 , H. Trillaud3 , B. Le-Bail4 , P. Bioulac-Sage4 , C. Balabaud1 , J.-F. Blanc1 . 1 Hepatogastroenterology and Digestive Oncology, 2 Digestive Surgery Unit, 3 Radiology Unit, Hˆ opital Saint-Andr´e, CHU Bordeaux, 4 Pathology Unit, Hˆ opital Pellegrin, Bordeaux, France E-mail: [email protected] Introduction: Metabolic syndrome (MS) is a risk factor of HCC usually via underlying NASH/NAFLD. The aim of this study was
Journal of Hepatology 2013 vol. 58 | S229–S407
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POSTERS to compare clinical, biological, pathological features as well as prognosis of HCC in patients with or without MS. Material and Methods: 925 consecutive patients with HCC were included between 01/2005 and 03/2012. Clinical, biological, pathological, radiological data were recorded and compared between patients with and without MS (NCEP ATP III). Followup included CT-Scan or RMI every 3/6 months (median follow-up 16.5 months). Results: MS was present in 29% of patients who were older (68.3 vs 64.48 years p < 0.001) and often male (90% vs 82% p = 0.02). Underlying liver disease was less advanced and HCC was developed more often on non-cirrhotic livers (28.8 vs 21.5% p = 0.01). Diagnosis is delayed in the MS group, with a low screening rate (28 vs 40% in non-MS (p < 0.01)). Overall survival (OS) was similar in the 2 groups (2.68 years (MS) vs 3.23 p = 0.44). Recurrence free survival (RFS) after curative treatment was similar in the 2 groups (2.18 years (MS) vs 2.49 p = 0.509) but late recurrences (>2 years) were more frequent in the MS group. A subgroup analysis was performed, comparing patients with MS only (n = 80), with those with alcoholic disease (n = 271) or hepatitis C (n = 106). HCC occurred more often on non-cirrhotic livers in the MS group (49%) vs 15% (HCV) and 13% (OH) (p = 0.01). Overall survival was similar for MS group and HCV group (36 months) but inferior for alcoholic disease group exhibiting a more severe underlying liver disease (22 months). No difference was observed between the 3 groups for the RFS after curative treatments. Conclusion: One third of patients diagnosed with HCC had MS, frequently associated with an excessive alcohol intake. In 9% of cases, MS was the only risk factor found. HCC with MS occurred more often on non-cirrhotic livers. In spite of a less severe hepatic disease in the MS group, OS was not better and the rate of recurrence, especially late recurrences (>2 years) are high. 632 AETIOLOGY OF CHRONIC LIVER DISEASE INFLUENCES CLINICAL PRESENTATION AND OUTCOME OF HEPATOCELLULAR CARCINOMA: A SINGLE CENTER COHORT STUDY F. Oliveri1 , C. Rastelli1 , P. Colombatto1 , B. Coco1 , P. Ciccorossi1 , V. Romagnoli1 , B. Cherubini1 , R. Lencioni2 , L. Crocetti2 , C. Bartolozzi3 , A. Campatelli4 , F. Filipponi5 , F. Bonino6 , M.R. Brunetto1 . 1 Hepatology Unit, 2 Diagnostic Interventional Radiology, 3 Radiology Department, 4 General Surgery, 5 Liver Transplantation Unit, 6 General Medicine II, Digestive and Liver Disease Unit, University Hospital of Pisa, Pisa, Italy E-mail: [email protected] Background and Aims: The epidemiologic patterns of chronic liver disease (CLD) and hepatocellular carcinoma (HCC) differ by geographic area; in Italy HCC incidence increased in recent years. We studied the impact of CLD aetiology on HCC patients’ clinical presentation and outcome. Methods: From year 2000 to 2010 490 consecutive HCC-patients were diagnosed and followed-up at our Hepatology Unit. CLD aetiology was HBV in 66 (13.5%), HCV in 314 (64.1%), HBV/HCV in 7 (1.4%) and non viral (alcohol/NASH/NAFLD) in 103 (21%). Occult HBV (HBsAg−/anti-HBc+) was present in 32.4% of HCV− and 42.6% of HCV+ patients. Age, sex, baseline features, therapy and outcomes were studied. Results: In Table 1 we report significant (Chi-square/ANOVA) different variables by CLD-aetiology. Age and profiles of HBV/HCV/non-viral HCC-patients differed significantly. In Alcohol/NASH/NAFLD patients prevalence of single HCC <5 cm (46.2%) was similar to that of HBV (45.5%), in spite of less frequent diagnosis on screening; shorter survival was influenced by end-stage cirrhosis (23.1%) and extrahepatic diseases (23.1%). HBVpatients were younger and showed higher HCC-related death rate S258
possibly because oral anti-HBV treatment delayed progression of cirrhosis. Survival independent factors (Cox-regression) were Child– Pugh, baseline HCC stage, vascular involvement and treatment. Table 1.
Age (mean, years) Sex (male) Cirrhosis (prevalence) Liver function: Child–Pugh A Liver decompensation* HCC Diagnosis at screening HCC stage: Unifocal ≤5 cm HCC treatment (yes) Cause of death**: HCC
Overall
HBsAg+
HCV+/ Anti-HBc+
HCV+/ Anti-HBc−
Nonviral
P
67.0 74.0% 96.2% 77.5% 20.6% 58.2% 54.5% 79.6% 64.9%
63.9 93.9% 93.9% 81.0% 16.7% 54.1% 45.5% 86.3% 85.2%
68.8 69.5% 98.9% 83.0% 11.6% 68.8% 60.0% 75.6% 70.0%
68.0 63.3% 96.1% 82.0% 17.2% 71.4% 61.7% 86.4% 57.7%
66.3 81.7% 95.2% 63.7% 35.6% 34.5% 46.2% 69.4% 53.8%
0.003 <0.001 0.011 0.019 <0.001 <0.001 0.037 0.019 0.010
*Ascites, bleeding, encephalopathy. **HCC Progression (vascular invasion or mts); Cirrhosis: overall 23.8% (26– 32.7% in HCV+/anti-HBc+/−); Extra-hepatic: 11.3% (23.1% in HBsAg−/anti-HCV−).
Conclusion: Clinical profile and outcome of HCC patients differs significantly according to the aetiology of the associated CLD. Decision making in both clinical trials and practice should take into account the different profiles when comparing different HCC therapeutic strategies. 633 A NOVEL APPROACH TO IMAGE ANALYSIS FOR HEPATIC ONCOLOGY DIAGNOSIS BASED ON FRACTAL GEOMETRY. PRELIMINARY RESULTS R. Bubnov1 , I.M. Melnyk2 . 1 The Centre of Ultrasound Diagnostics and Interventional Sonography, Clinical Hospital “Pheophania” of State Affairs Department, 2 International Research and Training Center for Information Technology and Systems NAS and MES of Ukraine, Kyiv, Ukraine E-mail: [email protected] Introduction: Biological and medical systems are predominantly irregular, complex and non-linear, since cannot be quantified by classical geometry approach. Novel mathematical algorithms can expand the information content of medical images, providing an objective measurement to reduce subjectivity in the perception and interpretation. The aim of the study was to investigate capabilities of fractal analysis for expand its diagnostic value of diagnostic imaging. Methods: Fractal Dimension (FD) is a statistical quantity that gives an indication of how completely a fractal appears to fill space, zooming down to more finer scales. We proposed a method of medical images analysis obtained from a wide range of sources – radiology imaging. The fractal parameters of these images were calculated for 7 patients with liver lesions for ultrasound, CT, MRI images and generated 3D vector and voxel models by patented method, ‘covering’ the parts of these expertly segmented images by two-dimensional geometric shapes (squares, rectangles, triangles, circles, ellipses) and three-dimensional (cubes, simplices, balls, ellipsoids, pyramids) with appling iteration method, which involves finding the appropriate (i-th) value approaching the value of FD. Results: FD was estimated as 1.67 for hepatocellular carcinoma case; 1.72 – for cholangiocarcinoma; 1.45–1.56 for complex cysts; and 1.15–1.35 for metastases. We consider that only threedimensional reconstruction from expertly segmented images allows to perform accurate analysis. The most informative description of self-similarity is fractal analysis, conducted with the maximum number of steps. However, objective analysis is limited by resolution of diagnostic equipment, is possible only under visual control by expert. The application of automated and semiautomated image analysis leads to control the process, correctly selecting the areas for research, preselecting a suppositive fractal structure. Conclusion: Fractal analysis of medical images is a promising non-invasive sophisticated approach, it should become highly informative indicator of pathological formations using nonlinear mathematical parameters of structure, gives insights into tumor morphology and can become a useful tool for analyzing tumor
Journal of Hepatology 2013 vol. 58 | S229–S407
the CC genotype, 26 the CT, and 10 the TT genotype. Only in patients with alcoholic liver disease has a significant association detected between the TT genotype and the presence of HCC (p < 0.05). The present study suggests that TT carriers with alcoholic cirrhosis bear an increased risk of developing HCC. Conclusion: The identified altered chromosomal regions may harbour tumour suppressor genes or Oncogenes that are involved in the multistep process of carcinogenesis or disease pathology. Identification of molecular pathways that drive the proliferation of neoplastic hepatocytes may enable development of drugs that can specifically target and kill those cells. 630 HIGH SERUM LEVELS OF THE INTERLEUKIN 33 RECEPTOR SOLUBLE ST2 AS A NEGATIVE PROGNOSTIC FACTOR IN HEPATOCELLULAR CARCINOMA D. Bergis1 , V. Kassis2 , A. Ranglack2 , V. Koeberle1 , A. Piiper1 , B. Kronenberger1 , S. Zeuzem1 , O. Waidmann1 , H.H. Radeke2 . 1 Department of Internal Medicine 1, 2 Pharmazentrum, J.W.Goethe University Hospital, Frankfurt/Main, Germany E-mail: [email protected] Background: Hepatocellular carcinoma (HCC) is the most common primary malignant liver tumor, usually arises in the setting of liver cirrhosis and has a poor prognosis. Cytokines like IL-6 or IL-10 are known to play an important role in hepatic carcinogenesis. The recently discovered Th2-cytokine interleukin (IL)-33 is a possible mediator in pancreatic and gastric carcinogenesis. IL-33 binds to its receptor soluble ST2 (sST2) which thereby acts as a regulator. The role of IL-33 and sST2 in HCC has not been elucidated yet. Methods: We conducted a case control study with 130 patients and 50 healthy controls. 65 patients suffered from HCC (HCC group), 65 patients had liver cirrhosis without HCC (LC group). We aimed to assess serum IL-33- and sST2 levels and their association with established prognostic scores such as MELD- and CLIP score, liver function parameters and overall survival (OS). Results: The concentration of the soluble IL-33 receptor sST2 significantly differed between the 3 cohorts with highest levels in patients with liver cirrhosis without HCC (p < 0.0001) and lowest levels in healthy controls (p < 0.0001). Patients with liver cirrhosis without HCC showed almost twice as high sST2 levels as patients with HCC. In contrast, IL-33 levels were similar between the cohorts. In patients with HCC sST2 levels were significantly associated with OS (p = 0.002) and significantly correlated with the CLIP- and the MELD-score, AFP, AST and CRP. IL-33 levels did not correlate with OS, the CLIP- or the MELD-score or liver function parameters in either of the groups. Conclusion: In the present study the serum concentration of the soluble IL-33 receptor sST2 was associated with prognosis of HCC indicating a potential role of the IL-33−/sST2 signal transduction in HCC pathogenesis. We therefore consider sST2 a new prognostic marker in HCC. 631 HEPATOCELLULAR CARCINOMA (HCC) AND METABOLIC SYNDROME: CLINICAL, BIOLOGICAL, PATHOLOGICAL FEATURES AND PROGNOSIS. ANALYSIS OF A PROSPECTIVE COHORT OF 925 HCC A. Le Cleac’h1 , L. Possenti1 , C. Blanc-Bisson1 , C. Laurent2 , H. Trillaud3 , B. Le-Bail4 , P. Bioulac-Sage4 , C. Balabaud1 , J.-F. Blanc1 . 1 Hepatogastroenterology and Digestive Oncology, 2 Digestive Surgery Unit, 3 Radiology Unit, Hˆ opital Saint-Andr´e, CHU Bordeaux, 4 Pathology Unit, Hˆ opital Pellegrin, Bordeaux, France E-mail: [email protected] Introduction: Metabolic syndrome (MS) is a risk factor of HCC usually via underlying NASH/NAFLD. The aim of this study was
Journal of Hepatology 2013 vol. 58 | S229–S407
S257
POSTERS to compare clinical, biological, pathological features as well as prognosis of HCC in patients with or without MS. Material and Methods: 925 consecutive patients with HCC were included between 01/2005 and 03/2012. Clinical, biological, pathological, radiological data were recorded and compared between patients with and without MS (NCEP ATP III). Followup included CT-Scan or RMI every 3/6 months (median follow-up 16.5 months). Results: MS was present in 29% of patients who were older (68.3 vs 64.48 years p < 0.001) and often male (90% vs 82% p = 0.02). Underlying liver disease was less advanced and HCC was developed more often on non-cirrhotic livers (28.8 vs 21.5% p = 0.01). Diagnosis is delayed in the MS group, with a low screening rate (28 vs 40% in non-MS (p < 0.01)). Overall survival (OS) was similar in the 2 groups (2.68 years (MS) vs 3.23 p = 0.44). Recurrence free survival (RFS) after curative treatment was similar in the 2 groups (2.18 years (MS) vs 2.49 p = 0.509) but late recurrences (>2 years) were more frequent in the MS group. A subgroup analysis was performed, comparing patients with MS only (n = 80), with those with alcoholic disease (n = 271) or hepatitis C (n = 106). HCC occurred more often on non-cirrhotic livers in the MS group (49%) vs 15% (HCV) and 13% (OH) (p = 0.01). Overall survival was similar for MS group and HCV group (36 months) but inferior for alcoholic disease group exhibiting a more severe underlying liver disease (22 months). No difference was observed between the 3 groups for the RFS after curative treatments. Conclusion: One third of patients diagnosed with HCC had MS, frequently associated with an excessive alcohol intake. In 9% of cases, MS was the only risk factor found. HCC with MS occurred more often on non-cirrhotic livers. In spite of a less severe hepatic disease in the MS group, OS was not better and the rate of recurrence, especially late recurrences (>2 years) are high. 632 AETIOLOGY OF CHRONIC LIVER DISEASE INFLUENCES CLINICAL PRESENTATION AND OUTCOME OF HEPATOCELLULAR CARCINOMA: A SINGLE CENTER COHORT STUDY F. Oliveri1 , C. Rastelli1 , P. Colombatto1 , B. Coco1 , P. Ciccorossi1 , V. Romagnoli1 , B. Cherubini1 , R. Lencioni2 , L. Crocetti2 , C. Bartolozzi3 , A. Campatelli4 , F. Filipponi5 , F. Bonino6 , M.R. Brunetto1 . 1 Hepatology Unit, 2 Diagnostic Interventional Radiology, 3 Radiology Department, 4 General Surgery, 5 Liver Transplantation Unit, 6 General Medicine II, Digestive and Liver Disease Unit, University Hospital of Pisa, Pisa, Italy E-mail: [email protected] Background and Aims: The epidemiologic patterns of chronic liver disease (CLD) and hepatocellular carcinoma (HCC) differ by geographic area; in Italy HCC incidence increased in recent years. We studied the impact of CLD aetiology on HCC patients’ clinical presentation and outcome. Methods: From year 2000 to 2010 490 consecutive HCC-patients were diagnosed and followed-up at our Hepatology Unit. CLD aetiology was HBV in 66 (13.5%), HCV in 314 (64.1%), HBV/HCV in 7 (1.4%) and non viral (alcohol/NASH/NAFLD) in 103 (21%). Occult HBV (HBsAg−/anti-HBc+) was present in 32.4% of HCV− and 42.6% of HCV+ patients. Age, sex, baseline features, therapy and outcomes were studied. Results: In Table 1 we report significant (Chi-square/ANOVA) different variables by CLD-aetiology. Age and profiles of HBV/HCV/non-viral HCC-patients differed significantly. In Alcohol/NASH/NAFLD patients prevalence of single HCC <5 cm (46.2%) was similar to that of HBV (45.5%), in spite of less frequent diagnosis on screening; shorter survival was influenced by end-stage cirrhosis (23.1%) and extrahepatic diseases (23.1%). HBVpatients were younger and showed higher HCC-related death rate S258
possibly because oral anti-HBV treatment delayed progression of cirrhosis. Survival independent factors (Cox-regression) were Child– Pugh, baseline HCC stage, vascular involvement and treatment. Table 1.
Age (mean, years) Sex (male) Cirrhosis (prevalence) Liver function: Child–Pugh A Liver decompensation* HCC Diagnosis at screening HCC stage: Unifocal ≤5 cm HCC treatment (yes) Cause of death**: HCC
Overall
HBsAg+
HCV+/ Anti-HBc+
HCV+/ Anti-HBc−
Nonviral
P
67.0 74.0% 96.2% 77.5% 20.6% 58.2% 54.5% 79.6% 64.9%
63.9 93.9% 93.9% 81.0% 16.7% 54.1% 45.5% 86.3% 85.2%
68.8 69.5% 98.9% 83.0% 11.6% 68.8% 60.0% 75.6% 70.0%
68.0 63.3% 96.1% 82.0% 17.2% 71.4% 61.7% 86.4% 57.7%
66.3 81.7% 95.2% 63.7% 35.6% 34.5% 46.2% 69.4% 53.8%
0.003 <0.001 0.011 0.019 <0.001 <0.001 0.037 0.019 0.010
*Ascites, bleeding, encephalopathy. **HCC Progression (vascular invasion or mts); Cirrhosis: overall 23.8% (26– 32.7% in HCV+/anti-HBc+/−); Extra-hepatic: 11.3% (23.1% in HBsAg−/anti-HCV−).
Conclusion: Clinical profile and outcome of HCC patients differs significantly according to the aetiology of the associated CLD. Decision making in both clinical trials and practice should take into account the different profiles when comparing different HCC therapeutic strategies. 633 A NOVEL APPROACH TO IMAGE ANALYSIS FOR HEPATIC ONCOLOGY DIAGNOSIS BASED ON FRACTAL GEOMETRY. PRELIMINARY RESULTS R. Bubnov1 , I.M. Melnyk2 . 1 The Centre of Ultrasound Diagnostics and Interventional Sonography, Clinical Hospital “Pheophania” of State Affairs Department, 2 International Research and Training Center for Information Technology and Systems NAS and MES of Ukraine, Kyiv, Ukraine E-mail: [email protected] Introduction: Biological and medical systems are predominantly irregular, complex and non-linear, since cannot be quantified by classical geometry approach. Novel mathematical algorithms can expand the information content of medical images, providing an objective measurement to reduce subjectivity in the perception and interpretation. The aim of the study was to investigate capabilities of fractal analysis for expand its diagnostic value of diagnostic imaging. Methods: Fractal Dimension (FD) is a statistical quantity that gives an indication of how completely a fractal appears to fill space, zooming down to more finer scales. We proposed a method of medical images analysis obtained from a wide range of sources – radiology imaging. The fractal parameters of these images were calculated for 7 patients with liver lesions for ultrasound, CT, MRI images and generated 3D vector and voxel models by patented method, ‘covering’ the parts of these expertly segmented images by two-dimensional geometric shapes (squares, rectangles, triangles, circles, ellipses) and three-dimensional (cubes, simplices, balls, ellipsoids, pyramids) with appling iteration method, which involves finding the appropriate (i-th) value approaching the value of FD. Results: FD was estimated as 1.67 for hepatocellular carcinoma case; 1.72 – for cholangiocarcinoma; 1.45–1.56 for complex cysts; and 1.15–1.35 for metastases. We consider that only threedimensional reconstruction from expertly segmented images allows to perform accurate analysis. The most informative description of self-similarity is fractal analysis, conducted with the maximum number of steps. However, objective analysis is limited by resolution of diagnostic equipment, is possible only under visual control by expert. The application of automated and semiautomated image analysis leads to control the process, correctly selecting the areas for research, preselecting a suppositive fractal structure. Conclusion: Fractal analysis of medical images is a promising non-invasive sophisticated approach, it should become highly informative indicator of pathological formations using nonlinear mathematical parameters of structure, gives insights into tumor morphology and can become a useful tool for analyzing tumor
Journal of Hepatology 2013 vol. 58 | S229–S407