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Hepatogastric Ligament Thickening: Analysis of Ultrasonography Features and Primary Causes
S42
Ultrasound in Medicine and Biology
Hospital, Sapporo/JP, 3Department of Radiology, Hokkaido University Hospital, Sapporo/JP, 4Department of Clinical Laboratory and Transfusion, Hokkaido University Hospital, Sapporo/JP, 5Department of Pediatrics, Hokkaido University Hospital, Sapporo/JP Purpose: Hepatic veno-occlusive disease (VOD) is severe complication of hematopoietic stem cell transplantation (HSCT). The purpose of this study was to diagnose VOD using ultrasound (US), and distinguish between VOD and graft-versus-host disease (GVHD). Material & Methods: From June 2008 to February 2011, 88 subjects underwent US before and after HSCT. VOD was diagnosed based on Baltimoa and/or Modified Seatle criteria, and GVHD hepatic biopsy. US findings were graded based on the following findings: ten findings in B mode (hepatomegaly (right and left lobe), splenomegaly, gall bladder wall thickness, diameter of each hepatic vein, portal vein and para-umbilical vein, and existence of ascites) and seven findings in Doppler (direction and mean velocity of portal vein, each hepatic vein’s wave form, appearance of blood flow signal in para-umbilical vein and resistive index of hepatic artery). VOD score, up to seventeen, was calculated by adding B mode and Doppler findings. Statistical analysis were performed by t-test and Tukey’s test (P,0.05) Results: Seven patients developed VOD (8.0%) and four GVHD (4.5%), Mean scores of pre HSCT, VOD and GVHD were 1.4, 8.1 and 3.7, respectively. There were significant differences among them (P,0.001). Significant difference was found between pre HSCT score in VOD 4.6 and in subjects that have not developed VOD 1.3 (P,0.001). Conclusion: VOD score might be useful to diagnose VOD, and possible criteria in the differentiation of GVHD.
SS 21.06 The Relationship Between Ultrasonographic Parameters and Densitometric Data in the Analysis of Body Composition A. Bazzocchi, D. Diano, F. Ponti, A. Andreone, E. Salizzoni, R. Canini Imaging Division, Clinical Department of Radiological and Histocytopathological Sciences, University of Bologna, Bologna/IT Purpose: Our aim was to investigate the link between adiposity fat indexes obtained using ultrasound (US) examination, total and android fat amount by dual-energy x-ray absorptiometry (DXA), and body weight (BW) in normal-weight, over-weight and obese subjects. Material & Methods: We retrospectively analyzed body composition (BC) parameters of 138 normal-weight (62M, 76F, age 41.2613.6year-old, BMI 22.361.5Kg/m2), 92 over-weight (60M, 32F, age 48.2613.3year-old, BMI 27.061.4Kg/m2) and 42 obese (4M, 38F, age 49.9612.8year-old, BMI 37.066.0Kg/m2) subjects. Data were collected from different studies in our Hospital where US and DXA evaluations were simultaneously performed for BC assessment. The carotid intimal-medial-thickness (CIMT), the ratio between minimum subcutaneous fat-thickness and maximum pre-peritoneal fat-thickness (wall-fat-index – WFI), and that one between maximum subcutaneous fat-thickness and intra-abdominal fat-thickness (MAR) were considered for US evaluations. Simple regression and ANOVA were used for the analysis (only p,0.05 were considered). Results: In all groups, WFI had significant correlations with total fat mass (FM) and FM percentage, while MAR got a relation with only BW; moreover, CIMT was related to android and whole-body FM. FM percentage in android region was linked to MAR and WFI only in normal-weight and over-weight subjects. Android FM was correlated with MAR only in normal-weight subjects.
Volume 37, Number 8S, 2011 Conclusion: DXA, US and BW look at the human body from different points of view. An integration of these three techniques should be considered when the assessment of BC is needed.
SS 21.07 Ultrasound Assessment of Fat Distribution in the Follow-up of Patients Undergoing Medical Treatment for Obesity A. Bazzocchi, F. Ponti, D. Diano, R. Femia, C. Sassi, G. Battista, R. Canini Imaging Division, Clinical Department of Radiological and Histocytopathological Sciences, University of Bologna, Bologna/IT Purpose: Visceral fat depots represent a very hot topic in the study of animal and human physio-pathology. Internal adipose tissue holds a prominent position in the definition of risk factors for many diseases, such as cardio-metabolic ones. Our purpose was to analyze changes of visceral and subcutaneous fat abdominal compartments by ultrasound (US) in patients undergoing medical treatment for obesity. Material & Methods: Forty-two obese patients were prospectively enrolled for a 3-month intensive cognitive-behaviour therapy. The study included US and dual-energy X-ray absorptiometry (DXA) evaluations of body composition (BC) at baseline, and after 3, 6 and 12 months. In the present abstract we focus our attention on the US ratio (MAR) between maximum subcutaneous fat-thickness (MSF) and intra-abdominal fat-thickness (IAF), and its connections with DXA parameters. Results: Twenty-one patients (4M, 17F, age 56.9611.1 year-old, BMI 37.567.4 Kg/m2) completed the entire follow-up program. In 18 patients a weight loss was achieved at 12 months and MAR decreased at both 3 and 6 months (respectively, D 5 -0.1360.14 and D 5 -0.1260.21, p,0.05, MSFY IAF[) with consensual reduction of the total fat mass percentage. However, MAR slightly increased at 12 months (D 5 0.0360.37, p 5 0.76, MSFY IAFY). Conclusion: DXA is considered a gold standard for BC assessment. Nevertheless, DXA is not able to discriminate between visceral and subcutaneous fat. US may be very helpful in providing adiposity indexes that reflect the real differential amount of the two fat compartments.
SS 21.10 Hepatogastric Ligament Thickening: Analysis of Ultrasonography Features and Primary Causes H. Zhang Diagnostic Ultrasound, Peking University Third Hospital, Beijing/CN Purpose: To review the ultrasonographic features of hepatogastric ligament thickening in 34 patients and assess the primary cause of this finding. Material & Methods: The author analyzed the medical records and ultrasonographic features of hepatogastric ligament thickening in 34 patients. Twenty healthy volunteer were examined to measure the thickness of the hepatogastric ligament also. The ultrasonographic features evaluated for the site were thickness; lymphadenopathy; and the change of or lesions within adjacent organ. The primary cause of hepatogastric ligament thickening was determined at histopathologic examination in 23 patients and in nine patients determined on the basis of follow-up and clinical data. The primary cause of hepatogastric ligament thickening in 2 patients was unknown. Results: Thirty-two of 34 patients had various underlying diseases. Twenty-three (67.6%) patients had a malignancy: 14 had gastric
Abstracts carcinoma, 3 had cholangiocellular carcinoma, one had Gallbladder Cancer, two had Transverse colon cancer, and 4 had gynecological malignancy. The mean thickness of the Hepatogastric ligament thickening was 3.761.1cm (0.860.3mm in control group). The primary cause of Hepatogastric ligament thickening was edma in 14 patients, inflammation and/or fibrosis in 5, malignant neoplasm in 12, and idiopathic in 2 patients. Conclusion: Hepatogastric ligament thickening appears as a result of malignancy, inflammation or hepatic edema. Hepatogastric ligament thickening was strongly associated with malignancy of adjacent and gynecological organ.
Mon, Aug 29, 2011 Hall B SS 22 10:30-12:00 Abdominal 5 - CEUS-Extrahepatic Applications SS 22.02 The Role of Contrast-Enhanced Ultrasound for the Assessment of Portal Vein Thrombosis M. Danila, I. Sporea, A. Popescu, R. Sirli, M. Sendroiu Gastroenterology and Hepatology, University of Medicine and Pharmacy, Timisoara/RO
S43
Material & Methods: Presentation of 30 cases of of CEUS with non i. v. low-dose administration of Sonovue(R) into cavities and hollow organs via drainage, e. g. interventional drainages and PTCD. Comparison of different modi and presets for the imaging of Sonovue(R) in these cases with Philips IU22(R). Results: The position of interventional Drainages in Cavities and PTCD, size, shape and development of drained abscesses, as well as presence or absence of leaks or fistulae to neighbouring compartments could be clearly demonstrated by low-dose CEUS in the majority of cases. Imaging control by contrast-enhanced CT or conventional XRay could be avoided in most cases. CEUS by conventional low MI (0.06) second harmonic pulse inversion technique was inferior to reduced MI THI technique concerning image resolution and penetration. Conclusion: Reduced MI THI low-dose Sonovue CEUS imaging is a promising alternative to contrast-enhanced CT or X-Ray imaging in interventional drainage procedures as well as in PTCD.
SS 22.04 Usefulness of Intracavitary Application of SonoVue in Hepatic and Perihepatic Fluid Lesions Z. A. Sparchez,1 P. Radu,2 M. Milas,1 R. Badea1 1 Ultrasound, 3rd Medical Clinic, Cluj Napoca/RO, 23rd Medical Clinic, Cluj Napoca/RO
Purpose: The aim of our study was to assess the applicability and value of the EFSUMB CEUS criteria for the diagnosis of portal vein thrombosis in clinical practice. Material & Methods: 46 consecutive patients with PVT were evaluated by means of ultrasound. The nature of PVT was assessed by means of CEUS. Benign portal vein thrombosis was diagnosed based of the following criteria: lack of vascularization of the portal thrombus on CEUS. Malignant portal vein thrombosis was diagnosed in patients with vascularized thrombus with wash out in the portal and/or late phase (EFSUMB criteria). Results: Out of 46 patients with PVT, 37 (80.4%) were subjects with liver cirrhosis, with or without visible hepatocellular carcinoma and 9 (19.6%) were patients with other abdominal or unknown pathology. 28 of 33 (84.8%) patients with liver cirrhosis and hepatocellular carcinoma had malignant PVT, and 5 (15.2%) of them had benign PVT. Other diseases complicated with PVT were acute pancreatitis, liver metastases. In 5 cases, PVT was found incidentally and the etiology of PVT was not discovered. CEUS was conclusive in 45/46(97.8%) of cases. Conclusion: Using EFSUMB criteria for CEUS examination in PVT, the result of our study was conclusive in 45/46 (97.8%) of the cases.
Purpose: The aim of the study was to assess the role of intracavitary application of contrast agents (ICAC) in intra- and perihepatic fluid lesions in terms of lesion delineation, establishing a possible communication to the biliary system and certifying a complication. Material & Methods: We enrolled 11 patients with intrahepatic lesions - 5 abscesses (3-7 cm in size), 3 biliary cysts (3-7 cm), 3 fluid collections after hydatic cyst surgery (6-8 cm) and 4 patients with perihepatic fluid collections (3-10 cm) after laparoscopic cholecystectomy or liver resection. Two drops of SonoVue were mixed with 50 ml saline and then injected through one catheter (8 cases) or 18G needles (7 cases) in the fluid lesions. Results: The ICAC resulted in a better delineation of the cavity in complex fluid lesions (2 multilocular abscesses). It also demonstrated the communication of the collection to the biliary system in 10 patients (the remaining 5 did not communicate with the biliary tree) and could also show the size of the biliary fistula (all patients with perihepatic collection had a large fistula to the biliary system). Conclusion: ICAC through a catheter or needle is a very useful technique to depict the anatomy of hepatic and perihepatic complex fluid collections and to monitor the drainage. It can also easily demonstrate the presence and size of a communication to the biliary system with important therapeutic consequences.
SS 22.03
SS 22.05
Low-Dose CEUS in Cavities and Hollow Organs: Promising New Imaging Option M. Wuestner, R. Thees-laurenz, C. Kappes-Sch€adler, E. Mertiny Zentrale Interdisziplinaere Sonographie, Bruederkrankenhaus, Trier/DE
Endocavitary Contrast-Enhanced Ultrasound (CEUS) in the Abdomen A. Heinzmann, T. M€uller, J. Leitlein, S. Kubicka, B. Braun, W. Blank Medizinische Klinik I, Klinikum am Steinenberg, Reutlingen/DE
Purpose: 1. To improve information on drainage placement, abscess geometry and progress of healing during interventional abscess therapy. 2. To find out if former radiological contrast applications in medical imaging can be replaced by CEUS.
Purpose: To demonstrate the benefit concerning localisation, measurement and visualisation of complications of drained fluid collections in the abdomen by applying ultrasound contrast agent via drainage catheters. In addition, to investigate the usefulness of CEUS in applying the agents in the biliary tract or when given orally.
Ultrasound in Medicine and Biology
Hospital, Sapporo/JP, 3Department of Radiology, Hokkaido University Hospital, Sapporo/JP, 4Department of Clinical Laboratory and Transfusion, Hokkaido University Hospital, Sapporo/JP, 5Department of Pediatrics, Hokkaido University Hospital, Sapporo/JP Purpose: Hepatic veno-occlusive disease (VOD) is severe complication of hematopoietic stem cell transplantation (HSCT). The purpose of this study was to diagnose VOD using ultrasound (US), and distinguish between VOD and graft-versus-host disease (GVHD). Material & Methods: From June 2008 to February 2011, 88 subjects underwent US before and after HSCT. VOD was diagnosed based on Baltimoa and/or Modified Seatle criteria, and GVHD hepatic biopsy. US findings were graded based on the following findings: ten findings in B mode (hepatomegaly (right and left lobe), splenomegaly, gall bladder wall thickness, diameter of each hepatic vein, portal vein and para-umbilical vein, and existence of ascites) and seven findings in Doppler (direction and mean velocity of portal vein, each hepatic vein’s wave form, appearance of blood flow signal in para-umbilical vein and resistive index of hepatic artery). VOD score, up to seventeen, was calculated by adding B mode and Doppler findings. Statistical analysis were performed by t-test and Tukey’s test (P,0.05) Results: Seven patients developed VOD (8.0%) and four GVHD (4.5%), Mean scores of pre HSCT, VOD and GVHD were 1.4, 8.1 and 3.7, respectively. There were significant differences among them (P,0.001). Significant difference was found between pre HSCT score in VOD 4.6 and in subjects that have not developed VOD 1.3 (P,0.001). Conclusion: VOD score might be useful to diagnose VOD, and possible criteria in the differentiation of GVHD.
SS 21.06 The Relationship Between Ultrasonographic Parameters and Densitometric Data in the Analysis of Body Composition A. Bazzocchi, D. Diano, F. Ponti, A. Andreone, E. Salizzoni, R. Canini Imaging Division, Clinical Department of Radiological and Histocytopathological Sciences, University of Bologna, Bologna/IT Purpose: Our aim was to investigate the link between adiposity fat indexes obtained using ultrasound (US) examination, total and android fat amount by dual-energy x-ray absorptiometry (DXA), and body weight (BW) in normal-weight, over-weight and obese subjects. Material & Methods: We retrospectively analyzed body composition (BC) parameters of 138 normal-weight (62M, 76F, age 41.2613.6year-old, BMI 22.361.5Kg/m2), 92 over-weight (60M, 32F, age 48.2613.3year-old, BMI 27.061.4Kg/m2) and 42 obese (4M, 38F, age 49.9612.8year-old, BMI 37.066.0Kg/m2) subjects. Data were collected from different studies in our Hospital where US and DXA evaluations were simultaneously performed for BC assessment. The carotid intimal-medial-thickness (CIMT), the ratio between minimum subcutaneous fat-thickness and maximum pre-peritoneal fat-thickness (wall-fat-index – WFI), and that one between maximum subcutaneous fat-thickness and intra-abdominal fat-thickness (MAR) were considered for US evaluations. Simple regression and ANOVA were used for the analysis (only p,0.05 were considered). Results: In all groups, WFI had significant correlations with total fat mass (FM) and FM percentage, while MAR got a relation with only BW; moreover, CIMT was related to android and whole-body FM. FM percentage in android region was linked to MAR and WFI only in normal-weight and over-weight subjects. Android FM was correlated with MAR only in normal-weight subjects.
Volume 37, Number 8S, 2011 Conclusion: DXA, US and BW look at the human body from different points of view. An integration of these three techniques should be considered when the assessment of BC is needed.
SS 21.07 Ultrasound Assessment of Fat Distribution in the Follow-up of Patients Undergoing Medical Treatment for Obesity A. Bazzocchi, F. Ponti, D. Diano, R. Femia, C. Sassi, G. Battista, R. Canini Imaging Division, Clinical Department of Radiological and Histocytopathological Sciences, University of Bologna, Bologna/IT Purpose: Visceral fat depots represent a very hot topic in the study of animal and human physio-pathology. Internal adipose tissue holds a prominent position in the definition of risk factors for many diseases, such as cardio-metabolic ones. Our purpose was to analyze changes of visceral and subcutaneous fat abdominal compartments by ultrasound (US) in patients undergoing medical treatment for obesity. Material & Methods: Forty-two obese patients were prospectively enrolled for a 3-month intensive cognitive-behaviour therapy. The study included US and dual-energy X-ray absorptiometry (DXA) evaluations of body composition (BC) at baseline, and after 3, 6 and 12 months. In the present abstract we focus our attention on the US ratio (MAR) between maximum subcutaneous fat-thickness (MSF) and intra-abdominal fat-thickness (IAF), and its connections with DXA parameters. Results: Twenty-one patients (4M, 17F, age 56.9611.1 year-old, BMI 37.567.4 Kg/m2) completed the entire follow-up program. In 18 patients a weight loss was achieved at 12 months and MAR decreased at both 3 and 6 months (respectively, D 5 -0.1360.14 and D 5 -0.1260.21, p,0.05, MSFY IAF[) with consensual reduction of the total fat mass percentage. However, MAR slightly increased at 12 months (D 5 0.0360.37, p 5 0.76, MSFY IAFY). Conclusion: DXA is considered a gold standard for BC assessment. Nevertheless, DXA is not able to discriminate between visceral and subcutaneous fat. US may be very helpful in providing adiposity indexes that reflect the real differential amount of the two fat compartments.
SS 21.10 Hepatogastric Ligament Thickening: Analysis of Ultrasonography Features and Primary Causes H. Zhang Diagnostic Ultrasound, Peking University Third Hospital, Beijing/CN Purpose: To review the ultrasonographic features of hepatogastric ligament thickening in 34 patients and assess the primary cause of this finding. Material & Methods: The author analyzed the medical records and ultrasonographic features of hepatogastric ligament thickening in 34 patients. Twenty healthy volunteer were examined to measure the thickness of the hepatogastric ligament also. The ultrasonographic features evaluated for the site were thickness; lymphadenopathy; and the change of or lesions within adjacent organ. The primary cause of hepatogastric ligament thickening was determined at histopathologic examination in 23 patients and in nine patients determined on the basis of follow-up and clinical data. The primary cause of hepatogastric ligament thickening in 2 patients was unknown. Results: Thirty-two of 34 patients had various underlying diseases. Twenty-three (67.6%) patients had a malignancy: 14 had gastric
Abstracts carcinoma, 3 had cholangiocellular carcinoma, one had Gallbladder Cancer, two had Transverse colon cancer, and 4 had gynecological malignancy. The mean thickness of the Hepatogastric ligament thickening was 3.761.1cm (0.860.3mm in control group). The primary cause of Hepatogastric ligament thickening was edma in 14 patients, inflammation and/or fibrosis in 5, malignant neoplasm in 12, and idiopathic in 2 patients. Conclusion: Hepatogastric ligament thickening appears as a result of malignancy, inflammation or hepatic edema. Hepatogastric ligament thickening was strongly associated with malignancy of adjacent and gynecological organ.
Mon, Aug 29, 2011 Hall B SS 22 10:30-12:00 Abdominal 5 - CEUS-Extrahepatic Applications SS 22.02 The Role of Contrast-Enhanced Ultrasound for the Assessment of Portal Vein Thrombosis M. Danila, I. Sporea, A. Popescu, R. Sirli, M. Sendroiu Gastroenterology and Hepatology, University of Medicine and Pharmacy, Timisoara/RO
S43
Material & Methods: Presentation of 30 cases of of CEUS with non i. v. low-dose administration of Sonovue(R) into cavities and hollow organs via drainage, e. g. interventional drainages and PTCD. Comparison of different modi and presets for the imaging of Sonovue(R) in these cases with Philips IU22(R). Results: The position of interventional Drainages in Cavities and PTCD, size, shape and development of drained abscesses, as well as presence or absence of leaks or fistulae to neighbouring compartments could be clearly demonstrated by low-dose CEUS in the majority of cases. Imaging control by contrast-enhanced CT or conventional XRay could be avoided in most cases. CEUS by conventional low MI (0.06) second harmonic pulse inversion technique was inferior to reduced MI THI technique concerning image resolution and penetration. Conclusion: Reduced MI THI low-dose Sonovue CEUS imaging is a promising alternative to contrast-enhanced CT or X-Ray imaging in interventional drainage procedures as well as in PTCD.
SS 22.04 Usefulness of Intracavitary Application of SonoVue in Hepatic and Perihepatic Fluid Lesions Z. A. Sparchez,1 P. Radu,2 M. Milas,1 R. Badea1 1 Ultrasound, 3rd Medical Clinic, Cluj Napoca/RO, 23rd Medical Clinic, Cluj Napoca/RO
Purpose: The aim of our study was to assess the applicability and value of the EFSUMB CEUS criteria for the diagnosis of portal vein thrombosis in clinical practice. Material & Methods: 46 consecutive patients with PVT were evaluated by means of ultrasound. The nature of PVT was assessed by means of CEUS. Benign portal vein thrombosis was diagnosed based of the following criteria: lack of vascularization of the portal thrombus on CEUS. Malignant portal vein thrombosis was diagnosed in patients with vascularized thrombus with wash out in the portal and/or late phase (EFSUMB criteria). Results: Out of 46 patients with PVT, 37 (80.4%) were subjects with liver cirrhosis, with or without visible hepatocellular carcinoma and 9 (19.6%) were patients with other abdominal or unknown pathology. 28 of 33 (84.8%) patients with liver cirrhosis and hepatocellular carcinoma had malignant PVT, and 5 (15.2%) of them had benign PVT. Other diseases complicated with PVT were acute pancreatitis, liver metastases. In 5 cases, PVT was found incidentally and the etiology of PVT was not discovered. CEUS was conclusive in 45/46(97.8%) of cases. Conclusion: Using EFSUMB criteria for CEUS examination in PVT, the result of our study was conclusive in 45/46 (97.8%) of the cases.
Purpose: The aim of the study was to assess the role of intracavitary application of contrast agents (ICAC) in intra- and perihepatic fluid lesions in terms of lesion delineation, establishing a possible communication to the biliary system and certifying a complication. Material & Methods: We enrolled 11 patients with intrahepatic lesions - 5 abscesses (3-7 cm in size), 3 biliary cysts (3-7 cm), 3 fluid collections after hydatic cyst surgery (6-8 cm) and 4 patients with perihepatic fluid collections (3-10 cm) after laparoscopic cholecystectomy or liver resection. Two drops of SonoVue were mixed with 50 ml saline and then injected through one catheter (8 cases) or 18G needles (7 cases) in the fluid lesions. Results: The ICAC resulted in a better delineation of the cavity in complex fluid lesions (2 multilocular abscesses). It also demonstrated the communication of the collection to the biliary system in 10 patients (the remaining 5 did not communicate with the biliary tree) and could also show the size of the biliary fistula (all patients with perihepatic collection had a large fistula to the biliary system). Conclusion: ICAC through a catheter or needle is a very useful technique to depict the anatomy of hepatic and perihepatic complex fluid collections and to monitor the drainage. It can also easily demonstrate the presence and size of a communication to the biliary system with important therapeutic consequences.
SS 22.03
SS 22.05
Low-Dose CEUS in Cavities and Hollow Organs: Promising New Imaging Option M. Wuestner, R. Thees-laurenz, C. Kappes-Sch€adler, E. Mertiny Zentrale Interdisziplinaere Sonographie, Bruederkrankenhaus, Trier/DE
Endocavitary Contrast-Enhanced Ultrasound (CEUS) in the Abdomen A. Heinzmann, T. M€uller, J. Leitlein, S. Kubicka, B. Braun, W. Blank Medizinische Klinik I, Klinikum am Steinenberg, Reutlingen/DE
Purpose: 1. To improve information on drainage placement, abscess geometry and progress of healing during interventional abscess therapy. 2. To find out if former radiological contrast applications in medical imaging can be replaced by CEUS.
Purpose: To demonstrate the benefit concerning localisation, measurement and visualisation of complications of drained fluid collections in the abdomen by applying ultrasound contrast agent via drainage catheters. In addition, to investigate the usefulness of CEUS in applying the agents in the biliary tract or when given orally.