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LIVER STIFFNESS VALUES MEASURED BY TRANSIENT ELASTOGRAPHY ARE INCREASED IN PATIENTS WITH ACUTELY DECOMPENSATED HEART FAILURE
Abstracts / Digestive and Liver Disease 41S (2009), S1–S167 ultrasound (CEUS) with second-generation intravascular contrast media (blood-pool). Aim of the present perspective study was to evaluate if Time To Peak (TTP), Maximum Peak Intensity (MPI) and Slope (Coefficient of the wash-in slope) (β) are able to predict and quantify inflammatory activity in ileal CD. Material and methods: The study was performed by means of digital US scanner Philips iU22 with dedicated software for low-mechanicalindex studies and a 4 to 8 MHz linear-array probe. After informed consent, between 2005 and 2007, fifty-four consecutive patients (M38, F16, age range 18-69 years; mean 35) affected by ileal CD without colon-rectal disease or with inactive colonic disease, were studied by CEUS with second generation contrast agent (SonoVue® i.v. 4,8 ml). According to Montreal classification 16 patients had inflammatory, 17 stricturing and 21 penetrating disease. The US data obtained after SV administration allow to draw up time-intensity curves through software-assisted HDI-QLab and to obtain following parameters: time to peak (TTP), maximum peak intensity (MPI) coefficient of the wash-in slope (β). Through ROC curve analysis, quantitative data were correlated with Biological Activity as Gold Standard, defined as the positivity of almost 3 between CDAI, laboratory parameters, endoscopy, radiology. Results: In distinguish active disease, TTP (seconds) with a cut-off >8.1 showed sensitivity 97.2% specificity 77.7% (p0.0001, AUC 0.86); MPI (Db), cut-off >24, sensitivity 97.2%, specificity 83.3% (p0.0001, AUC 0.927); Slope (Db/sec), cut-off >4.5, sensitivity 86.1%, specificity 83.3%, (p0.0001, AUC 0.891). Conclusions: This study demonstrates that TTP, MPI and Slope are able to quantify inflammatory activity in ileal CD. Quantitative CEUS and definite cut-off could improve the reliability of conventional US to detect active bowel wall inflammation in CD.CEUS could be used in the follow-up because of lack of radiation exposure. # T. Imaging techniques 1. Ultrasounds
P.232 CONTRAST ENHANCED ULTRASONOGRAPHY (CEUS) IN THE DIAGNOSIS AND CHARACTERIZATION OF HEPATOCARCINOMA (HCC) AND IN THE FOLLOW-UP AFTER PERCUTANEOUS ABLATIVE THERAPIES (PATs): A RETROSPECTIVE STUDY M.C. Nacchiero ∗ ,1 , G. Verderosa 1 , E. Ierardi 1 , N. Muscatiello 1 , F. Diterlizzi 1 , N. Crucinio 2 , C. Panella 1 1 Gastroenterologia Universitaria Azienda Mista Ospedali Riuniti, Foggia; 2 Gastroenterologia Ospedaliera Azienda Mista Ospedali Riuniti, Foggia
Background and aim: While the role of contrast enhanced ultrasonography (CEUS) has been well stated in the diagnosis of hepatocarcinoma (HCC), few data are available about its usefulness in the follow-up after loco-regional treatments. We performed a retrospective analysis of the use of a microbubble of hexafluoride (SonoVue Bracco Italy) for the characterization of hepatocarcinoma both at the diagnosis and during its follow-up after percutaneous ablative therapies (PATs). Material and methods: From 2001 to 2008 we studied 99 patients with 128 nodules of HCC (size 1-2 cm) in livers with cirrhosis or chronic hepatitis. We used histology, computed tomography (CT) or magnetic resonance (MR) as “gold standard” in order to calculate the values of the two main quality parameters (sensitivity and specificity). The diagnosis of HCC was based on well-known criteria of contrast pattern (Quaia E et al, Radiology 2004; 292:420) and its characterization included the number, size and site of the nodules. The evaluation of therapeutic effect followed known literature criteria (Meloni MF et al, Am J Roentegenol 2001; 377:175). Results: CEUS showed a high value of sensitivity (94.1%) and a good one of specificity (77.7%) for either the diagnosis and the characteriza-
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tion of focal liver HCC nodules. This last value was strongly affected by some lesions which were not confirmed by TC or MR and were predominantly found in the case of multiple lesions in the same liver. These case were considered as false positive. In the follow-up, CEUS showed a complete agreement with TC and MR (100% of specificity) and a good sensitivity (83.3%). This last value was due to some false positive results in incomplete necrosis assessment. Conclusions: Our data suggest: a) in the diagnostic phase, the higher sensitivity compared to specificity suggests its usefulness in the detection of HCC even if a confirmation with TC or MR is advisable; b) in the follow-up, in case of a complete necrosis, the lower sensitivity compared to specificity accounts for the possibility of false negative results thus recommending the confirmation by TC or MR; c) if there is an incomplete necrosis, CEUS alone is able to identify it and there is no need of confirmation with TC or MR to indicate the continuation of the therapy. # T. Imaging techniques 1. Ultrasounds
P.233 LIVER STIFFNESS VALUES MEASURED BY TRANSIENT ELASTOGRAPHY ARE INCREASED IN PATIENTS WITH ACUTELY DECOMPENSATED HEART FAILURE P. Pozzoni ∗ ,1 , D. Prati 2 , A. Berzuini 2 , A. Gerosa 2 , C. Canovi 1 , E.E. Molteni 1 , M. Barbarini 3 , F. Bonino 4 , A. Colli 1 1 Department of Medicine, A. Manzoni Hospital, Lecco; 2 Department of Transfusion Medicine and Hematology, A. Manzoni Hospital, Lecco; 3 Department of Laboratory Medicine, A. Manzoni Hospital, Lecco; 4 IRCCS Fondazione Policlinico, Mangiagalli e Regina Elena, Milano
Background and aim: Liver stiffness measurement (LSM) by Transient Elastography (TE) is increasingly used as non invasive estimate of liver fibrosis in patients with chronic liver disease. Commonly used cutoff values are >7 kPa for significant fibrosis and >14 for cirrhosis. However, there is growing evidence that fibrosis is not the only determinant of liver stiffness: inflammation, cholestasis and variation in the parenchymal blood content can also interfere. In case of heart failure the increased pressure in the right cardiac chambers is followed by dilation of the hepatic veins and distension of the capsule with an enlarged and firm liver. We studied a series of patients with acutely decompensated heart failure (ADHF), in order to describe the variations of liver stiffness and assess their relation with clinical course and laboratory data. Material and methods: 23 consecutive patients (9 males, 14 females, aged 79.7±12.2 years) with clinical diagnosis of ADHF requiring intravenous diuretics were included. Exclusion criteria were: BMI >30 and suspected diagnosis of liver disease on the basis of history, ultrasonographic or biochemical parameters. At admission and discharge all patients underwent TE and simultaneous blood sample for NT pro β natriuretic peptide (NTproβBNP), which is released in response to volume overload (values >900 pg/ml are diagnostic for ADHF). Results: At admission, NTproβBNP was >900 pg/ml in 22 patients. LSM failed in 3 (13%), and was >7 in 12/20 patients (60%) and >14 in 5/20 (25%) Between admission and discharge, we observed a significant reduction of both LSM (median 8.85; IQr 6.30, 12.63 vs. 7.80; 5.85, 11.75; p<0.001), and NTproβBNP values (median 7226; IQr 3254, 13625 vs. 4441; 1216- 6116; p<0.001). The delta of variation between admission and discharge of liver stiffness and NTproβBNP were significantly related (R= 0.536, P<0.05). Conclusions: Our data indicate that 60% percent of patients with ADHF have increased liver stiffness as assessed by TE. The return to clinical compensation is accompanied by LSM reduction as compared to baseline values, and the extent of LSM variation parallels that of NTproβBNP values. Thus, LSM likely reflects reversible hepatic congestion. # T. Imaging techniques 1. Ultrasounds
P.232 CONTRAST ENHANCED ULTRASONOGRAPHY (CEUS) IN THE DIAGNOSIS AND CHARACTERIZATION OF HEPATOCARCINOMA (HCC) AND IN THE FOLLOW-UP AFTER PERCUTANEOUS ABLATIVE THERAPIES (PATs): A RETROSPECTIVE STUDY M.C. Nacchiero ∗ ,1 , G. Verderosa 1 , E. Ierardi 1 , N. Muscatiello 1 , F. Diterlizzi 1 , N. Crucinio 2 , C. Panella 1 1 Gastroenterologia Universitaria Azienda Mista Ospedali Riuniti, Foggia; 2 Gastroenterologia Ospedaliera Azienda Mista Ospedali Riuniti, Foggia
Background and aim: While the role of contrast enhanced ultrasonography (CEUS) has been well stated in the diagnosis of hepatocarcinoma (HCC), few data are available about its usefulness in the follow-up after loco-regional treatments. We performed a retrospective analysis of the use of a microbubble of hexafluoride (SonoVue Bracco Italy) for the characterization of hepatocarcinoma both at the diagnosis and during its follow-up after percutaneous ablative therapies (PATs). Material and methods: From 2001 to 2008 we studied 99 patients with 128 nodules of HCC (size 1-2 cm) in livers with cirrhosis or chronic hepatitis. We used histology, computed tomography (CT) or magnetic resonance (MR) as “gold standard” in order to calculate the values of the two main quality parameters (sensitivity and specificity). The diagnosis of HCC was based on well-known criteria of contrast pattern (Quaia E et al, Radiology 2004; 292:420) and its characterization included the number, size and site of the nodules. The evaluation of therapeutic effect followed known literature criteria (Meloni MF et al, Am J Roentegenol 2001; 377:175). Results: CEUS showed a high value of sensitivity (94.1%) and a good one of specificity (77.7%) for either the diagnosis and the characteriza-
S161
tion of focal liver HCC nodules. This last value was strongly affected by some lesions which were not confirmed by TC or MR and were predominantly found in the case of multiple lesions in the same liver. These case were considered as false positive. In the follow-up, CEUS showed a complete agreement with TC and MR (100% of specificity) and a good sensitivity (83.3%). This last value was due to some false positive results in incomplete necrosis assessment. Conclusions: Our data suggest: a) in the diagnostic phase, the higher sensitivity compared to specificity suggests its usefulness in the detection of HCC even if a confirmation with TC or MR is advisable; b) in the follow-up, in case of a complete necrosis, the lower sensitivity compared to specificity accounts for the possibility of false negative results thus recommending the confirmation by TC or MR; c) if there is an incomplete necrosis, CEUS alone is able to identify it and there is no need of confirmation with TC or MR to indicate the continuation of the therapy. # T. Imaging techniques 1. Ultrasounds
P.233 LIVER STIFFNESS VALUES MEASURED BY TRANSIENT ELASTOGRAPHY ARE INCREASED IN PATIENTS WITH ACUTELY DECOMPENSATED HEART FAILURE P. Pozzoni ∗ ,1 , D. Prati 2 , A. Berzuini 2 , A. Gerosa 2 , C. Canovi 1 , E.E. Molteni 1 , M. Barbarini 3 , F. Bonino 4 , A. Colli 1 1 Department of Medicine, A. Manzoni Hospital, Lecco; 2 Department of Transfusion Medicine and Hematology, A. Manzoni Hospital, Lecco; 3 Department of Laboratory Medicine, A. Manzoni Hospital, Lecco; 4 IRCCS Fondazione Policlinico, Mangiagalli e Regina Elena, Milano
Background and aim: Liver stiffness measurement (LSM) by Transient Elastography (TE) is increasingly used as non invasive estimate of liver fibrosis in patients with chronic liver disease. Commonly used cutoff values are >7 kPa for significant fibrosis and >14 for cirrhosis. However, there is growing evidence that fibrosis is not the only determinant of liver stiffness: inflammation, cholestasis and variation in the parenchymal blood content can also interfere. In case of heart failure the increased pressure in the right cardiac chambers is followed by dilation of the hepatic veins and distension of the capsule with an enlarged and firm liver. We studied a series of patients with acutely decompensated heart failure (ADHF), in order to describe the variations of liver stiffness and assess their relation with clinical course and laboratory data. Material and methods: 23 consecutive patients (9 males, 14 females, aged 79.7±12.2 years) with clinical diagnosis of ADHF requiring intravenous diuretics were included. Exclusion criteria were: BMI >30 and suspected diagnosis of liver disease on the basis of history, ultrasonographic or biochemical parameters. At admission and discharge all patients underwent TE and simultaneous blood sample for NT pro β natriuretic peptide (NTproβBNP), which is released in response to volume overload (values >900 pg/ml are diagnostic for ADHF). Results: At admission, NTproβBNP was >900 pg/ml in 22 patients. LSM failed in 3 (13%), and was >7 in 12/20 patients (60%) and >14 in 5/20 (25%) Between admission and discharge, we observed a significant reduction of both LSM (median 8.85; IQr 6.30, 12.63 vs. 7.80; 5.85, 11.75; p<0.001), and NTproβBNP values (median 7226; IQr 3254, 13625 vs. 4441; 1216- 6116; p<0.001). The delta of variation between admission and discharge of liver stiffness and NTproβBNP were significantly related (R= 0.536, P<0.05). Conclusions: Our data indicate that 60% percent of patients with ADHF have increased liver stiffness as assessed by TE. The return to clinical compensation is accompanied by LSM reduction as compared to baseline values, and the extent of LSM variation parallels that of NTproβBNP values. Thus, LSM likely reflects reversible hepatic congestion. # T. Imaging techniques 1. Ultrasounds