- Email: [email protected]
P1039 APPLICABILITY (APP) CRITERIA FOR REAL-TIME SHEAR WAVE ELASTOGRAPHY (RT-SWE) BY AIXPLORER COMPARED TO TRANSIENT ELASTOGRAPHY (TE) BY FIBROSCAN AND TO FIBROTEST
POSTERS 2.59; 95% 1.89–3.53; P = 0.000) and ARFI (OR: 4.2; 95% CI: 2.0–8.73; p = 0.000) were independent predictors. The AUROCs are shown in Table 1. The optimal ARFI cutoff value for advanced fibrosis was ≥1.33 m/s and ≥1.4 m/s for cirrhosis.
of Hepatology GH Piti´e-Salpˆetri`ere, 4 Hepatology Research Unit, BioPredictive, 5 ANRS, 6 BioPredictive, 7 Biochemistry Department GH Piti´e-Salpˆetri`ere, APHP UPMC Paris Liver Center, Paris, France E-mail: [email protected]
Table 1. AUROC for advanced fibrosis and cirrhosis
Background and Aims: Applicability of non-invasive methods, liver stiffness measurements (LSM) by Fibroscan and Fibrotest, are defined after excluding failures and unreliable results (Castera 2010, Poynard 2010). RT-SWE by Aixplorer is a new 3D-elastography coupled with a B-mode imaging. Aims: To better identify applicability criteria for SWE in terms of positioning and acquisition procedure. Methods: We used standard-AUROCs and the strength of concordance with validated methods, LSM and Fibrotest. Each patient had 3-SWE regions of interest (ROI) studied [right lobe (RL)] with 3 measures within each: central-zone (Q-boxC), zone displayed in blue-color (Q-boxB), and in red-color (Q-boxR). Results: 189 prospective-patients were pre-included with App-FT; 166 (87.8%) had concomitant App-LSM: 57% males, age 53 yrs, BMI 25 kg/m2 , ALT 40 IU/L; 30% advanced fibrosis (AF) as per Fibrotest. Q-boxC and the mean of three C-measurements correlated with Fibrotest (p < 0.05). Q-boxB correlated with Fibrotest (p < 0.05) unlike Q-boxR (p = NS). Taking Fibrotest as standard, the best AUROCs were obtained for Q-boxC (0.73) and Q-boxB (0.74), but not different from the mean of 3 Q-boxC (0.71) and Q-boxB (0.69). Using the mean of 3 Q-boxC (-B) does not improve diagnosis provided by Qbox-C (-B) alone (p = NS). SWE with a ratio SD/meanSWE >60% versus <60% were less correlated to LSM (Spearman correlation-coefficient = 0.11, p = 0.55 vs 0.37, p < 0.0001) and to Fibrotest (SCC = 0.14, p = 0.46 vs 0.33, p < 0.001). Conclusions: A single measurement in the central-zone or bluezone of the ROI has the best accuracy similar to the mean of 3 measurements. ROI zones displayed in red have to be avoided as they are poorly correlated with validated fibrosis markers. SD should be included among quality criteria for SWE-reliability.
Advanced fibrosis
Spleen index Conventional ultrasonography score ARFI
Cirrhosis
AUROC
95% CI
P value
AUROC
95% CI
P value
0.674 0.729 0.749
0.6–0.75 0.65–0.8 0.68–0.82
0.00 0.000 0.000
0.659 0.772 0.736
0.58–0.74 0.7–0.85 0.67–0.81
0.00 0.00 0.00
Conclusions: In patients with hepatitis B or C, ARFI, conventional ultrasonography and spleen index are helpful in measurement of liver fibrosis. P1038 NEW QUALITY CRITERIA FOR TRANSIENT ELASTROGRAPHY CAN INCREASE THE PROPORTION OF VALID MEASUREMENTS WITH HIGH ACCURACY FOR DETECTION OF LIVER CIRRHOSIS AND PORTAL HYPERTENSION P. Schwabl1 , S. Bota1 , P. Salzl1 , M. Mandorfer1 , B.-A. Payer1 , A. Ferlitsch1 , J. Stift2 , F. Wrba2 , M. Trauner1 , M. Peck-Radosavljevic1 , T. Reiberger1 , Vienna Hepatic Hemodynamic Lab. 1 Dept. of Internal Medicine III, Div. of Gastroenterology & Hepatology, Medical University Vienna, 2 Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria E-mail: [email protected] Background and Aims: Recently, new quality criteria for transient elastography (TE) measurements have been proposed (Boursier et. al. Hepatology 2013): very reliable: IQR/M <0.1; reliable: IQR 0.1–0.3, or IQR/M >0.3 if TE <7.1 kPa; poor reliable: IQR/M >0.3 if TE >7.1 kPa. We evaluated the diagnostic power and accuracy of TE measurements according to these new quality criteria (accurate = very reliable + reliable) for non-invasive assessment of liver fibrosis (liver biopsy) and portal hypertension (HVPG). Methods: Patients undergoing TE, HVPG measurement and liver biopsy within 3 months at a tertiary care were retrospectively identified. Results: Among 278 patients (48.7±13.1 years, 74.7% male, 75.7% viral etiology, 57% F3/F4), traditional TE quality criteria identified 71.6% reliable measurements, while new criteria yielded in 83.2% accurate LS measurements (23.1% very reliable, 60.1% reliable). Reliable TE values according to traditional or new criteria were all significantly and similarly strong correlated with fibrosis stage (R = 0.648 vs. R = 0.636) and HVPG (R = 0.836 vs. R = 0.846). The accuracy for diagnosing liver cirrhosis (F4, cut-off: 14.5 kPa) was 76.5% and 75.0% for traditional and new TE criteria, respectively. The positive (PPV) and negative (NPV) values for new criteria at the 14.5 kPa cut-off were 83% and 70%. For predicting HVPG ≥10 mmHg (cut-off: 16.1 kPa), the accuracies were 88.9% and 89.8% using traditional or new criteria, respectively. Both criteria resulted in AUCs for diagnosis of HVPG ≥10 mmHg of over 0.95 with a PPV and NPV of 76% and 97%, respectively. Conclusions: Applying new quality criteria for TE measurements significantly increases the number of valid TE measurements without affecting accuracy of TE for diagnosis of liver cirrhosis and portal hypertension. P1039 APPLICABILITY (APP) CRITERIA FOR REAL-TIME SHEAR WAVE ELASTOGRAPHY (RT-SWE) BY AIXPLORER COMPARED TO TRANSIENT ELASTOGRAPHY (TE) BY FIBROSCAN AND TO FIBROTEST N. Seurat1 , H. Perazzo2 , E. Luckina2 , L. Royer2 , M. Munteanu3 , Y. Ngo4 , L. Fedchuk5 , O. Deckmyn6 , D. Monneret7 , F. ImbertBismut7 , V. Ratziu1 , T. Poynard1 . 1 Department of Hepatology GH Piti´e-Salpˆetri`ere, 2 APHP UPMC Paris Liver Center, 3 Department
7C. VIRAL HEPATITIS: HEPATITIS B & D – CLINICAL (THERAPY, NEW COMPOUNDS, RESISTANCE) P1040 TENOFOVIR FOR THE PROPHYLAXIS OF HBV REACTIVATION IN ANTI-HBC-POSITIVE PATIENTS WITH HEMATOLOGIC MALIGNANCIES TREATED WITH RITUXIMAB: PRELIMINARY RESULTS OF A RANDOMIZED STUDY (PREBLIN STUDY) M. Buti1 , R. Morillas2 , M.L. Manzano3 , M. Garc´ıa-Retortillo4 , 5 8 M.L. Gutierrez ´ , L. Mart´ın6 , M. Prieto7 , E. Suarez ´ , F. Gea9 , 12 13 ´ Simon M. Rodr´ıguez10 , J.M. Zozaya11 , J. Lopez ´ , M. Gomez ´ , M.A. ´ 14 , 15 16 1 1 L.E. Morano , A. Pardo , R. Esteban . Hepatology, Vall d’Hebron Hospital, Barcelona, 2 Hepatology, Germans Trias i Pujol Hospital, Badalona, 3 Hepatology, October 12 Hospital, Madrid, 4 Hepatology, Del Mar Hospital, Barcelona, 5 Hospital Foundation Alcorc´ on, Alcorc´ on, Madrid, 6 Hepatology, Donostia Hospital, San Sebasti´ an, 7 Hepatology, La Fe Hospital, Valencia, 8 Hepatology, Valme Hospital, Sevilla, 9 Hepatology, La Paz Hospital, Madrid, 10 Hepatology, Central Hospital of Asturias, Oviedo, 11 Gastroenterology, Navarra Hospital, Pamplona, 12 Hematology, Ram´ on y Cajal Hospital, Madrid, 13 Gastroenterology, Getafe Hospital, Getafe, Madrid, 14 Hepatology, Lozano Blesa Hospital, Zaragoza, 15 Infectious Diseases, Do Meixoeiro Hospital, Vigo, 16 Gastroenterology, Joan XXIII Hospital, Tarragona, Spain E-mail: [email protected] Background and Aims: Patients positive for HBsAg or anti-HBc are at risk of severe HBV reactivation due to immunosuppressive treatment with rituximab (RTX). Lamivudine prophylaxis reduces
Journal of Hepatology 2014 vol. 60 | S361–S522
S421
of Hepatology GH Piti´e-Salpˆetri`ere, 4 Hepatology Research Unit, BioPredictive, 5 ANRS, 6 BioPredictive, 7 Biochemistry Department GH Piti´e-Salpˆetri`ere, APHP UPMC Paris Liver Center, Paris, France E-mail: [email protected]
Table 1. AUROC for advanced fibrosis and cirrhosis
Background and Aims: Applicability of non-invasive methods, liver stiffness measurements (LSM) by Fibroscan and Fibrotest, are defined after excluding failures and unreliable results (Castera 2010, Poynard 2010). RT-SWE by Aixplorer is a new 3D-elastography coupled with a B-mode imaging. Aims: To better identify applicability criteria for SWE in terms of positioning and acquisition procedure. Methods: We used standard-AUROCs and the strength of concordance with validated methods, LSM and Fibrotest. Each patient had 3-SWE regions of interest (ROI) studied [right lobe (RL)] with 3 measures within each: central-zone (Q-boxC), zone displayed in blue-color (Q-boxB), and in red-color (Q-boxR). Results: 189 prospective-patients were pre-included with App-FT; 166 (87.8%) had concomitant App-LSM: 57% males, age 53 yrs, BMI 25 kg/m2 , ALT 40 IU/L; 30% advanced fibrosis (AF) as per Fibrotest. Q-boxC and the mean of three C-measurements correlated with Fibrotest (p < 0.05). Q-boxB correlated with Fibrotest (p < 0.05) unlike Q-boxR (p = NS). Taking Fibrotest as standard, the best AUROCs were obtained for Q-boxC (0.73) and Q-boxB (0.74), but not different from the mean of 3 Q-boxC (0.71) and Q-boxB (0.69). Using the mean of 3 Q-boxC (-B) does not improve diagnosis provided by Qbox-C (-B) alone (p = NS). SWE with a ratio SD/meanSWE >60% versus <60% were less correlated to LSM (Spearman correlation-coefficient = 0.11, p = 0.55 vs 0.37, p < 0.0001) and to Fibrotest (SCC = 0.14, p = 0.46 vs 0.33, p < 0.001). Conclusions: A single measurement in the central-zone or bluezone of the ROI has the best accuracy similar to the mean of 3 measurements. ROI zones displayed in red have to be avoided as they are poorly correlated with validated fibrosis markers. SD should be included among quality criteria for SWE-reliability.
Advanced fibrosis
Spleen index Conventional ultrasonography score ARFI
Cirrhosis
AUROC
95% CI
P value
AUROC
95% CI
P value
0.674 0.729 0.749
0.6–0.75 0.65–0.8 0.68–0.82
0.00 0.000 0.000
0.659 0.772 0.736
0.58–0.74 0.7–0.85 0.67–0.81
0.00 0.00 0.00
Conclusions: In patients with hepatitis B or C, ARFI, conventional ultrasonography and spleen index are helpful in measurement of liver fibrosis. P1038 NEW QUALITY CRITERIA FOR TRANSIENT ELASTROGRAPHY CAN INCREASE THE PROPORTION OF VALID MEASUREMENTS WITH HIGH ACCURACY FOR DETECTION OF LIVER CIRRHOSIS AND PORTAL HYPERTENSION P. Schwabl1 , S. Bota1 , P. Salzl1 , M. Mandorfer1 , B.-A. Payer1 , A. Ferlitsch1 , J. Stift2 , F. Wrba2 , M. Trauner1 , M. Peck-Radosavljevic1 , T. Reiberger1 , Vienna Hepatic Hemodynamic Lab. 1 Dept. of Internal Medicine III, Div. of Gastroenterology & Hepatology, Medical University Vienna, 2 Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria E-mail: [email protected] Background and Aims: Recently, new quality criteria for transient elastography (TE) measurements have been proposed (Boursier et. al. Hepatology 2013): very reliable: IQR/M <0.1; reliable: IQR 0.1–0.3, or IQR/M >0.3 if TE <7.1 kPa; poor reliable: IQR/M >0.3 if TE >7.1 kPa. We evaluated the diagnostic power and accuracy of TE measurements according to these new quality criteria (accurate = very reliable + reliable) for non-invasive assessment of liver fibrosis (liver biopsy) and portal hypertension (HVPG). Methods: Patients undergoing TE, HVPG measurement and liver biopsy within 3 months at a tertiary care were retrospectively identified. Results: Among 278 patients (48.7±13.1 years, 74.7% male, 75.7% viral etiology, 57% F3/F4), traditional TE quality criteria identified 71.6% reliable measurements, while new criteria yielded in 83.2% accurate LS measurements (23.1% very reliable, 60.1% reliable). Reliable TE values according to traditional or new criteria were all significantly and similarly strong correlated with fibrosis stage (R = 0.648 vs. R = 0.636) and HVPG (R = 0.836 vs. R = 0.846). The accuracy for diagnosing liver cirrhosis (F4, cut-off: 14.5 kPa) was 76.5% and 75.0% for traditional and new TE criteria, respectively. The positive (PPV) and negative (NPV) values for new criteria at the 14.5 kPa cut-off were 83% and 70%. For predicting HVPG ≥10 mmHg (cut-off: 16.1 kPa), the accuracies were 88.9% and 89.8% using traditional or new criteria, respectively. Both criteria resulted in AUCs for diagnosis of HVPG ≥10 mmHg of over 0.95 with a PPV and NPV of 76% and 97%, respectively. Conclusions: Applying new quality criteria for TE measurements significantly increases the number of valid TE measurements without affecting accuracy of TE for diagnosis of liver cirrhosis and portal hypertension. P1039 APPLICABILITY (APP) CRITERIA FOR REAL-TIME SHEAR WAVE ELASTOGRAPHY (RT-SWE) BY AIXPLORER COMPARED TO TRANSIENT ELASTOGRAPHY (TE) BY FIBROSCAN AND TO FIBROTEST N. Seurat1 , H. Perazzo2 , E. Luckina2 , L. Royer2 , M. Munteanu3 , Y. Ngo4 , L. Fedchuk5 , O. Deckmyn6 , D. Monneret7 , F. ImbertBismut7 , V. Ratziu1 , T. Poynard1 . 1 Department of Hepatology GH Piti´e-Salpˆetri`ere, 2 APHP UPMC Paris Liver Center, 3 Department
7C. VIRAL HEPATITIS: HEPATITIS B & D – CLINICAL (THERAPY, NEW COMPOUNDS, RESISTANCE) P1040 TENOFOVIR FOR THE PROPHYLAXIS OF HBV REACTIVATION IN ANTI-HBC-POSITIVE PATIENTS WITH HEMATOLOGIC MALIGNANCIES TREATED WITH RITUXIMAB: PRELIMINARY RESULTS OF A RANDOMIZED STUDY (PREBLIN STUDY) M. Buti1 , R. Morillas2 , M.L. Manzano3 , M. Garc´ıa-Retortillo4 , 5 8 M.L. Gutierrez ´ , L. Mart´ın6 , M. Prieto7 , E. Suarez ´ , F. Gea9 , 12 13 ´ Simon M. Rodr´ıguez10 , J.M. Zozaya11 , J. Lopez ´ , M. Gomez ´ , M.A. ´ 14 , 15 16 1 1 L.E. Morano , A. Pardo , R. Esteban . Hepatology, Vall d’Hebron Hospital, Barcelona, 2 Hepatology, Germans Trias i Pujol Hospital, Badalona, 3 Hepatology, October 12 Hospital, Madrid, 4 Hepatology, Del Mar Hospital, Barcelona, 5 Hospital Foundation Alcorc´ on, Alcorc´ on, Madrid, 6 Hepatology, Donostia Hospital, San Sebasti´ an, 7 Hepatology, La Fe Hospital, Valencia, 8 Hepatology, Valme Hospital, Sevilla, 9 Hepatology, La Paz Hospital, Madrid, 10 Hepatology, Central Hospital of Asturias, Oviedo, 11 Gastroenterology, Navarra Hospital, Pamplona, 12 Hematology, Ram´ on y Cajal Hospital, Madrid, 13 Gastroenterology, Getafe Hospital, Getafe, Madrid, 14 Hepatology, Lozano Blesa Hospital, Zaragoza, 15 Infectious Diseases, Do Meixoeiro Hospital, Vigo, 16 Gastroenterology, Joan XXIII Hospital, Tarragona, Spain E-mail: [email protected] Background and Aims: Patients positive for HBsAg or anti-HBc are at risk of severe HBV reactivation due to immunosuppressive treatment with rituximab (RTX). Lamivudine prophylaxis reduces
Journal of Hepatology 2014 vol. 60 | S361–S522
S421