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PA.78 DIAGNOSIS OF HEPATOCELLULAR CARCINOMA IN PATIENTS WITH CIRRHOSIS: CONTRAST-ENHANCED ULTRASOUND VERSUS CONTRAST-ENHANCED HELICAL CT
Abstracts / Digestive and Liver Disease 40S (2008), S1–S195 Results: When the patient was 32 years old he was operated by hepatorraphia after fracturing his liver in a road traffic accident, and diffuse nodular liver surface, with portal congestion and splenomegaly, was found during surgical procedures, suggesting the presence of cirrhosis. Liver cirrhosis was confirmed by ultrasound and scintigraphy investigations. AST and ALT serum levels were 47 and 58 IU/L, respectively, without biochemical evidence of liver failure. Diagnostic tests for viral hepatitis or other causes of chronic liver disease resulted negative. A further liver aspiration biopsy was performed. The collected specimens were evaluated by hematoxylin-eosin, Mallory’s, PAS-diastase, and Gomori’s stains, showing the liver parenchyma diffusely transformed into nodules approximately 1 mm in size, not separated by fibrosis, with expanded liver cell plates sorrounded by atrophic and compressed hepatocytes. Such features provided diagnosis of nodular regenerative hyperplasia (NRH), without findings of liver cirrhosis. Conclusions: NRH may develop liver abnormalities of difficult interpretation and resemble cirrhosis at abdominal ultrasonography or other techniques. The correct diagnosis is reached by liver biopsy, but stainings for collagen are often essential for an adequate sample appraisal. Since NRH increases the risk of non-cirrhotic/non-neoplastic portal hypertension, these patients must be strictly followed by clinical, laboratory and instrumental surveillance. # F. Cirrhosis & its complications 2. Portal hypertension
PA.77 FACTORS PREDICTING SURVIVAL IN HEPATOCELLULAR CARCINOMA: MONOCENTRIC ANALYSIS OF 402 PATIENTS IN NORTH ITALY G. Aragona ∗ ,1 , G. Marinone 1 , G. Sbolli 1 , L.G. Cavallaro 2 , G. Comparato 1 , M. Di Stasi 1 , F. Giangregorio 1 , P. Tansini 1 , L. Fanigliulo 1 , G. Leandro 3 , F. Fornari 1 Civile, Piacenza; 2 Ospedale Maggiore, Belluno; 3 Ospedale De Bellis, Bari
1 Ospedale
Background and aim: The prognosis of patients with HCC still remains dismal. Many factors such as patient’s general conditions as well as tumor features have been proven of prognostic significance. Our aim is to analyse several variable associated with prognosis in a large numbers of inpatients with HCC at presentation. Material and methods: The files of 402 consecutive inpatients with HCC observed in a single tertiary care hospital between 1996 and 2006 have been reviewed. Results: Of the 402 patients (mean age 70.8 years; range 36-94), 241 (60%) were male (mean age 69.7 years; range 44-89) and 161 (40.%) were female (mean age 72.2 years; range 36-94). All patients were classified by Child-Pugh’s classification (class A 71.6%, B 7%, C 21.4% patients). At presentation, 305 (75.9%) patients had less than three lesions, while 97 (24.1%) patients had more than three lesions. The tumour size was <3cm in 188 (46.8%), between 3-5cm in 151 (37.6%) and >5cm in 63 (15.7%) patients. Radio-frequency thermal ablation (RFTA), Percutaneous ethanol injection (PEI), transarterial chemoembolisation (TACE), tumour resection and multimodality combination therapy were performed at presentation in 118 (29.4%), 27(6,7%), 61 (15.2%), 27 (6.7%) and 92 (22.9%) patients respectively; 77 (19.2%) patients didn’t receive any treatment because of advanced disease. The median overall time survival was 33 months (95% confidence interval, 27-39 months). The 1-, 2-, 3-, 4-, and 5-year cumulative survival rates were 77, 60, 46, 39, and 28%, respectively. The following factors were associated with worse prognosis on univariate analysis: age older than 65 years, Child’s A and B cirrhosis, portal vein thrombosis, presence of large oesophageal varices and ascites. In multivariate analysis independent predictors of survival were Child’s classification, alpha-fetoprotein, tumor size, echogenicity, portal vein obstruction and transcatheter arterial chemoembolization. Percutaneous ablation therapies and aetiology of liver disease are not predictors of survival.
S103
Conclusions: tumor features and patient clinical condition remain the main prognostic factors for survival. Both variables could lead treatment choice even if prospective validation of these parameters in predicting survival is needed. # F. Cirrhosis & its complications 5. Others
PA.78 DIAGNOSIS OF HEPATOCELLULAR CARCINOMA IN PATIENTS WITH CIRRHOSIS: CONTRAST-ENHANCED ULTRASOUND VERSUS CONTRAST-ENHANCED HELICAL CT E. Amadei ∗ , R. Orefice, M. Koch ACO S.Filippo Neri, Roma Background and aim: In the last years the incidence of hepatocellular carcinoma (HCC) is rising in cirrhotic patients worldwide early detection is important, since the most effective treatment for HCC is surgical resection or local ablation therapy when the tumor is small. The objective of our study was to evaluate efficacy of contrast-enhanced sonography using a second-generation contrast agent for the evaluation of hepatocellular carcinoma in patients with cirrhosis by comparing the results to those obtained with contrast-enhanced helical CT. Material and methods: Between October 2005 and March 2007, 44 patients with cirrhosis (34 men and 10 women; age range, 47-80 years; mean age, 67 years) who had a single nodule of hepatocellular carcinoma, detected during ultrasound (US) surveillance according to the EASL recommendation, were selected to be studied from a cohort of 350 patients with cirrhosis. The size range of the 44 nodules was 10-55 mm, 17 (38%) were 20 mm smaller (range, 10-20 mm; 27 (62%) were larger than 20 mm(range, 21-45 mm). After baseline US scan evaluation, we initiated the contrast-specific mode. The micro bubble contrast agent (sulphur hexafluoride: SonoVue) was injected intravenously as a bolus of 2.4 mL (5 mg/mL) by using a 20-gauge cannula; a 10-mL normal saline flush followed.CT scans were obtained in all patients. Results: For the 17 hepatocellular carcinomas 20 mm or smaller, contrast-enhanced sonography showed 9 (53.6%) as hypervascular and 6 (35.7%) as avascular; 2 (10.7%) carcinomas were missed. On CT, 7 (42.9%) of the 17 hepatocellular carcinomas appeared hypervascular, 8 (46.4%) appeared hypovascular, and 2 (10.7%) were missed. For the 27 hepatocellular carcinomas larger than 20 mm, contrast-enhanced sonography showed 24 (91.3%) as hypervascular and 3 (8.7%) as avascular. On CT, 21 (76.1%) hepatocellular carcinomas appeared hypervascular, 5 (17.4%) appeared hypovascular, and 1 (6.5%) were missed. Differences between CT appearance of hepatocellular carcinomas and contrast-enhanced sonographic appearance of the carcinomas were not statistically significant. Concordance between contrast-enhanced sonographic and CT appearances was observed in 36 (82.4%) of 44 cases. Conclusions: Contrast-enhanced sonography is similar to CT for detecting hepatocellular carcinoma hypervascularity. # F. Cirrhosis & its complications 5. Others
PA.79 SMALL INTESTINAL BACTERIAL OVERGROWTH OF COLONIC-TYPE CARBOHIDRATES FERMENTATIVE BACTERIA IN CIRRHOTIC PATIENTS G. Merra ∗ , A. Dal Lago, E. Scarpellini, R. Finizio, M. Santoro, M.G. Spitilli, E.C. Lauritano, M. Gabrielli, V. Valenza, G. Gasbarrini, G. Ghirlanda, A. Gasbarrini U.C.S.C. - “Agostino Gemelli” General Hospital, Rome Background and aim: Small intestinal bacterial overgrowth (SIBO) is a clinical condition characterized by abnormally high colonic-type
PA.77 FACTORS PREDICTING SURVIVAL IN HEPATOCELLULAR CARCINOMA: MONOCENTRIC ANALYSIS OF 402 PATIENTS IN NORTH ITALY G. Aragona ∗ ,1 , G. Marinone 1 , G. Sbolli 1 , L.G. Cavallaro 2 , G. Comparato 1 , M. Di Stasi 1 , F. Giangregorio 1 , P. Tansini 1 , L. Fanigliulo 1 , G. Leandro 3 , F. Fornari 1 Civile, Piacenza; 2 Ospedale Maggiore, Belluno; 3 Ospedale De Bellis, Bari
1 Ospedale
Background and aim: The prognosis of patients with HCC still remains dismal. Many factors such as patient’s general conditions as well as tumor features have been proven of prognostic significance. Our aim is to analyse several variable associated with prognosis in a large numbers of inpatients with HCC at presentation. Material and methods: The files of 402 consecutive inpatients with HCC observed in a single tertiary care hospital between 1996 and 2006 have been reviewed. Results: Of the 402 patients (mean age 70.8 years; range 36-94), 241 (60%) were male (mean age 69.7 years; range 44-89) and 161 (40.%) were female (mean age 72.2 years; range 36-94). All patients were classified by Child-Pugh’s classification (class A 71.6%, B 7%, C 21.4% patients). At presentation, 305 (75.9%) patients had less than three lesions, while 97 (24.1%) patients had more than three lesions. The tumour size was <3cm in 188 (46.8%), between 3-5cm in 151 (37.6%) and >5cm in 63 (15.7%) patients. Radio-frequency thermal ablation (RFTA), Percutaneous ethanol injection (PEI), transarterial chemoembolisation (TACE), tumour resection and multimodality combination therapy were performed at presentation in 118 (29.4%), 27(6,7%), 61 (15.2%), 27 (6.7%) and 92 (22.9%) patients respectively; 77 (19.2%) patients didn’t receive any treatment because of advanced disease. The median overall time survival was 33 months (95% confidence interval, 27-39 months). The 1-, 2-, 3-, 4-, and 5-year cumulative survival rates were 77, 60, 46, 39, and 28%, respectively. The following factors were associated with worse prognosis on univariate analysis: age older than 65 years, Child’s A and B cirrhosis, portal vein thrombosis, presence of large oesophageal varices and ascites. In multivariate analysis independent predictors of survival were Child’s classification, alpha-fetoprotein, tumor size, echogenicity, portal vein obstruction and transcatheter arterial chemoembolization. Percutaneous ablation therapies and aetiology of liver disease are not predictors of survival.
S103
Conclusions: tumor features and patient clinical condition remain the main prognostic factors for survival. Both variables could lead treatment choice even if prospective validation of these parameters in predicting survival is needed. # F. Cirrhosis & its complications 5. Others
PA.78 DIAGNOSIS OF HEPATOCELLULAR CARCINOMA IN PATIENTS WITH CIRRHOSIS: CONTRAST-ENHANCED ULTRASOUND VERSUS CONTRAST-ENHANCED HELICAL CT E. Amadei ∗ , R. Orefice, M. Koch ACO S.Filippo Neri, Roma Background and aim: In the last years the incidence of hepatocellular carcinoma (HCC) is rising in cirrhotic patients worldwide early detection is important, since the most effective treatment for HCC is surgical resection or local ablation therapy when the tumor is small. The objective of our study was to evaluate efficacy of contrast-enhanced sonography using a second-generation contrast agent for the evaluation of hepatocellular carcinoma in patients with cirrhosis by comparing the results to those obtained with contrast-enhanced helical CT. Material and methods: Between October 2005 and March 2007, 44 patients with cirrhosis (34 men and 10 women; age range, 47-80 years; mean age, 67 years) who had a single nodule of hepatocellular carcinoma, detected during ultrasound (US) surveillance according to the EASL recommendation, were selected to be studied from a cohort of 350 patients with cirrhosis. The size range of the 44 nodules was 10-55 mm, 17 (38%) were 20 mm smaller (range, 10-20 mm; 27 (62%) were larger than 20 mm(range, 21-45 mm). After baseline US scan evaluation, we initiated the contrast-specific mode. The micro bubble contrast agent (sulphur hexafluoride: SonoVue) was injected intravenously as a bolus of 2.4 mL (5 mg/mL) by using a 20-gauge cannula; a 10-mL normal saline flush followed.CT scans were obtained in all patients. Results: For the 17 hepatocellular carcinomas 20 mm or smaller, contrast-enhanced sonography showed 9 (53.6%) as hypervascular and 6 (35.7%) as avascular; 2 (10.7%) carcinomas were missed. On CT, 7 (42.9%) of the 17 hepatocellular carcinomas appeared hypervascular, 8 (46.4%) appeared hypovascular, and 2 (10.7%) were missed. For the 27 hepatocellular carcinomas larger than 20 mm, contrast-enhanced sonography showed 24 (91.3%) as hypervascular and 3 (8.7%) as avascular. On CT, 21 (76.1%) hepatocellular carcinomas appeared hypervascular, 5 (17.4%) appeared hypovascular, and 1 (6.5%) were missed. Differences between CT appearance of hepatocellular carcinomas and contrast-enhanced sonographic appearance of the carcinomas were not statistically significant. Concordance between contrast-enhanced sonographic and CT appearances was observed in 36 (82.4%) of 44 cases. Conclusions: Contrast-enhanced sonography is similar to CT for detecting hepatocellular carcinoma hypervascularity. # F. Cirrhosis & its complications 5. Others
PA.79 SMALL INTESTINAL BACTERIAL OVERGROWTH OF COLONIC-TYPE CARBOHIDRATES FERMENTATIVE BACTERIA IN CIRRHOTIC PATIENTS G. Merra ∗ , A. Dal Lago, E. Scarpellini, R. Finizio, M. Santoro, M.G. Spitilli, E.C. Lauritano, M. Gabrielli, V. Valenza, G. Gasbarrini, G. Ghirlanda, A. Gasbarrini U.C.S.C. - “Agostino Gemelli” General Hospital, Rome Background and aim: Small intestinal bacterial overgrowth (SIBO) is a clinical condition characterized by abnormally high colonic-type