The Effects of Normothermic Ex-Situ Perfusion on Liver Elasticity Measurements Using Shearwave Elastography

Abstracts OPT7-004 Liver Stiffness Measurements with Supersonic Shearwave Elastography in the Preoperative Evaluation of the Liver Fibrosis for Infants with Biliary Atresia Luyao Zhou Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-sen University, China Objectives: To investigate the value of Supersonic shear-wave elastography (SSWE) in the assessment of hepatic fibrosis in patients with biliary atresia (BA) and to analyze factors that might influence the SSWE value. Methods: The ethics committee approved this study, and informed parental consent was obtained. From January 2012 to January 2016, sixty-seven infants with BA who preoperatively had SSWE measurements and consequently underwent Kasai portoenterostomy were ruled in. All patients were also underwent preoperative serologic testing. Interoperative liver specimens were reviewed in a blinded manner by two pathologists using METAVIR criteria. SSWE measurements were correlated with pathological results, age and serologic testing results.Performance of SSWE in differentiating liver fibrosis was determined by using areas under the receiver operating characteristic curve (AUCs). Results: The SSWE value of F0 (n51), F1 (n516), F2 (n528), F3 (n518), F4 (n54) was 8.2Kpa，11.0（8.4-12.2）Kpa，12.6 (10.1-13.9）Kpa，16.6（14.7-24.0）Kpa, 20.3（13.4-37.2）Kpa, respectively. SSWE value were significantly correlated with g-glutamyltranspeptidase (P50.010), age(P＜0.001) and liver fibrosis P＜ 0.001). Logistic regression analysis demonstrated that liver fibrosis(P ＜0.001) and age（P50.033）were significantly associated with SSWE. The AUC for differentiating severe fibrosis or greater ($F3) was 0.896, with an optimal cutoff value of 13.2 Kpa. Conclusions: Preoperative SSWE measurements for infants with BA could be used as a noninvasive tool for prodicting severe fibrosis or geater ($F3). However, SSWE value might be influenced by infant’s age. OPT7-005 The Effects of Normothermic Ex-Situ Perfusion on Liver Elasticity Measurements Using Shearwave Elastography Andrew McNeill,1 R. S. Figueiredo,2 B. Stenberg,3 A. Sewpaul,2 D. M. Manas,2 S. A. White,2 C. H. Wilson2 1 Department of Radiology, Freeman Hospital, UK, United Kingdom, 2 Department of Hepatobiliary Surgery, Freeman Hospital, UK, 3 Department of Radiology, Ultrasound, Freeman Hospital, UK Objectives: Ex situ liver perfusion offers the potential to ‘‘recondition’’ organs prior to transplantation. Vasoconstriction during cold storage may be reduced by perfusion, which in turn, should result in a ‘‘relaxation’’ of the liver and decreased stiffness. To our knowledge this is the first report of direct shearwave elastography measurements in human ex-vivo livers on machine perfusion. Methods: 9 human livers declined for transplantation underwent exvivo normothermic perfusion with a red-cell based perfusate at fixed pressures (arterial pressure 75 mmHg, portal pressure 5 mmHg). Shearwave elastography (ElastPQ, Philips healthcare) was performed at zero, two and six hours in the centre of the right lobe. Six measurements were made at each time interval and the velocities averaged. Other factors were measured such as warm ischaemic time, lactate, bile production and biopsies were taken at regular intervals. Results: Shearwave elasticity measurements were achievable in all livers. Elasticity mean at baseline was 1.932 m/s (SD 0.154 m/s), at two hours 1.652 m/s (0.164 m/s) and at six hours 1.806 m/s (SD 0.137 m/s). Liver elasticity reduced between zero and two hours in almost

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all livers (8 of 9 livers) and then rose again between two and six hours (6 of 9 livers). This suggests that normothermic perfusion is reducing vasoconstriction and washing out the microcirculation making the liver more compliant in the early phase, however, these effects are diminished in long term perfusion. Conclusions: Shearwave elastography of ex-vivo liver transplants is possible and demonstrates a reduction of liver elasticity in the first two hours of normothermic perfusion. OPT7-006 Association of Lower Hardness Sonoelastography of Quadriceps Muscle with Sarcopenia Ying-Chou Chen, Chi-Hua Ko, Jia-Feng Chen, Chung-Yuan Hsu, Wen-Chan Chiu Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Taiwan Objectives: Reduced muscle mass had associated with high mortality. So it is urgent for simple techniques to early detection sarcopenia. Our objective was to examine the validity of sonoelastography to predict sarcopenia in osteoporotic patients. This study aimed to evaluate the association of sonoelastography and dual-energy X-ray absorptiometry in patients with sarcopenia and osteoporosis. Methods: We conducted an observational study in Kaohsiung Chang Gang Memorial Hospital. Sarcopenia was determined using a dual-energy X-ray absorptiometry. Sonoelastography was performed over mid thigh over quadriceps muscle. We measure hardness and elastography ratio of quadriceps over subcutaneous fat tissue. ROC analysis was used to find best cut-off point. Results: A total 78 (33 sarcopenia, 45 non-sarcopenia) patients were enrolled. The mean age was 79.61 6 6.54 years in sarcopenia group and 76.5166.58 in non-sarcopenia group(p50.05). Most patients (91%) were women. Sonoelastography showed sarcopenia patients had more soft than non-sarcopenia patients, furthermore the elastography ratio of quadriceps over subcutaneous tissue was lower than non-sarcopenia patients. When the cut points determined by receiver operating characteristic (ROC) curve analysis were applied, The best cut-point of hardness was 75.28%(sensitivity, 0.511; 1-specificity, 0.091), while the best cut-point of quadriceps over subcutaneous tissue was 1.07 (sensitivity, 0.556; 1-specificity, 0.121). Conclusions: Sonoelastography was easily applicable in patients with sarcopenia and osteoporosis. Using hardness content and elastography ratio of quadriceps over subcutaneous ratio render more information of muscle character. Early detection of sarcopenia with sonoelastography in patients with osteoporosis afford future trend of preventive medicine in geriatric patients. OPT7-007 Real-Time Elastography for the Diagnosis of Liver Fibrosis in Chronic Hepatitis B Xi Chen Department of Ultrasound, Xi Jing Hosipital, China Objectives: Liver fibrosis is the pathological basis of many chronic liver diseases. Therefore, it is very important to provide an accurate assessment of the degree of liver fibrosis for diagnosis of the disease, and in patients with chronic viral hepatitis, select appropriate antiviral therapy and predict prognosis. Real-time elastography (RTE) is a novel noninvasive ultrasonography modality for measuring liver elasticity that has been recently applied to the quantitiative assessment of liver fibrosis. The ratio of the elastic strain of liver to the elastic strain of intercostal muscle has been determined using RTE. The aims of this study were, first, to evaluate the accuracy of the quantitative assessment of liver fibrosis in patients with chronic viral hepatitis B by calculating the elastic strain ratios determined for different stages of liver fibrosis;