Sa1004 Measurement of Liver and Spleen Stiffness by ARFI Elastography: Intra-and Inter-Observer Variability and Predictors of Variability

Abstract

Staging hepatocellular carcinoma (HCC) is an esential step in the decision regarding treatment options. Malignant portal vein thrombosis is a contraindication for all curative treatment, thus establishing the nature (benign or malignant) of PVT is mandatory for staging the disease. The AIM of this paper was to assess the role of contrast enhanced ultrasound (CEUS) for the staging of HCC in patients with liver cirrhosis. METHODS: We evaluated 86 consecutive patients with liver cirrhosis and known HCC, who were discovered with PVT located in different parts of the portal system. Before CEUS we performed a standard ultrasound and a Doppler examination. We used 2.4 ml of second generation contrast agent (SonoVue) for every examination. During the CEUS examination we followed the arterial, portal and late phases as defined in the EFSUMB Guidelines (1) and also the enhancement pattern as described by Rossi et al. (Type 1: thrombus enhancement is absent in all three phasesbenign thrombus; and for malign thrombus-Type 2: diffuse thrombus enhancement that is visible only during the early arterial phase; Type 3: linear or punctate enhancement; Type 4: multilinear or multipunctate enhancement)(2). RESULTS: PVT was located in the proximity of HCC in 63 of the 86 cases (73.2 %). 11 cases (12.7%) were Type 1 Rossi (benign thrombus), 44 cases (51.1%) were Type 2, 14 cases (16.2%) were Type 3 and 17 cases (19.7%) were Type 4 Rossi. Using CEUS we could characterise and obtain a conclusive diagnosis in 85 of the 86 patients (98.8%). CONCLUSIONS CEUS is a method with a good sensibility for the characterisation of PVT in patients with HCC, that allows the staging of the disease for a good therapeutic decision. BIBLIOGRAPHY: 1. M. Claudon, C. F. Dietrich, B. I. Choi, D. O. Cosgrove, M. Kudo, C. P. Nolsoe, F. Piscaglia, S. R. Wilson, R. G. Barr, M. C. Chammas, N. G. Chaubal, M.-H. Chen, D. A. Clevert, J. M. Correas, H. Ding, F. Forsberg, J. B. Fowlkes, R. N. Gibson, B. B. Goldberg, N. Lassau, E. L. S. Leen, R. F. Mattrey, F. Moriyasu, L. Solbiati, H.-P. Weskott, H.-X. Xu. Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver-Update 2012. Published online: 2012 Ultraschall in Med. 2. Rossi S. et al. Contrast-Enhanced Versus Conventional and Color Doppler Sonography for the Detection of Thrombosis of the Portal and Hepatic Venous Systems. AJR 2006; 186:763-773.