Triphasic CT Research Articles

Association of p53 codon 72 polymorphism and hTERT polymorphism (rs2736098) with risk of hepatocellular carcinoma. A pilot study in Egyptian patients

Human HCC is among the most frequent worldwide malignancies. However, no effective therapy has existed as of yet. The purpose of this study is to look into the molecular evaluation of the p53 Arg72Pro and hTERT rs2736098 polymorphisms in hepatocellular carcinoma. The study was conducted in 70 untreated known cases of HCC and 40 healthy controls. The levels of alfa fetoprotein (AFP) were tests for all samples to detect the early stages of HCC. Triphasic CT was abdomen for patients with HCC to determine the stages of HCC. All samples were tests for biochemical and hematological parameters as liver functions tests. Genotyping of hTERT and p53 gene was done by PCR-Restricted fragment length polymorphism-PCR (PCR-RFLP). P53 Arg72Pro distributions showed that there are statistically significant differences between HCC and the control group in either genotype (Arg/Arg) or allele (G) distribution. Moreover, a significant association was found between HCC and the control group regarding hTERT rs2736098 (GG) genotype and (G) allele. No statistically significant correlation was detected between the studied polymorphisms and the clinicopathologic markers or SNPs stratification based on HCV carrier in HCC groups. In Conclusion: There is an association of p53 codon 72 polymorphism and hTERT polymorphism (rs2736098) with risk of hepatocellular carcinoma in Egyptian patients, which could be used as a potential non-invasive biomarker to attain early diagnosis of HCC.

Evaluation of serum alpha fetoprotein-L3 as an accuracy novel biomarker for the early diagnosis of hepatocellular carcinoma in Egyptian patients.

BackgroundMost Hepatocellular Carcinomas (HCCs) are diagnosed at an advanced stage. However, HCC early diagnosis is complicated by the coexistence of inflammation and cirrhosis. The unsatisfactory sensitivity and specificity of Alpha-fetoprotien (AFP) for screening of early-stage HCC paved the way for new novel biomarkers to complement AFP such as AFP-L3. The aim of this study was the Evaluation of alpha fetoprotein-L3 (AFP-L3) as earlier marker in diagnosis of hepatocellular carcinoma in Egyptian patients. This study was conducted on 80 patients categorized into 2 groups; group 2 (40 patients with chronic active hepatitis) and group 3 (40 patients with HCC). HCC diagnosis was done by clinical, triphasic CT and positive US for focal lesion, in addition to 20 healthy individuals as controls (group 1).ResultsThe median range of AFP and AFP-L3 were highly statistically significant difference between HCC group and other groups [p < 0.001]. In this study ALT, AST, Total & direct bilirubin and albumin results showed highly significant differences between HCC group and other groups. Serum AFP-L3 shows sensitivity 100%, specificity 100%, positive predictive value 100% and negative predictive value 100% with AUC = 1 in HCC cases.ConclusionSerum AFP-L3 may serve as a diagnostic biomarker for the detection of early stage of HCC and show higher sensitivity than AFP.

Role of diffusion weighted MRI in patients with hepatocellular carcinoma: prediction and assessment of response to trans-arterial chemoembolization

Aim: The study goal is to detect if apparent diffusion coefficient (ADC), a quantitative parameter of diffusion-weighted imaging (DWI), can recognize HCC post TACE residuals. Results were obtained by using MRI_DWI & ADC and were compared with those of Tri phasic-computed tomography (CT). patient and Methods MRI-DWI was performed to 20 patients with 24 HCC focal lesions before and 1month after TACE to calculate the ADC value of HCC. Patients were also evaluated with Tri phasic-CT after TACE. CT was performed within 1 month after TACE. Results: All patients under the study shows pretreatment restricted Diffusion weighted images with low ADC value. Mean ADC value before treatment was 1.14× 10¯³ ±0.29× 10¯³ and ranged from 0.819× 10¯³ to 2.48× 10¯³. 9 cases (45%) cases show post-TACE good therapeutic response with facilitated diffusion & mean ADC value 1.32×10¯³ with significant increase compared to pre-treatment values. 11 cases (55%) shows post-TACE partial or no therapeutic response with restricted diffusion & mean ADC value 1.18×10¯³. However, there was no statistical significant difference between ADC value of resolved and that of residual cases (P-value=0.067), DWI could predict the response of treatment as CT by 100%. All cases of Good therapeutic response had a facilitated diffusion, all cases of partial therapeutic response had a restricted diffusion but less than pretreatment and all cases with no therapeutic response had a restricted diffusion but more than pretreatment. Conclusion DWI could evaluate HCC necrosis of tumor after chemoembolization, and the ADC importance might be its ability to detect viable necrotic tumor tissues. Furthermore, DWI-MRI determines improved liver lesion location. So, DWI can be used as an option for HCC patients short term follow up after chemoembolization and may direct patient control for decreasing radiation CT examination exposure and the danger of contrast material-induced nephropathy.

Significance of Carbohydrate Antigen 19-9 as a biomarker in Hepatocellular Carcinoma and Cholangiocarcinoma

Background &amp; Aims: Combined hepatocellular - cholangiocarcinomas (cHCC-CCs) are rare malignancies representing less than 1% of all primary liver cancers. Correct preoperative diagnosis is desirable because the frequency of lymph node metastasis in ICC and cHCC-CC, making lymph node dissection a necessity if curative resection to be attempted. This study aimed to investigate the significance of elevated CA19-9 in suspecting a diagnosis of Intrahepatic Cholangiocarcinoma (ICC) “non-invasively” in patients with typical radiological features of HCC. Methods This cross-sectional study was conducted on 54 patients with typical radiological criteria of HCC and elevated CA19-9 level. And were classified into two groups I included 22 patients (40.74%) who were diagnosed as HCC, group II included 30 patients (55.56%) were diagnosed as ICC, and there were 2 patients (3.7%) were diagnosed as cHCC-CC. Tumor markers (AFP and CA19-9), dynamic study (Triphasic CT or Dynamic MRI) were done for all patients. Target liver biopsy was done for histopathology and immuno-histochemistry using specific monoclonal antibodies against Glypican-3, Hep-par1, CK-7, CK-19 and CK-20 were done. Results: There was a statistically significant difference between HCC and ICC as regard CA19-9 and Alpha-fetoprotein (AFP). CA19-9 and AFP cut-offs were ˃ 58.9 U/mL and ˂ 25.8 ng/mL, respectively favoring the diagnosis of ICC, with very high sensitivity and specificity. CA19-9 level was 176.3 and 156.7 U/mL while AFP level was 460 and 170 ng/mL in cHCC-CC cases, respectively. Conclusion: CA19-9 could be a diagnostic marker of ICC in cases of typical radiological criteria of HCC with elevated CA19-9.

ROLE OF TRANSIENT ELASTOGRAPHY IN EARLY DETECTION OF HEPATOCELLULAR CARCINOMA IN CIRRHOTIC PATIENTS

Abstract:Background:Hepatocellular carcinoma is the most common primary malignancy of the liver and one of the most frequent causes of death in patients with liver cirrhosis.In Egypt it is one of the most challenging tumors with high incidence, prevalence and mortality rates . The degree of liver fibrosis is the strongest indicator of risk for HCC development, that’s why liver stiffness measured by TE is useful in demarcating patients at a high risk for HCC, who require frequent check-up by imaging examinations. Aim of work: The aim of this study was to study the role of US elastography (FibroScan) in early detection of HCC in cirrhotic patients in comparison with triphasic CT.Patient and methods:This study was conducted on 100 patients with liver cirrhosis, 50 of them had HCC. All the patient was diagnosed with liver cirrhosis by US examination and underwent fibroscan to estimate the degree of fibrosis and then triphasic CT to confirm or exclude the presence of HCC. Results:There is a correlation between high TE results and the incidence of HCC detection by CT, HCC detection was (100%) in the groups with LSM value (>30KPa) and low (9.6%) in the group with LSM value (15-25KPa).Conclusion:The higher LSM the more liability for the patient to have HCC on CT scanning.Keywords: Hepatocellular carcinoma, transient elastography, triphasic CT, liver stiffness measurment.

Role of transient elastography in the prediction of de novo recurrence of hepatocellular carcinoma after radiofrequency ablation: single-center Egyptian study

BackgroundRadiofrequency is one of the curative treatment options for hepatocellular carcinoma (HCC). Despite the progressive improvements in the efficacy of radiofrequency, the survival of patients with HCC who undergo radiofrequency remains disappointing, mainly due to frequent intrahepatic recurrence of HCC after radiofrequency. We aimed to evaluate the role of transient elastography (TE) in the prediction of de novo recurrence of HCC after radiofrequency and to compare between transient elastography and the serological fibrosis indices in the prediction of de novo recurrence of HCC.ResultsThirty HCC patients underwent baseline transient elastography for preinterventional assessment of the degree of fibrosis. Also noninvasive serum fibrosis indices were calculated from baseline data, including age platelet index (API), cirrhosis discrimination score (CDS), and FIB-4 index. Patients achieving complete response after 1 month post radiofrequency ablation were followed for further 12 months by triphasic abdominal CT scan to detect de novo lesions according to modified RECIST criteria. Baseline means of CDS, FIB4, and API were 6.03 ± 1.5, 3.98 ± 2.58, and 1.24 ± 1.08, respectively. Transient elastography revealed 28 patients with F4 and only 2 patients with F3 (mean liver stiffness 22.45 ± 10.36 Kba). There was a significant negative correlation between liver stiffness (LS) and de novo recurrence of HCC (mean of LS in patients with a complete response was 17.19 ± 3.32 while in those with de novo recurrence was 36.94 ± 5.93, with the best cut off value ≥24.65 (p value < 0.001). There was no significant correlation between CDC, FIB4, API scores, and de novo recurrence of HCC. It was found that the liver stiffness was significantly associated with the prediction of hepatic decompensation (p value <0.001). Also, liver stiffness at the cutoff value > 42.75 (p value = 0.031) was significantly associated with the prediction of 1-year mortality after radiofrequency ablation.ConclusionOur data suggested that liver stiffness measurement in hepatocellular carcinoma patients was a useful predictor of de novo recurrence, overall survival, and possibility of hepatic decompensation after radiofrequency ablation.

Is serum endocan a sensitive biomarker for early recurrence of hepatocellular carcinoma after radiofrequency ablation?

Hepatocellular cancer (HCC) is one of the common liver cancers and considered to be the sixth most commonly occurring cancer in the world and the second leading cause of death among cancer patients. More recent studies on HCC showed that the elevated serum endocan level was a predictive factor of recurrence after radiofrequency ablation. The aim of this study is to evaluate the serum endocan level as a prognostic biomarker for recurrence of HCC after percutaneous radiofrequency ablation. Analytic-prospective study was carried out in Suez Canal University Hospitals. The study was carried out on 80 patients classified into three groups: group 1 (control group) consisted of 20 apparently healthy persons; group 2 consisted of 20 patients with liver cirrhosis; and group 3 consisted of 40 treatment-naive HCC patients who were prepared for radiofrequency ablation. All HCC patients (who were confirmed to have complete ablation after RF) were followed up by using triphasic abdominal CT, serum AFP and serum endocan assessment at 3 and 6 months after radiofrequency ablation. Our study revealed a high level of serum endocan in the HCC group with a statistically significant difference (<0.001) between the three groups. HCC patients had a higher level of serum endocan (6.2 ± 2.25) followed by an liver cirrhosis group (2.0 ± 1.29) and then the control group (1.0 ± 0.3). The serum endocan level had a positive correlation with recurrence of HCC (P < 0.0001). There was a positive correlation between serum endocan and serum alanine transferase (P = 0.02), and a positive correlation between serum endocan and the number of tumors (P = 0.01). Serum endocan is considered as a prognostic biomarker for tumor recurrence in HCC patients after radiofrequency ablation.

Abdominal vessel depiction on virtual triphasic spectral detector CT: initial clinical experience

PurposeTo evaluate vessel assessment in virtual monoenergetic images (VMI40keV) and virtual-non-contrast images (VNC) derived from venous phase spectral detector computed tomography (SDCT) acquisitions in comparison to arterial phase and true non-contrast (TNC) images.MethodsTriphasic abdominal SDCT was performed in 25 patients including TNC, arterial and venous phase. VMI40keV and VNC were reconstructed from the venous phase and compared to conventional arterial-phase images (CIart), TNC and conventional venous-phase images (CIven). Vessel contrast and virtual contrast removal were analyzed with region-of-interest-based measurements and in a qualitative assessment.ResultsQuantitative analysis revealed no significant attenuation differences between TNC and VNC in arterial vessels (p-range 0.07–0.47) except for the renal artery (p = 0.011). For venous vessels, significant differences between TNC and VNC were found for all veins (p < 0.001) except the inferior vena cava (p = 0.26), yet these differences remained within a 10 HU range in most patients. No significant attenuation differences were found between CIart/VMI40keV in arterial vessels (p-range 0.06–0.86). Contrast-to-noise ratio provided by VMI40keV and CIart was equivalent for all arterial vessels assessed (p-range 0.14–0.91).Qualitatively, VMI40keV showed similar enhancement of abdominal and pelvic arteries as CIart and VNC were rated comparable to TNC.ConclusionOur study suggests that VNC and VMI40keV derived from single venous-phase SDCT offer comparable assessment of major abdominal vessels as provided by routine triphasic examinations, if no dynamic contrast information is required.

Association between Prothrombin Induced by Vitamin K Absence-II (PIVKA-II) and Barcelona Clinic Liver Cancer (BCLC) Stage, Tumor Size, Portal Venous Thrombosis in Hepatocellular Carcinoma Patients

Hepatocellular carcinoma is one of the major cancer problems in the world because of the low early screening awareness in patients. Serum alpha-fetoprotein is not adequate as a single screening tool, especially for small HCCs, thus, prothrombin induced by vitamin K absence-II (PIVKA-II) can help in detecting small HCCs. Barcelona Clinic Liver Cancer (BCLC) stage remains to be the preferred HCC classification because it can predict the outcome and help in choosing available treatment options according to stages. This study aims to investigate the association between PIVKA-II levels with BCLC stage, tumor size, portal venous thrombosis in HCC patients. We enrolled patients with newly diagnosed HCC at the Adam Malik General Hospital, Medan, Indonesia from January to December 2018. Patients with HCC were classified according to BCLC stages, findings of portal venous thrombosis and tumor size from triphasic CT scan were noted, and serum PIVKA-II levels were measured. Sixty patients were included in this study. There were significant differences in serum PIVKA-II levels with different stages of BCLC (p &lt; 0.001). Significantly higher serum PIVKA-II levels were detected in patients with portal venous thrombosis (p &lt; 0.001) and larger size tumors (p &lt; 0.003). Our study shows that serum PIVKA-II levels can help to diagnose, differentiate between stages of BCLC, and determine the prognosis in patients with HCC.

Surgical Feasibility, Determinants, and Overall Efficacy of Neoadjuvant 177Lu-DOTATATE PRRT for Locally Advanced Unresectable Gastroenteropancreatic Neuroendocrine Tumors.

We assessed 177Lu-DOTATATE peptide receptor radionuclide therapy (PRRT) in the neoadjuvant setting in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs). We also evaluated the variables associated with resectability of the primary tumor after PRRT. Methods: This study included 57 GEP-NET patients who had a primary tumor that was unresectable (because of vascular involvement as defined using the pancreatic ductal adenocarcinoma criteria of the National Comprehensive Cancer Network) and who underwent 177Lu-DOTATATE therapy without any prior surgery. They were categorized into 2 groups: 23 patients without liver metastases (group 1) and 34 patients with potentially resectable liver metastases (group 2). 177Lu-DOTATATE was administered with mixed amino acid-based renal protection at a dose of 7.4 GBq (200 mCi) per cycle. Surgical resectability was evaluated using triphasic contrast-enhanced abdominal CT imaging at 3 different time points during the PRRT course. Four broad categories of overall PRRT response were evaluated. The Kaplan-Meier product-limit method was used to calculate progression-free survival (PFS) and overall survival (OS). Associations between variables and a resectable primary tumor after PRRT were analyzed using the χ2 test, with a P value of less than 0.05 considered statistically significant. Results: After 177Lu-DOTATATE therapy, the unresectable primary tumor became resectable in 15 of 57 (26.3%) patients (7 patients in group 1 and 8 patients in group 2). A complete or partial response to PRRT was seen in 48 patients (84%), 23 patients (40%), 18 patients (31%), and 23 patients (40%) using symptomatic, biochemical, molecular imaging, and anatomic imaging criteria, respectively. Estimated rates of PFS were 95% and 90% at 2 y in groups 1 and 2, respectively. The 2-y OS of the 2 groups combined was 92.1%. The rate at which the primary tumor was resectable after PRRT was significantly higher in patients who had duodenal neuroendocrine tumors, patients who had GEP-NETs with no regional lymph node involvement, patients for whom the primary tumor was smaller than 5 cm, patients for whom liver metastases were no larger than 1.5 cm, patients for whom there were no more than 3 liver metastases, and patients for whom 18F-FDG uptake in the primary tumor had an SUVmax of less than 5. Conclusion: In a moderate fraction of GEP-NET patients, with or without liver metastases, whose primary tumor was unresectable because of vascular involvement, the primary tumor converted from unresectable to resectable after 177Lu-DOTATATE therapy, signifying that neoadjuvant PRRT can be considered in such patients. The effective control of symptoms, favorable morphologic and functional imaging response, and durable PFS and OS that we observed after 177Lu-DOTATATE PRRT may lead to less morbidity and mortality in these patients.

Total laparoscopic pancreaticoduodenectomy in 26 patients: single surgeon experience

Background: Total laparoscopic pancreaticoduodenectomy (TLPD) has become more feasible and preferred surgery for periampullary tumour. With the innovation of latest equipment and continuous learning curve, this has become more sophisticated and rampant, along the advantages of minimal invasive surgery. Methods: We analysed data of all the 26 patients who underwent TLPD from October 2015 to November 2019. Preoperative haematological, liver function test, tumour marker, MRCP, triphasic CT, scan with pancreatic protocol, endoscopic ultrasound guided fine needle aspiration or brush cytology done for confirmation of diagnosis, nodal status and operability. Meticulously selected patients with periampullary carcinoma of tumour size≤2.5 cm included. Demographic data, operative time, length of hospital stay, post-operative complication and pathological analyses of resected specimen (en bloc) observed. Results: TLPD for periampullary tumours attempted in twenty-six patients among them six converted to open surgery. Patients were of both genders and mean age was 45 (27-60, SD7.4) years. The mean operative time was 353 SD 28.77 (306-420) minutes. Postoperatively, there were few complications and mean length of hospital stay was 11 (9-13 days) days. The histopathology revealed maximum no. of cholangiocarcinoma with negative margins and positive nodes in all the patients.Conclusions: TLPD is feasible, safe and promising alternative to the standard open surgery with expert hands. This has benefits of short hospital stay, less blood loss, cosmetic, early recovery with few complications. Short-term surgical outcomes are superior or comparable to open surgery.

Characterization of focal liver lesions using sulphur hexafluoride (SF6) microbubble contrast-enhanced ultrasonography

BackgroundFocal hepatic lesions incidentally detected during ultrasound usually need further step for proper characterization. The aim of this study was to highlight the efficacy of microbubble contrast-enhanced ultrasonography (CEUS) in characterization of focal liver lesions. This prospective study was conducted on 60 patients presented with hepatic focal lesions in the period from January 2019 to June 2020. CEUS studies were performed after a baseline conventional ultrasound with the same machine by the same operator. The ultrasound contrast agent used is second-generation US contrast agent. The enhancement patterns of the hepatic lesions were studied during the vascular phases up to 5 min and the data were correlated with histopathology, triphasic contrast-enhanced CT, and clinical follow-up.ResultsCEUS demonstrated a sensitivity of 94.2%, specificity of 88.9%, positive predictive value of 91%, negative predictive value of 94.1%, and accuracy of 92.3% for characterization of hepatic focal lesions, compared to a sensitivity of 100%, specificity of 81.8%, positive predictive value of 84%, negative predictive value of 100%, and accuracy of 90.7% for triphasic CT.ConclusionCEUS is an effective tool in characterization of HFLs and recommended as a second diagnostic step after conventional ultrasound to immediately establish the diagnosis especially in patients with contraindications to CECT.

Role of Triphasic CT in Evaluation of Causes and Hemodynamics of Transient Hepatic Attenuation Difference

Background:THAD is important sign of underlying liver disorder. Purpose:To evaluate role of triphasic CT in detecting causes and hemodynamics of transient hepatic attenuation difference that is important sign of an underlying liver disorder. Patients and methods:We retrospectively evaluated 40 patients with THAD, their age ranges were from 25-75 years old. The study was done over a period of 24 months (Jan 2018–Dec 2019), for each patient triphasic CT liver examination was performed, during the arterial, portal and delayed phases. We assessed attenuation of THAD area in different phases, morphology, relation to focal lesions and etiopathogenesis of THAD. Results: 27/40 patients with THAD presented with hyperdensity in the arterial phase and become isodense to the normal liver parenchyma in other phases, 3/40 patients with THAD presented with hyperdensity in the arterial phase, persist in the porto-venous phase and become isodense in the delayed phase. Different morphology of THAD was detected as follow; sectorial pattern (32), polymorphous pattern (5), diffuse (2) and multi-segmental THADs (1). 28/40 patients with THAD are related to focal lesion and12/40 patients with THAD unrelated to focal lesion. We detected etiopathogenesis of THAD as follow; 35/40 patients with THAD was due to portal hypoperfusion, 4/40 was due to primary increase arterial blood inflow and 1/40 was cryptogenic. Conclusion: THADs are benign entities associated to focal lesions or other diseases of the liver, radiologists should be familiar with it to avoid false-positive diagnosis of pseudo lesions and not to overestimate the extent of the disease.

ROLE OF COLOR DOPPLER ULTRASONOGRAPHY VERSUS TRIPHASIC CT WITH PORTOGRAPHY IN PORTAL VEIN THROMBOSIS

Back ground: Although portal vein thrombosis is a rare event among general population, its prevalence in cirrhotic patients about 28 % (1). Generally liver cirrhosis is a widespread disease, the differentiation between bland and malignant thrombus is very essential as neoplastic portal vein thrombosis gravely affects the prognosis and the subsequent treatment options (1). Doppler ultrasonography usually the first noninvasive modality used to diagnose portal vein thrombosis, using color and spectral data analysis. Triphasic CT with portography is very helpful to differentiate bland from malignant thrombus and enable characterization of malignant portal vein thrombosis using maximum intensity projection (MIP) reconstruction allow better analysis of the thrombus (2).Aim of the work: To show the role of color Doppler ultrasonography (US) and Triphasic CT in diagnosis of portal vein thrombosis (PVT) and differentiation between bland and tumoral thrombus.Patient and Methods: This study included 32 cases presented with portal vein thrombosis clinically and radiologically.Results: Of the 32 subjects,21 had malignant PVT and 11 patients had benign PVT. Direct invasion of portal vein from adjacent focal lesion had the highest sensitivity 95.2 % was achieved, with a specificity of 100 %. The Positive predictive value (PPV) was 100 %, while the negative predictive value (NPV) was 91.7 %. Early arterial enhancement and rapid washout of contrast showed 76.2 % sensitivity and 100 % specificity, PPV 100 % and NPV 68.8 %. Pulsatile flow within the thrombus depicted 38.1 % sensitivity, 100 % specificity with PPV 100 % and NPV 45.8 %.Conclusion: Triphasic CT and color Doppler US have to be considered a useful tools in evaluating portal vein thrombosis provides helpful information for the detection and characterization of malignant and benign portal vein thrombi.

. Role Of PET/CT in Assessment Of Post Interventional Treatment of Hepatocellular Carcinoma

Purpose: to highlight the role of PET/CT in evaluation of post interventional treatment (radiofrequency ablation & TACE) of hepatocellular carcinoma. Background: Hepatocellular carcinoma (HCC) is one of the major causes of mortality among patients with cirrhosis. It represents about 11.85% of the malignancies of all GIT organs and 1.78% of the total malignancies among Egyptians. Patients and methods: From February 2018 to November 2019, twenty five patients (20 males and 5 females, their age ranged from 44 to 75 years with mean age of 60.60 ± 7.35 years) were referred to the radiology unit with hepatocellular carcinoma and had underwent TACE ( 2 patients had history of combined TACE and RFA procedures ). 18F-FDG PET/CT and triphasic CT examinations were conducted in a private radiology center in Cairo for all patients using combined PET-CT machine (Philips intgenuity TF PET/CT 128 slices). Results:PET/CT showed true positive results in 20 patients, true negative results in 3 patients, false negative results at one patient and false positive results at one patient. In our study, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 18F -FDG PET/CT were 95.24%, 75%, 95.24%, 75% and 92% respectively. Conclusion:PET/CT showed higher accuracy in assessment of the intervention bed without affection by lipiodol artifact as well as detection of extra hepatic spread of HCC in single whole body examination which is crucial for patients preparing for liver transplantation and differentiation between benign and malignant portal vein thrombosis.

Microwave Ablation and/or Transcatheter Arterial Chemo-embolization in the Treatment of Hepatocellular Carcinoma

Background and study aim: Percutaneous microwave ablation (MWA) and trans-arterial chemo-embolization (TACE) are established therapies for treatment of HCC patients. Lower rates of complete response with mono-therapies have been reported. Therefore, combined treatment strategies, including combined TACE and MWA have been used. The study aimed at comparing the efficacy of MWA mono-therapy; TACE mono-therapy and combined TACE-MWA in the treatment of 3- 5 cm HCC. Patients and methods: The study prospectively included 102 patients with 113 hepatic focal lesions (3-5 cm) diagnosed as HCC by contrast-enhanced triphasic CT or dynamic MRI. Thirty-five HCC in 34 patients were subjected to MWA mono-therapy; 41 HCC in 34 patients were subjected to TACE mono-therapy, while 37 HCC in 34 patients were subjected to combined TACE-MWA therapy. Follow up by contrast-enhanced CT or MRI was done at one month, and every 3 months, up to one year after treatment. Therapeutic tumor response and local tumor progression were evaluated and compared among the groups. Results: After one year follow up, the combined TACE-MWA group showed a higher rate of complete response (CR) (83.3%) when compared to MWA group (76.5%) and TACE group (66.6%) (P>0.05). The local tumor progression (LTP) rate in the combined TACE-MWA group was lower (16.6%) than that in MWA group (23.5%) and TACE group (33.3%) (P=0.2). Conclusion: Combined TACE-MWA therapy appears to be non-significantly superior to MWA mono-therapy and TACE mono-therapy in terms of complete tumor response and local tumor progression in patients with 3-5 cm HCC.

Hypervascular Nodules and Stiffer Liver are Associated with Recurrence after Microwave Ablation in Patients with Hepatocellular Carcinoma: A Double-Center Analysis

Background and Aims The aim of this study was to detect the most important risk factors for recurrence after microwave ablation (MWA) of hepatocellular carcinoma (HCC). Methods A total of 92 patients with 110 HCC focal lesions (FLs) underwent MWA therapy. All the patients underwent triphasic CT before and after 1 and 3 months of MWA therapy. Complete ablation and recurrence rates were recorded, and the risk factors associated with recurrence were analyzed. Results Regarding the 110 HCC FLs that were detected pre-MWA, adequate ablation was recorded post-MWA procedure in 88 FLs (80%) and incomplete ablation in 22 FLs (showed residual contrast enhancement). However, there were newly detected lesions (17 FLs). The rate of recurrence was significantly higher in patients with multiple larger (> 4 cm) sized and hypervascular nodules. Diabetics were significantly associated with a higher recurrence rate of HCC. The rate of recurrence was significantly higher in patients with baseline level of serum alfa-fetoprotein (AFP) ≥200 ng/mL. Stiffer liver> 25 kPa had higher incidence for recurrence after ablation. Conclusion Meticulous follow-up is mandatory in diabetic patients, patients with AFP > 200 ng/dL starting value, hypervascular large hepatic FL, and in stiffer liver> 25 kPa, as these patients have higher incidence for recurrence after ablation.

Association Between the ACE (I/D) Gene Polymorphism and Hepatocellular Carcinoma Risk in Egyptian HCV Patients

Background: Hepatocellular carcinoma is one of the most fatal malignancies worldwide and is related to many risk factors. Chronic HCV is associated with a 20–30-fold increased risk for HCC. Angiotensin-converting enzyme (ACE) is overexpressed in many cancers and plays a major role in angiogenesis and carcinogenesis. Aim: We aimed to elucidate the effect of the ACE I/D gene polymorphism in patients with HCV-related liver cirrhosis and HCC, and its relationship to clinical parameters. Patients and Methods: The study included 180 participants, cirrhotic (n=60), HCC (n=60) and control healthy subjects (n=60). Liver and renal function tests, alpha-fetoprotein, HCV antibodies and triphasic CT were assessed. ACE Gene polymorphism was assessed by Nested PCR. Results: We observed higher frequencies of DD (36.7%) and DI (51.7%) genotypes, along with the D allele (62.5%), in HCC patients compared to those of cirrhotic cases (10%, 40% and 30%, respectively) and control subjects (6.7%, 38.3%, and 25.8%, respectively). DD and DI genotypes increased the risk and predicted the occurrence of HCC by OR 25.932 and OR 6.354, respectively. The D allele conveys significant risk for HCC compared to control and cirrhotic groups with OR 4.785 and OR 3.889, respectively. Both DD genotype and D allele are significantly correlated with larger tumor size and metastasis. Conclusion: The ACE I/D polymorphism (DD genotype and D allele) is significantly associated with HCC risk in HCV patients and is correlated with increased tumor growth and advanced stage.

Serum Long Intergenic Non-Coding Ribonucleic Acid LINC00152 as a Potential Predictor of Hepatocellular Carcinoma in Egyptian Patients

Background and study aim: HCC diagnosis is mostly dependent on imaging studies as well as laboratory tests. The aim of this study is to evaluate possible significance of circulating Linc00152 level as a potential diagnostic marker for HCC diagnosis among Egyptian patients. Patients and Methods: This Cohort (Prospective observational) study was conducted on 60 patients, who were further divided into three groups; 30 patients with cirrhosis and HCC on top (group I), this group was further subdivided into: 15 HCC patients (stage C and D) according to Barcelona-Clinic Liver Cancer (BCLC) staging system (group IA) and 15 HCC patients (stage A and B) according to BCLC staging system (group IB); 15 cirrhotic patients without HCC (group II), lastly 15 healthy subjects with matched age and sex as a control Group (group III). All were subjected to history taking, clinical evaluation, basic liver functions, AFP, ultrasound abdomen followed by Triphasic CT abdomen to document presence of HCC and Linc00152 level assessment Results: Circulating Linc00152 was elevated in-group I compared to two other groups. Serum Linc00152 yielded showed 90% sensitivity and 66.67% specificity in discriminating HCC from cirrhosis, compared to AFP that showed 63.33% sensitivity and 60% specificity, Combination of Linc00152 and AFP might possess a higher ability to discriminate between HCC and cirrhosis rather than without combination. Conclusion: HCC is clearly accompanied by over expression of serum Linc00152. This study suggested that Linc00152 may be promising diagnostic markers for early HCC, also for cirrhosis detection.

P1705ARE DIRECT-ACTING ANTI-VIRAL DRUGS ACCUSED OF INCREASED INCIDENCE OF HEPATOCELLULAR CARCINOMA IN ENDEMIC AREA: A PILOT STUDY

Abstract Background and Aims Great progression in treating hepatitis C infection has been made with the new Interferon-free regimens. Reports about developing hepatocellular carcinoma after DAAs have been spotlighted. Kidney transplantation and hemodialysis are considered risk factors for developing malignancies. Here we are evaluating the prevalence of HCC after DAAs treatment in high risk population. Method This cross-sectional study was held in Urology and Nephrology Center, Mansoura University, Egypt including. Total number of 165 patients received DAAs included in this study in 2 phases. The first phase included 50 patients (12 hemodialysis and 38 kidney transplant recipients). All patients completed DAAs course as treatment for hepatitis C infection (HCV) 24 months ago. Alfa feto protein and liver ultrasound (Use of both modalities combined yielded sensitivity (99.2%) and specificity (68.3%)) was used to screening of HCC for all patients. Triphasic CT liver with 86% to 94% sensitivity was done for all hemodialysis patients and KTRs with suspicious lesions or high alfa-feto protein. Results Our patients mean age was 52.32±3.2 years with male predominance. Mean Hemodialysis duration was 48.21±12.3 months and mean kidney transplantation duration was 36.21±6.7 months. Baseline laboratory investigations: ALT: 39.17±16.3 iu/l, Albumin: 3.6±1.32 g/dl, Bilirubin: 0.54±0.21, Hemoglobin: 10.57±1.9 g/dl, AFP: 5.3±2.4 ng/ml. Baseline liver US: normal (49%), enlarged (42%) and cirrhotic (9%) (No focal lesions). Fibro scan: F0 (26%), F1 (31%), F2 (32%) and F3 (11%). None of them experienced hepatic encephalopathy attacks or bleeding varices. All hemodialysis patients received Ombitasvir/Paritaprevir/Ritonavir (OMV/PTV/RTV) regimen (3 months). Only 2 KTRs received OMV/PTV/RTV regimen (3 months), the remaining 36 KTRs received Sofosbuvir/Daclatasvir regimen (6 months). Only 1 case reported relapse within 3 month after completing treatment. The rest achieved 12-week and 24-week SVR successfully. After 2 years from completing treatment, there was significant improvement in ALT levels. Four KTRs passed to graft failure due to accelerated immunologic response (rejection episodes) and 7 KTRs showed rise of serum creatinine (biopsy-proven rejection). Mean AFP rose up to 7.6±2.4 ng/ml with no statistical difference. Three hemodialysis patients and 4 KTRs showed rise in alfa-feto protein above normal values (10ng/dl). Four out of them exceeded 500ng/ml (1 HD and 3 KTRs). Abdominal US revealed: no change (39 patients), enlargement (6 patients) and cirrhosis (5 patients). Suspicious mass was found in 11 patients. Triphasic CT then was done for all hemodialysis patients and 9 KTRs. Regarding hemodialysis, 1 patient was diagnosed as HCC based on increased enhancement by Triphasic CT and alfa-fetoprotein was &amp;gt;500 ng/ml. Regarding KTRs, HCC was diagnosed in 2 patients and liver metastasis secondary to lymphoma was diagnosed in 1 case. The other patients with suspicious lesions (5 patients) showed uniform enhancement by Triphasic CT suggesting benign lesions. So, we have 3 (6%) out of 50 patients has been diagnosed as HCC after DAAs. By retrieval of their data, HCV duration was over 10 years and the liver was cirrhotic or enlarged with cirrhotic changes by ultrasound. Baseline ALT was slightly high without significant improvement after treatment. Also, baseline alfa-feto protein was high. The 3 patients were F2 or F3. Conclusion Hepatocellular carcinoma incidence after Direct-acting anti-virals is related mostly to the poor condition of the patients at baseline not to the drug itself and HCC in such cases could be considered as a part of disease progression not a drug complication.