An Tang MD, Presenter: Nothing to Disclose

Tae Kyoung Kim MD, Abstract Co-Author: Nothing to Disclose

Hyun-Jung Jang, Abstract Co-Author: Nothing to Disclose

Raffi Karshafian MS, Abstract Co-Author: Nothing to Disclose

Peter Nicholas Burns PhD, Abstract Co-Author: Nothing to Disclose

Stephanie Ruth Wilson MD, Abstract Co-Author: Research Consultant, Bristol-Myers Squibb Company Advisory Board, Koninklijke Philips Electronics NV

Jenny Heathcote MD, Abstract Co-Author: Nothing to Disclose

Maha Guindi MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

Cirrhosis is associated with several intrahepatic and extrahepatic hemodynamic changes. Previous studies proposed the measurement of hepatic vein transit time (HVTT) as a non-invasive index of diffuse liver disease severity. We sought to validate the use of HVTT in a cohort of patients with contemporary biopsy correlation.

Thirty-four consecutive patients (mean age 49, 17 M) with clinical suspicion of fibrosis were studied prospectively (17 HBV, 7 HCV, 5 PBC, 5 others). The 10 first patients were scanned twice by 2 different radiologists in a randomized sequence to evaluate the reproducibility of the technique. After an overnight fast, the patients were scanned in pulse-inversion mode (iU22, Philips, Bothell, WA) during repeated bolus injections of microbubbles (Definity, BMS Imaging, Boston MA). The time-intensity curves in an hepatic artery and vein were analyzed with quantification software (Q-Lab, Philips, Bothell, WA). HVTT was defined as the time from antecubital vein injection to sustained rise in Doppler signal >10% above baseline; hepatic artery transit time (HATT) as the similar arrival time in the hepatic artery. The transit times were correlated with fibrosis stage from liver biopsies performed within a short time interval (mean 7.6 d).

Transit time was measured successfully in 33/34 patients, with good reproducibility (Intra-observer ICC=0.86; inter-observer ICC=0.62). Mean (SEM) HVTT for absence/minimal fibrosis (n=14), moderate fibrosis (n=15) and cirrhosis (n=5) groups were 21.4 (2.4), 20.9 (1.7), 18.1 (2.0) seconds respectively. Mean (SEM) HATT for the absence/minimal fibrosis, moderate fibrosis and cirrhosis groups were 10.5 (1.6), 9.6 (0.8), 9.4 (1.5) seconds respectively. The very low correlation between HVTT and fibrosis (r=-0.05) and HATT and fibrosis (r=+0.09) prevented us from validating previously published threshold values to distinguish mild from advanced fibrosis.

This study does not confirm earlier appearance of contrast in cirrhosis and does not validate HVTT as a reliable surrogate marker of fibrosis.

Despite encouraging early results in the literature, our study does not validate the use of HVTT as a reliable marker of fibrosis.

Tang, A, Kim, T, Jang, H, Karshafian, R, Burns, P, Wilson, S, Heathcote, J, Guindi, M, et al, , Hepatic Vein Transit Times Using a Microbubble Agent to Predict Severity of Hepatic Disease Noninvasively.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4434536.html