Teresa Abbattista MD, Presenter: Nothing to Disclose

Francesco Ridolfi, Abstract Co-Author: Nothing to Disclose

Eugenio Brunelli, Abstract Co-Author: Nothing to Disclose

Paolo Busilacchi, Abstract Co-Author: Nothing to Disclose

Recent works showed that the early enhancement of hepatic veins (Hepatic Vein Arrival Time, HVAT) is able to distinguish cirrhosis from chronic liver diseases. Aim of this study was to determine if a contrast-enhanced ultrasound dedicated software could be used to give a reproducible quantitative map of haemodynamic changes of hepatic parenchyma and to differentiate liver cirrhosis from chronic hepatitis.  

Contrast-enhanced hepatic ultrasonography with sulfur hexafluoride-filled microbubbles (Sonovue, Bracco S.p.a., Milan, Italy) was performed on 17 patients with virus related liver cirrhosis, 20 patients with chronic hepatitis B/C, and 10 controls without any evidence of liver disease. Contrast-enhanced ultrasound dedicated software (Qontrast, Bracco S.p.a., Milan, Italy) was used to obtain maps of the enhancement of hepatic parenchyma including a main hepatic vein. Post-processing enhancement intensity was analyzed to determine RBF (region of blood flow), TTP (time to peak), RBV (region of blood value) and peak (enhancement peak quantity).

TTP was significantly reduced in patients with liver cirrhosis both respect to patients with viral chronic hepatitis (69.2  12 vs. 81.3  15.3 seconds, p=0.01) and respect to control patients (86.3  20.3 seconds, p=0.007). Peak was higher in patients with chronic hepatitis (25.5  8.7 respect to 22.4  6.4 in patients affected by liver cirrhosis and 18.9  7.1 in control patients): this difference approched but not reached the statistical significance (chronic hepatitis vs. control: p=0.055). No statistically significant differences were observed for the other parameters studied (RBF, RBV) . Quontrast revealed a high reproducibility: inter- and intraobserver kappa coefficients for calculation of TTPs were 0.77 and 0.85, respectively.

Early TTPs seem to be predictive of liver cirrhosis and confirm data obtained from analysis of HVAT. The observed trend in reaching the highest peak of enhancement in chronic hepatitis should be due to wider vascular bed that is present  during the inflammatory and fibrotic processes that characterize several chronic liver diseases of viral origin.

This examination  is useful to quantify vascularization in chronic liver disease and using dedicated software for analysis of contrast-enhanced liver ultrasound improves reproducibility.

Abbattista, T, Ridolfi, F, Brunelli, E, Busilacchi, P, Haemodynamic Changes Occurring in Liver Cirrhosis: Evaluation by a Contrast-enhanced Ultrasound Dedicated Software and Potentially Clinical Applications.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9008594.html