Lidia Monti, Abstract Co-Author: Nothing to Disclose

Marco Salsano, Presenter: Nothing to Disclose

Manila Candusso, Abstract Co-Author: Nothing to Disclose

Giuliano Torre, Abstract Co-Author: Nothing to Disclose

Chiara Grimaldi, Abstract Co-Author: Nothing to Disclose

Paola Francalanci, Abstract Co-Author: Nothing to Disclose

Francesco Callea, Abstract Co-Author: Nothing to Disclose

Giovanna Soglia MD, Abstract Co-Author: Nothing to Disclose

Alfonso Avolio, Abstract Co-Author: Nothing to Disclose

Lorenzo Bonomo MD, Abstract Co-Author: Nothing to Disclose

Jean De Ville De Goyet, Abstract Co-Author: Nothing to Disclose

Paolo Toma, Abstract Co-Author: Nothing to Disclose

Acoustic radiation force impulse (ARFI) imaging has been developed as a new non-invasive ultrasound-based elastography modality to investigate liver stiffness using shear wave velocity (SWV). The aim of this study was to evaluate the role of ARFI imaging for assessing episodes of liver dysfunction (rejection, hepatitis, cholangitis and fibrosis) during the post-operative course after pediatric LT.

ARFI was performed using an US device (Acuson S2000, Siemens Medical Solutions) equipped with a 4-MHz transducer. SWV by ARFI imaging was performed in 59 pediatric LT recipients (median 6 month after transplantation). Liver transplantation was performed with a full liver graft in 15 cases (25%) and with a split liver (segments II-III) in 44 (75%). SWV was measured ten times to quantify hepatic stiffness. Liver biopsy and laboratory analysis (including aminotransferases, alkaline phosphatases, albumin and bilirubin) were performed in a range of time from one day to one month from the ARFI imaging. SWV was compared to biochemical parameters using liver biopsy as reference standard. Data were evaluated retrospectively.

During the study period ARFI was performed 138 times. According to histopathology there were 15 rejections, 29 hepatitis episodes, 12 cholangitis episodes. Median SWV (m/s, IQR) was higher in patients with diagnosis of graft rejection than in patients without liver disease [2.03, 1.67-2.44, vs 1.22, 1.09-1.31, p < 0.01]. Median SWVs in patients with hepatitis and cholangitis were respectively 1.80, (IQR = 1.49-2.06) and 2.07 (IQR = 1.91-2.48). A few patients had fibrosis with a median SWV of 1.67 m/s. At ROC curve analysis ARFI resulted able to predict rejection (AUC = 0,932), hepatitis (AUC = 0,916) and cholangitis (AUC = 0,949). Statistical analysis wasn’t reliable for fibrosis (n = 4).

SWV obtained by ARFI predicts the diagnosis of rejection, hepatitis and cholangitis in pediatric liver transplantation independently to biochemical markers. ARFI could be useful to reduce the number of liver biopsy in order to guide the immunosuppressive therapy.

ARFI, together with serological markers, is an efficient modality for the diagnosis of graft dysfunction allowing the reduction in the number of liver biopsies in pediatric patients after LT.

Monti, L, Salsano, M, Candusso, M, Torre, G, Grimaldi, C, Francalanci, P, Callea, F, Soglia, G, Avolio, A, Bonomo, L, De Ville De Goyet, J, Toma, P, Diagnosis of Liver Rejection by Acoustic Radiation Force Impulse in Pediatric Liver Transplant Patients.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14010766.html