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Topic
Abdominal vascular imaging, Liver - Diffuse Liver Disease
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Ronot, Clichy, FR","photo":""},"playlist":[{"name":"","source":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/77\/v\/487_1p.mp4","source_path":"s3:\/\/eu-cslide-prod-recordings\/esgar2020\/77\/v\/487_1p.mp4","cover":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/77\/6DA82F86.jpg","data":[],"tracks":[],"chapters":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/77\/v\/487_1p.vtt","thumbnails":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/77\/v\/487_1p-thumbnails.vtt"}]},{"name":"SS 11.5 - Head-to-head comparison of liver stiffness measurement using transient elastography, 2D-shear wave elastography and MR elastography for non-invasive evaluation of clinically significant portal hypertension","mode":"playlist","public":true,"info":{"id":617,"presentation":"SS 11.5 - Head-to-head comparison of liver stiffness measurement using transient elastography, 2D-shear wave elastography and MR elastography for non-invasive evaluation of clinically significant portal hypertension","session":"SS 11 - Diffuse liver diseases: assessment of portal hypertension and liver function","presenter":"F. Andrade, Clichy, FR","photo":""},"playlist":[{"name":"","source":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/77\/v\/617_1p.mp4","source_path":"s3:\/\/eu-cslide-prod-recordings\/esgar2020\/77\/v\/617_1p.mp4","cover":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/77\/C5FE49E0.jpg","data":[],"tracks":[],"chapters":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/77\/v\/617_1p.vtt","thumbnails":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/77\/v\/617_1p-thumbnails.vtt"}]},{"name":"SS 11.8 - The value of MRI-defined sarcopenia in predicting hepatic decompensation and mortality in patients with chronic liver disease","mode":"playlist","public":true,"info":{"id":439,"presentation":"SS 11.8 - The value of MRI-defined sarcopenia in predicting hepatic decompensation and mortality in patients with chronic liver disease","session":"SS 11 - Diffuse liver diseases: assessment of portal hypertension and liver function","presenter":"L. Beer, Vienna, AT","photo":""},"playlist":[{"name":"","source":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/77\/v\/439_2p.mp4","source_path":"s3:\/\/eu-cslide-prod-recordings\/esgar2020\/77\/v\/439_2p.mp4","cover":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/77\/7CE3D1C7.jpg","data":[],"tracks":[],"chapters":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/77\/v\/439_2p.vtt","thumbnails":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/77\/v\/439_2p-thumbnails.vtt"}]},{"name":"SS 11.9 - Diagnostic performance of contrast-enhanced CT for the diagnosis of porto-sinusoidal vascular disease: a case-control study","mode":"playlist","public":true,"info":{"id":517,"presentation":"SS 11.9 - Diagnostic performance of contrast-enhanced CT for the diagnosis of porto-sinusoidal vascular disease: a case-control study","session":"SS 11 - Diffuse liver diseases: assessment of portal hypertension and liver function","presenter":"M. Ronot, Clichy, FR","photo":""},"playlist":[{"name":"","source":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/77\/v\/517_1p.mp4","source_path":"s3:\/\/eu-cslide-prod-recordings\/esgar2020\/77\/v\/517_1p.mp4","cover":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/77\/2EC9F2E3.jpg","data":[],"tracks":[],"chapters":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/77\/v\/517_1p.vtt","thumbnails":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/77\/v\/517_1p-thumbnails.vtt"}]},{"name":"SS 11.10 - Chronic diffuse liver disease multiparametric US imaging: attenuation imaging and dispersion imaging role in the quantitative evaluation of steatosis and viscosity","mode":"playlist","public":true,"info":{"id":795,"presentation":"SS 11.10 - Chronic diffuse liver disease multiparametric US imaging: attenuation imaging and dispersion imaging role in the quantitative evaluation of steatosis and viscosity","session":"SS 11 - Diffuse liver diseases: assessment of portal hypertension and liver function","presenter":"M. Radzina, RIGA, LV","photo":""},"playlist":[{"name":"","source":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/77\/v\/795_1p.mp4","source_path":"s3:\/\/eu-cslide-prod-recordings\/esgar2020\/77\/v\/795_1p.mp4","cover":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/77\/D3C187BB.jpg","data":[],"tracks":[],"chapters":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/77\/v\/795_1p.vtt","thumbnails":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/77\/v\/795_1p-thumbnails.vtt"}]}]
{"type":2,"code":"9E32WM02k"}
[session]
[presentation]
[presenter]
SS 11.1 - First report of the International Registry for Congenital Portosystemic Shunts
Presentation Number
SS 11.1
Channel
On-demand channel 4
Purpose
To describe patients followed by centres participating in the first International Registry for Congenital Portosystemic Shunts (IRCPSS).
Material and methods
Retrospective analysis of patients with CPSS from 15 centres. Porto-hepatic shunts were defined as intrahepatic (IH-CPSS) and others were defined as extrahepatic (EH-CPSS).
Results
242 patients were analysed with 122 IH-CPSS, 120 EH-CPSS. 24% were identified pre-natally with 75% IH-CPSS. 189 (76%) patients were diagnosed post-natally at a mean age of 39.1mo (0-200) for IH-CPSS and 61.9mo (0-192) for EH-CPSS. Both forms were equally frequent when diagnosed post-natally. Among them, symptoms were equally frequent among IH-CPSS (57%) or EH-CPSS (61%) CPSS. When comparing IH-CPSS and EH-CPSS, IH-CPSS were more likely to have neonatal hypoglycemia (9.8%vs 5%) and cholestasis (22.9% vs 15%) and EH-CPSS were more likely to have cardiopulmonary (33.3% vs 10.6%), neurocognitive (31.6% vs 9%) complications and liver nodules (39% vs 18%). Patients with EH-CPSS were more likely to have several symptoms than patients with IH-CPSS. Closure: 38.5% of IH-CPSS closed spontaneously vs 3% of EH-CPSS. When persistent, IH-CPSS were mostly treated using embolization and EH-CPSS using surgery with about 40% preventive closure. 8 patients had liver transplantation.
Conclusion
Prenatal diagnosis shows higher prevalence of IH-CPSS. Frequent spontaneous closure of IH-CPSS explains the equal frequency of both forms on post-natally diagnosed group. CPSS should be sought in infants with hypoglycemia or cholestasis and in children and adults with liver nodules, cardiopulmonary symptoms or neurocognitive deficits. IRCPSS will be helpful for further studies.
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[session]
[presentation]
[presenter]
SS 11.3 - Comparison between transient elastography and liver surface nodularity for the detection of clinically significant portal hypertension
Presentation Number
SS 11.3
Channel
On-demand channel 4
Purpose
To compare the performance of liver surface nodularity (LSN), liver stiffness (LS) measured by transient elastography (TE) and derive a score for the detection of clinically significant portal hypertension (CSPH) in patients with HCC developed on cirrhosis.
Material and methods
Patients with HCC developed on cirrhosis who underwent CT, LS and hepatic venous pressure gradient (HVPG) measurements within 30 days between 2015 and 2018 were included. Accuracy of LSN, LS, and LS-spleen-size-to-platelet ratio score (LSPS) for predicting CSPH was evaluated with the area under ROC curve (AUROC).
Results
A total of 140 patients underwent both tests (109 men [78%], mean 63±9 yo), including 39 (28%) with CSPH. LSN was valid in 130 patients (93%) and correlated with HVPG (r=0.68; P<.001). Patients with CSPH had a higher LSN than those without (3.1±0.4 vs. 2.5±0.3, p<0.001; AUROC: 0.87±0.31). LS measurement was valid in 132 patients (94%) and correlated with HVPG (r=0.75, P<.001; AUROC 0.87±0.04). In patients with both valid tests (n=122), there was no significant difference in terms of diagnostic performance between LSN, LS and LSPS (DeLong, P=.28 to .65). A two-step algorithm combining LSN and LSPS resulted in 108/140 patients (77%) correctly classified with 8% error.
Conclusion
LSN score showed similar diagnostic performance and feasibility as LS for detecting CSPH. Combination of LSN and LSPS may improve non-invasive patient classification.
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[session]
[presentation]
[presenter]
SS 11.5 - Head-to-head comparison of liver stiffness measurement using transient elastography, 2D-shear wave elastography and MR elastography for non-invasive evaluation of clinically significant portal hypertension
Presentation Number
SS 11.5
Channel
On-demand channel 4
Purpose
To compare technical success rate and diagnostic performance of transient elastography (TE), 2D-shear wave elastography (2D-SWE) and MR elastography (MRE) for the detection of clinically significant portal hypertension (CSPH) in patients with compensated cirrhosis.
Material and methods
A monocentric prospective study was conducted including patients with biopsy-proven cirrhosis, without history of liver decompensation, undergoing TE, 2D-SWE, MRE and hepatic venous portal gradient (HVPG) measurements within <30 days. Technical success rate was defined for TE according to European Association for the Study of the Liver (EASL) guidelines; for 2D-SWE as homogenous color with stability for ≥3 seconds in the region of interest, and for MRE as any value obtained. Ability of estimating HVPG and identifying patients with CSPH was compared between TE, 2D-SWE and MRE using area under ROC curve (AUROCs).
Results
We included 44 patients (32 men; median 58 yr; 26 (59%) with CSPH). Technical success rate was higher with MRE (100%), than with TE (89%; p=0.024) or 2D-SWE (93%; p=0.075). HVPG correlated with TE (r=0.692; p<0.0001), 2D-SWE (r=0.623; p<0.0001), and MRE parameters [storage modulus (Gd), r=0.522, p=0.001; loss modulus (Gl) r=0.540, p=0.0007; shear modulus (Gabs) r=0.529, p=0.0009)]. Patients with CSPH had higher liver stiffness by TE (32 vs. 17kPa; p=0.01), 2D-SWE (20 vs. 14kPa; p=0.008) or MRE (Gd 5.9 vs. 3.8kPa, p=0.01; Gl 3.2 vs.1.9kPa, p=0.005; Gabs 7.0 vs. 4.5kPa; p=0.008) than patients without. AUROCs ranged from 0.87 to 0.81 and did not significantly differ between the three methods.
Conclusion
In patients without any history of cirrhosis decompensation, liver TE, 2D-SWE and MRE correlated well with HVPG and had similar performance for detecting CSPH.
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[session]
[presentation]
[presenter]
SS 11.7 - The role of gadoxetic acid-enhanced MRI in predicting post-hepatectomy liver failure after major hepatic resection for colorectal cancer metastasis after chemotherapy and diagnosing chemotherapeutic-associated liver injuries
Presentation Number
SS 11.7
Channel
On-demand channel 4
Purpose
To investigate whether preoperative gadoxetic acid-enhanced MRI predicts post-hepatectomy liver failure (PHLF) after major hepatic resection (MHR) for colorectal cancer (CRC) metastasis after chemotherapy and diagnosing chemotherapeutic-associated liver injuries.
Material and methods
48 patients with CRC metastasis underwent gadoxetic acid-enhanced MRI after chemotherapy and after MHR. The signal intensity of liver parenchyma was measured using regions of interest at four segments on pre-contrast T1w imaging (SIpre) and on hepatocyte phase 20 minutes after gadoxetic acid infusion (SIhp); the mean value was calculated at each phase. The relative liver enhancement (RLE) was calculated with the formula: (SIhp - SIpre)/SIpre.
Results
There was a significant correlation between aspartate aminotransferase (AST) (p<0.00001), alanine aminotransferase (ALT) (p<0.00001), indocyanine green retention test (p=0.0005), number of chemotherapy cycles (p=0.001) and RLE. 17 patients (35.42%) experienced PHLF. A significant difference of RLE in the two groups (p=0.002) was found, with a cut-off value of 0.81 (sensitivity: 64.7 %, specificity: 32.2%). 2 patients (4.17%) had certain diagnosis of nonalcoholic steatohepatitis (NASH), 15 (31.25%) uncertain and 24 (50%) had no NASH. 7 patients' data were not available. No significant difference of RLE was found between groups with and without diagnosis of NASH. Sinusoidal dilatation grade 1 was present in 13 (27.08%) patients, grade 2 in 22 (45.83%) and grade 3 in 11 (22.92%). 1 patient (2.08%) had no sinusoidal dilatation. 1 patient's data were not available. No significant correlation was found between sinusoidal dilatation grade and RLE.
Conclusion
Preoperative gadoxetic acid-enhanced MR can predict PHLF after MHR, but cannot diagnose chemotherapeutic-associated liver injuries.
SS 11.8 - The value of MRI-defined sarcopenia in predicting hepatic decompensation and mortality in patients with chronic liver disease
Presentation Number
SS 11.8
Channel
On-demand channel 4
Purpose
To explore whether sarcopenia, diagnosed by an abbreviated MRI protocol is a risk factor for hepatic decompensation and mortality in patients with chronic liver disease (CLD).
Material and methods
In this retrospective single-centre study, we included 265 patients (164 men, mean age 54 ±16 years) with CLD who had undergone MRI of the liver between 2010 and 2015. Transverse psoas muscle thickness (TPMT) was measured on unenhanced and contrast-enhanced T1-weighted and T2-weighted axial images. Sarcopenia was defined by height-adjusted and gender-specific cut-offs in women as TPMT <8mm/m and in men as TPMT <12mm/m, respectively. Patients were further stratified into three prognostic stages according to the absence of advanced fibrosis (FIB-4<1.45, non-advanced CLD), compensated-advanced CLD (cACLD); and decompensated-advanced CLD (dACLD).
Results
The inter-observer agreement for the TPMT measurements (κ=0.98; 95% confidence-interval [CI]: 0.96-0.98), as well as the intra-observer agreement between the three image sequences (κ=0.99; 95%CI: 0.99-1.00) were excellent. Sarcopenia was not predictive of further hepatic decompensation. In patients with cACLD and dACLD, sarcopenia was a risk factor for mortality (cACLD: hazard ratio (HR): 3.13, 95%CI: 1.33-7.06; dACLD: HR: 2.34, 95%CI: 1.29-4.26) on univariate analysis. After adjusting for sex, Child-Turcotte-Pugh score, serum creatinine, and sodium levels, sarcopenia (adjusted HR: 2.66, 95% CI: 1.05-6.75) remained an independent risk factor for mortality in patients with cACLD.
Conclusion
Sarcopenia can be easily evaluated by a short MRI exam without the need for contrast injection. Sarcopenia is a risk factor for mortality, especially in patients with cACLD.
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[session]
[presentation]
[presenter]
SS 11.9 - Diagnostic performance of contrast-enhanced CT for the diagnosis of porto-sinusoidal vascular disease: a case-control study
Presentation Number
SS 11.9
Channel
On-demand channel 4
Purpose
To identify features at CT that can be used to raise suspicion of porto-sinusoidal vascular disease (PSVD) in patients with signs of portal hypertension.
Material and methods
This retrospective monocentric study included patients with PSVD who underwent a liver biopsy between 2011 and 2018 and performed CT within a year from biopsy. Each patient with PSVD was matched on severity of ascites with two patients with histologically proven cirrhosis. CT images were reviewed by two independent radiologists, not aware of the liver disease, and classified according to pre-specified criteria.
Results
52 patients with PSVD [23 women; 60 years (43-68)] and 104 patients with cirrhosis [23 women; 62 years (52-68)] were included. Patients with PSVD had more significantly frequent abnormalities of intrahepatic and/or extrahepatic portal vein, mesenteric and/or splenic vein thrombosis, inter-hepatic vein collaterals, hepatic veins near the capsulae and had larger spleen. Patients with PSVD had less frequently an association of atrophy of segment IV with hypertrophy of segment I, a nodular liver surface and fibrous bands. Using binary logistic regression, imaging features associated with PSVD were the absence of combined atrophy of segment IV-hypertrophy of segment I, and absence of nodular liver surface (OR=4.7 (IC95% 1.8-12.3) p=0.002 for both). Sensitivity and specificity of the association of these two criteria for the diagnosis of PSVD was 67% and 84%, respectively.
Conclusion
In patients with signs of portal hypertension, absence of combined atrophy of segment IV with hypertrophy of segment I and absence of nodular surface of the liver should raise suspicion of PSVD.
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[session]
[presentation]
[presenter]
SS 11.10 - Chronic diffuse liver disease multiparametric US imaging: attenuation imaging and dispersion imaging role in the quantitative evaluation of steatosis and viscosity
Presentation Number
SS 11.10
Channel
On-demand channel 4
Purpose
The aim of the study was to analyze the diagnostic value of liver US attenuation imaging (ATI) and dispersion imaging in the quantitative evaluation of steatosis and viscosity in cases of diffuse chronic diseases.
Material and methods
During the prospective study from April 2019 till September 2019, 47 patients with confirmed diffuse liver disease by various etiologies: virus hepatitis B (n=3) and hepatitis C (n=13), autoimmune hepatitis (n=4), steatohepatosis (n=13) and alcohol-related cirrhosis (n=5) were examined with Canon Aplio i800 ultrasound equipment, 50 healthy patients were taken as control cohort. Multiparametric evaluation by US was performed: US elastography for fibrosis, ATI for steatosis and dispersion imaging for viscosity.
Results
There was statistically significant difference among etiology groups and ATI (p=0.035) with predominantly high-attenuation intensity range >0.5-0.9 dB/cm/MHz and median value in steatohepatosis and relatively higher in VHC group up to 0.7. ATI median values had moderate correlation with steatosis qualitative assessment on B mode image (normal or hyperechogenic liver structure) (rs=0.5; p=0.0001). There was no statistically significant difference in viscosity (dispersion) values among etiology groups. Dispersion data revealed alterations in liver tissue viscosity with moderate linear correlation to fibrosis stage (rp=0.40; p=0.005) with higher value tendency towards higher fibrosis stage, but no correlation to steatosis findings (p=0.051).
Conclusion
Multiparametric ultrasound of chronic liver disease can provide added value with reliable quantitative measurements in steatohepatosis using ATI. Dispersion imaging has no defined thresholds for liver viscosity alterations among various etiologies, but shows correlation to fibrosis grade.
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