Performance of a new elastographic method (ARFI technology) compared to unidimensional transient elastography in the noninvasive assessment of chronic hepatitis C. Preliminary results.

BACKGROUND AND AIMS: The current study aims to evaluate the performance of a new elastographic method (ARFI) in noninvasive fibrosis assessment and to compare it to another validated technology (transient elastography, TE). METHOD: 112 consecutive chronic hepatitis C patients (histologically proven according to the Metavir scoring system: 12.5% F0, 26.6% F1, 16.1% F2, 7.1% F3, 37.5% F4) were prospectively included in this study. They were examined on the same day, using both ARFI (with shear wave velocity--SWV-quantification) and TE (with liver stiffness quantification). RESULTS: SWV is correlated only with fibrosis (r=0.717, p less than 0.0001) and necroinflammatory activity (r=0.328, p=0.014), but not with steatosis (r=0.122, p=0.321). There is a significant increase of SWV in parallel with the increase in the fibrosis stage: 1.079+/-0.150 (F0-F1), 1.504+/-0.895 (F2), 1.520+/-0.575 (F3), 2.552+/-0.782 (F4), p<0.0001, but there is a certain degree of overlap between the consecutive stages F1-F2 (p=0.072), F2-F3 (p=0.965). SWV cut-off values (m/s) that were predictive for each fibrosis stage were: 1.19 (F more or equal to 1), 1.34 (F>or=2), 1.61 (F more or equal to 3) and 2.00 (F4). AUROC for ARFI vs TE were: 0.709 vs 0.902, p=0.006 (F>or=1), 0.851 vs 0.941, p=0.022 (F>or=2), 0.869 vs 0.926, p=0.153 (F>or=3) and 0.911 vs 0.945, p=0.331 (F4). CONCLUSIONS: ARFI allows SWV quantification, in strong correlation with the fibrosis stage. Steatosis does not influence SWV. The maximal performance of the method consists of the prediction in severe fibrosis and cirrhosis. The diagnostic accuracy is strongly comparable to TE only for the prediction of severe fibrosis and cirrhosis, whereas for earlier stages, TE performs better.

Analysis of histopathological changes that influence liver stiffness in chronic hepatitis C. Results from a cohort of 324 patients.

AIM: The current study aims to assess the role of the histological parameters in liver biopsy for explaining the variance of liver stiffness, as well as the performance of transient elastography in quantifying liver fibrosis in patients with chronic hepatitis C. METHODS: 324 consecutive CHC patients were prospectively included in this study. All of them had positive HCV-RNA in serum and had underwent percutaneous liver biopsy for grading and staging the diseases (METAVIR scoring system). All were referred to liver stiffness measurement 1 day prior to biopsy. RESULTS: Liver stiffness values were strongly correlated with fibrosis (r=0.759, p<0.0005). They also correlated with steatosis (r=0.255, p<0.0005), necroinflammatory activity (r=0.378, p<0.0005) and hepatic iron deposition (r=0.143, p=0.03). The univariate regression analysis demonstrated that fibrosis (sq.R=0.610, p<0.0005), activity (sq.R=0.145, p<0.0005) and steatosis (sq.R=0.037, p=0.002) were correlated with liver stiffness. In multiple regression analysis, all three variables independently influenced liver stiffness: fibrosis (p<0.0005), activity (p=0.039) and steatosis (p=0.025). Together they explained 62.4% of the variance of the liver stiffness. The areas under ROC curve for the diagnosis of fibrosis F > or =1, F > or =2, F > or =3, and F=4 were 0.936, 0.862, 0.910 and 0.938, for the cut-off values of 4.9 kPa, 7.4 kPa, 9.1 kPa and 11.85 kPa respectively. CONCLUSIONS: Transient elastography is a useful method for chronic hepatitis C assessment. Fibrosis is the main predictor of liver stiffness, but activity and steatosis also influence liver stiffness.

Diagnosis and treatment of extrahepatic cholangiocarcinoma: results in a series of 124 patients.

AIM: The aim of the study was to evaluate the diagnostic methods and therapeutical results in patients with extrahepatic cholangiocarcinoma admitted between 2000 and 2003 and to assess the efficacy of various imaging methods. MATERIAL AND METHOD: We included 124 consecutive patients with suspected cholangiocarcinoma who underwent endoscopic retrograde cholangiopancreatography (ERCP) between 2000 and 2003. Every patient underwent an ultrasound (US) examination before ERCP. ERCP was considered as the "gold standard" for diagnosis. The therapy applied consisted of endoscopic stenting, US guided biliary drainage or surgery. The sensitivity, specificity and accuracy were calculated for every tumour localisation and also globally for all tumours. RESULTS: The sensitivity, specificity and accuracy of US were 85.9 %, 76.9 %, and 84.4 % for hilar localization, 59.1 %, 50 % and 57.1 % for the mid bile duct (CBD) and 33.3 %, 42.8 % and 36.8 % for the distal CBD tumours. The global performances for US in diagnosing extrahepatic cholangiocarcinoma were 73.5 %, 61.5 % and 70.9 %. In 73 cases (74.5%) an endoscopic stent was placed. In 11 cases (11.2%) we performed an US guided biliary drainage and in 14 cases (14.2%) surgery was recommended. CONCLUSIONS: Ultrasonography proved to be a reliable method for the diagnosis of cholangiocarcinoma in spite of its low accuracy for distal localization. The combination of the two investigations (US and ERCP) was very efficient in the management of these patients. Endoscopic stenting for hilar localization is a good therapeutical option.

Eosinophilic ascites in a patient with toxocara canis infection. A case report.

We report the case of a young female patient, admitted for a recent ascites of unknown origin. The acute onset was with colicky abdominal pain and peritoneal effusion, which led to the suspicion of perforated ulcer. A diagnostic laparoscopy was performed which showed free peritoneal fluid and normal abdominal viscera. At upper gastro-intestinal endoscopy, performed a few days later, patchy erythema in the antral region and duodenal edema were revealed. Duodenal biopsies showed marked eosinophilic infiltration. The ascitic fluid was straw coloured, sterile with 90% eosinophils. Eosinophilic gastroenteritis was suspected, but differential diagnosis required the exclusion of migrant parasites. The stool exams were negative but serology for Toxocara antibodies was positive. The treatment with albendazole (Zentel 400 mg twice a day for 5 days) led to the disappearance of signs and symptoms. The eosinophilic infiltrate of the gut was absent in duodenal biopsies taken two months later.

Radiofrequency by open surgical approach in the treatment of hepatic tumours: early experience with 14 cases.

The aim of the study was the evaluation of radiofrequency in the treatment of hepatic tumours during laparotomy performed for hepatic tumours. The initial experience with 14 patients operated for hepatic tumours (5 primary and 9 metastatic) is presented. The paper also presents the technique concerning the intensity and duration of the power applied, the association with the surgical resection, the immediate postoperative evolution and the dynamics of the hepatic enzymes as well as the postoperative results of ultrasound and CT examinations performed within the first 6 weeks. The indications of RF during laparotomy and the place of RF ablation in the treatment of liver tumours in comparison with other ablation techniques are discussed

In situ thermal ablation of focal liver neoplasms, with a special emphasis on the intraoperative ultrasound-guided radio frequency ablation method.

In the last two decades an important number of image-guided procedures have been developed in order to treat focal liver tumors through ablation in a similar way with the surgical procedure, which is still considered as the curative method for patients with resectable hepatic tumours. Unfortunately this criteria does not apply to all patients and in those cases (nonsurgical patients), the techniques are becoming frequently used as standard independent or adjuvant therapies. Tumour ablation using thermal procedures is now considered as one of the most promising among these alternative ablation therapies. It is the goal of these techniques together with the continuous improvement in technology and increasing clinical experience, to become the treatment of choice for limited liver tumours, challenging surgical resection