1298: Additional Application of Interferon-Apha After Complete Destruction (CD) of Hepatocellular Carcinoma (HCC): Influence on Local Tumor Progression (LTP)

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Ultrasound in Medicine and Biology

Results: There were 4 types of enhancement patterns observed in the 113 lesions on CEUS. Type I, 49 (43.4%) nodules demonstrated simultaneous enhancement with the liver parenchyma and, therefore, the nodules appeared isoechoic to the liver throughout the arterial, portal and parenchymal phases; Type II, 27 (23.9%) nodules demonstrated delayed enhancement in the portal phase and then became isoechoic to the liver in parenchymal phase; Type III, 28 (24.8%) nodules presented delayed or simultaneous enhancement with the liver and then slight wash-out causing a hypoechoic appearance in the parenchymal phase; Type IV, 9 (8.0%) nodules presented slight enhancement with hyperechoic during arterial phase and slight wash-out with hypoechoic to the liver during the parenchymal phase. The ratio of hepatocellular dysplasia were significantly higher in type III/IV enhancement patterns than in type I/II (P⬍0.05). There were no significant statistical differences in hepatocellular regeneration, degeneration, necrosis, fibrous tissue hyperplasia, inflammatory cellular infiltration between type III/IV and type I/II enhancement patterns (P⬎0.05). Conclusions: The analysis of hemodynamics and the degree of hepatocellular atypia of RNs can help to monitor the development of RNs, and CEUS is useful in the clinical practice for the study of nodular lesions in cirrhotic patients. Key Words: Ultrasonography; Contrast agent; Cirrhosis; Regenerative nodule 1295 Portal Hyperperfusion in Living Donor Liver Transplantation Yu Fan Cheng, Chang Gung Memorial Hospital, Taiwan Portal hyperperfusion in a small-size liver graft is one cause of posttransplant graft dysfunction. We retrospectively analyzed the potential risk factors predicting the development of portal hyperperfusion in 43 adult living donor liver transplantation recipients. The following were evaluated: age, body weight, native liver disease, spleen size, graft size, graft-torecipient weight ratio (GRWR), total portal flow, recipient portal venous flow per 100 g graft weight (RPVF), graft-torecipient spleen size ratio (GRSSR) and portosystemic shunting. Spleen size was directly proportional to the total portal flow (p⫽0.001) and RPVF (p⫽0.014). Graft hyperperfusion (RPVF flow ⬎250 mL/min/ 100 g graft) was seen in eight recipients. If the GRSSR was ⬍0.6, 5 of 11 cases were found to have graft hyperperfusion (p ⫽ 0.017). The presence of portosystemic shunting was significant in decreasing excessive RPVF (p ⫽ 0.059). A decrease in portal flow in the hyperperfused grafts was achieved by intraoperative splenic artery ligation or splenectomy. Spleen size is a major factor contributing to portal flow after transplant. The GRSSR is associated with posttransplant graft hyperperfusion at a ratio of ⬍0.6.

Volume 35, Number 8S, 2009 CDUS were also performed during the 1st week of postoperative days. Postoperative enhanced CT studies were performed on cases of hyperbilirubinemia Results: The MHV vein grafts reconstructed were including 15 V5s, 18 V8s and 13 of V5 ⫹V8 in one anastomosis. CDUS had detected normal outflow in 52% (24/46), poor flow velocity (⬍10cm/sec) or flat waveform in 37% (17/46) and no flow in 11% (5/46). Postoperative complications with marked ascites, pleural effusion and/or persisted hyperbilirubinemia were noted in 7 cases including 3 cases of marginal graft-recipient weight ratio (⬍1.0). CT scans was performed for complications with significant venous congestion. Conclusion: Poor outflow of the reconstructed MHV graft detected by CDUS is significant to the graft dysfunction. CDUS is the best modality for evaluation of the outflow patency during and post LDLT. 1297 Detection of Recurrent Lesions in HCC Patients Treated with Radiofrequency Ablation (RFA): A Comparison of Contrast Enhanced Ultrasonography with CT Ying Dai, Beijing Cancer Hospital & Institute, China Objective: To investigate the diagnostic value of ultrasonography combined with contrast enhanced ultrasonography (CEUS) in detection of recurrent lesions in HCC patients treated with radiofrequency ablation (RFA) compared with Compute Tomography (CT). Methods: One hundred and seventy-three patients with HCC treated with curative RFA were enrolled in this study. All patients received both CEUS with SonoVue and CT at regular intervals. Nodules with contrast enhancement during the arterial phase (hypervascular) on CEUS were diagnosed as malignant. Biopsy and pathological confirmation or enlargement during follow-up were regarded to be the reference standard. Results: Altogether 102 hypervascular nodules were detected in 50 patients. Of them, 102 nodules in 41 patients were confirmed as malignant. The other nodules were confirmed as benign including 14 regenerative nodules, 3 abnormal perfusion, 2 vascular malformation, 1 hemangioma and 1 vessel cross-section. The sensitivity, specificity and accuracy rate for CEUS in the detection of recurrent nodules were 85.2% (69/81), 38.1% (8/21) and 75.5% (77/102). The sensitivity, specificity and accuracy rate for CT were 85.2% (69/81), 80.1% (17/21) and 84.3% (86/102). There was no statistical significance between the two method (X2⫽2.473, P⫽0.116). Conclusion: CEUS was helpful to detect recurrent nodules in HCC patients treated with RFA, comparable with CT. Keywords: contrast enhanced ultrasonography; hepatocellular carcinoma, radiofrequency ablation, recurrence

1296 1298 Doppler Ultrasound of the Venous Graft (Middle Hepatic Vein) in Adult Living Donor Liver Transplantation Yu Fan Cheng, Chang Gung Memorial Hospital, Taiwan T L Huang, Kaohsiung Medical Center, Taiwan Objective: To assess the patency of the reconstructed middle hepatic vein (MHV) with cryopreserved vein graft in adult living Donor liver transplantation (LDLT) Materials and Methods: From 2006 to 2008 Mar, there were 46 adult LDLT cases included with the MHV reconstructed by cryopreserved vein grafts. The branches drained segment 5 (V5) and/or segment 8 (V8) were reconstructed by size ⬎ 5 mm. Color Doppler ultrasound (CDUS) was performed to make sure of patency immediately after reperfusion of the graft. If no flow or poor flow velocity and /or monophasic waveform was abnormal, readjust of venous flow or re-do anastomosis may be done under CDUS recheck.

Additional Application of Interferon-Apha After Complete Destruction (CD) of Hepatocellular Carcinoma (HCC): Influence on Local Tumor Progression (LTP) Jordan G Genov, Clinic of Gastroenterology, University Hospital “Queen Joanna”, Bulgaria Nikola G Grigorov, Clinic of Gastroenterology, University Hospital “Queen Joanna”, Bulgaria Rumiana G Mitova, Clinic of Gastroenterology, University Hospital “Queen Joanna”, Bulgaria Branimir S Golemanov, Clinic of Gastroenterology, University Hospital “Queen Joanna”, Bulgaria Ljudmil R Dinkov, Clinic of Gastroenterology, University Hospital “Queen Joanna”, Bulgaria Marin P Donov, Clinic of Gastroenterology, University Hospital “Queen Joanna”, Bulgaria

Abstracts Background: Interferon-alpha blocks cell cycle in HCC cultures, modulates proto-oncogen expression, induces apoptosis, activates NK-cells, inhibits neoangiogenesis and suppresses hepatoma proliferation in proportion to the applied dose. Aim: To estimate the role of Interferon-alpha in the prevention of LTP after accomplished CD of HCC. Methods: Ex-vivo hepatoma cell lines were created and proliferation was suppressed by Interferon-alpha at 72 hours of culture, thus giving rationale for local administration of the drug. 46 patients with 48 HCC (size 3.5-14.5cm) were treated with US-guided percutaneous single-session large-amount (30-138 ml) ethanol instillation (Shot-PEI) in a 7-year period. The achieved destruction was assessed using contrast-enhanced US/CT and biopsy. Interferon-alpha was injected intra- and perilesionally in 12 patients with fulfilled CD, for 1-4 months 1-3x weekly. Patients were followed-up for 6-43 months. The results were compared to a control group treated with Shot-PEI alone. LTP was retreated when feasible. Results: LTP developed in 5 cases treated with Interferon-alpha (41.7%). Time to LTP ranged 11-34 months. In 1 patient LTP occurred twice and in 1 case – thrice. In the control group LTP rate was 44.4% (n. s.), with mild difference concerning time to LTP, and similar cumulative 36-months survival. Conclusion: The success of the first ablation predetermines favourable outcome. The applied schedule of additional treatment with Interferonalpha fails to exhibit clear advantage in terms of LTP. Further studies are needed to elucidate its role in the prevention of LTP, including identification of the subgroup of patients/tumors-responders to Interferon-alpha and improvement of the dose regimen. 1299 Artificial Pleural Effusion and Ascites in Radiofrequency Ablation for Elderly Patients with Hepatocellular Carcinoma Atsushi Hiraoka, Gastroenterology, Ehime Prefectural Central Hospital, Japan Takahide Uehara, Gastroenterology, Ehime Prefectural Central Hospital, Japan Satoshi Hidaka, Gastroenterology, Ehime Prefectural Central Hospital, Japan Aki Hasebe, Gastroenterology, Ehime Prefectural Central Hospital, Japan Soichi Ichikawa, Gastroenterology, Ehime Prefectural Central Hospital, Japan Yasunao Miyamoto, Gastroenterology, Ehime Prefectural Central Hospital, Japan Tomoyuki Ninomiya, Gastroenterology, Ehime Prefectural Central Hospital, Japan Kojiro Michitaka, Gastroenterology, Ehime Prefectural Central Hospital, Japan Background/Aim: Artificial pleural effusion and/or ascites have been used in radiofrequency ablation therapy (RFA) for patients with hepatocellular carcinoma (HCC) next to lung and gastrointestinal tract. Recently, elderly patients have been increased in Japan and have been treated same manner as younger if they have good performance status (PS). We assessed the safety of artificial pleural effusion and ascites in elderly HCC, retrospectively. Methods: Eighty six patients who were treated with RFA against HCC from January 2000 to December 2008 and were divided into elderly group (⬎⫽75 years old, n⫽27) and non-elderly group, (⬍75, n⫽59), and compared their clinical data, complications and local recurrence rate were analyzed. Results: Age and the level of alpha fetoprotein (AFP) were higher in elderly group as compared to non-elderly group (79.0 ⫾ 2.6 vs. 65.3 ⫾ 7.1 years, 579.5 ⫾ 4786.6 vs. 125.0 ⫾ 411.2 mAU/ml: P⬍0.01 and P⫽0.02, respectively). There were no significant differences for ChildPugh class, tumor size, hospital days and in local recurrence rates after

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1, and 2 years between the groups (elderly group vs non-elderly group: 0% and 10.0% vs. 8.5% and 18.9%; P⫽0.575). As for complications, there was no severe complication in elderly group while 1 of hemothorax and 1 of pneumothorax were observed in non-elderly. Conclusions: Artificial pleural effusion and ascites could be used safe and in same manner as non-elderly patients in RFA procedure for elderly HCC. 1300 Hepatocellular Carcinoma Associated with Liver Abscess Ching-I Huang, Division of Hepatobiliary Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, Taiwan Liang-Yen Wang, Division of Hepatobiliary Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, Taiwan Wan-Long Chuang, Division of Hepatobiliary Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, Taiwan Background: Hepatitis B and Hepatitis C are prevalent in Taiwan. Patients with chronic hepatitis have high risk of progressing to liver cirrhosis and hepato-cellular carcinoma (HCC). However, HCC associated with liver abscess is very rare. Aim: Accordingly, we wished to analyze the characteristics of ultrasonography (US) between these patients diagnosed as liver abscess and attempt to make a differential diagnosis with HCC. Methods: From January 2005 through July 2007, we retrospectively reviewed a total of 9 patients of HCC with abscess formation at the Kaohsiung Medical University Hospital (Kaohsiung, Taiwan). Their images with ultrasonography were analyzed. Results: The imaging studies with abdominal ultrasonography show lowechoic liver tumors with irregular margin. Liver cirrhosis background was not revealed in 8 patients(8/9). HCC with central necrosis and liver abscess cannot be differential diagnosis definitely from the 2D sonography. Conclusions: Inflammatory liver changes may mimic solid neoplasms. It is difficult to make an accurate differential diagnosis clinically, especially in cases of HCC with abscess. The final diagnosis usually depends on aspiration and pathology, especially the patients with liver cirrhosis diagnosis. Keywords: hepatocellular carcinoma, liver abscess, abdominal sonography. 1301 Hepatofugal Portal Flow on Doppler Sonography in Patients with Various Hepatic Diseases Hye Jeon Hwang, Departments of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Korea Kyoung Won Kim, Departments of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Korea Eugene K Choi, Departments of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Korea Woo Kyoung Jeong, Departments of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Korea Pyo-Nyun Kim, Departments of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Korea Sun A Kim, Departments of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Korea Eun Sil Yu, Departments of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Korea Hepatofugal portal flow develops under various conditions due to the absence of valves in the portal vein. This finding can be appreciated on color and spectral Doppler sonography in patients with 1) diffuse liver diseases, 2) focal hepatic tumors, or 3) hepatic trauma or iatrogenic injury. Pathophysiologically, hepatofugal portal flow is attributed to arterioportal shunt. Nontraumatic arterioportal shunt can be classified