2004

Elevated serum AFP more than 100 ng/ml in chronic hepatitis Bpatients without HCC: Follow-up 5–12 MHz SonoCT findings ofhepatic parenchymaCha SH, Chung HH, Lee KY, Lee SH, Seo BK, Kim T-K, Je B-K,Kim BH, Ansan Hospital Korea University, Korea

Objectives: To evaluate follow-up 5–12 MHz SonoCT findings ofhepatic parenchyma with elevated serum alphofetoprotein (AFP) morethan 100ng/ml (EAFP100) in chronic hepatitis B (CHB) patients with-out hepatocellular carcinoma (HCC).Methods: Total 23 CHB patients with EAFP100 were included in thestudy. Interval between the initial and the last 5–12 MHz SonoCTexamination was ranged from 9 to 44 (average 23.5) months andEAFP100 was revealed 1 to 4 times (average 1.7/total 9.7 times) duringthat period. No HCC was detected at more than six months radiologicaland/or clinical follow-up after the last 5–12 MHz SonoCT examination.Two radiologists analyzed changes of 5–12 MHz SonoCT findings ofhepatic parenchyma in consensus and statistical analysis was done.Results: Among 23 cases, 14 (61%) revealed changed and nine (39%)revealed unchanged 5–12MHz SonoCT finding. In changed group,eight (57%) showed normal-looking echo of liver initially but heter-ogenous echo, or multiple, small hypoechoic or hyperechoic nodules onthe last examination. In unchanged group six (66%) showed diffusehypoechoic-honeycomb echo on initial and last examination. Averagefollow up period of changed and unchanged group with 5–12 MHzSonoCT was 22. 4 and 20.2 months, respectively, and statisticallyinsignificant (p � 0.924). Average serum AFP titer of changed andunchanged group was 83.52 and 39.8 ng/ml, respectively, but statisti-cally insignificant (p � 0.052).Conclusions: Follow-up 5–12 MHz SonoCT can help to evaluatehepatic parenchyma with EAFP100 in CHB patients without HCC.

2005

Relation between indexes of spleen and G/S staging in chronicviral hepatitisMiao L, Wang J, Ge H, Peking University Third Hospital, China

Objectives: To discuss the relation between indexes of spleen and G/Sstaging in chronic viral hepatitis.Methods: According to the pathology of needle biopsy, the liverfibrosis status was graded as S0 � S4, and the inflammatory reaction inthe liver was graded as Gl � G4. The discrepancy of spleen indexeswas compared between the case group and the control group andamong G/S stagings.Results: The size of spleen, the inside diameter of splenic artery andvein, the blood flow of spleen were increased as the G/S staging andbecame higher as the patient’s condition became graver. These indexeswere higher in case group than those in the control group. The corre-lation coefficients between SPT and D1SPV, Vs2SPV, SPFV, D2SPV,VsSPA were 0.510, 0.510, 0.447, 0.353, 0.353, respectively.Conclusions: The size of spleen, the inside diameters of splenic arteryand vein, hemodynamic indexes of spleen are helpful to estimate thepatient’s disease.

2006

Relation between pathological changes of gallbladder and G/Sstaging in chronic viral hepatitisWang J, Miao L, Ge H, Peking University Third Hospital, China

Objectives: To discuss the relation between pathological changes ofgallbladder (GB) and G/S staging in chronic viral hepatitis.Methods: According to the pathology of needle biopsy, the status ofhepatic fibrosis was graded as S0 � S4, and the inflammatory reaction

in the liver was graded as Gl � G4. The discrepancy of GB indexeswere compared between the case group and the control group andamong G/S stagings.Results: The size of GB and the thickness of the GB wall in the casegroup were larger and more thick than those in control group. So didthe smooth rate of GB wall. Eight bilateral gallbladders were alloccurred in case group. GB became larger as the G/S staging becamehigher, so did the smooth rate of GB wall and bilateral gallbladder. Thevalue of GB indexes became higher as the patient’s condition becamegraver according to the inflammatory activity of the liver, so did thesmooth rate of GB wall.Conclusions: Pathological changes of GB in chronic virus hepatitiswere related with G/S stagings, the course of disease and the severityof chronic virus hepatitis. A serial observation was made to patholog-ical changes of GB in chronic virus hepatitis which can help doctors tojudge patient’s condition and provide the information for diagnosis andtherapy.

2008

Weakness of visual grading in the diagnosis of fatty liver onultrasound: Result from comparison with quantitativemeasurementLee CH, Choi JW, Kim KA, Park CM, Guro Hospital, KoreaUniversity, Korea

Objectives: To evaluate the weakness of visual grading for fatty liver(FL) through the comparison with hepatorenal echogenicity ratio(HER).Methods: The ultrasound was applied to 281 patients. The echogenic-ity of the liver was measured in three ROI close to the adjacent rightkidney. Similar measurements were performed in the right renal cortex.The HER (mean liver/kidney echogenicity) was then calculated. Thedegree of hepatic echogenicity were classified into normal, mild, mod-erate, and severe using the reference figure on PACS. The statisticalanalysis for multiple comparison of the average HER of the four groupswas carried out using a one-way ANOVA.Results: Among the 281 patients, there were 60 normal (mean HER:1.33), 81 mild FL (mean 1.45), 86 moderate FL (mean 2.03) and 54severe FL (mean 2.46). The HER of the normal and mild FL had nosignificant difference (p � 0.05), but there were significant differences(p � 0.01) between the mild FL and moderate FL, and the moderate FLand severe FL.Conclusions: The weakness of visual grading in the diagnosis of FL onultrasound was differentiation of the mild FL from the normal. There-fore, we proposed that the HER be added as a quantitative value for thedetermination of the brightness of FL, especially in mild FL.

YOUNG INVESTIGATOR AWARD PRESENTATION (I)

2009

Detection of hepatocellular carcinoma capsule by contrast-enhanced ultrasound using LevovistBhattacharjee P, Saito A, Chiba M, Katagiri S, Katsuragawa H,Takasaki K, Tokyo Women’s Medical University, Japan

Objectives: To investigate the diagnostic potential of contrast-en-hanced ultrasound (CEUS) in the detection of hepatocellular carcinoma(HCC) capsule.Methods: Thirty-six HCC nodules (mean diameter; 2.3 cm) from 36patients who had undergone hepatectomy were examined by CEUSusing Levovist with agent detection imaging. We classified the appear-ance of the tumor artery, tumor enhancement and washout into severalpatterns on CEUS. The ultrasound findings and pathological findings

Abstracts P85

from operated specimens were compared to assess the ability of CEUSto detect HCC capsules.Results: During the arterial phase, 80.0% nodules of encapsulatedHCC and 14.3% nodules of non-encapsulated HCC showed a surround-ing artery with branches pattern (p � 0.0001). A branching artery wasfound in 71.4% nonencapsulated HCC nodules but in only 20.0%encapsulated HCC nodules (p � 0.01). The sensitivity, specificity andaccuracy of surrounding artery with branches for the detection of theHCC capsule were 80%, 86% and 83%, respectively and branchingartery for the detection of capsular absence were 71%, 80% and 75%,respectively. The pattern of enhancement or washout did not correlatewith the presence of a capsule.Conclusions: CEUS enables the easy and reliable detection of HCCcapsules and, therefore, helpful in deciding the appropriate method oftreatment for HCC.

2010

T1 rectal cancer on preoperative endoluminal ultrasonography:Long-term follow-up results after surgical resectionKim MJ, Song SY, Lee SJ, Lim HK, Lee EJ, Chun HK, Lee WJ, KimSH, Choi D, Lee JM, Samsung Medical Center, Korea

Objectives: To evaluate the long-term follow-up results of T1 rectalcancer on preoperative EUS treated with surgical resection.Methods: During a recent five years, 38 patients were diagnosed as T1rectal cancer on preoperative EUS. Thirty-four patients underwenttransanal endoscopic microsurgery and four patients were performedlow anterior resection. The therapeutic result was evaluated with fol-low-up contrast-enhanced CT. All patients were followed up every 6months to 1 year with CT (mean, 29.6 months). We correlated EUSstaging with postoperative pathological staging. The rates of local anddistant recurrence, and disease-free and cumulative survival rates wereanalyzed.Results: The positive predictive value of preoperative EUS was 92%(35/38). Three (8%) of 38 patients were underestimated to T1 onpreoperative EUS, which were T2 at postoperative pathology. Themean size of the tumor was 2.1 cm. There was no local recurrence andtwo patients (5%) showed distant metastasis. The 1-, 3- and 5-yearcancer-free survival rates were 97%, 97%,and 78%, respectively. Noone was dead of rectal cancer during follow-up periods.Conclusions: EUS was a valuable modality for preoperative staging ofT1 rectal cancer, and rectal cancer as T1 stage on preoperative EUSmight expect excellent results after surgical resection.

2011

Assessment of cystic renal masses based on Bosniakclassification: Comparison of CT and contrast-enhanced USPark BK, Kim B, Kim C, Ko K, Samsung Medical Center,Sungkyunkwan University School of Medicine, Korea; Mayo Clinic,Minnesota, United States of America

Objectives: To compare imaging features of computed tomography(CT) and contrast-enhanced US (CEUS) imaging in the assessment ofcystic renal masses using Bosniak classification.Methods: CT and CEUS images of 72 cystic renal masses in 71patients were retrospectively analyzed for septa number, wall and/orsepta thickness and degree of enhancement by two radiologists inconsensus on the basis of Bosniak classification. In 25 pathologically-confirmed lesions, diagnostic accuracy for malignancy were comparedbetween CT and CEUS.Results: CEUS and CT images showed same Bosniak classification in54 (75%) lesions and there were differences in 18 (25%) lesions. CEUSimages depicted more septa in 23 (32%) lesions, more thickened walland/or septa in 16 (22%) lesions and stronger enhancement in 24 (33%)

lesions. CEUS upgraded Bosniak classifications in eight lesions from IIto IIF (n � 7) or III (n �1), six from IIF to III (n � 4) or IV (n � 2),and two from III to IV. Diagnostic accuracy of CT and CEUS imagesfor malignancy was 84% and 88%, respectively but there was nostatistical difference.Conclusions: CEUS imaging mostly revealed similar Bosniak classi-fication to CT but in some lesions demonstrated additional septa,thickness of wall and/or septa, and enhancement, resulting in upgradeof Bosniak classification.

2013

Radiofrequency ablation with epinephrine injection: In Vivostudy in a pig liver modelKim HJ, Lee DH, Lim JW, Ko YT, Kyunghee University Hospital,Korea

Objectives: To determine whether epinephrine injection prior to ra-diofrequency (RF) ablation can increase the extent of thermally medi-ated coagulation in in-vivo pig liver tissue.Methods: Eighteen RF ablation zones were created in six pigs withusing a 17-gauge internally cooled electrode under ultrasound guid-ance. Three RF ablation zones were created in each pig under threeconditions: RF ablation alone, RF ablation after the injection of 3 mLof normal saline and RF ablation after the injection of 3 mL ofepinephrine (1:10,000 solution). After RF ablation, the short-axis andlong-axis diameters of the white zones in the gross specimens werecompared.Results: Three RF ablations were technically unsuccessful. So, com-parison was finally possible in 15 RF ablation zones. The mean short-axis and long-axis diameters of white zone of RF ablation after epi-nephrine injection (17.2 mm � 1.8, 20.8 mm � 3.7) were larger thanRF ablation only (10 mm � 1.2, 12.2 mm � 1.1) and RF ablation afternormal saline injection (12.8 mm � 1.5, 15.6 mm � 2.5) (p � .05).Conclusions: RF ablation with epinephrine injection can increase thediameter of the RF ablation zone of the liver and so it may be useful fortreating larger lesions.

2014

Characterization of small focal liver lesions using real-timecontrast-enhanced sonographyXu H-X, Lu M-D, Liu G-J, Xie X-Y, Department of MedicalUltrasonics, The First Affiliated Hospital, Sun Yat-Sen University,China; Department of Hepatobiliary Surgery, The First AffiliatedHospital, Sun Yat-Sen University, China

Objectives: To assess the diagnostic performance of real-time contrast-enhanced sonography in characterization of small focal liver lesions incomparison with baseline sonography.Methods: Two hundred small focal liver lesions (�3.0 cm in diameter)in 200 patients were examined by real-time contrast-enhanced sono-graphic mode of contrast pulse sequencing with a sulphur hexafluoride-filled microbubble contrast agent. Two independent investigators re-viewed the sonographic images before and after contrast agent admin-istration.Results: ROC analysis revealed significant improvement in differenti-ating between malignant and benign small focal liver lesions that theareas under the ROC curve [Az] were 0.856 and 0.857 at baselinesonography versus 0.954 and 0.943 at contrast-enhanced sonography (p� 0.001 and p � 0.003). The sensitivity, negative predictive value andaccuracy for both investigators also improved significantly after re-viewing contrast-enhanced sonographic images (all p � 0.001). Abetter interobserver agreement was achieved after reviewing of con-trast-enhanced sonography images (� � 0.425 at baseline sonographyversus � � 0.716 at contrast-enhanced sonography) and a better result

P86 Ultrasound in Medicine and Biology Volume 32, Number 5S, 2006