STEATO-HEPATITIS IN OBESE PATIENTS SUBMITTED TO BARIATRIC SURGERY (BS): UTILITY OF CONTRAST-ENHANCED US WITH TIME-INTENSITY CURVES (CEUS-TIS) FOR DIAGNOSIS: INITIAL EXPERIENCE

Francesco Giangregorio*, Edoardo Baldini&, Adriano Zangrandi, Carlo Paties, Fabio Fornari*, Patrizio Capelli&,

*Gastroenterology Department, Guglielmo da Saliceto Hospital, Piacenza, Italy&Surgery Department, Guglielmo da Saliceto Hospital, Piacenza, ItalyPathology Department, Guglielmo da Saliceto Hospital, Piacenza, Italy

INTRODUCTIONNon-alcoholic fatty liver disease (NAFLD) is a clinico-pathologic spectrum that ranges from simple steatosis to non-alcoholic steatohepatitis (NASH)[1].

Its important establishing the diagnosis of NASH, both for prognosis and for indentifying potential candidates for future treatment protocols[2]. Surgeons evaluation could not identify NASH individuals. Routine liver biopsy during bariatric operations is mandatory to differentiate NASH and nonalcoholic fatty liver disease[3, 4]. Miele L, Forgione A, Hernandez AP, Gabrieli ML, Vero V, Di RP, Greco AV, Gasbarrini G, Gasbarrini A, Grieco A: The natural history and risk factors for progression of non-alcoholic fatty liver disease and steatohepatitis. EurRevMedPharmacolSci 2005, 9(5):273-277.Vuppalanchi R, Chalasani N: Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: Selected practical issues in their evaluation and management. Hepatology 2009, 49(1):306-317.Charlton MR: Fibrosing NASH: On Being a Blind Man in a Dark Room Looking for a Black Cat (That Isnt There). Gastroenterology 2011, 140(1):25-28.Gholam PM, Flancbaum L, Machan JT, Charney DA, Kotler DP: Nonalcoholic fatty liver disease in severely obese subjects. Am J Gastroenterol 2007, 102(2):399-408

AIM

Aim of the study was to understand if clinical data, blood examination, conventional US, colordoppler examination of splanchnic vasa or contrast-enhanced US with time-intensity curves studies were able to detect differences between simple steatosis from NASH.

MATERIALS

from September 2010 to April 2012 we studied 75 morbidly obese patients (MOP), submitted to laparoscopic bariatric surgery (66 females; 9 males; mean age: 43,6 Y, range: 21-61; mean BMI 45,4 kg/m2; all HBV and HCV negative patients).We collected clinical data, blood examinations, and the day before surgery patients were submitted to: conventional US colordoppler evaluation of Portal System contrast-enhanced US with time intensity curves off-line elaborated with QONTRAST software (Bracco, Italy)

MATERIALS

Clinical data: hepatomegaly

Biochemical data: SGOT, SGPT, cholesterol, triglycerides, TSH

MATERIALSconventional US (hepatomegaly, irregular margins, steatosis, splenomegaly) colordoppler evaluation of Portal System (Portal vein diameter, mean blood flow velocity, hepatic and splenic artery resistence index) contrast-enhanced US with time intensity curves off-line elaborated with QONTRAST software (Bracco, Italy) ) (CEUS-TIS); time to peak (TTP); peak% (P%); red blood volume (RBV) and flow (RBF); mean time to transit (MTT)).

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**Portal VeinHepatic VeinHepatic arterySplenic artery

*arterial phaseportal phaselate phase

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METHODSLiver biopsy was performed during bariatric surgery. Clinical, ultrasonographic, colordoppler and CEUS-TIS data were compared to hystology; sensitivity (sens), specificity(spec), diagnostic accuracy(DA), positive predictive (PPV) and negative predictive value (NPV) were calculated; comparison among data were performed with receiver operating curves (ROC) (spss version 18); Z test was calculated to evaluate statistical significance among AUC-ROC (p1.96)

*RESULTS: dataHystologic diagnosis: 57 non pathological normal:12steatosis: 45 (30 initial, 15 overt steatosis)18 pathological 12 initial steatohepatitis 6 overt hepatitis

*RESULTS: data

RESULTS: statistical analysis

**RESULTS: auc ROC

SUMMARY

Clinical and ultrasonographic criteria are not useful for discriminating simple steatosis from steato-hepatitis in obese patients.

Only CEUS TIS may help to establishing the diagnosis of NASH in a non-invasive way

*Grazie dellattenzione!!!