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INTRODUCTION

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 & ,

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INTRODUCTION

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  1. 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, Italy • £Pathology Department, Guglielmo da Saliceto Hospital, Piacenza, Italy

  2. INTRODUCTION • Non-alcoholic fatty liver disease (NAFLD) is a clinico-pathologic spectrum that ranges from simple steatosis to non-alcoholic steatohepatitis (NASH)[1]. • It’s 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 Isn’t 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

  3. 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.

  4. 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)

  5. MATERIALS Clinical data: hepatomegaly Biochemical data: SGOT, SGPT, cholesterol, triglycerides, TSH

  6. MATERIALS • conventional 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)).

  7. 7

  8. Hepatic Vein Portal Vein Hepatic artery Splenic artery 8

  9. arterial phase portal phase late phase

  10. 10

  11. METHODS • Liver 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 (p<0.05 if Z>1.96)

  12. RESULTS: data • Hystologic diagnosis: • 57 non pathological • normal: 12 • steatosis: 45 • (30 initial, 15 overt steatosis) • 18 pathological • 12 initial steatohepatitis • 6 overt hepatitis 12

  13. RESULTS: data 13

  14. RESULTS: statistical analysis

  15. RESULTS: auc ROC 15

  16. 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

  17. Grazie dell’attenzione!!! e.baldini@ausl.pc.it

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