Plenary Session l : Hepatic Vein Arrival Times Using a Microbubble Contrast Ultrasonography can Predict Disease Severity Non-invasively in Patients with Alcoholic Liver Disease

Background: A reliable non-invasive assessment of the severity is essential in the management of chronic liver disease. The hepatic vein arrival time (HVAT) as assessed by microbubble contrast-enhanced ultrasonography (CEUS) has been known to show good correlation with histological grade in HCV related liver disease. However, little has been known about the relationship with alcoholic liver disease. We investigated the utility of HVAT in prediction of histological grade of alcohol related chronic liver disease. Methods: One-hundred twenty seven patients with biopsy proven alcohol related chronic liver disease were studied prospectively. Histological grades were estimated by METAVIR fibrosis scoring system (F0-F4). After an overnight fast, a bolus of contrast agent (SonoVue) was injected into an antecubital vein and signals were recorded from the right or middle hepatic veins for analysis. HVATs were calculated as the time from injection to a sustained rise in Doppler signal 10% above baseline. Results: Mean HVAT from F0 to F4 cirrhosis showed a significant progressive shortening of 26.1±5.5 (F0, 7), 20.3±1.4 (F1, 9), 17.4±0.6 (F2, 12), 15.1±1.4 (F3, 34) and 12.7±1.8 (F4, 65) seconds, respectively (P<0.001). The area under the receiver operating characteristic curve (AUROC) was 0.924 for F4 cirrhosis and the sensitivity, specificity for F4 cirrhosis for an HVAT cutoff value of 14.8 sec were 87.7%, 82.3%, respectively. In addition, HVAT also showed significant correlation with Child- Pugh`s score (P<0.001, r2=0.406), the presence of large esophageal varices (P=0.002), ascites (P<0.001) and the history of esophageal variceal hemorrhage (P=0.036). Conclusions: HVAT using a microbubble CEUS could be effective noninvasive method in assessment of the histological severity and disease severity in alcohol related chronic liver disease.