Hiroki Utsunomiya

Recent trends of Japanese hepatocellular carcinoma due to HCV in aging society.

BACKGROUND/AIMS The mean age of hepatocellular carcinoma (HCC) patients has increased (=65 years old). We want to identify the recent trend of the clinical features of HCC patients due to hepatitis C virus (HCV) (HCV-HCC). METHODOLOGY From 2000 to 2009, 855 naive HCC patients were admitted. HCV-HCC patients were divided into two groups, first period group (2000-04, n=270) and second period group (2005-09, n=343) and the clinical features of HCV-HCC were investigated. RESULTS There was no difference in gender, TNM stage and percentages of HCV-HCC between the periods. On the other hand, the ratio of HCV-HCC patients with worse liver function (Child-Pugh B or C), elderly (=75 years old) and the population of patients treated with low invasive radiofrequency ablation were increased (30.0% to 42.0%, 17.2% to 35.8% and 25.1% to 36.2%, respectively; p<0.01). The 1y-, 3y- and 5y-survival rate of HCV-HCC did not show differences (82.1%, 60.5% and 44.7% vs. 81.8%, 56.9% and 37.7%, respectively; p=0.219). CONCLUSIONS The ratio of aged HCV-HCC as well as HCV-HCC patients with worse liver function was increased. The less invasive treatment for HCC in these patients and the quick anti-viral treatment for HCV patients should be considered to avoid occurrence of HCC in Japan.

Mo1144 Efficacy of Diagnosis for Acute Cholecystitis With Contrast Enhanced Ultrasonography: Evaluation for Blood Flow of the Gall Bladder Wall

Aim/background: In early phase of acute cholecystitis (AC), ultrasonography (US) or enhanced computed tomography (CECT) sometimes do not show the typical findings. Therefore, its diagnosis is difficult in many patients. We evaluated the efficacy for diagnosis of AC with contrast enhanced US (CEUS). Methods: Subjects were 21 patients who were suspected for AC and 13 controls. B-mode US, CECT, and CEUS were performed in all of them. The symptoms of 21 patients, who were suspected for AC, were any one of upper abdominal pain and/or an attack of fever with elevation of the levels of white blood cell and/or C-reactive protein. B-mode US and CECT were reviewed for distension of GB, GB wall thickness, existence of debris in GB, pericholecystic fluid, subserosal edema, pericholecystic stranding. For diagnosis of AC by B-mode US, more than two findings of the three typical findings (distension of GB, GB wall thickness, existence of debris in GB) were necessary and distension of GB was an indispensable finding. Definitive diagnosis of AC was done by histopathological examination, the result of culture of bile juice from GB, and/or the typical finding of CECT including pericholecystic stranding. CEUS was performed with Perfulbutane (Sonazoid®). Movie video was recorded during the procedure and analysis was done with Receiver Operating Characteristic (ROC), that was focused on the GB wall in arterial phase of CEUS (20-60 seconds after injection of Sonazoid®). The results of analysis for ROC and clinical results were evaluated. Results: Nineteen of 21 patients, who were suspected for AC, were diagnosed as AC. Time intensity curve (TIC) was higher and acceleration time (ACT) was shorter in patients with AC than those without AC (4.50±2.31 vs. 2.34±1.26, P<0.01, and 8.2±2.4 vs. 15.8±7.1 seconds, P<0.01, respectively). These findings indicated the increase of the blood flow and the acceleration of the flow speed, respectively. Cut off values of TIC and ACT for diagnosis in ROC analysis were settled as >1.34, and as <15.8 respectively. With the cut off values of both TIC and ACT, seventeen patients were diagnosed as AC (17/19, 89.5%). Diagnostic value for AC with CEUS using above cut off values was equal to that of CECT (sensitivity and specificity: 89.5% and 100% vs. 73.7% and 100%, respectively). On the other hand, diagnostic value for AC of B-mode was worse (sensitivity and specificity: 21.1% and 100%). In five cases that could not be diagnosed by CECT, CEUS could diagnose them as AC. Conclusion: TIC was high and ACT was shortened in patients with AC. CEUS enabled the accurate diagnosis of AC in majority of patients whose findings of CECT or B-mode US were not typical with AC. CEUS was useful for the diagnosis of AC by analyzing TIC and ACT.