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Objective: This study assessed the clinical usefulness of shear wave elastography (SWE) during ultrasound for differentiating between focal nodular hyperplasias (FNHs) and hepatocellular adenomas (HAs).Materials and Methods: SWE was performed on 56 patients presenting with 76 liver lesions (57 FNHs and 19HAs) that were confirmed by MRI and contrast-enhanced ultrasound (CEUS) (n=55) or by histology (n=21). A mean elasticity value was obtained for each lesion. The ratios of the elasticity of the lesions to the elasticity of the surrounding liver were determined. The optimal elasticity cut-off value for distinguishing between the two lesion types was determined using ROC analysis. All lesions that were classified as "undetermined" after CEUS were reclassified using the elasticity values.Results: The mean elasticity value was 46.99 ± 31.15 kPa for FNHs and 12.08 ± 10.68 kPa for HAs (p<0.0001). The mean relative elasticity ratio values were 7.94 ± 6.43 and 1.91 ± 1.70, respectively (p<0.0001). The ROC analysis showed a maximal accuracy of 95% for identification with a cut-off of 18.8 kPa for lesion elasticity (accuracy of 96% with a cut-off of 1.98 for the relative elasticity ratio). A total of 68 CEUS were performed, and 17 lesions (25%) were classified as "undetermined" after CEUS. With these cut-off values 16 lesions (94.1%) were correctly reclassified as FNHs.Conclusion: SWE is a useful adjunctive tool for differentiation between FNH and HA during ultrasound examination. [ABSTRACT FROM AUTHOR]

Background The aim of this retrospective study was to evaluate the prognostic value of different scores (including Child–Pugh and Model for End Stage Liver Diseases) in cirrhotic patients treated with transjugular intrahepatic porto-systemic shunt for refractory ascites. Methods Overall, 111 patients with transjugular intrahepatic porto-systemic shunt insertion between January 1998 and July 2012 were included. Results Survival rates (without transplantation) were 82.0% at 3 months, and 59.4% at 1 year. In addition to standard parameters, a new simple classification based on platelet count and glomerular filtration rate showed strong prognostic ability and could distinguish 3 groups of patients (Log-rank test, p < 0.001): a “good-prognosis” group with platelet counts above 125 × 10 9 L −1 and a glomerular filtration rate above 90 mL/min (1-year survival rate 92%), a “poor-prognosis” group with platelet counts below 125 × 10 9 L −1 and a glomerular filtration rate below 90 mL/min (1-year survival rate 34.8%), and an “intermediate-prognosis” group (1-year survival rate 58.2%). Multivariate analysis showed a hazard ratio of 6.34 for the intermediate class and of 12.623 for the high class. Conclusions A new and simple classification including platelet count and glomerular filtration rate is highly predictive of survival in patients with refractory ascites treated with transjugular intrahepatic porto-systemic shunt and could be used to select patients for this procedure. [ABSTRACT FROM AUTHOR]

Abstract: We studied correlation and agreement between perfusion parameters derived from contrast-enhanced ultrasonography (CEUS) and computed tomography (CT). Both techniques were performed in 16 patients with proven liver metastases from endocrine tumor. Replenishment study after ultrasound-induced destruction of microbubbles was used for CEUS quantification. CEUS-derived relative values of blood flow, blood volume and mean transit time were compared with perfusion CT–derived parameters measured in the same tumors. Significant correlation was observed between CEUS normalized values and CT absolute tumor values for blood flow (r = 0.58; p = 0.018), blood volume (r = 0.61; p = 0.012) and mean transit time (r = 0.52; p = 0.037). Correlation was not significant for non-normalized values. Agreement between CEUS normalized values and perfusion CT relative values was significant (p < 0.04). Estimated bias between CEUS and CT for relative perfusion values was −1.38 (−5.02; 2.27) for blood flow, +0.26 (−0.79; 1.31) for blood volume and +0.21 (−0.46; 0.87) for mean transit time. We conclude that normalization markedly increased correlation between CEUS- and CT-derived perfusion values and allowed agreement assessment. [Copyright &y& Elsevier]