2077859 Ultrasound In HCC Surveillance: What Is The Quality Of Ultrasound And What Factors Affect Quality?

s S17 Methods: From January 2011 to July 2014, 131 patients with 134 lesions diagnosed using colonoscopy prior to US and CT were enrolled. US was performed using Aplio SSA-770A/790A (Toshiba) with 375BT, 674BT, and 705BT probes. Contrast-enhanced US was performed with Sonazoid in 72 patients. CT entailed contrast-enhanced singlephase imaging at a 5-mm slice thickness. In addition to clinical evaluation according to the TNM classification (UICC 7 edition), the above-mentioned factors were confirmed histopathologicay. The concordance rate and diagnostic performance of US and CT were compared. k coefficient and McNemar test were used for statistical analysis, with significance defined at P , 0.05. Results: Of the 134 lesions, US could detect 129 lesions (96%) and CT 93 lesions (69%) (P , 0.001).The overall accuracy, Tis, T1, T2, T3, and T4 in T-stage determined using US vs. CT were 64% vs. 61%, 67% vs. 100%, 74% vs. 50%, 45% vs. 44%, 69% vs. 67%, and 42% vs. 52%, respectively. k coefficients of T-stages in US and CT were 0.45 and 0.29, respectively, indicating moderate and fair reproducibility. Positive N was detected in 48 lesions. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of US vs. CT were 60% vs. 50%, 69% vs. 79%, 66% vs. 69%, 52% vs. 57%, and 69% vs. 74%, respectively. k coefficients of US and CT were 0.28 and 0.30, respectively, both indicating fair reproducibility. Positive H was detected in 19 cases. Sensitivity, specificity, accuracy, PPV, and NPV of US vs. CT were 100% vs. 100%, 100% vs. 94%, 100% vs. 95%, 100% vs. 73%, and 100% vs. 100%, respectively. Conclusions: Tumor detectability of US was better than that of CT. Determination of T-stage was moderately coincided with US while fairly with CT. The diagnostic performance of N was satisfied in neither US nor CT, and diagnosis of hepatic metastasis was not different between the two modalities. 2077859 Ultrasound In HCC Surveillance: What Is The Quality Of Ultrasound And What Factors Affect Quality? Yuko Kono, Kartik Joshi, Katherine Richman, Mary O’Boyle Medicine, University of California, San Diego, San Diego, CA, United States; Radiology, University of California, San Diego, San Diego, CA, United States Objectives: To investigate the quality and contributing factors of ultrasound (US) in hepatocellular carcinoma (HCC) surveillance. Methods: With IRB approval, US images and medical records were retrospectively reviewed with a waiver of consent. 194 consecutive US abdomen ordered HCC surveillance at single institution in 2012 were identified, 80 were excluded (known HCC or US was done for other purposes than HCC surveillance), resulting in 114 US studies eligible for the analysis. Patient demographics and laboratory values including gender, age, ethnicity, etiology of liver disease, presence of cirrhosis, MELD score, Child-Pugh score, presence of ascites, and body mass index (BMI) were recorded. An experienced radiologist rated US quality as excellent, good, fair and poor, based on the visual clarity of the liver, penetration, and noted exam limitations. The assessment was repeated 6 months later by the same radiologist. Proportional odds regression models were used to identify factors that are univariately associated with US imaging quality, along with multivariate analysis. Intra-rater reliability was assessed using Cohen’s kappa score. P-values less than 0.05 were considered statistically significant. Results: 99 patients were cirrhotic of any etiology and 15 had hepatitis B without cirrhosis. Among the 114 US studies, 8.1% was rated as excellent, 29.3% as good, 23% as fair, and 39.6% as poor. Themain limitations were body habitus, ascites, and heterogeneous liver. There were 9 cases with liver lesions, but none were HCC. Multivariate analysis showed the negative effects of higher BMI (p,0.001), presence of ascites (p50.039) and presence of cirrhosis (p50.042) on the quality of US. The weighted Cohen’s kappa score was k50.748 for the inter-rater reliability. Conclusions: This is a small retrospective study on US quality in the United States in the setting of HCC surveillance, showing that the quality of US was inadequate in nearly 2/3 of the patients. In multivariate analysis, higher BMI, ascites and cirrhosis significantly worsened US quality. More studies are needed, on a larger scale, to assess US quality, its contributing factors and its influence on the effectiveness of HCC surveillance. 2064557 Natural History And Clinical Significance Of Isolated Biliary Sludge Diagnosed At Outpatient Sonography Paul Armstrong Hill, Robert Harris Radiology, Dartmouth Hitchcock Medical Center, West Lebanon, NH, United States Objectives: Gallbladder sludge is a not uncommon diagnosis on routine abdominal ultrasound examinations in ICU or chronically ill inpatients, yet its clinical significance in the outpatient setting is uncertain. We examined an ambulatory, oupatient population to determine its natural history and subsequent complications. Methods:We conducted a retrospective search of our Institutional clinical database for all ultrasound reports using the keywords ‘‘biliary sludge’’ and ‘‘no gallstones’’ from March 2011 to February 2014.We then reviewed electronic medical records, including all subsequent imaging for each patient to evaluate for any biliary complications following the sonographic diagnosis of biliary sludge. Results: Of the 104 patients reviewed, 27 developed a biliary complication including; cholelithiasis, cholecystitis, choledocholithiasis and pancreatitis. The most frequent developing complication was cholecystitis: 12 chronic and 2 acute cases, with 12 being acalculous. A total of 8 patients developed gallstones and 2 developed concomittant cholecystitis. An additional 4 patients without gallstones developed pancreatitis. Of those without complications, 83% had resolution of biliary sludge. Conclusions: Biliary sludge frequently resolved spontaneously in those with follow up imaging and no biliary related complications. However, 26% of outpatients with isolated gallbladder sludge developed cholelithiasis or inflammation of the pancreatico-biliary structures. This result implies a stepwise development of sludge to microlithiasis and gallstones, leading to cholecystitis or pancreatitis. Gallbladder sludge may act as a chronic mucosal irritant or reflect overall biliary dysfunction.