and depth of inclusion (P < 0.001). There wasno signif i cant difference instiffness and SD according to the observer. Morphologic score differedsignif i cantly only in the size of the inclusion (P < 0.001).When the depthof the inclusion was 7 cm, the stiffness was the highest, and the 10-mmsized inclusions showed lower morphological scores than the other inclu-sions (all P < 0.001). In conclusion, 2D SWE assessment for focallesions could be affected by background stiffness and depth of focallesions, and it may have a limitation in evaluating focal hepatic lesions.Clinical utility of FibroScan ? as a noninvasive diag-nostic test for primary biliary cholangitisSatoru Joshita, 1,2 Takeji Umemura, 1,2 Eiji Tanaka 11 Gastroenterology, Shinshu University School of Medicine,Matsumoto, Nagano, Japan,2 Research Center for Next GenerationMedicine, Shinshu University, Matsumoto, Nagano, JapanBackground/Aims: Primary biliary cholangitis (PBC) is a chronic,slowly progressive, liver-specif i c autoimmune liver disease. Somepatients with PBC display disease progression regardless of ursodeoxy-cholic acid therapy. Therefore, it is important to accurately diagnosethe clinical stage of PBC. This study investigated the utility and clini-cal advantages of vibration-controlled transient elastography (VCTE)using FibroScan ? for assessing disease status in PBC.Methods: Forty-f i ve treatment na? ¨ve PBC patients (80% female,median age: 63 years), all of whom had undergone liver biopsy for his-tological assessment, were enrolled. Relationships between clinicalindices and VCTE were compared with those for other noninvasivemarkers (FIB4 index and AST-to-platelet ratio index [APRI]) as wellas platelet count (PLT) and several clinical features.Results: The numbers of patients with histologically-assessed clinicalstage I+II (early stage) and III+IV (late stage) PBC as def i ned by Sche-uer or Nakanuma classif i cation were 33 and 12 and 31 and 14, respec-tively. The median VCTE and controlled attenuation parameter (CAP)of FibroScan ? were respectively 5.9 kPa and 205 dB/m. Respectivemedian VCTE values in early- and late-stage PBC patients were 5.1and 8.3 (p = 0.003). VCTE was signif i cantly correlated with Scheuer(r = 0.48, p = 0.0008) and Nakanuma (r = 0.49, p = 0.0006) classif i ca-tion disease stage, whereas CAP was not but was associated with bodyweight (r = 0.38, p = 0.011). VCTE was also signif i cantly related toFIB4 index (r = 0.39, p = 0.0082) and APRI (r = 0.51, p = 0.0003), butnot with PLT (-0.25, p = 0.10). The areas under the receiver operatingcharacteristic curve (AUROC) for diagnosing PBC stage II or more forVCTE, FIB4 index, and APRI were 0.75, 0.66, and 0.73, respectively(p > 0.05 for each comparison). The AUROCs for diagnosing late-stage PBC for VCTE, FIB4 index, and APRI were 0.78, 0.71, and 0.70,respectively (p > 0.05 for each comparison). A combination of VCTE> 6.0 kPa and FIB4 > 2.0 could predict late-stage PBC with a sensitiv-ity of 0.8, specif i city of 0.8, and accuracy of 0.8.Conclusions: VCTE using FibroScan ? provided comparable results toestablished markers for the assessment of liver f i brosis in patients withPBC. Further validation and better detection strategies are needed tomore accurately identify PBC disease stage.Possibilities of gastrointestinal ultrasonography indetection of pathological processes of distal esophagusand cardio-esophageal zoneElene KhmaladzeTbilisi State University Clinic "VIVAMEDI" and Medical Center"Gastroenterolog", Tbilisi, GeorgiaIntroduction: Gastrointestinal ultrasonography has existed in the worldmedical practice more than 35 years ago.The f i rst works on this subjectdate back to 1978-79 years. Lately ultrasound diagnostics has beenunfairly relegated to the background due to development and introduc-tion of ultramodern diagnostic technologies such as computed, mag-netic-resonance and positron-emission tomography. But recentlyultrasonography as a whole and gastrointestinal ultrasonography in par-ticular are gaining strength in many countries, although they meet someresistance. Along with informative ultrasound techniques of the stomachand intestines, recently ultrasonography of the distal esophagus and thecardioesophageal zone has become widespread.Objectives: The purpose of this work is to determine the advantages,value and objectives of in identifying organic and functional patholo-gyof the distal esophagus and cardio-esophageal zone.Advantages:1. Non-invasiveness and toleratibility by all categories of patients incomparison to endoscopic studies.2. Absence of radiation in comparison to X-ray and CT.3. Visualization and evaluation of all layers of the esophagus’s wall incontrast to endoscopy.4. Budget method in comparison with CT and MRTValue:1. Availability for the general population2. Ability to use as a screening diagnostic methodAim:1. Primary detection of pathological processes of the cardio-esophagealzone2. Patient’s orientation to further examination if it’s necessary3. Patient orientation towards conservative treatment by gastroenterol-ogists, or operative treatment by surgeons.Methods: Examined patients were grouped according to the followingpathological processes, revealed by ultrasonography:1. Cardial insuff i ciency - with hiatal ring’s dilatation to 16-18 mm2. Sliding unf i xed hiatal hernia - with a hiatal ring’s dilatation over18 mm, changing during a Valsalva maneuver3. Sliding f i xed hiatal hernia- with hiatal ring’s dilatation over 18 mm,not changing during the Valsalva maneuver4. Distal ref l ux esophagitis, including erosive and ulcerative5. Tumors of the distal esophagus and cardioesophageal zoneThere are certain limitations visualization of the cardioesophagealzone:1. Hypersthenic constitutional patient type2. Excessive thickness of subcutaneous fat3. Increased f l atulence in the stomachHowever, in most cases, ultrasound diagnosis of the pathology of thecardio-esophageal zone is carried out smoothly and very successfully.Conclusion: Gastrointestinal ultrasonography is a valuable informa-tive non-invasive, non-radiating method for diagnosing functionaland organic diseases of the distal esophagus and cardioesophagealzone, which deserves wide application in world medical diagnosticpractice.This technique can be widely used in the screening of ref l uxdisease, inf l ammatory and oncological pathology of the cardioeso-phageal zone.Big steps in advances of doppler ultrasoundJin Sil Kim, 1 Kyoung Won Kim, 2 Se-Young Kim, 2 Hye Young Jang, 2Jae Hyun Kwon, 3 Sung Gyu Lee 31 Department of Radiology and Medical Research Institute, College ofMedicine, Ewha Womans University, Seoul, Korea,2 Department ofRadiology and Research Institute of Radiology, Asan Medical Center,University of Ulsan College of Medicine, Seoul, Korea,3 Division ofLiver Transplantation and Hepatobiliary Surgery, Department ofSurgery, University of Ulsan College of Medicine, Asan MedicalCenter, Seoul, KoreaS98 Ultrasound in Medicine & Biology Volume 45, Number S1, 2019
