POSTERS Methods: Patients from two Greek referral centers were included. All patients were antiHBe (+) and underwent liver biopsy (LB) and LSM with a 6-month maximum interval. LB had at least 1.5cm length and was evaluated using the Ishak scoring system by two experienced liver pathologists. Unreliable LSM was defined as interquantile range (IQR)/LSM >0.3 and/or success rate (SR) <60%. Both LSM operators had adequate experience (>100, <500 examinations). Results: 79 patients were analyzed. LSM was considered unreliable in 20/79 (25.3%). Patients with unreliable LSM tended to be older (54 vs. 47 years, p = 0.08) and heavier – as measured by body mass index – (27.1 vs. 24.6, p = 0.08) as compared to those with reliable LSM. The median age of patients with reliable LSM was 47 years (range 22–71). 74% were male and the mean BMI was 25.2±3.2. The median AST, ALT and HBV-DNA values were: 30IU/L (12– 300); 42 IU/L (13–360); 8.4×10 3 IU/ml (0–2×10 9 ). The distribution of patients in different fibrosis stages was: 0 (n = 7), 1 (n = 18), 2 (n = 17), 3 (n = 7), 4 (n = 5), 5 (n = 2), 6 (n = 3). Fibrosis stage was significantly associated with LSM (r = 0.46, p = 0.0002). In addition, LSM was associated with AST and ALT levels (r = 0.38, p = 0.01; r = 0.32, p = 0.03, respectively) and male gender as compared to female (6.7 vs. 5.2, p = 0.04). The area under receiver-operating characteristic curves were 0.74 for stage ≥3, 0.85 for ≥4, 0.87 for ≥5 and 0.86 for stage = 6. For stage ≥5, the optimal LSM cut-off value was 7.7kPa by maximizing the sum of sensitivity and specificity (positive predictive value: 26.3%, negative predictive value: 100%). Conclusion: LSM in patients with antiHBe(+) CHB appears to correlate well with fibrosis stages. The cut-off value of 7.7kPa can exclude cirrhosis, thus offering a useful everyday tool in the assessment of CHB patients. 351 WHY AND HOW TO USE ACOUSTIC RADIATION FORCE IMPULSE ELASTOGRAPHY (ARFI) IN OUR DAILY PRACTICE? I. Sporea, S. Bota, R. Sirli, A. Popescu, M. Danila, M. Sendroiu. Gastroenterology and Hepatology, University of Medicine and Pharmacy V.Babes, Timisoara, Romania E-mail: isporea@umft.ro Background and Aim: ARFI elastography is a new method used mainly for the assessment of liver fibrosis. The aim of our paper was to assess the value of liver stiffness (LS) measurement by means of ARFI as a predictive factor for the severity of fibrosis, for the presence of vascular decompensation in cirrhotic patients and for the etiology of ascites. Methods: We performed ARFI measurements in 511 subjects, mean age 53.2±14.8 years: 10 ARFI measurements in each patient and a median value was calculated, expressed in meters/second (m/s). We considered as reliable only measurements with IQR < 30% and SR ≥ 60%. Results: In 14 patients (2.7%), we did not obtain valid measurements. We included 77 healthy volunteers, 78 patients with HCV and 37 with HBV chronic hepatitis (with liver biopsy), 285 patients with liver cirrhosis and 34 patients with non- cirrhotic ascites. The mean LS value determined by ARFI in healthy volunteers was 1.15±0.21 m/s. The mean values of ARFI measurements in patients with chronic HCV hepatitis with LB were: F1 = 1.18±0.11 m/s, F2 = 1.34±0.54 m/s, F3 = 1.77±0.68 m/s and F4 = 2.42±0.70 m/s. In HCV chronic hepatitis, the cut-off value for F2 was 1.33 m/s (AUROC = 0.76), for F3 – 1.66 m/s (AUROC = 0.80) and for F4 – 1.79 m/s (AUROC = 0.86). In cirrhotic patients we found a statistically significant higher ARFI LS values in patients with ascites vs. those without ascites (3.05±0.71 m/s vs. 2.73±0.67 m/s) (p < 0.001). The best cut-off value for predicting ascites in cirrhotic patients was 2.52m/s (AUROC 0.64). For a cut-off value of 1.8 m/s for predicting cirrhosis (and ascites in the context of cirrhosis), ARFI had 94.7% accuracy for predicting the cirrhotic etiology of ascites. Conclusion: ARFI is a feasible method in most of the patients (97.3%). This method is useful for evaluation of liver fibrosis in chronic hepatitis comparison with liver biopsy. It has a very good predictive value for the presence of cirrhosis, for the cirrhotic etiology of ascites and in cirrhotic patients it can be a predictor of vascular decompensation. 352 CAN WE USE TOGHETER TRANSIENT ELASTOGRAPHY (TE) AND ACOUSTIC RADIATION FORCE IMPULSE ELASTOGRAPHY (ARFI) TO IMPROVE FIBROSIS EVALUATION IN PATIENTS WITH CHRONIC HCV HEPATITIS? I. Sporea 1 , R. Sirli 1 , A. Popescu 1 , R. Badea 2 , M. Lupsor 2 , M. Focsa 3 , M. Danila 1 , S. Bota 1 . 1 Gastroenterology and Hepatology, University of Medicine and Pharmacy, Timisoara, 2 Medical Imaging, 3rd Medical Clinic, University of Medicine and Pharmacy, Cluj-Napoca, 3 Biophysics and Medical Informatics, University of Medicine and Pharmacy, Timisoara, Romania E-mail: isporea@umft.ro Background and Aim: Liver biopsy (LB) is still considered the “gold standard” for the assessment of liver fibrosis. The aim of this study was to find if by combining 2 elastographic methods: Acoustic Radiation Force Impulse Elastography (ARFI) and Transient Elastography (TE) we can improve the prediction of fibrosis in patients with chronic HCV hepatitis. Methods: Our study included 197 patients with anti HCV+. In each patient we performed in the same session LB, assessed according to the Metavir score, liver stiffness (LS) measurements by mean of TE and ARFI. 10 LS measurements were performed both by TE and ARFI; median values were calculated and expressed in kiloPascals (kPa) and meters/second (m/s), respectively. Only TE and ARFI measurements with IQR < 30% and SR ≥ 60% were considered reliable. Results: On LB 13 (6.6%) patients had F0, 32 (16.2%) had F1, 52 (26.4%) had F2, 47 (23.9%) had F3 and 53 (26.9%) had F4. A direct, strong correlation was found between TE measurements and fibrosis (r = 0.741), between ARFI in fibrosis (r = 0.730) and also between TE and ARFI (r = 0.675). The predictive values of TE and ARFI, alone or in combination, for F ≥ 2 and F4, respectively, are presented in Table 1. Table 1 F≥2 F=4 Cut-off AUROC Se (%) Sp (%) Cut-off AUROC Se (%) Sp (%) TE 6.7 kPa 0.87 77.5 86.7 12.2 kPa 0.97 96.2 89.6 ARFI 1.2 m/s 0.84 76.9 86.7 1.8 m/s 0.91 90.4 85.6 TE + ARFI 6.7 kPa and 1.2 m/s - 60.5 93.3 12.2 kPa and 1.8 m/s - 84.9 94.4 TE or ARFI 6.7 kPa or 1.2 m/s - 86.1 71.1 12.2 kPa or 1.8 m/s - 96.2 83.3 Conclusion: TE used in combination with ARFI is highly specific for predicting significant fibrosis, so that in patients with higher LS measurements than the proposed cut-offs for both methods, LB could be avoided. In our study, by using both elastographic methods in combination, 60.5% of the liver biopsies could be avoided. Journal of Hepatology 2011 vol. 54 | S61–S208 S141