Sa1007 The Role of Dynamic Contrast Enhanced Ultrasound in Focal Liver Lesion Characterization: Preliminary Results Maria Elena Ainora, Matteo Garcovich, Brigida E. Annicchiarico, Gianluigi Caracciolo, Davide Roccarina, Francesca D'Aversa, Francesca Romana Ponziani, Laura Riccardi, Massimo Siciliano, Gian Ludovico Rapaccini, Maurizio Pompili, Antonio Gasbarrini, Maria Assunta Zocco Background and aim. Contrast enhanced ultrasound (CEUS) has improved the diagnostic work up of focal liver lesions and, according to international guidelines, is often used as the first method of choice in differentiating benign from malign lesions. However, interpreta- tion of the contrast-enhancement patterns is a subjective modality with a certain degree of inter-observer variability. In the last years, quantitative approaches able to measure the amount and the time course of contrast uptake have shown great promise in revealing tumour response to anti-angiogenic drugs in patients with different types of malignant lesions. We evaluate the feasibility of dynamic CEUS (D-CEUS) with perfusion software as a diagnostic tool in characterizing different types of liver lesions. Patients and methods. CEUS with second generation contrast agent (Sonovue, Bracco) was performed in 22 benign and 15 malignant hepatic lesions in 32 patients 15 female and 17 male; aged 51±12 years). All cases were confirmed by MRI. Lesion vasculature was assessed in a specific harmonic mode associated with a perfusion and quantification software (Q-Lab, Philips). Five D-CEUS functional parameters (peak intensity, PI; time to PI, TP; area under the curve, AUC; slope of wash in, Pw; mean transit time, MTT) were extracted from time intensity curves and were compared among groups and applied to characterize different types of lesions. Statistical analysis was performed by a non-parametric test and a p value < 0.01 was considered statistically significant. Results. We report the preliminary results obtained in 14 hemangio- mas, 8 focal nodular hyperplasias (FNH) and 20 hepatocellular carcinomas (HCC). Compari- son between benign and malignant lesions revealed no statistically significant differences in all the perfusion parameters except for MTT that was longer in the first group (p = 0.005). For individual analysis, PI, AUC, and Pwi, were significantly higher in FNH than both in hemangiomas and HCC, while TTP was significantly shorter in FNH than in HCC. When we compared hemagiomas and HCC, PI, Pwi and TTP were significantly lower in the former than in the latter. Conclusion. Quantitative analysis provide a more reliable characterization of different types of liver lesions and could be an excellent tool to improve the diagnostic accuracy of CEUS. However further studies with a greater number of patients are required to confirm these results. Sa1008 Evaluation of Stiffness of the Spleen (Fibrospleen) in a Real Life Cohort of Patients With All Stages of Liver Diseases Phil Meister, Alexander Dechene, Lars P. Bechmann, Mechthild Beste, Guido Gerken, Christoph Jochum Background: Recent publications have shown that performing fibroscan of the spleen (fibros- pleen) can predict the development of esophageal varices in patients with cirrhosis of the liver. The aim of the present study was to evaluate the fibrospleen as a diagnostic tool in a broader cohort of patients with liver diseases with and without cirrhosis. Methods: 182 consecutive patients [80 female and 102 male, median age 51.8 years] who underwent a fibroscan test at the University Hospital of Essen, Germany, from September 1st to October 10th received a fibroscan of the spleen after obtaining informed consent. The test was performed using Fibroscan touch™ (Echosens™, France). 46 patients were liver transplant recipients, 57 had a viral hepatitis, 28 an autoimmune and 26 a fatty liver disease, further 19 patients suffered from vascular or genetic liver diseases. The patients were further divided in 3 groups regarding their fibroscan of the liver (<7 kPa n=62, 7-14 kPa n=57 and >14 kPa n=63). The fibrospleen was correlated to the flow velocity of the portal vein and spleen size. Statistical analyses were performed using GraphPad Prism v 6.0. Results: In a total of 108 patients a valid fibrospleen was possible. The fibrospleen resulted in generally higher values than the fibroscan of the liver. Between the three groups the mean value increased from 28.8 to 33.4 to 52.2 kPa, respectively. The ratio between fibroscan of the liver and fibrospleen increased from 0.33 to 0.44 to 1.15 between the three groups. These differences were statistically significant. The fibrospleen correlated significantly with fibroscan of the liver (pearson coefficient 0.49; p=0.0001) and the size of the spleen (pearson coefficient 0.57; p<0.0001). There was no correlation to the portal flow velocity. The strongest correlation was seen in patients with viral hepatitis, the weakest correlation was seen in patients with a fibroscan of the liver between 7-14 kPa. Conclusion: The fibrospleen shows a linear correla- tion to liver stiffness in all stages of liver diseases. It correlates to the size of the spleen and is independent of the portal flow velocity. This suggests that fibrospleen may offer further information in the staging of liver disease and a valuable addition to the fibroscan. Prospective analyses are required to evaluate the potential of the fibrospleen in the diagnosis of liver diseases and its complications. Sa1009 Does Portal Vein Size and/or Portal Vein Velocity Correlate With Degree of Liver Fibrosis on Biopsy? Amy Tyberg, Daniela Jodorkovsky, Anthony Gilet, Swetha Dasari, Angela Tong, Bharath Raju, Edward Lebovics INTRODUCTION: Liver biopsy is an invasive means of determining the degree of fibrosis in patients with liver disease. Liver fibrosis leading to portal hypertension may cause portal vein dilation and/or decreased portal vein velocity (PVV). Whether the degree of portal vein dilation or the decrease in PVV correlates with the degree of liver fibrosis remains unknown. Portal vein size (PVS) can be determined by non-invasive testing such as abdominal ultrasound (US), computed tomography scan (CT) or magnetic resonance imaging (MRI) and would be a desirable alternative to biopsy. This study evaluated whether PVV or PVS by US, CT, and/or MRI correlates with degree of liver fibrosis on biopsy. METHODS: This study was a retrospective chart review of patients at Westchester Medical Center. All patients who S-935 AASLD Abstracts underwent liver biopsy from June 2011 through August 2013 and who had an abdominal US, CT scan, or MRI within the same year of their liver biopsy were included. The primary objective was whether PVS and/or PVV correlated with the degree of fibrosis (stage 0-4) on biopsy. Data was analyzed using Pearson's correlation coefficient. RESULTS: 147 patients were included in the analysis. Findings are summarized in Table 1. US was done in 24 patients, CT in 92 patients, MRI in 67 patients, and PVV in 96 patients. US could not reliably measure PVS in 79 out of 103 patients (77%). There was a weak correlation between degree of fibrosis and PVV (R=-0.24, p=0.008, N=96). There was also a weak correlation between degree of fibrosis and PVS on CT (R=-0.24, p=0.008, N=92). There was no significant correlation between degree of fibrosis and PVS on US (R=-0.18, p=0.19 ,N=24) or on MRI (R= -0.16, p=0.08, N=67). Compared with stage 4 fibrosis, patients with stage 0-3 fibrosis did not have significantly different PVS on US (14.1 vs. 13.9, p=0.89), CT (15.4 vs. 17.2, p=0.06), or MRI (16.12 vs. 16.19, p=0.95). Patients with stage 3-4 fibrosis did not differ from patients with stage 0-2 fibrosis on US (14.17 vs. 13.41, p=0.48) or MRI (16.39 vs. 15.66, p=0.42) but did differ on CT (17.3 vs. 15.78, p=0.03). The PVV did not differ between those patients with stage 4 vs. stage 0-3 fibrosis (31.1 vs. 37.5, p=0.31) or between those patients with stage 3-4 vs stage 0-2 fibrosis (38.01 vs 32.3, p=0.23). CONCLUSION: PVV and PVS on imaging did not reliably predict fibrosis stage. The lack of correlation may have been affected by small numbers of patients in various subgroups. Table 1 Sa1010 The Predictors of Transplant Free Survival in Fulminant Autoimmune Acute Liver Failure: The Acute Liver Failure Study Group Experience Daniel Ganger, R. Todd Stravitz, K. Rajender Reddy, Zurabi Lominadze, Holly Battenhouse, Jaime L. Speiser, William M. Lee BACKGROUND AND AIMS: Fulminant autoimmune liver failure has a variable course and often requires transplantation. The role of corticosteroids (CS) remains undefined. Our aim was to identify the variables that predict transplant free survival (TFS) at 21 days from presentation and to assess the role of corticosteroids. METHODS: We conducted a retrospec- tive analysis of all patients enrolled in the Acute Liver Failure Study Group Registry between 1998 and 6/2013. Acute Liver Injury (ALI) was defined as INR ≥2 without encephalopathy and acute liver failure (ALF) as INR ≥1.5 with encephalopathy. Autoimmune (AI) etiology was determined by histology and/or autoimmune markers (ANA and antismooth muscle antibody). Lille model to predict response was used in those who received steroids for at least a week. RESULTS: 116 (70.3%) of a total of 165 AI patients presented with ALF. Half of patients presenting with ALI (24/49) progressed to ALF. Only 45 patients received CS, 35.6% ALI and 64.1% ALF, but of those who did not receive CS, 92.5% had ALF (p<0.001). Transplant at 21 days occurred in 45.5% of patients, without difference between those who received CS or did not. Platelet count and MELD score were used to construct a model with AUROC of 0.845. The Lille score at 7 days did not predict TFS of those on CS. CONCLUSIONS: MELD and higher platelet count were the only significant predictors of TFS. CS do not improve survival and were not given in most cases of AI that present with ALF. Acknowledgement: This research was supported by NIDDK U01-DK-58369. All AIH Subjects by Steroid Status (N=165) AASLD Abstracts