1. www.postersession.com Noncirrhotic portal hypertension (NCPH) comprises diseases of the liver manifesting with portal hypertension due to intrahepatic or prehepatic lesions in the absence of cirrhosis. Patients with NCPH can mimic cirrhosis on routine imaging like ultrasonography and CT scan. Knowledge of radiologic mimics of cirrhosis is increasingly important because an erroneous diagnosis of cirrhosis in some settings could adversely impact contemporary treatment options. Liver and spleen stiffness (LS and SS) measured by ARFI has similar predictive value to tissue elastography (TE) for detecting significant fibrosis and cirrhosis. The limitations of TE, such as narrow intercostal spaces, ascites and obesity, do not appear to apply to the use of ARFI elastography. There is scarity of data on LS and SS measurements by ARFI in patients with NCPH and its value in predicting presence or absence of esophageal varices as well as bleeding from varices. So, the aim of our study was to measure LS and SS by ARFI elastography in NCPH and whether it helps to correct the erroneous diagnosis of cirrhosis in patients with NCPH. Methods Conclusions Evaluation of liver and spleen stiffness by acoustic radiation force impulse (ARFI) in non cirrhotic portal hypertension (NCPH) Apurva Shah 1, Deepak Amarapurkar1 1. Bombay Hospital and Medical Research center, Mumbai,India Bibliography A prospective study conducted at single tertiary hospital in department of Gastroenterology and Radiology. 171 patients undergoing liver biopsy for evaluation of liver disease with or without portal hypertension (cirrhosis and NCPH) were subjected to LS and SS measurement by ARFI prior to biopsy. History, physical examination, relevant blood investigations, esophagogastroduodenoscopy and imaging (ultrasonography and Doppler (whenever indicated)) were done in all patients. Sixty one age matched patients who had undergone ultrasonography as a part of routine health check-up and had normal liver function test, hepatitis B & C serology negative, no history of alcohol consumption and BMI within a normal range and normal findings on ultrasonography served as control. LS and SS measurement by ARFI: After six hours of fasting, patients underwent complete upper abdominal US. Immediately after US, ARFI elastography was performed with Acuson S2000 high- density ultrasound system. For evaluation of LS, ARFI scanning was done in the intercostal space in the right lobe of liver with minimal scanning pressure applied by the operator, patient lying in the dorsal decubitus position, right arm maximally abducted and the patient was asked to hold breath for a moment. A measurement depth of 2-3 cm below the liver capsule was chosen to standardize the examination. Similarly, SS was taken in intercostal spaces, 1 cm below splenic capsule, with patient lying in right decubitus and arm maximally abducted. The Acuson S2000 has a memory capability and more than five successful, usually ten acquisitions, was performed for each patients and the mean value of LS and SS was calculated in m/sec. P value of less than.05 was considered to indicate a significant difference. 1.Sarin SK, Sollano JD, Chawla YK, Amarapurkar D, Hamid S, Hashizume M, et al. Members of the APASL working party on portal hypertension. Consensus on extra-hepatic portal vein obstruction. Liver Int 2006; 26:512-519. 2.Jha P, Poder L, Wang ZJ, Westphalen AC, Yeh BM, Coakley FV. Radiologic mimics of cirrhosis. AJR Am J Roentgenol. 2010 ; 194(4):993-9.. 3.Bota S, Herkner H, Sporea I, Salzl P, Sirli R, Neghina AM, et al. Meta- analysis: ARFI elastography versus transient elastography for the evaluation of liver fibrosis. Liver Int. 2013;33(8):1138-47. 4.Bodh, V. and Chawla, Y. Noncirrhotic intrahepatic portal hypertension.Clinical Liver Disease.2014; 3: 129–132. 5.Khanna R, Sarin SK. Non-cirrhotic portal hypertension—diagnosis and management. J Hepatol 2014;60:421-441. Patients with NCPH had higher LS and SS values compared to that of the healthy subjects and lower LS as compared to cirrhotics. Patients with variceal bleed in NCPH had higher SS values than did those without bleed. So, SS could be more reliable indicator in presinusoidal disease and SS can be used to discriminate patients with a bleed from those without a bleed with high sensitivity and specificity in NCPH patients. LS and SS values does not differentiate small and large esophageal varices in NCPH. Most patients of NCPH who had undergone liver biopsy had no fibrosis. LS and SS were not significantly different in different stages of fibrosis in NCPH patients. Mean LS in NCPH group who had fibrosis stage 0 was lower than that of cirrhotic patients but the difference was not significant. In conclusion, LS and SS measurement by ARFI helps to correct erroneous diagnosis of cirrhosis in NCPH when used in context of clinical examination, liver function test and colour Doppler ultrasonography and also helps to predict patients with variceal bleed. Introduction Results Table 1: Demographic and biochemical profile Table 2: Size of esophageal varices, ARFI and APRI in NCPH Order online at https://www.postersession.com/order/ Parameters NCPH subjects (n= 40) Control subjects (n = 61) P value Mean age (y)39.7 ± 14.4 (14-77)41.6 ± 17.9 (18-81).641 Male-to-female ratio20: 2042:19 BMI ( kg/ m 2 )22.1 ± 5.521.9 ± 6.5.850 Median hemoglobin (g/dL) 10.9 (6-16)13 (8-16).004 Median total leukocyte count (mm 3 /dL) 6035(2300-13000)8200 (4000- 15000).064 Median platelet count (thousands/mL) 154250.059 Mean total bilirubin (mg/dL) 1 ± 0.60.7± 0.5.013 Median aspartate aminotransferase (IU/l) 30(15-84)24(14-90).143 Median alanine aminotransferase (IU/l) 38 (15-97)30 (15-291).189 Mean serum albumin (g/dL) 3.8 ± 0.63.9 ± 0.7.468 Mean LS (m/s)1.7±0.51.4 ±0.2.001 Mean SS (m/s)3.4 ±0.52.4 ± 0.5.000 APRI0.7 ± 0.60.3 ± 0.2.001 VaricesLS (m/s), n = 21SS (m/s), n = 21APRI (n = 21) small1.67 ± 0.533.42 ± 0.530.926 ± 0.832 large1.85 ± 0.533.46 ±0.330. 816 ± 0.520 P value0.4620.8250.713 (SS was available for 21 patients as 16 patients had undergone splenectomy and 3 subjects had no varices) Table 3: Variceal bleed and ARFI in NCPH Variceal bleedLS (m/s), n = 21SS (m/s), n = 21APRI (n = 21) Yes (n = 6)1.54 ± 0.413.76 ±0.270.850 ± 0.444 No (n = 15)1.87 ± 0.553.32 ± 0.410.868 ± 0.736 P value0.1990.0280.957 Table 4: Association between ARFI values with fibrosis and diagnosis Fibrosis stage Mean ARFI values – LS (m/s) ( mean  SD) NNCPF,EHPOVN Others (Cirrhosis) 032 1.60  0.29 25 1.78  0.55 14 1.92  0.20 7 2.10  0.76 21 2.02  0.00 11 1.80  0.49 31 1.86  0.00 30 2.37  0.57 42 1.74  0.05 48 2.61  0.60 By Student t test P = 0.126, Not Significant