Liver and spleen stiffness measured by acoustic radiation force impulse elastography for noninvasive assessment of liver fibrosis and esophageal varices in patients with chronic hepatitis B.

OBJECTIVES: To evaluate the performance of liver and spleen stiffness measured by acoustic radiation force impulse (ARFI) elastography for noninvasive assessment of liver fibrosis and esophageal varices in patients with chronic hepatitis B virus. METHODS: Two hundred sixty-four participants, of whom 60 were healthy volunteers (classified as stage 0), 66 were patients with chronic hepatitis B who had undergone liver biopsy, and 138 were patients with hepatitis B-related cirrhosis, were enrolled in this study. Median liver and spleen stiffness values (meters per second) from 10 successful measurements per participant were obtained. Patients with cirrhosis were examined by upper endoscopy. RESULTS: Significant linear correlations were found between liver (Spearman ρ = 0.87; P < .001) and spleen (Spearman ρ = 0.76; P < .001) stiffness and the fibrosis stage. Liver and spleen stiffness values increased as fibrosis progressed; however, overlaps in liver stiffness were detected in stages 0 and 1 and 1 and 2, and overlaps in spleen stiffness were observed in stages 0 and 1, 1 and 2, and 2 and 3. Liver stiffness cutoff values were 1.69 m/s for predicting stage 3 or greater (area under the receiver operating characteristic curve [AUROC] = 0.99) and 1.88 m/s for stage 4 (AUROC = 0.97). The spleen stiffness cutoff value was 2.72 m/s for stage 4 (AUROC = 0.96). Liver stiffness was not correlated with the varix grade, whereas a significant linear correlation (Spearman ρ = 0.65; P < .001) between spleen stiffness and the varix grade was found. The optimal spleen stiffness cutoff value for predicting varices was 3.16 m/s (AUROC = 0.83). CONCLUSIONS: Liver and spleen stiffness values measured by ARFI elastography are reliable predictors of liver fibrosis. Spleen stiffness measured by ARFI can be used as a non-invasive method for determining the presence and severity of esophageal varices; however, evidence to support a similar role for liver stiffness is lacking.

Elevation of plasma membrane permeability upon laser irradiation of extracellular microbubbles.

Laser-mediated gene transfection has received much attention as a new method for targeted gene therapy because of the high controllability of laser energy and direction. In this report, we describe a combination laser-microbubble system that enables membrane-impermeable molecules to penetrate cell membranes. The main theories we apply are optical breakdown and photoacoustic generation, which are induced by laser irradiation. Firstly, different types of laser light (Ar-green, Novus Varia poly-wavelength and Nd:YAG laser) were adopted to blast liposome microbubble contrast medium; subsequently, the Nd:YAG laser (1064 nm, 4 ns), which could successfully blast microbubbles, and ultrasound were used in combination to irradiate a mixture of liposome microbubbles and retinoblastoma (Rb) cells. After irradiation, membrane permeability was evaluated by flow cytometric assay using propidium iodide (PI) and fluorescein diacetate (FDA). The proportion of permeabilized resealed cells was affected by changes in the light energy. All of the Nd:YAG laser, Nd:YAG combination laser-microbubble and combination ultrasound-microbubble systems were able to permeabilize the Rb cells. These results suggest that this combination laser-microbubble system is a new means of delivering exogenous materials into living cells.

The treatment of liver fibrosis induced by hepatocyte growth factor-directed, ultrasound-targeted microbubble destruction in rats.

OBJECTIVE: The purpose of this study was to explore the feasibility of using ultrasound-targeted microbubble destruction to treat liver fibrosis induced by hepatocyte growth factor (HGF). METHODS: Forty Wistar rats were divided into five groups after the models of liver fibrosis were prepared: (1) HGF, ultrasound, and microbubbles (HGF+US/MB); (2) HGF and ultrasound (HGF+US); (3) HGF and microbubbles (HGF+MB); (4) HGF (HGF); and (5) model alone (MA). All rats were killed after being transfected for 14 days. Recovery of the liver was detect by diffusion-weighted imaging (DWI) and pathological methods. Collagen I expression was detected by immunohistochemistry. Hepatocyte growth factor expression in the liver was detect by western blotting. RESULTS: The results of DWI and pathological examination showed the recovery of liver in HGF+US/MB group were better than those of other groups. In HGF+US/MB group, collagen I expression was less, and HGF protein was the highest among all the groups. CONCLUSIONS: Ultrasound-targeted microbubble destruction could deliver HGF into the fibrotic liver and produce an antifibrosis effect, which could provide a novel strategy for gene therapy of liver fibrosis.