ABSTRACT
Abstract Hepatic steatosis, or fatty liver disease, occurs due to the accumulation of lipids in hepatocytes. When it becomes chronic, lobular inflammation develops and the disease can evolve to hepatic fibrosis, liver cirrhosis, or hepatocellular carcinoma. Early diagnosis is desirable because patients diagnosed in the early stage of the disease respond better to treatment. In the early stages of fatty liver disease, the physical examination is often unremarkable. Fatty liver disease and hepatic fibrosis can be diagnosed and monitored through laboratory tests, imaging, and biopsy. Among the imaging methods, ultrasound stands out as an effective means of diagnosing and following patients with liver disease. Ultrasound used in conjunction with elastography (ultrasound elastography) has recently shown great utility in the follow-up of such patients. Ultrasound elastography studies the degree of deformation (stiffness) of an organ or lesion, so that when there is hardening, fibrosis, or cirrhosis of the liver, those alterations are well demonstrated. In this review article, we discuss the application of the different types of ultrasound elastography for liver studies: transient elastography, point shear wave elastography, and two-dimensional shear wave elastography. Although magnetic resonance elastography may also be used in the analysis of liver fibrosis, it will not be addressed in this article.
Resumo Esteatose hepática ocorre pelo acúmulo de lipídios nos hepatócitos, sua cronificação cursa com inflamação lobular e evolui com fibrose hepática, cirrose e carcinoma hepatocelular. O diagnóstico precoce do acometimento hepático é desejável em razão da melhor resposta terapêutica dos pacientes na fase inicial da doença. O exame físico nas fases iniciais da doença não apresenta alterações. O diagnóstico e o controle evolutivo da esteatose e fibrose hepática podem ser realizados por exames laboratoriais, exames de imagens e biópsia. Entre os exames de imagem, destaca-se a ultrassonografia (US) no diagnóstico e acompanhamento dos pacientes com doença hepática. Atualmente, a US associada à elastografia vem se destacando para acompanhamento desses pacientes. A elastografia por US estuda o grau de deformação (ou dureza) do órgão ou lesão, de modo que quando há endurecimento do fígado, por fibrose ou cirrose, essa alteração é bem demonstrada na elastografia por US. Neste artigo de revisão nos propusemos a discutir a aplicação dos diversos tipos de elastografia por US para estudo do fígado: elastografia transitória, point-shear wave elastography e 2D-shear wave elastography. A elastografia por ressonância magnética também pode ser utilizada na análise de fibrose hepática, mas não será abordada neste artigo.
ABSTRACT
Abstract Purpose: To evaluate the hyaluronic acid (HA) inflammatory reaction, fibroblasts, fibrosis and duration of effect in the dorsal region of tobacco-exposed rats. Methods: Ten Wistar rats were divided into two groups: tobacco-exposed-group (TEG;n=5) and air-control-group (CG;n=5). The TEG animals were tobacco-exposed twice a day, 30-minutes/session, during 60 days. After this period, all animals received 0.1 mL HA subcutaneous injection in the dorsal area. The volume of HA was measured immediately after HA injection and weekly using a hand-caliper in nine weeks. After this period, all the animals were euthanized, and a specimen of was collected to evaluate inflammatory cells, fibroblasts, and fibrosis by HE. Results: This study showed a higher inflammatory reaction in TEG than CG: inflammatory cell-count (CG: 1.07±0.9; TEG: 8.61±0.36, p<0.001); fibroblast count (CG: 2.92±0.17; TEG: 19.14±0.62, p<0.001), and fibrosis quantification (CG: 2.0; TEG: 3.75, p<0.001). The analysis of the HA volume in nine weeks in the dorsal region did not show a difference between groups (p=0.39). Conclusions: This study suggested that the HA injection in the TEG caused an increase in inflammatory cell count, fibroblast, and fibrosis quantification when compared to the CG. There was no difference in the duration of effect of HA between the groups.