Cytokines in inflammatory bowel diseases - Update 2020.

Inflammatory Bowel Diseases (IBD), namely Crohn's Disease and Ulcerative Colitis, cause a significant disease burden in modern civilization. Ever since the introduction of anti-TNF-directed therapies 20 years ago, cytokines have attracted a lot of research attention and several cytokine-directed therapies have been implemented in the clinical treatment of these diseases. The research progress in these past years has underlined the importance of both myeloid and lymphoid elements of the immune system in the pathogenesis of IBD and their cytokine-mediated interplay. The conceptual framework of the mucosal cytokine network has shifted during these years from a T helper (Th) dichotomy (Th1/Th2) to the effector/regulatory T cell balance, while nowadays, the importance of myeloid cell instruction of lymphocytes, namely by IL-12 and IL-23, is increasingly recognized. Anti-IL-12p40 agents, like ustekinumab, groundbreakingly changed patient care, and anti-IL23p19-directed approaches are on the verge of grand success. In this review we present a modular approach to understand the cytokine network and put it into the context of the pathogenesis of IBD with a special focus on publications since 2014.

Correction to: Influence of cancer and acute inflammatory disease on taste perception: a clinical pilot study.

The Acknowledgement Statement was incorrect in the original publication of this article [1] and the previous correction note [2]. The correct statement is as follows.

Correction to: Influence of cancer and acute inflammatory disease on taste perception: a clinical pilot study.

The "Acknowledgment Statement" of the published paper is incorrect. The correct statement should be the below: Acknowledgements We thank Sarah Vogel for her support in taste test realization and Yvonne Sauermann for preparation of the tastant solutions. The present work was carried out by Ms. Schalk in order to meet the requirements for the awarding of the title of Dr. med. at the FAU.

Circadian profiling reveals higher histamine plasma levels and lower diamine oxidase serum activities in 24% of patients with suspected histamine intolerance compared to food allergy and controls.

BACKGROUND: Histamine intolerance is thought to trigger manifold clinical symptoms after ingesting histamine-rich food due to reduced activity of diamine oxidase (DAO). No study has hitherto systematically assessed daily fluctuations of histamine levels and DAO activities in symptomatic patients. The aim of the study was to investigate the presence of histamine intolerance, to therefore establish day profiles of histamine levels and DAO activities, and to compare the results between patients with suspected histamine intolerance, food allergy and healthy controls. METHODS: We determined day profiles of histamine plasma levels and DAO serum activities in 33 patients with suspected histamine intolerance, in 21 patients with proven food allergy and in 10 healthy control patients. Clinical symptoms, food intolerances and further clinical and laboratory chemical parameters were evaluated. RESULTS: Twenty-four percent (8 of 33) suspected histamine-intolerant patients showed elevated histamine levels during the day. That might be caused by constantly and significantly reduced DAO activities in these patients compared to food-allergic and control patients. The remaining 25 patients presented normal histamine levels and DAO activities, but an increased prevalence of multiple food intolerances compared to the other subgroup of suspected histamine-intolerants. There was no correlation between subjective complaints and serological histamine parameters in patients with suspected histamine intolerance. CONCLUSIONS: We determined by daily profiling that decreased DAO activities correlated with elevated histamine levels in a subgroup of suspected histamine-intolerants. This finding discriminates these patients from food intolerant individuals with similar clinical symptoms and strongly suggests the presence of histamine intolerance.

Influence of cancer and acute inflammatory disease on taste perception: a clinical pilot study.

PURPOSE: Cancer patients are at high risk of malnutrition and tumor cachexia further increasing morbidity and mortality. Reasons for cachexia are not clear yet, but inflammatory processes as well as the occurrence of taste disorders reducing nutrient uptake are discussed to play key roles. The purpose of this study was to gain insight into causative factors of taste disturbance in cancer patients. Does the cancer itself, inflammatory processes or cancer therapy influence taste disorders? METHODS: To capture an underlying taste disorder patients with cancer (n = 42), acutely hospitalized inflammatory disease patients (n = 57) and healthy controls (n = 39) were examined. To assess the influence of chemotherapy, patients with and without chemotherapy were compared. Taste tests were performed according to DIN ISO 3972:2011. Inflammation was recorded using laboratory parameters. Statistical evaluation was conducted using the Software R. RESULTS: Cancer patients showed significantly increased taste thresholds for sweet, salty, and umami compared to healthy controls. There were no significant differences in taste detection and recognition between patients with former, current, or without chemotherapeutical treatment. Patients with an acute inflammatory disease showed an increased taste threshold for umami compared to healthy controls. CONCLUSIONS: It could be shown that cancer patients suffer from taste disorders irrespective of an existing chemotherapeutical treatment. Cancer-related inflammation appears to have a greater impact on taste perception than an acute inflammatory process. Therefore, an adapted dietary adjustment should be carried out at an early stage for cancer patients in order to avoid nutritional disorders caused by a taste disorder.

Acoustic radiation force impulse (ARFI) elastography of the bowel wall as a possible marker of inflammatory activity in patients with Crohn's disease.

AIM: To evaluate acoustic radiation force impulse (ARFI) shear-wave velocities of the bowel wall in patients with Crohn's disease (CD). MATERIAL AND METHODS: ARFI shear-wave elastography was analysed within the wall of the stomach, terminal ileum, and sigmoid, and correlated with ultrasound signs of activity in CD patients both retrospectively and in a prospective cohort. RESULTS: A total of 77 retrospective and 21 prospective CD patients were included. ARFI elastography in the stomach, the normal ileum, and sigmoid was lower than in ileitis or sigmoiditis. Retrospectively, the ARFI values correlated with the bowel wall thickness and Limberg vascularisation score. Prospectively, there was no correlation between ARFI and bowel wall thickness, Limberg score, clinical activity, or C-reactive protein. A cut-off analysis of 105 ileal ARFI measurements showed a cut-off value of 1.92 m/s for the diagnosis of ileal inflammation with 75.3% sensitivity and 87.5% specificity. CONCLUSION: In patients with CD, ARFI shear-wave velocities show a trend to higher values in inflamed bowel wall thickening on B-mode ultrasound; however, the differences appear small and may not be clinically significant. The factors influencing ARFI measurements of the bowel wall require further investigation.

[What rheumatologists can learn from gastroenterologists]. / Was der Rheumatologe vom Gastroenterologen lernen kann.

BACKGROUND: Chronic inflammatory diseases are complex disorders, which due to their multitude of manifestations require interdisciplinary treatment. OBJECTIVE: The aim of this article is to provide a brief overview of current strategies and innovations for chronic inflammatory bowel diseases. METHODS: A literature search was carried out in PubMed. RESULTS: Shared pathophysiological pathways in chronic inflammatory diseases sometimes lead to common targets in treatment; however, there are also relevant specific differences with respect to treatment. CONCLUSION: Due to the many extraintestinal organ manifestations, chronic inflammatory bowel diseases require interdisciplinary treatment.

[Inflammatory bowel diseases : Crohn's disease and ulcerative colitis]. / Chronisch-entzündliche Darmerkrankungen : Morbus Crohn und Colitis ulcerosa.

Inflammatory bowel diseases (IBD) are complex diseases. Epidemiological studies suggest rising incidences in industrialized countries. The article is based on a literature search in PubMed and is oriented on the current guidelines published by the European Crohn's and Colitis Organisation. IBD are characterized by chronic diarrhoea, abdominal pain and peranal haemorrhage. Extraintestinal manifestations commonly affect joints, skin, eyes and bile tracts. Early diagnosis and therapeutic intervention determine individual patient outcome. Medical treatment currently includes aminosalicylates, corticosteroids, thiopurines, calcineurin inhibitors and biologicals. IBDs require anti-inflammatory and if necessary immunosuppressive therapy. Due to extraintestinal complications and the possible need for surgical intervention, an interdisciplinary approach is important.

Outcome, comorbidity, hospitalization and 30-day mortality after closure of acute perforations and postoperative anastomotic leaks by the over-the-scope clip (OTSC) in an unselected cohort of patients.

BACKGROUND: Acute gastrointestinal (GI) wall defects contain a high risk of morbidity and mortality and may be closed endoscopically by a full-thickness over-the-scope clip (OTSC). METHODS: Unselected consecutive patients presenting with acute non-surgical perforations or postoperative anastomotic leaks or perforations underwent attempted OTSC placement as primary closure method after interdisciplinary consensus in three tertiary referral centres. Their clinical data and intervention characteristics were evaluated in an intention to treat analysis during a 24-month period to assess closure rates, 30-day mortality, hospitalization and comorbidity. RESULTS: In total, 34 patients (16 females, 18 males, 69.5 years) were included with 22 non-surgical perforations and 12 postoperative anastomotic leaks or perforations. Definitive closure of the perforations and leaks was achieved in 26/34 patients (76.5 %). Successful closure of the GI wall defect resulted in a significantly shorter hospital stay (8 days, p = 0.03) and was significantly correlated with comorbidity (r = 0.56, p = 0.005). In the group with OTSC failure, hospitalization was 18 days and 6 of 8 patients (75 %) required immediate surgery. Three deaths occurred in the group with successful OTSC closure due to comorbidity, while one death in the OTSC failure group was related to a refractory perforation. Favourable indications and locations for a successful OTSC procedure were identified as PEG complications, endoscopic or postoperative leaks of stomach, colon or rectum, respectively. CONCLUSIONS: In unselected patients, OTSC was effective for closure of acute GI wall defects in more than 75 % of all patients. Clinical success and short hospitalization were best achieved in patients without comorbidity, but closure of the perforation or the anastomotic leak was found to be not the only parameter relevant for patient outcome and mortality.

High-definition endoscopy with iScan and Lugol's solution for the detection of inflammation in patients with nonerosive reflux disease: histologic evaluation in comparison with a control group.

Nonerosive reflux disease (NERD) is commonly diagnosed in patients with symptoms of reflux. The aim of the present study was to determine whether high-definition endoscopy (HD) plus equipped with the iScan function or chromoendoscopy with Lugol's solution might permit the differentiation of NERD patients from those without reflux symptoms, proven by targeted biopsies of endoscopic lesions. A total of 100 patients without regular intake of proton pump inhibitors and with a normal conventional upper endoscopy were prospectively divided into NERD patients and controls. A second upper endoscopy was performed using HD+ with additional iScan function and then Lugol's solution was applied. Biopsy specimens were taken from the gastroesophageal junction in all patients. A total of 65 patients with reflux symptoms and 27 controls were included. HD(+) endoscopy with iScan revealed subtle mucosal breaks in 52 patients; the subsequent biopsies confirmed esophagitis in all cases. After Lugol's solution, 58 patients showed mucosal breaks. Sensitivity for the iScan procedure was 82.5%, whereas that for Lugol's solution was 92.06%. Excellent positive predictive values of 100% and 98.3%, respectively, were noted. The present study suggests that the majority of patients with NERD and typical symptoms of reflux disease can be identified by iScan or Lugol's chromoendoscopy as minimal erosive reflux disease (ERD) patients.

Comparison of Acoustic Radiation Force Impulse (ARFI) Elastography Measurements with the 4C1 Transducer to the 6C1HD Transducer: A Phantom and Patient Study.

Purpose: The aim of this study was to evaluate whether acoustic radiation force impulse (ARFI) elastography done with the 4C1 probe yields comparable results to the recently introduced 6C1HD probe. Materials and Methods: Measurements with the 4C1 and 6C1HD probes (Acuson S2000) were performed and compared in four different inclusions of an elasticity phantom model (QA049 CIRS) as well as in the liver of healthy individuals and patients with liver cirrhosis. Results: Measurements with the 6C1HD probe were slightly higher in all phantom inclusions (8, 14, 45, 80kPA) with a mean of 1.48 m/s (95 %-CI; 1.47 - 1.49), 2.18 m/s (95 %-CI; 2.17 - 2.19), 3.61 m/s (95 %-CI; 3.57 - 3.64) and 4.34 m/s (95 %-CI; 4.29 - 4.39) compared to the 4C1 transducer with 1.46 m/s (95 %-CI; 1.45 - 1.47), 2.15 m/s (95 %-CI; 2.14 - 2.16), 3.39 m/s (95 %-CI; 3.37 - 3.41) and 3.98 m/s (95 %-CI; 3.75 - 4.21), respectively (p = 0.04, p < 0.01, p < 0.01, p < 0.01). Cirrhotic patients (n = 40) had a higher mean shear wave speed with 3.00 m/s (95 %-CI; 2.80 - 3.21) with the 6C1HD transducer compared to 2.81 m/s (95 %-CI; 2.64 - 2.99) with the 4C1 transducer (p = 0.03). Healthy individuals (n = 20) had a mean shear wave speed of 1.12 m/s (95 %-CI; 1.06 - 1.17) with the 6C1HD probe and 1.12 m/s (95 %-CI; 1.05 - 1.19) with the 4C1 probe (p = 0.96). Conclusion: ARFI values assessed with a 6C1HD transducer are slightly higher than measurements with a 4C1 transducer in an ARFI phantom and in patients with liver cirrhosis. As the difference is small, current cut-off values keep their usefulness but should be interpreted with caution if measurements are close to the cut-off.

LI-RADS-CEUS - Proposal for a Contrast-Enhanced Ultrasound Algorithm for the Diagnosis of Hepatocellular Carcinoma in High-Risk Populations.

Purpose: To develop a contrast-enhanced ultrasound algorithm (LI-RADS-CEUS = liver imaging reporting and data system with contrast-enhanced ultrasound) for the diagnosis of hepatocellular carcinoma (HCC) in patients at risk. Materials and Methods: A CEUS algorithm (LI-RADS-CEUS) was designed analogously to CT- and MRI-based LI-RADS. LI-RADS-CEUS was evaluated retrospectively in 50 patients at risk with confirmed HCC or non-HCC lesions (test group) with subsequent validation in a prospective cohort of 50 patients (validation group). Results were compared to histology, CE-CT and CE-MRI as reference standards. Results: Tumor diagnosis in the test group/validation group (n = 50/50) were 46/41 HCCs, 3/3 intrahepatic cholangiocellular carcinomas (ICCs) and 1/6 benign lesions. The diagnostic accuracy of LI-RADS-CEUS for HCC, ICC and non-HCC-non-ICC-lesions was 89 %. For the diagnosis of HCC, the diagnostic accuracy was 93.5 % (43/46 cases) in the test group and 95.1 % (39/41 cases) in the validation group. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 94.3 %, 66.6 %, 94.3 % and 66.6 %, respectively (mean values from both cohorts). Histological findings of HCC were available in 40 versus 23 cases (in total: G1 / G2/G3: 15/35/13). Arterial hyperenhancement was seen in 68/87 (78.2 %) of HCCs. Arterial hyperenhancement with subsequent portal venous or late phase hypoenhancement was seen in 66 % of HCCs. Conclusion: LI-RADS-CEUS offers a CEUS algorithm for standardized assessment and reporting of focal liver lesions in patients at risk for HCC. Arterial hyperenhancement in CEUS is the key feature for the diagnosis of HCC in patients at risk, whereas washout is not a necessary prerequisite.

Quantitative perfusion analysis in pancreatic contrast enhanced ultrasound (DCE-US): a promising tool for the differentiation between autoimmune pancreatitis and pancreatic cancer.

In the work-up of focal pancreatic lesions autoimmune pancreatitis (AIP) is a rare differential diagnosis to pancreatic cancer (PC) with similar clinical constellations. The aim of our study was to compare differences between proven AIP and PC using transabdominal dynamic contrast enhanced ultrasound (DCE-US). Therefore we recorded 3-minute-clips of CEUS examinations and analyzed perfusion parameters with VueBox®-quantification software. To obtain DCE-US Parameters, Regions-of-Interest were selected within the lesions and the surrounding pancreas parenchyma, serving as reference tissue. We compared 3 patients with AIP (mean age: 58 years; lesion mean size: 40 mm) to 17 patients with PC (mean age: 68 years; lesion mean size: 35.9 mm). Significant differences between PC and parenchyma could be found in the following parameters: Peak-Enhancement (PE), Wash-in-and-Wash-out-AUC, Wash-in Perfusion-Index. PE of AIP was comparable to normal parenchyma. The relation of PE between parenchyma and lesion (ΔPE) AIP and PC was significantly different [AIP: 0.21 (±0.06); PC: 0.81 (±0.1); p<0.01]. PE of neoplastic lesions was significantly lower as AIP and normal parenchyma (p<0.01). Therefore perfusion analysis in DCE-US can help to differentiate hypovascular PC from AIP presenting nearly isovascular time intensity curves. Diagnostic accuracy of DCE-US in this setting has to be validated in future prospective studies in comparison to CT and MRI.

CEUS in hepatocellular carcinoma and intrahepatic cholangiocellular carcinoma in 320 patients - early or late washout matters: a subanalysis of the DEGUM multicenter trial.

PURPOSE: The aim of the study was the comparison of tumor vascularization and contrast enhancement in contrast-enhanced ultrasound (CEUS) for the characterization of hepatocellular carcinoma (HCC) and intrahepatic cholangiocellular carcinoma (ICC). We present data of the subpopulations HCC and ICC examined in the DEGUM multicenter trial for the characterization of focal liver lesions in clinical practice. MATERIALS AND METHODS: Based on the data of the DEGUM multicenter trial (1349 patients), all patients with histologically proven HCC (n = 278) and ICC (n = 42) were analyzed. The vascularity pattern and contrast enhancement pattern during the arterial, portal-venous and late phase were compared. RESULTS: An underlying liver cirrhosis was found in 214/278 patients with HCC (76.9 %) and 7/42 patients with ICC (16.7 %). In CEUS, HCC showed a global arterial hyperenhancement compared to ICC (HCC: tumor center: 60.3 %; tumor periphery: 75 %; ICC: tumor center: 16.7 %; tumor periphery: 40.5 %). ICC showed an initial contrast enhancement primarily at the tumor periphery (ICC: 85.7 % vs. HCC: 61 %) followed by an early portal-venous contrast washout in the tumor center (ICC: 85.8 % vs. HCC: 49.8 %) and tumor periphery (ICC: 66.7 % vs. HCC: 32.6 %). HCC showed a delayed contrast washout (late phase hypoenhancement: HCC: 75 % vs. ICC: 92.9 %). CONCLUSION: ICCs are rare in cirrhotic livers. CEUS can demonstrate differences in the vascularization patterns between HCC and ICC. HCC showed an arterial global hyperenhancement and delayed contrast washout in the late phase. ICCs are characterized by an arterial contrast enhancement at the tumor periphery with early contrast washout of the vascularized parts of the lesions in the portal-venous and late phase.

Prospective Evaluation of Acoustic Radiation Force Impulse (ARFI) Elastography and High-Frequency B-Mode Ultrasound in Compensated Patients for the Diagnosis of Liver Fibrosis/Cirrhosis in Comparison to Mini-Laparoscopic Biopsy.

PURPOSE: Ultrasound is a well-established noninvasive test for assessing patients with liver disease. This study aims to prospectively compare ultrasound to the new technique elastography (ARFI) for the assessment of liver fibrosis/cirrhosis. MATERIALS AND METHODS: High-frequency B-mode ultrasound (liver surface/vein irregularity, liver homogeneity, spleen size), ARFI quantification, mini-laparoscopic liver evaluation including biopsy were prospectively obtained in compensated patients scheduled for liver biopsy. For the diagnosis of cirrhosis, a combined gold standard (cirrhosis at histology and/or at macroscopic liver evaluation) was used. RESULTS: Out of 157 patients, 35 patients were diagnosed cirrhotic. Ultrasound (combination of liver vein and/or surface irregularity) showed no significant difference compared to ARFI quantification for the diagnosis of significant liver fibrosis (Ishak> = 3) and cirrhosis. Diagnosis of cirrhosis had a sensitivity/specificity/PPV/NPV of 83 %(±â€Š12) / 82 %(±â€Š7) / 57 %(±â€Š14) / 94 %(±â€Š4), respectively, with ultrasound and 86 %(±â€Š12) / 81 %(±â€Š7) / 57 %(±â€Š13) / 95 %(±â€Š4), respectively, with ARFI quantification. The sensitivity/specificity/PPV/NPV for the detection of significant fibrosis were 68 %(±â€Š13) / 86 %(±â€Š7) / 71 %(±â€Š13) / 84 %(±â€Š7), respectively, for ultrasound and 70 %(±â€Š12) / 84 %(±â€Š7) / 69 %(±â€Š12) / 84 %(±â€Š7), respectively, for ARFI quantification. CONCLUSION: ARFI elastography and high-frequency B-mode ultrasound show similar and good results for the diagnosis of compensated liver cirrhosis and high-grade fibrosis. A key benefit of both methods is the high NPV suggesting them as noninvasive exclusion tests.

Outcome analysis of liver stiffness by ARFI (acoustic radiation force impulse) elastometry in patients with chronic viral hepatitis B and C.

AIM: To evaluate the association between liver stiffness measured by acoustic radiation force impulse (ARFI) elastometry and the outcome of antiviral treatment in patients with chronic viral hepatitis B and C. MATERIALS AND METHODS: Thirty-eight patients with chronic viral hepatitis B (n = 16) or hepatitis C (n = 22) underwent liver biopsy and ARFI elastometry of the right hepatic lobe. A follow-up assessment using ARFI was performed a mean of 2.3 years after the baseline evaluation. The patients with favourable outcome were classified in group S and those receiving no treatment, showing no response to treatment, or experiencing a relapse were classified in group N. RESULTS: The 38 patients had an initial mean ARFI value of 1.56 ± 0.62 m/s as compared with 1.54 ± 0.64 m/s in the follow-up evaluation. Group S showed a significant decline in ARFI values (1.55 ± 0.60 m/s versus 1.34 ± 0.47 m/s; p < 0.05) and included 16 (64%) patients with lower shear wave velocities at follow-up. In group N, liver stiffness values showed a slight but not significant increase (1.57 ± 0.70 m/s versus 1.93 ± 0.77 m/s). CONCLUSION: Changes in liver stiffness during antiviral therapy can be assessed by ARFI reflecting response or no response. ARFI elastometry is an additional, useful tool for the follow-up assessment of treatment outcome in patients with chronic viral hepatitis B or C infection.

Liver stiffness assessed by acoustic radiation force impulse (ARFI) technology is considerably increased in patients with cholestasis.

PURPOSE: To explore the impact of cholestasis on liver stiffness assessed by acoustic radiation force impulse (ARFI) technology. MATERIALS AND METHODS: Over a period of four months, patients with sonographic cholestasis and increased cholestatic blood values (Bilirubin, γGT, AP > 2 times ULN) scheduled for endoscopic therapy were recruited. Exclusion criteria were: known liver disease; signs of cirrhosis at ultrasound (irregular liver veins and/or surface); heart insufficiency (NYHA III-VI). ARFI (Siemens S2000), ultrasound and blood examinations were performed before and in a subgroup after successful biliary drainage. RESULTS: In total, 21 patients with cholestasis were included in the study. ARFI measurements were above the cut-off for cirrhosis (1.8  m/s) in all patients with a mean of 2.91  m/s ±â€Š0.89  m/s without a history or signs of cirrhosis. Bilirubin, γGT and AP were elevated on average to 9.7 ±â€Š5.3  mg/dl, 1192 ±â€Š960  U/l and 730 ±â€Š389  U/l. A subgroup of 10 patients was measured after successful drainage. ARFI measurements declined in all patients of that subgroup on average by 0.76  m/s at a mean time interval of 4.5 days (p < 0.001). CONCLUSION: Cholestasis significantly increases liver stiffness assessed by ARFI. Therefore, it is important to exclude profound cholestasis when using ARFI for evaluating patients for liver fibrosis.

Postinterventional pain and complications of sonographically guided interventions in the liver and pancreas.

PURPOSE: Sonographically guided interventions in abdominal organs are routine procedures with rare severe complications. However, potential patient discomfort or pain is frequently not addressed in the literature. MATERIALS AND METHODS: In a prospective 1-year study, the peri- and postinterventional pain of patients undergoing sonographically guided punctures of the liver and pancreas was analyzed. Data acquisition was done with a standardized questionnaire. This included three numeric rating scales (NRS) ranging from "0" to "10" to be answered at puncture and 1 hour and 4 hours later. Data concerning complications and administered analgesic medication was acquired from the patients' charts. RESULTS: 223/274 patients could be analyzed (83 %). 91 women (40.8 %) and 132 men (59.2 %) were included. The mean age was 56.0 yrs. Overall the average level of pain was 2.98  at puncture, 1.21 after 1 hour and 0.71 after 4 hours. In patients with diagnostic biopsies, the pain levels were 3.37(0  h)/1.33(1  h)/0.71(4  h) for liver parenchyma, 2.64(0  h)/0.95(1  h)/0.65(4  h) for focal liver lesions and 3.1(0  h)/1.9(1  h)/1.1(4  h) for pancreatic punctures. The pain levels at therapeutic interventions were 3.00(0  h)/2.00(1  h)/0.50(4  h). Female and younger (< 50 yrs) patients had statistically significantly more pain at puncture and 1 hour postintervention. Only minor complications occurred (0.9 %). CONCLUSION: Severe pain after sonographically guided interventions is rare. Most patients suffer only from mild pain postinterventionally.

Dynamic contrast-enhanced ultrasound (DCE-US) for the characterization of hepatocellular carcinoma and cholangiocellular carcinoma.

PURPOSE: In a prospective study, we compared the different perfusion kinetics of HCC and ICC using dynamic contrast-enhanced ultrasound (DCE-US). MATERIALS AND METHODS: Patients with proven HCC and ICC were included. Three-minute video clips of CEUS examinations (CPS - low MI mode) after a bolus injection of 1.2 ml SonoVue were recorded and analyzed with quantification software (VueBox). Parameters for the arterial contrast enhancement [rise time (RT), time-to-peak (TTP)] towards portal venous contrast enhancement [mean transit time (local) (mTTl) and fall time (FT)] were quantified. Furthermore, contrast wash-out after peak enhancement (PE) (40 s, 80 s, 100 s and 120 s after PE) was compared between HCC and ICC. RESULTS: 43 patients with proven HCC (n = 23 HCC; cirrhosis n = 16) and ICC (n = 20 ICC; Cirrhosis n = 6) were examined. No statistical difference of the arterial DCEUS parameters was found between HCC and ICC. Contrast enhancement of the portal venous and late phases showed significantly lower values in the ICC group indicating early wash-out of the contrast agent: mTTl (p = 0.0209): HCC 118.4 s (SD±â€Š88.4); ICC 64.8 s (SD±â€Š49.7). FT (p = 0.0433): HCC 42.5 s (SD±â€Š27.7); ICC 27.7 s (SD±â€Š16.2). The percental loss of intensity at a definite time point after PE was significantly higher in ICC than in HCC lesions. CONCLUSION: DCE-US is able to detect and quantify differences in perfusion kinetics between HCC and ICC. Whereas arterial contrast enhancement patterns may overlap between HCC and ICC, a timed characterization of wash-out kinetics may offer an additional tool to characterize HCC and ICC. The presence of a rapid loss of signal intensity in the early portal venous phase is significantly higher in ICC than in HCC lesions.

Acoustic radiation force impulse (ARFI) and high-frequency ultrasound of the liver surface for the diagnosis of compensated liver cirrhosis.

PURPOSE: To evaluate the diagnostic value of acoustic radiation force impulse (ARFI) and high-frequency ultrasound of the liver surface, using histology as a gold standard for the diagnosis of compensated liver cirrhosis. MATERIALS AND METHODS: 73 patients without ascites undergoing liver biopsy were included in the study. The left and right liver lobes were examined with ARFI and high-frequency ultrasound. Liver surface irregularity was quantified using image analysis software to calculate the difference between the real surface and the approximated physiological surface through a 20 mm standardized line. RESULTS: There is a significant difference between cirrhotic and non-cirrhotic patients for both quantified liver surface (QLS) and ARFI (p < 0.001). The mean values for QLS of the left lobe were 0.71 ± 0.24 mm and 1.17 ±â€Š0.80 mm, of the right lobe 0.56 ±â€Š0.26 mm and 0.87 ±â€Š0.26 mm for non-cirrhotic and cirrhotic patients, respectively. The mean values of ARFI measurements of the left lobe were 2.04 ±â€Š0.76 m/s and 2.85 ±â€Š0.81 m/s, of the right lobe 1.65 ±â€Š0.61 m/s and 3.02 ±â€Š0.77 m/s for non-cirrhotic and cirrhotic patients, respectively. Diagnostic accuracy (AUROC) was 0.78/0.80 for QLS and 0.77/0.91 for ARFI of the left/right lobe, respectively. ARFI of the right lobe is significantly better than ARFI of the left (p = 0.023) or QLS of the left (p = 0.025)/right (p = 0.046) lobe of the liver. CONCLUSION: Assessment of liver surface irregularity by high-frequency ultrasound (QLS) is a useful diagnostic test for the assessment of compensated liver cirrhosis. ARFI of the right liver lobe is significantly better than high-frequency ultrasound (QLS of the left/right lobe of the liver) and ARFI of the left lobe of the liver.