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1.
Acta Gastroenterol Belg ; 84(1): 43-50, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33639692

RESUMEN

Background: Assessment of liver disease severity in chronic Hepatitis C (CHC) is essential both in pretreatment and posttreatment period. We assessed the impact of direct-acting antiviral therapy on liver stiffness regression measured by Vibration Controlled Transient Elastography (VCTE) in patients with CHC and evaluated the diagnostic performance of the APRI and FIB-4 scores compared to VCTE in detecting advanced fibrosis and cirrhosis (F3/F4). Methodology: Retrospective analysis of consecutive patients with CHC who underwent VCTE before and after DAA therapy was done. APRI and FIB-4 scores were compared to VCTE. Results: 88 (56.78%) patients-12 (F3) and 76 (F4) according to VCTE, had advanced fibrosis pretreatment, which reduced to 69 (44.52%) - 10 (F3) and 59 (F4) after 12 weeks DAA therapy. Significant reduction in VCTE value from 14.08 ± 9.05 KPa to 11.84 ± 8.31 KPa (p=0.002) was noted. There is significant reduction in APRI, FIB-4 and GUCI score posttreatment which was not the case with Lok score and Bonacini score. Before therapy, FIB-4 outperformed others to predict advanced fibrosis with score >2.13 (AUC 0.93), having sensitivity 76%, specificity 96% and accuracy 86%. However posttreatment, APRI and GUCI score performed best to predict F3/F4 fibrosis with score >0.63 (AUC 0.97) and >0.64 (AUC 0.96), having sensitivity, specificity and accuracy of 85%, 96.6% and 92% ; 85%, 6.6% and 92% respectively. Conclusion: Before therapy, FIB-4 had the best accuracy in predicting advanced fibrosis whereas APRI and GUCI score were the best indices post-treatment.


Asunto(s)
Diagnóstico por Imagen de Elasticidad , Hepatitis C Crónica , Antivirales , Aspartato Aminotransferasas , Biomarcadores , Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/tratamiento farmacológico , Humanos , Cirrosis Hepática/diagnóstico por imagen , Estudios Retrospectivos , Vibración
2.
Medicine (Baltimore) ; 100(4): e23636, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530167

RESUMEN

BACKGROUND: Early stage of cirrhosis is of great value in the diagnosis and management in patients with chronic liver disease (CLD). Recent studies have shown that quantitative liver surface nodularity (LSN) score based on imaging techniques can be used to predict the early cirrhosis stage noninvasively, with varied diagnostic accuracy and limited sample size. Hence, this study will evaluate the diagnostic accuracy of LSN in the prediction of early cirrhosis. METHODS: We will conduct a comprehensive search in PubMed, Web of Science, Cochrane Library, and Chinese biomedical databases to identify eligible studies. The literature screening, data extraction, data analysis, and quality assessment will then be carried out. The summary receiver-operating-characteristic (ROC) and pooled sensitivity, specificity will be calculated to summarize the diagnostic performance of LSN using a random-effect model. A meta-regression analysis will be performed to investigate the underlying cause of the heterogeneity. RESULTS: This study will evaluate the diagnostic accuracy of LSN score in the identification of early cirrhosis, which may further determine whether this method can be used as an alternative in the assessment of CLD patients. CONCLUSIONS: This study will help to determine the diagnostic accuracy and summarize the recent evidence on this issue. STUDY REGISTRATION: INPLASY2020100096.


Asunto(s)
Cirrosis Hepática/diagnóstico por imagen , Hepatopatías/diagnóstico por imagen , Biomarcadores/análisis , Enfermedad Crónica , Humanos , Hígado/diagnóstico por imagen , Hígado/patología , Cirrosis Hepática/etiología , Hepatopatías/complicaciones , Metaanálisis como Asunto , Valor Predictivo de las Pruebas , Curva ROC , Proyectos de Investigación , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Revisiones Sistemáticas como Asunto
3.
Am J Clin Nutr ; 113(3): 593-601, 2021 03 11.
Artículo en Inglés | MEDLINE | ID: mdl-33515016

RESUMEN

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is the most prevalent liver disease in the United States. Food-insecure individuals often depend on low-cost, energy-dense but nutritionally poor foods, resulting in obesity and chronic diseases related to NAFLD. OBJECTIVES: To determine whether food insecurity is associated with NAFLD in a cohort of HIV and hepatitis C virus (HCV) infected and uninfected adults. METHODS: We conducted a cross-sectional analysis of low-income, middle-aged adults from the Miami Adult Studies on HIV (MASH) cohort without a history of excessive alcohol consumption. Food security was assessed with the USDA's Household Food Security Survey. MRIs were used to assess liver steatosis and fibrosis. Metabolic parameters were assessed from fasting blood, anthropometrics, and vitals. RESULTS: Of the total 603 participants, 32.0% reported food insecurity. The prevalences of NAFLD, fibrosis, and advanced fibrosis were 16.1%, 15.1%, and 4.6%, respectively. For every 5 kg/m2 increase in BMI, the odds of NAFLD increased by a factor of 3.83 (95% CI, 2.37-6.19) in food-insecure participants compared to 1.32 (95% CI, 1.04-1.67) in food-secure participants. Food insecurity was associated with increased odds for any liver fibrosis (OR, 1.65; 95% CI, 1.01-2.72) and advanced liver fibrosis (OR, 2.82; 95% CI, 1.22-6.54), adjusted for confounders. HIV and HCV infections were associated with increased risks for fibrosis, but the relationship between food insecurity and liver fibrosis did not differ between infected and uninfected participants. CONCLUSIONS: Among low-income, middle-aged adults, food insecurity exacerbated the risk for NAFLD associated with a higher BMI and independently increased the risk for advanced liver fibrosis. People who experience food insecurity, particularly those vulnerable to chronic diseases and viral infections, may be at increased risk for liver-related morbidity and mortality. Improving access to adequate nutrition and preventing obesity among low-income groups may lessen the growing burden of NAFLD and other chronic diseases.


Asunto(s)
Infecciones por VIH/complicaciones , VIH-1 , Cirrosis Hepática/diagnóstico por imagen , Enfermedad del Hígado Graso no Alcohólico/diagnóstico por imagen , Pobreza , Estudios Transversales , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Factores de Riesgo
4.
AJR Am J Roentgenol ; 216(3): 659-668, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33474981

RESUMEN

OBJECTIVE. The purpose of this study was to evaluate the utility of laboratory and CT metrics in identifying patients with high-risk nonalcoholic fatty liver disease (NAFLD). MATERIALS AND METHODS. Patients with biopsy-proven NAFLD who underwent CT within 1 year of biopsy were included. Histopathologic review was performed by an experienced gastrointestinal pathologist to determine steatosis, inflammation, and fibrosis. The presence of any lobular inflammation and hepatocyte ballooning was categorized as nonalcoholic steatohepatitis (NASH). Patients with NAFLD and advanced fibrosis (stage F3 or higher) were categorized as having high-risk NAFLD. Aspartate transaminase to platelet ratio index and Fibrosis-4 (FIB-4) laboratory scores were calculated. CT metrics included hepatic attenuation, liver segmental volume ratio (LSVR), splenic volume, liver surface nodularity score, and selected texture features. In addition, two readers subjectively assessed the presence of NASH (present or not present) and fibrosis (stages F0-F4). RESULTS. A total of 186 patients with NAFLD (mean age, 49 years; 74 men and 112 women) were included. Of these, 87 (47%) had NASH and 112 (60%) had moderate to severe steatosis. A total of 51 patients were classified as fibrosis stage F0, 42 as F1, 23 as F2, 37 as F3, and 33 as F4. Additionally, 70 (38%) had advanced fibrosis (stage F3 or F4) and were considered to have high-risk NAFLD. FIB-4 score correlated with fibrosis (ROC AUC of 0.75 for identifying high-risk NAFLD). Of the individual CT parameters, LSVR and splenic volume performed best (AUC of 0.69 for both for detecting high-risk NAFLD). Subjective reader assessment performed best among all parameters (AUCs of 0.78 for reader 1 and 0.79 for reader 2 for detecting high-risk NAFLD). FIB-4 and subjective scores were complementary (combined AUC of 0.82 for detecting high-risk NAFLD). For NASH assessment, FIB-4 performed best (AUC of 0.68), whereas the AUCs were less than 0.60 for all individual CT features and subjective assessments. CONCLUSION. FIB-4 and multiple CT findings can identify patients with high-risk NAFLD (advanced fibrosis or cirrhosis). However, the presence of NASH is elusive on CT.


Asunto(s)
Enfermedad del Hígado Graso no Alcohólico/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Aspartato Aminotransferasas/análisis , Femenino , Humanos , Hígado/diagnóstico por imagen , Cirrosis Hepática/diagnóstico por imagen , Cirrosis Hepática/patología , Masculino , Persona de Mediana Edad , Enfermedad del Hígado Graso no Alcohólico/patología , Recuento de Plaquetas , Curva ROC , Estudios Retrospectivos , Bazo/diagnóstico por imagen
5.
Life Sci ; 269: 119086, 2021 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-33476634

RESUMEN

AIM: To evaluate the diagnostic performance of combining 18F-2-fluoro-2-D-deoxyglucose-positron emission tomography (18F-FDG PET) and gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) for liver fibrosis staging. MATERIALS AND METHODS: Male New Zealand white rabbits (n = 48) were treated with carbon tetrachloride (CCl4) to induce liver fibrosis, while control group rabbits (n = 8) received normal saline. The liver tissues of rabbits were histopathologically examined (classified according to the METAVIR classification system) for liver fibrosis staging and real-time polymerase chain reaction (RT-PCR) was used to ensure diagnostic accuracy. Integrated PET/MRI was performed. The mean standardised uptake value (SUVmean) and relative enhancement (RE) were evaluated for different liver fibrosis stages using a Mann-Whitney U test. The performance of PET/MRI was evaluated by using the receiver operating characteristic curve (ROC) and the area under the ROC curve (AUC). KEY FINDINGS: In total, 10, 16, and 8 rabbits classified into no fibrosis (F0), mild fibrosis (F1-2), and severe fibrosis (F3-4) categories, respectively. There were significant differences in SUVmean and RE between F0 and F3-4 and between F1-2 and F3-4 (p < 0.01), but no significance between F0 and F1-2 (p > 0.5). Combined SUVmean and RE performed well in staging liver fibrosis, with AUC of 0.8 for F0 or greater, 0.744 for F0 or F1-2, 0.945 for F1-2 or F3-4, and 0.962 for F3-4. SIGNIFICANCE: Combining SUVmean and RE provides high accuracy for grading liver fibrosis, especially in the differentiation between F1-2 and F3-4. 18F-FDG and Gd-EOB-DTPA-enhanced PET/MRI could be a non-invasive diagnostic method to guide the selection of clinical treatment options.


Asunto(s)
Fluorodesoxiglucosa F18/farmacocinética , Gadolinio DTPA/farmacocinética , Cirrosis Hepática/patología , Imagen por Resonancia Magnética/métodos , Tomografía de Emisión de Positrones/métodos , Radiofármacos/farmacocinética , Animales , Tetracloruro de Carbono/toxicidad , Medios de Contraste , Cirrosis Hepática/inducido químicamente , Cirrosis Hepática/diagnóstico por imagen , Cirrosis Hepática/metabolismo , Masculino , Conejos , Distribución Tisular
6.
BMC Surg ; 21(1): 57, 2021 Jan 23.
Artículo en Inglés | MEDLINE | ID: mdl-33485329

RESUMEN

BACKGROUND: To determine the standard remnant liver volume (SRLV) threshold to avoid postoperative hepatic insufficiency inpatients in different stages of hepatic fibrosis who undergo right hemi-hepatectomy. METHODS: Data for 85 patients at our single medical center were analysed prospectively to examine whether the following factors differed significantly between those who experienced postoperative hepatic insufficiency and those who did not: height, prothrombin time, remnant liver volume, SRLV or hepatic fibrosis stage. RESULTS: Logistic regression showed SRLV and hepatic fibrosis stage to be independent risk factors for postoperative hepatic insufficiency. The threshold SRLV for predicting insufficiency was 203.2 ml/m2 across all patients [area under receiver operating characteristic curve (AUC) 0.778, sensitivity 66.67%, specificity 83.64%, p<0.0001), 193.8 ml/m2 for patients with severe hepatic fibrosis (AUC 0.938, sensitivity 91.30%, specificity 85.71%, p<0.0001), and 224.3 ml/m2 for patients with cirrhosis (AUC 0.888, sensitivity 100%, specificity 64.29%, p<0.0001). CONCLUSIONS: Right hemi-hepatectomy may be safer in Chinese patients when the standard remnant liver volume is more than 203.2 ml/m2 in the absence of hepatic fibrosis or cirrhosis, 193.8 ml/m2 in the presence of severe hepatic fibrosis or 224.3 ml/m2 in the presence of cirrhosis.


Asunto(s)
Carcinoma Hepatocelular , Hepatectomía/efectos adversos , Cirrosis Hepática , Neoplasias Hepáticas , Hígado , Adulto , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/cirugía , Simulación por Computador , Femenino , Hepatectomía/métodos , Insuficiencia Hepática/etiología , Insuficiencia Hepática/prevención & control , Humanos , Imagenología Tridimensional , Hígado/diagnóstico por imagen , Hígado/patología , Hígado/cirugía , Cirrosis Hepática/complicaciones , Cirrosis Hepática/diagnóstico por imagen , Cirrosis Hepática/patología , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Estudios Prospectivos , Estándares de Referencia , Valores de Referencia , Factores de Riesgo , Tomografía Computarizada por Rayos X
7.
Magn Reson Imaging ; 75: 9-20, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32926993

RESUMEN

Liver cirrhosis is a leading cause of death worldwide, with 1-year mortality rates of up to 57% in decompensated patients. Hepatocellular carcinoma (HCC) is the most common primary tumor in cirrhotic livers and the second leading cause of cancer-related mortality worldwide. Annually, up to 8% of patients with cirrhosis develop HCC. The diagnosis of HCC rarely requires histological confirmation: in fact, according to the most recent guidelines, the imaging features of HCC are almost always sufficient for a certain diagnosis. Thus, the role of the radiologist is pivotal because the accurate detection and characterization of focal liver lesions in patients with cirrhosis are essential in improving clinical outcomes. Despite recent technical innovations in liver imaging, several issues remain for radiologists regarding the differentiation of HCC from other hepatic lesions, particularly benign lesions and pseudolesions. It is important to avoid misdiagnosis of benign liver lesions as HCC (false-positive cases) because this diagnostic misinterpretation may lead to ineligibility of a patient for potentially curative treatments or inappropriate assignment of high priority scores to patients on waiting lists for liver transplantation. This review presents a pocket guide that could be useful for the radiologist in the diagnosis of benign lesions and pseudolesions in cirrhotic livers, highlighting the imaging features that help in making the correct diagnosis of macroregenerative nodules; siderotic nodules; arterioportal shunts; hemangiomas, including fast-filling hemangiomas, hemangiomas with pseudowashout, and sclerosed hemangiomas; confluent fibrosis; pseudomasses in chronic portal vein thrombosis; and focal fatty changes.


Asunto(s)
Diagnóstico por Imagen , Cirrosis Hepática/diagnóstico por imagen , Carcinoma Hepatocelular/diagnóstico por imagen , Diagnóstico Diferencial , Humanos , Neoplasias Hepáticas/diagnóstico por imagen
9.
Zhonghua Yi Xue Za Zhi ; 100(40): 3164-3168, 2020 Nov 03.
Artículo en Chino | MEDLINE | ID: mdl-33142400

RESUMEN

Objective: To evaluate the feasibility of transient elastography (FibroTouch) in obese children and to investigate the liver characteristics of obese children based on FibroTouch. Methods: Children (5-18 years of age) from the Guangzhou Women and Children's Medical Center were examined by FibroTouch. The fat attenuation parameter (FAP) was used to assess liver fat deposition, and liver stiffness measurement (LSM) was used to assess liver fibrosis. The children were divided into obesity group (n=67) and non-obesity group (n=139). The FAP, LSM, and their influencing factors were analysed in the obese group. Results: The total effective rate of FibroTouch in non-sedated children aged 5-18 years (n=229) was 97.8%. The FAP value 259.4 (235.9-275.5) dB/m in obese children was significantly higher than that in the control group 178.1 (168.7-195.6) dB/m, (Z=-10.586, P<0.001). The LSM value in obese children 5.9 (4.5-7.5) kPa was significantly higher than that in non-obese children 3.2 (2.3-4.1) kPa, (Z=-8.832, P<0.001). The proportion of liver fibrosis in obese group was 30%, and that of nonalcoholic fatty liver was 65.7%. Logistic regression analysis showed that BMI percentile (≥ 95%) was an independent factor for significant liver fibrosis (OR=1.267, 95%CI: 1.056-1.519, P=0.011) and nonalcoholic fatty liver disease (OR=1.248, 95%CI: 1.007-1.546, P=0.043). Conclusions: FibroTouch can be successfully applied to obese children. Fibrotouch can accurately evaluate the liver fibrosis and fat attenuation parameters in obese children. Obese children have higher FAP and LSM, which increase the risk of non-alcoholic fatty liver and liver fibrosis.


Asunto(s)
Diagnóstico por Imagen de Elasticidad , Enfermedad del Hígado Graso no Alcohólico , Adolescente , Niño , Preescolar , Femenino , Humanos , Hígado/diagnóstico por imagen , Cirrosis Hepática/diagnóstico por imagen , Cirrosis Hepática/patología , Enfermedad del Hígado Graso no Alcohólico/diagnóstico por imagen , Obesidad
10.
Rev. esp. enferm. dig ; 112(11): 826-831, nov. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-198765

RESUMEN

INTRODUCCIÓN: la calidad de la asistencia prestada a los pacientes cirróticos se puede medir analizando una serie de indicadores. Los estudios publicados hasta la actualidad muestran una tasa de adherencia a las indicaciones de las guías clínicas del 40-80 %. OBJETIVO: valorar la calidad de la asistencia prestada en un hospital docente de tercer nivel. MÉTODOS: estudio observacional retrospectivo en pacientes cirróticos controlados durante un semestre en consultas externas. Se han revisado 324 historias clínicas recogiendo 14 indicadores de calidad de cinco dominios diferentes y se ha estudiado la adherencia global y en relación a la experiencia del médico responsable. RESULTADOS: excelentes (más del 90 % de adherencia) en indicadores relacionados con documentación de la etiología de la cirrosis y profilaxis de la hemorragia digestiva por varices; aceptables (60-90 %) en despistaje del carcinoma hepatocelular y valoración de la gravedad de la enfermedad; y malos (menos del 50 %) en vacunaciones. Los residentes obtuvieron significativamente mejores resultados que los adjuntos en etiología, valoración de la gravedad y dos indicadores de profilaxis de hemorragia digestiva. Por su parte, los adjuntos presentaron mejores resultados en el despistaje de carcinoma hepatocelular. CONCLUSIONES: a pesar de haber obtenido excelentes resultados en algunos indicadores, muchos deben ser mejorados, especialmente las vacunaciones. La calidad asistencial prestada por los residentes es igual o incluso mejor que la prestada por los adjuntos. Analizar la calidad asistencial es esencial para medir y mejorar la atención prestada a los pacientes cirróticos, y puede ser una herramienta muy eficaz para supervisar a los especialistas en formación


No disponible


Asunto(s)
Humanos , Masculino , Femenino , Calidad de la Atención de Salud/estadística & datos numéricos , Cirrosis Hepática/terapia , Estudios Retrospectivos , Atención Terciaria de Salud , Garantía de la Calidad de Atención de Salud , Estadísticas no Paramétricas , Cirrosis Hepática/diagnóstico por imagen , Ultrasonografía , Endoscopía , Índice de Severidad de la Enfermedad , Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/terapia
11.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(9): 1109-1114, 2020.
Artículo en Inglés, Chino | MEDLINE | ID: mdl-33051426

RESUMEN

OBJECTIVES: To investigate volume changes of subcortical structures in patients with post-hepatitis B cirrhosis. METHODS: Thirty patients with post-hepatitis B cirrhosis (the cirrhosis group) and 24 age- and sex-matched healthy controls (the control group) were enrolled in this prospective study. All subjects underwent neuropsychological tests, blood biochemical determinations, and cerebral MRI. Volumes of 18 selected subcortical structures were automatically segmented and analyzed by the FreeSurfer. In the cirrhosis group, the relationships between abnormal subcortical volumes and clinical index or neurocognitive performance were investigated. The relationships between globus pallidus volumes and pallidal hyperintensity were also examined. RESULTS: Compared with the healthy controls, patients with post-hepatitis B cirrhosis displayed smaller bilateral putamen, amygdala, and nucleus accumbens volumes and larger bilateral globus pallidus volumes (P<0.001 or P=0.001). In the cirrhosis group, the volumes of left putamen and amygdala were negatively correlated with the number connection test-A (NCT-A)(left putamen r=-0.410, P=0.034; left amygdala r=-0.439, P=0.022), and the volumes of bilateral globus pallidus were positively correlated with pallidal index (PI) (left globus pallidus r=0.889, P<0.001; right globus pallidus r=0.900, P<0.001). CONCLUSIONS: Abnormalities of subcortical volumes appear bilaterally symmetrical in patients with post-hepatitis B cirrhosis. Atrophy of left putamen and amygdala might contribute to poor neurocognitive performance, and the manganese deposition might contribute to the increased globus pallidus volumes in patients with post-hepatitis B cirrhosis.


Asunto(s)
Hepatitis B , Imagen por Resonancia Magnética , Hepatitis B/complicaciones , Hepatitis B/diagnóstico por imagen , Humanos , Cirrosis Hepática/diagnóstico por imagen , Pruebas Neuropsicológicas , Estudios Prospectivos
12.
PLoS One ; 15(9): e0239624, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32986732

RESUMEN

Technologies for digitizing tissues provide important quantitative data for liver histopathology investigation. We aimed to assess liver fibrosis degree with quantitative morphometric measurements of histopathological sections utilizing digital image analysis (DIA) and to further investigate if a correlation with histopathologic scoring (Scheuer staging) exists. A retrospective study of patients with at least two post-liver transplant biopsies having a Scheuer stage of ≤ 2 at baseline were gathered. Portal tract fibrotic percentage (%) and size (µm2) were measured by DIA, while clinical fibrosis score was measured by the Scheuer system. Correlations between DIA measurements and Scheuer scores were computed by Spearman correlation analysis. Differences between mean levels of fibrosis (score, size, and percentage) at baseline versus second visit were computed by Student's t-test. P values < 0.05 were considered significant. Of 22 patients who met the study criteria, 54 biopsies were included for analysis. Average levels ±standard error [S.E.] of portal tract fibrotic percentage (%) and size (µm2) progressed from 46.5 ± 3.6% at baseline to 61.8 ± 3.8% at the second visit (P = 0.005 by Student's t-test), and from 28,075 ± 3,232 µm2 at base line to 67,146 ± 10,639 µm2 at the second visit (P = 0.002 by Student's t-test), respectively. Average levels of Scheuer fibrosis scores progressed from 0.55±0.19 at baseline to 1.14±0.26 at the second visit (P = 0.02 by Student's t-test). Portal tract fibrotic percentage (%) and portal tract fibrotic size were directly correlated with clinical Scheuer fibrosis stage, with Spearman correlation coefficient and P value computed as r = 0.70, P < 0.0001 and r = 0.41, P = 0.002, respectively. Digital quantitative assessment of portal triad size and fibrosis percentage demonstrates a strong correlation with visually assessed histologic stage of liver fibrosis and complements the standard assessment for allograft monitoring, suggesting the utility of future WSI analysis.


Asunto(s)
Procesamiento de Imagen Asistido por Computador/métodos , Cirrosis Hepática/diagnóstico por imagen , Trasplante de Hígado , Índice de Severidad de la Enfermedad , Adulto , Anciano , Biopsia , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Hepacivirus , Hepatitis C Crónica/cirugía , Hepatitis C Crónica/virología , Humanos , Cirrosis Hepática/patología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
13.
Clinics (Sao Paulo) ; 75: e1670, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32935822

RESUMEN

OBJECTIVES: Acoustic radiation force impulse (ARFI) elastography, the aspartate aminotransferase-to-alanine aminotransferase ratio (AAR), aspartate aminotransferase-to-platelet ratio index (APRI), and the fibrosis-4 (FIB-4) index are widely used to assess liver fibrosis. However, efficacies of these methods in the evaluation of hepatic functional reserve remain unclear. In this study, we investigated the relationship between ARFI elastography combined with either AAR, APRI, or FIB-4 index and Child-Pugh (CP) class for the evaluation of hepatic functional reserve in patients with chronic hepatitis B (CHB)-related cirrhosis. METHODS: The shear wave velocities of 104 patients with clinically confirmed CHB-related cirrhosis were determined using the ARFI; and clinical serum markers (e.g. ALT, AST, PLT) were used to calculate the AAR, APRI, and FIB-4 index. Cirrhosis patients were scored according to their CP class. The ARFI, AAR, APRI, and FIB-4 index were compared with the CP class. The efficacy of each indicator in diagnosis was analyzed using the receiver operating characteristic (ROC) curve and the ARFI combined with either the AAR, APRI, or FIB-4 index, which is used to predict decompensated cirrhosis. RESULTS: No significant differences were observed in gender and age among CP classes A, B, and C patients (p>0.05). The ARFI values and the AAR, APRI, and FIB-4 index of patients with CP classes A, B, and C were significantly different (p<0.05). With an increasing CP class, the ARFI, AAR, APRI, and FIB-4 values increased. The correlation between the ARFI and the CP class was stronger than that between the AAR, APRI, and FIB-4 index and the CP class. The area under the ROC curve for the diagnosis of decompensated cirrhosis using the ARFI was 0.841, which was higher than that for the AAR, APRI, and FIB-4 index. According to the area under the curve results, no significant differences were found when the ARFI was combined with either the AAR, APRI, or FIB-4 index and when the ARFI alone was used. CONCLUSIONS: The ARFI value has a strong correlation with the CP class. Therefore, ARFI elastography complements CP class in the assessment of the hepatic functional reserve in patients with CHB-related cirrhosis.


Asunto(s)
Acústica , Alanina Transaminasa/sangre , Aspartato Aminotransferasas/sangre , Diagnóstico por Imagen de Elasticidad , Cirrosis Hepática/patología , Biomarcadores/sangre , Biopsia , Niño , Diagnóstico por Imagen de Elasticidad/métodos , Femenino , Humanos , Hígado/patología , Cirrosis Hepática/sangre , Cirrosis Hepática/diagnóstico por imagen , Masculino , Valor Predictivo de las Pruebas , Curva ROC , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad
14.
Medicine (Baltimore) ; 99(33): e21387, 2020 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-32871988

RESUMEN

To investigate the estimated glomerular filtration rates of chronic hepatitis B (CHB) patients with or without liver cirrhosis, and to explore the related risk factors.A total of 559 CHB patients were enrolled. Liver cirrhosis was diagnosed with ultrasound. The Child-Pugh scoring system was used to stage patients with liver cirrhosis. The Modification of Diet in Renal Disease (MDRD) formula was used to calculate the estimated glomerular filtration rate (eGFR).A total of 296 patients were involved. The results showed that the incidence of renal impairment in patients with liver cirrhosis was 8.45% (25/296). The incidence of renal impairment in Child-Pugh C patients was significantly higher than that in Child-Pugh B and Child-Pugh Grade A patients (i.e., 17.2% [17/99] vs 6.67% [7/105] vs 1.09% [1/92], respectively, P < .001); age, hyperuricemia, and Child-Pugh score are all risk factors for impaired renal function.With the deterioration of liver function in patients with cirrhosis, the incidence of impaired renal function has increased significantly, and renal function should be closely monitored to guide patients in clinical medication.


Asunto(s)
Tasa de Filtración Glomerular , Hepatitis B Crónica/complicaciones , Cirrosis Hepática/complicaciones , Insuficiencia Renal/etiología , Adulto , Femenino , Humanos , Cirrosis Hepática/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Factores de Riesgo
15.
Indian J Gastroenterol ; 39(3): 253-260, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32833144

RESUMEN

BACKGROUND: Liver fibrosis is a frequent complication of chronic hepatitis C virus (HCV) infection. Its evaluation is very important for the prognosis of these patients. The aim of this study was to evaluate the possibility of exploiting the platelet to lymphocyte ratio and the neutrophil to lymphocyte ratio as non-invasive predictive markers of liver fibrosis. METHODS: We recruited 120 patients with chronic HCV infection. They were subjected to various clinical investigations to assess the severity of fibrosis. Transient elastography and some serological tests were performed, and the platelet to lymphocyte ratio and the neutrophil to lymphocyte ratio were estimated. RESULTS: Sixty-four patients had F4 fibrosis (defined by elastography) and their platelet to lymphocyte ratio (69.92 ± 26.47) was lower than in patients with non-F4 fibrosis (95.19 ± 48.15) (p = 0.001). The neutrophil to lymphocyte ratio was also estimated, but the difference between the 2 groups of patients was not significant statistically (p = 0.07). CONCLUSION: The platelet to lymphocyte ratio can be used as a predictive biomarker of liver fibrosis, unlike the neutrophil to lymphocyte ratio which is not predictive of this HCV-related chronic hepatitis complication. More studies are needed to validate this hypothesis.


Asunto(s)
Hepatitis C Crónica/complicaciones , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/etiología , Recuento de Linfocitos , Recuento de Plaquetas , Anciano , Biomarcadores/sangre , Diagnóstico por Imagen de Elasticidad/métodos , Femenino , Humanos , Recuento de Leucocitos , Cirrosis Hepática/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Neutrófilos , Valor Predictivo de las Pruebas
16.
PLoS One ; 15(8): e0236977, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32822391

RESUMEN

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is increasingly widespread with an overall global estimated prevalence of 25%. Type 2 diabetes Mellitus (T2DM) is a key contributor to NAFLD progression and predicts moderate-severe liver fibrosis and mortality. However, there is currently no uniform consensus on routine NAFLD screening among T2DM patients, and the risk factors of NAFLD and advanced fibrosis among T2DM patients remain to be clarified fully. AIM: We explored the prevalence, clinical spectrum, and risk factors of NAFLD and liver fibrosis among T2DM patients. METHODS: This is a cross-sectional study that enrolled subjects from a primary care clinic and a diabetes centre in Singapore. Subjects aged 21 to 70 years of all ethnic groups with an established T2DM diagnosis were included. Subjects with chronic liver diseases of other aetiologies were excluded. All subjects underwent transient elastography for hepatic steatosis and fibrosis assessment. Their demographics, anthropometric measurements and clinical parameters were collected. Statistical analysis was performed using STATA/SE16.0 software. RESULTS: Among 449 enrolled T2DM subjects, 436 with complete data and valid transient elastography results were analysed. Overall, 78.72% (344/436) of the T2DM subjects had NAFLD, of which 13.08% (45/344) had increased liver stiffness. Higher ALT level (OR = 1.08; 95% CI: 1.03-1.14; p = 0.004), obesity (BMI ≥ 27.5 kg/m2, OR = 2.64; 95% CI: 1.28-5.44; p = 0.008) and metabolic syndrome (OR = 4.36; 95% CI 1.40-13.58; p = 0.011) were independent factors associated with increased CAP (NAFLD). Higher AST level (OR = 1.06; 95% CI: 1.02-1.11; p = 0.008), CAP value (OR = 1.02; 95% CI: 1.00-1.03; p = 0.003), lower platelet count (OR = 0.99; 95% CI: 0.98-1.00; p = 0.009) and concomitant hypertension (OR = 4.56; 95% CI: 1.18-17.62; p = 0.028) were independent factors associated with increased liver stiffness. CONCLUSIONS: Our study demonstrated a considerably high prevalence of NAFLD among T2DM patients, with the proportion of advanced liver fibrosis among T2DM NAFLD patients much higher than the general population. Given that NAFLD is largely asymptomatic, increased awareness and vigilance for identifying NAFLD and increased liver stiffness among T2DM patients should be advocated.


Asunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Adulto , Anciano , Estudios Transversales , Diabetes Mellitus Tipo 2/diagnóstico por imagen , Diagnóstico por Imagen de Elasticidad , Femenino , Humanos , Cirrosis Hepática/complicaciones , Cirrosis Hepática/diagnóstico por imagen , Cirrosis Hepática/epidemiología , Masculino , Persona de Mediana Edad , Enfermedad del Hígado Graso no Alcohólico/diagnóstico por imagen , Enfermedad del Hígado Graso no Alcohólico/epidemiología , Prevalencia , Factores de Riesgo , Singapur/epidemiología , Adulto Joven
17.
Zhonghua Gan Zang Bing Za Zhi ; 28(7): 567-572, 2020 Jul 20.
Artículo en Chino | MEDLINE | ID: mdl-32791791

RESUMEN

Objective: To investigate the clinical and diagnostic value of liver stiffness measurement (LSM) for the evaluation and comparison of aspartate aminotransferas/platelet ratio index (APRI), fibrosis 4 indexes (FIB-4) and NAFLD fibrosis score (NFS) with liver fibrosis staging in relation to nonalcoholic fatty liver disease (NAFLD). Methods: 103 cases with NAFLD who met the inclusion criteria confirmed by liver biopsy were selected for retrospective analysis. The results of serological tests and LSM were recorded. The APRI, FIB-4 and NFS were calculated. The accuracy and applicability of four liver fibrosis models in the diagnosis of liver fibrosis in NAFLD patients were compared with the receiver operating characteristic curve (ROC), and the diagnostic cut-off value of LSM was established. Results: Varying degrees of LSM, APRI, FIB-4 and NFS had shown positive correlations with the increasing degree of liver fibrosis. Among them, LSM was positively correlated with the degree of liver fibrosis, and the correlation coefficient was r = 0.727, P < 0.0001. Consistent with this, the area under the receiver operating characteristic curve, sensitivity, and specificity of LSM diagnosis of liver fibrosis in different stages was significantly higher than APRI, FIB-4 and NFS. Area under receiver operating characteristic curve of LSM was 0.862 and 0.928 for significant liver fibrosis (f ≥ 2), and advanced liver fibrosis (f ≥ 3). Conclusion: LSM has a good diagnostic exclusion value for NAFLD-induced fibrosis, and its sensitivity and specificity are better than APRI, FIB-4 and NFS.


Asunto(s)
Cirrosis Hepática/patología , Hígado/patología , Enfermedad del Hígado Graso no Alcohólico , Humanos , Hígado/diagnóstico por imagen , Cirrosis Hepática/diagnóstico por imagen , Enfermedad del Hígado Graso no Alcohólico/diagnóstico por imagen , Enfermedad del Hígado Graso no Alcohólico/patología , Curva ROC , Estudios Retrospectivos
18.
J Vasc Interv Radiol ; 31(9): 1401-1407, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32792278

RESUMEN

PURPOSE: To assess the safety and feasibility of using a radiofrequency (RF) wire for portosystemic shunt creation. MATERIALS AND METHODS: Ten patients undergoing elective creation of a transjugular intrahepatic portosystemic shunt (TIPS) or a direct intrahepatic portosystemic shunt (DIPS) were prospectively enrolled. Primary outcomes were the safety and feasibility of RF wire used for the creation of TIPS and DIPS. Median age was 66.5 ± 6.1 years. Causes of liver disease included alcohol (n = 5), nonalcoholic steatohepatitis (n = 2), hepatitis C virus (n = 1), primary biliary cirrhosis (n = 1), autoimmune hepatitis (n = 1). The median score for model for end-stage liver disease was 11 ± 4.3. The Rosch-Uchida TIPS set was used with intravascular ultrasonography guidance in all cases. A 0.035-inch RF wire was used in lieu of the trocar needle through the 5-F TIPS set catheter to create a track between the hepatic vein and the portal vein. All shunts were created using stent grafts. RESULTS: Technical success rate was 100%. In 7 of 10 patients, portal vein access was achieved with a single pass. A DIPS was created in 2 patients based on anatomic favorability. Median fluoroscopy time was 13.3 ± 3.8 min, and median total procedure time was 102 ± 19 min. The wire passed through parenchyma without subjective deflection. There was 1 case of extracapsular puncture with no clinical consequence. The RF wire was too stiff to curve into the main portal vein, requiring wire exchange in all but 1 case. Mean portosystemic gradient decreased from 13.9 ± 3.3 to 5.9 ± 2.1 mm Hg. No immediate complications were encountered. Shunt patency was 100% at 30 days. CONCLUSIONS: Creation of TIPS and DIPS using an RF wire was safe and feasible, enabling creation of an intrahepatic track without subjective deflection in cirrhotic patients.


Asunto(s)
Catéteres , Cirrosis Hepática/cirugía , Derivación Portosistémica Intrahepática Transyugular/instrumentación , Ablación por Radiofrecuencia/instrumentación , Anciano , Estudios de Factibilidad , Femenino , Fluoroscopía , Humanos , Cirrosis Hepática/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Tempo Operativo , Derivación Portosistémica Intrahepática Transyugular/efectos adversos , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Ablación por Radiofrecuencia/efectos adversos , Radiografía Intervencional , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía Intervencional
19.
J Vasc Interv Radiol ; 31(8): 1256-1262.e3, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32654961

RESUMEN

PURPOSE: To evaluate feasibility, procedural outcomes, and safety aspects of implantation of the alfapump system for management of refractory ascites by interventional radiology (IR) methods. MATERIALS AND METHODS: The multicenter open-label prospective MOSAIC study included 29 patients (mean age 60.0 y ± 9.9; range, 32-72 y, 17 [56.7%] male) with cirrhotic refractory ascites who received an alfapump system implanted by IR. The fully subcutaneous alfapump system consists of a pump and 2 silicone catheters, whose distal ends are inserted in the peritoneum and the bladder, respectively. The device moves ascites from the peritoneum to the bladder, reducing the requirement of paracentesis. Pumped volume and speed can be customized as required. The implant procedure was performed under general or local anesthesia. Both catheters were placed under ultrasound guidance. The pump was inserted in a subcutaneous pocket on the upper abdomen. Incidence and severity of procedure-related serious adverse events up to 3 months after implantation were recorded. RESULTS: Technical success was achieved in 29 (100%) IR implant procedures. The pump was usually implanted on the right abdomen (76.7%). In 5 patients, deviation from the Instructions for Use was required. Adverse events (requirement of additional incisions, postoperative bleed) occurred in 3 patients. At 3 months after implantation, 3 possibly procedure-related serious adverse events (ascites leakage, bacterial peritonitis, postoperative bleeding) had occurred. Two explantations (2/29; 6.8%) (cellulitis, pump pocket infection) and 4 reinterventions (pump or catheter replacement) were required, corresponding to an adverse event incidence rate of 9/29 (31.0%). CONCLUSIONS: Placement of the alfapump using IR methods is both feasible and technically successful.


Asunto(s)
Ascitis/terapia , Catéteres , Drenaje/instrumentación , Suministros de Energía Eléctrica , Cirrosis Hepática/terapia , Radiografía Intervencional , Adulto , Anciano , Ascitis/diagnóstico por imagen , Ascitis/epidemiología , Canadá/epidemiología , Remoción de Dispositivos , Drenaje/efectos adversos , Diseño de Equipo , Estudios de Factibilidad , Femenino , Humanos , Incidencia , Cirrosis Hepática/diagnóstico por imagen , Cirrosis Hepática/epidemiología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios Prospectivos , Radiografía Intervencional/efectos adversos , Factores de Riesgo , Factores de Tiempo , Estados Unidos/epidemiología
20.
Clin Imaging ; 68: 143-147, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32615516

RESUMEN

Coagulopathy coupled with severe portal hypertension in the setting of cirrhosis increases the risk of mortality from variceal bleeding in pregnant women. Studies suggest transjugular intrahepatic portosystemic shunt (TIPS) creation to be a safe procedure during pregnancy in preventing variceal bleeding complications; however, it is not typically employed in severely decompensated cirrhosis. This case report of a pregnant woman presenting at 34.7 weeks' gestation demonstrates successful variceal mapping, emergent TIPS creation and variceal embolization to allow safe cesarean delivery despite severe hypofibrinogenemia and decompensated alcoholic cirrhosis. With careful medical optimization, angiographic imaging and vascular interventional radiology may be employed outside of usual indications to achieve safe pregnancy delivery and postpartum recovery.


Asunto(s)
Várices Esofágicas y Gástricas , Derivación Portosistémica Intrahepática Transyugular , Várices Esofágicas y Gástricas/complicaciones , Várices Esofágicas y Gástricas/diagnóstico por imagen , Várices Esofágicas y Gástricas/terapia , Femenino , Hemorragia Gastrointestinal/diagnóstico por imagen , Hemorragia Gastrointestinal/terapia , Humanos , Cirrosis Hepática/complicaciones , Cirrosis Hepática/diagnóstico por imagen , Embarazo , Tercer Trimestre del Embarazo , Radiología Intervencional , Resultado del Tratamiento
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