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1.
Eur Rev Med Pharmacol Sci ; 25(4): 2146-2151, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33660834

RESUMO

OBJECTIVE: COVID-19, the newly emerging infectious disease, has been associated with acute liver injury, often related to progression to severe pneumonia. The association between moderate-severe liver injury and more severe clinical course of COVID-19 has suggested that liver injury is prevalent in severe than in mild cases of COVID-19, while no difference in liver involvement has been reported between survivors and non-survivors. The spectrum of liver involvement during COVID-19 ranges from an asymptomatic elevation of liver enzymes to severe hepatitis. Only rarely, cases with acute hepatitis have been reported in the absence of respiratory symptoms. Both epithelial and biliary cells possess the angiotensin-converting enzyme-2 receptors that SARS-CoV-2 uses to be internalized. However, to our knowledge, no ultrastructural identification of the virus in liver cells has been reported to date. Here we provide evidence of SARS-CoV-2 in the liver of two patients, a 34-year-old woman and a 60-year-old man with COVID-19. PATIENTS AND METHODS: We investigated two patients with COVID-19 showing several virions within cytoplasmic vacuoles of cholangiocytes and in endothelial cells of hepatic sinusoids. In both patients, we performed histological and ultrastructural examinations by liver biopsy. After two months, both patients were free of symptoms, and the SARS-CoV-2 infection had resolved. RESULTS: Liver biopsy histological and ultrastructural examination showed liver injury and several virions within cytoplasmic vacuoles of cholangiocytes and in endothelial cells of hepatic sinusoids. CONCLUSIONS: Although most studies in COVID-19 have been focused on the lungs, recently, cholestatic liver pathology has been introduced in the spectrum of pathological changes related to COVID-19. To the best of our knowledge, those presented in this paper are the first images of hepatic SARS-CoV-2 infected liver cells. Our findings suggest a role for cholangiocytes and biliary structures in the COVID-19.


Assuntos
/complicações , Hepatopatias/complicações , Fígado/virologia , /isolamento & purificação , Adulto , Biópsia , /virologia , Células Epiteliais/virologia , Feminino , Humanos , Fígado/diagnóstico por imagem , Hepatopatias/diagnóstico por imagem , Hepatopatias/virologia , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Vírion/isolamento & purificação
2.
Am J Vet Res ; 82(4): 286-291, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33764829

RESUMO

OBJECTIVE: To evaluate stiffness of the liver parenchyma in healthy adult cats by means of point shear wave elastography (PSWE). ANIMALS: 18 client-owned adult (1- to 6-year-old) healthy cats. PROCEDURES: Echogenicity and echotexture of the liver parenchyma were assessed by means of conventional B-mode ultrasonography. The shear wave velocity (Vs) of the right and left portions of the liver were measured by means of PSWE. RESULTS: B-mode ultrasonography revealed no abnormalities in echotexture or echogenicity of the liver parenchyma in any cat. Mean (95% CI) Vs in the liver parenchyma was 1.46 m/s (1.36 to 1.55 m/s) for the right portion, 1.36 m/s (1.26 to 1.47 m/s) for the left portion, and 1.43 m/s (1.35 to 1.51 m/s) overall. The difference in mean Vs between the 2 portions of the liver was significant. No significant correlation was found between Vs and body weight or between Vs and the depth at which this variable was measured. CONCLUSIONS AND CLINICAL RELEVANCE: Quantitative PSWE of the liver was feasible in healthy adult cats. The obtained values for Vs may be useful for interpretation of and comparison with values measured in cats with liver disease. Additional research is needed to explore the potential usefulness of PSWE for diagnostic purposes.


Assuntos
Doenças do Gato , Técnicas de Imagem por Elasticidade , Hepatopatias , Animais , Peso Corporal , Gatos , Técnicas de Imagem por Elasticidade/veterinária , Fígado/diagnóstico por imagem , Hepatopatias/diagnóstico por imagem , Hepatopatias/veterinária , Reprodutibilidade dos Testes
3.
Medicine (Baltimore) ; 100(4): e23636, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530167

RESUMO

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.


Assuntos
Cirrose Hepática/diagnóstico por imagem , Hepatopatias/diagnóstico por imagem , Biomarcadores/análise , Doença Crônica , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Cirrose Hepática/etiologia , Hepatopatias/complicações , Metanálise como Assunto , Valor Preditivo dos Testes , Curva ROC , Projetos de Pesquisa , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Revisões Sistemáticas como Assunto
4.
Medicine (Baltimore) ; 100(3): e24243, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546044

RESUMO

RATIONALE: Hepatic splenosis or heterotopic auto-transplantation of spleen in the liver usually occurs after either spleen trauma or surgery. It is of great importance for the differential diagnosis of hepatic splenosis and other liver tumors because surgery is usually not needed if a diagnosis of splenosis is confirmed. PATIENT CONCERNS: Multiple hepatic masses were revealed by grayscale ultrasound in a 55-year-old man complaining of persistent colic in the upper abdomen after greasy food. DIAGNOSIS: Benign neoplasm with enlarged lymph node in the gastro-hepatic ligament was suspected by contrast enhanced US. The nature of the hepatic mass was undetermined by CECT. INTERVENTIONS: The lesions were surgically removed. OUTCOMES: Multiple splenic tissue implants in the liver and peritoneum were confirmed by pathology after surgery. The patient recovered well and was followed up for more than 1 year without recurrence. LESSONS: Splenosis should be included in the differential diagnosis of focal liver lesion in patients with a history of spleen trauma or surgery. In spite of nonspecific findings on pre-contrast ultrasound, splenosis shows characteristic homogeneous hyperenhancement in arterial and portal phases, as well as prolonged hyperenhancement in the late phase for more than 5 minutes. Furthermore, the confidence of the diagnosis of splenosis may be enhanced by identifying multiple masses with similar enhancing patterns in other regions of the abdominal cavity.


Assuntos
Coristoma/diagnóstico por imagem , Hepatopatias/diagnóstico por imagem , Baço , Humanos , Masculino , Pessoa de Meia-Idade , Fosfolipídeos , Hexafluoreto de Enxofre , Ultrassonografia
5.
PLoS One ; 16(2): e0244781, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33606703

RESUMO

PURPOSE: This study was conducted to evaluate the role of liver sonography in patients with coronavirus disease 2019 (COVID-19) and elevated liver enzymes. MATERIALS AND METHODS: In this retrospective study, patients tested positive for SARS-CoV-2 in our emergency ward between January 01 and April 24, 2020 and elevated liver enzymes were included (Cohort 1). Additionally, the local radiology information system was screened for sonographies in COVID-19 patients at the intensive care unit in the same period (Cohort 2). Liver sonographies and histologic specimen were reviewed and suspicious findings recorded. Medical records were reviewed for clinical data. Ultrasound findings and clinical data were correlated with severity of liver enzyme elevation. RESULTS: Cohort 1: 126 patients were evaluated, of which 47 (37.3%) had elevated liver enzymes. Severity of liver enzyme elevation was associated with death (p<0.001). 8 patients (6.3%) had suspicious ultrasound findings, including signs of acute hepatitis (n = 5, e.g. thickening of gall bladder wall, hepatomegaly, decreased echogenicity of liver parenchyma) and vascular complications (n = 4). Cohort 2: 39 patients were evaluated, of which 14 are also included in Cohort 1. 19 patients (48.7%) had suspicious ultrasound findings, of which 13 patients had signs of acute hepatitis and 6 had vascular complications. Pathology was performed in 6 patients. Predominant findings were severe cholestasis and macrophage activation. CONCLUSION: For most hospitalized COVID-19 patients, elevated liver enzymes cause little concern as they are only mild to moderate. However, in severely ill patients bedside sonography is a powerful tool to reveal different patterns of vascular, cholestatic or inflammatory complications in the liver, which are associated with high mortality. In addition, macrophage activation as histopathologic correlate for a hyperinflammatory syndrome seems to be a frequent complication in COVID-19.


Assuntos
Hepatopatias , Fígado/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , /diagnóstico por imagem , Feminino , Humanos , Hepatopatias/diagnóstico por imagem , Hepatopatias/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ultrassonografia
6.
PLoS One ; 15(10): e0239743, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33002028

RESUMO

PURPOSE: The purpose of this study was to investigate whether the cardiac motion artifact that regularly appears in diffusion-weighted imaging of the left liver lobe might be reduced by acquiring images in inspiration, when the coupling between heart and liver might be minimal. MATERIALS AND METHODS: 43 patients with known or suspected focal liver lesions were examined at 1.5 T with breath hold acquisition, once in inspiration and once in expiration. Data were acquired with a diffusion-weighted echo planar imaging sequence and two b-values (b50 = 50 s/mm² and b800 = 800 s/mm²). The severity of the cardiac motion artifact in the left liver lobe was rated by two experienced radiologists for both b-values with a 5 point Likert scale. Additionally, the normalized signal S(b800)/S(b50) in the left liver lobe was computed. The Wilcoxon signed-rank test was used comparing the scores of the two readers obtained in inspiration and expiration, and to compare the normalized signal in inspiration and expiration. RESULTS: The normalized signal in inspiration was slightly higher than in expiration (0.349±0.077 vs 0.336±0.058), which would indicate a slight reduction of the cardiac motion artifact, but this difference was not significant (p = 0.24). In the qualitative evaluation, the readers did not observe a significant difference for b50 (reader 1: p = 0.61; reader 2: p = 0.18). For b800, reader 1 observed a significant difference of small effect size favouring expiration (p = 0.03 with a difference of mean Likert scores of 0.27), while reader 2 observed no significant difference (p = 0.62). CONCLUSION: Acquiring the data in inspiration does not lead to a markedly reduced cardiac motion artifact in diffusion-weighted imaging of the left liver lobe and is in this regard not to be preferred over acquiring the data in expiration.


Assuntos
Coração/fisiologia , Fígado/diagnóstico por imagem , Respiração , Adulto , Idoso , Idoso de 80 Anos ou mais , Artefatos , Suspensão da Respiração , Imagem de Difusão por Ressonância Magnética , Expiração , Feminino , Humanos , Fígado/anatomia & histologia , Fígado/fisiologia , Hepatopatias/diagnóstico por imagem , Hepatopatias/patologia , Hepatopatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
7.
Zhonghua Gan Zang Bing Za Zhi ; 28(10): 876-881, 2020 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-33105934

RESUMO

Objective: To evaluate the clinical value of ultrasound attenuation parameters (UAP) in diagnosing the liver steatosis degree in patients with chronic liver disease, and to explore the relevant factors that affect UAP detection values. Methods: 130 cases with chronic liver disease diagnosed as liver steatosis by liver biopsy during January 2014 to May 2019 were selected from the Hepatology Department of Integrated Traditional Chinese and Western Medicine of the Third Hospital of Hebei Medical University. UAP and liver stiffness (LSM) were detected by iLivTouch, and the body mass index (BMI) was calculated. Simultaneously, serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyltransferase (GGT), total bilirubin (TBil), triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL) levels and peripheral platelet (PLT) counts were measured. The correlation between UAP and liver steatosis was analyzed based on the liver histopathological results. SPSS 21.0 statistical software was used for statistical analysis. Receiver operating characteristic curve (ROC) was used to analyze the accuracy and specificity of UAP in the diagnosis of liver steatosis in patients with chronic liver disease. Spearman's rank correlation analysis was used to study the relevant factors affecting UAP value. Results: The histopathological changes of liver biopsy showed that there were 43 cases of grade F1, 47 cases of F2, 32 cases of F3 and 8 cases of F4. UAP and BMI (r = 0.363, P < 0.001), and UAP and liver steatosis degree (r = 0.380, P < 0.001) were positively correlated. BMI and the liver steatosis degree were independent predictors of UAP value. The cut-off points for UAP to diagnose liver steatosis degree were 276 dB/m for F≥2, 288 dB/m for F≥2, 293 dB/m for F≥3, and F = 4, respectively. The sensitivity and specificity was 0.379, 0.500, 0.750, and 0.930, 0.922, 0.836, respectively. Conclusion: Ultrasonic attenuation parameters cannot only determine the presence or absence of liver steatosis in patients with chronic liver disease, but also can better assess the liver steatosis degree.


Assuntos
Fígado Gorduroso , Hepatopatias , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Biomarcadores/sangue , Fígado Gorduroso/diagnóstico por imagem , Humanos , Hepatopatias/diagnóstico por imagem , Hepatopatias/patologia
8.
J Gastroenterol ; 55(11): 1098-1106, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32776161

RESUMO

BACKGROUND: COVID-19 has emerged as a threat to human health. Liver dysfunction has been reported to occur frequently in patients with COVID-19, although its significance has not yet been elucidated. METHODS: The subjects were 35 patients with COVID-19, and clinical characteristics were retrospectively analyzed. COVID-19 patients requiring ventilator were classified as having severe COVID-19. RESULTS: All 35 patients were diagnosed as having mild-to-moderate COVID-19 at admission, but the severity aggravated to severe in 8 patients (22.9%) in hospital. Hepatocellular-type liver injury, defined as elevation of the serum AST and/or ALT levels to ≥ 3 times the ULN, was seen in 2 patients (5.7%), and cholestasis-type liver injury, defined as elevation of the serum ALP, γ-GTP and/or total bilirubin levels to ≥ twice the ULN, was seen in 4 patients (11.4%). A total of 9 patients (25.7%) fulfilled the criteria for liver injury. The percentage of patients with liver injury was higher in patients with severe COVID-19 than in the remaining patients (P = 0.001). Both the hepatic CT attenuation values and the liver-to-spleen attenuation (L/S) ratios at admission were lower in the former patients than in the latter patients (P < 0.001). ROC curve revealed the optimal cut-off value of the L/S ratio of 1.03 for discriminating between patients with severe and non-severe diseases. The hepatic CT attenuation values increased at the remission phase of the disease as compared to the values at admission (P = 0.012). CONCLUSION: Liver dysfunction associated with reduced hepatic CT attenuation values correlated with the disease severity in patients with COVID-19.


Assuntos
Infecções por Coronavirus/complicações , Hepatopatias/diagnóstico por imagem , Pneumonia Viral/complicações , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/fisiopatologia , Feminino , Humanos , Japão , Hepatopatias/virologia , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/fisiopatologia , Respiração Artificial , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto Jovem
9.
Ann R Coll Surg Engl ; 102(9): e1-e4, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32734771

RESUMO

Bile duct hamartomas are typically small benign liver lesions that can radiologically mimic metastases on ultrasound and computed tomography, as well as macroscopically. We present a rare and interesting case and review the relevant literature. A 49-year-old woman underwent ultrasound investigation for right upper quadrant pain, which revealed diffuse liver lesions. In the setting of her previous vulval cancer, it was suspected that she had hepatic metastases. This was strongly reinforced with computed tomography and elevated CA 19-9 levels. A liver biopsy revealed diffuse and multifocal bile duct hamartomas and positron emission tomography was negative for metastases or features of cancer recurrence. A diagnosis of diffuse liver hamartomatosis was made. In view of the continuing clinical and laboratory picture, she required regular follow-up. The collective features of this case are unique, as the isolated characteristics of particular interest have not been previously described in the context of a single case. Bile duct hamartomas should be included in the differential diagnosis of multiple liver lesions. CA 19-9 is not a reliable marker for differential diagnosis of this entity.


Assuntos
Hamartoma/diagnóstico , Hepatopatias/diagnóstico , Neoplasias Hepáticas/secundário , Diagnóstico Diferencial , Feminino , Hamartoma/diagnóstico por imagem , Hamartoma/patologia , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Hepatopatias/diagnóstico por imagem , Hepatopatias/patologia , Neoplasias Hepáticas/diagnóstico , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Neoplasias Vulvares/patologia
10.
Korean J Radiol ; 21(8): 987-997, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32677383

RESUMO

OBJECTIVE: Measurement of the liver and spleen volumes has clinical implications. Although computed tomography (CT) volumetry is considered to be the most reliable noninvasive method for liver and spleen volume measurement, it has limited application in clinical practice due to its time-consuming segmentation process. We aimed to develop and validate a deep learning algorithm (DLA) for fully automated liver and spleen segmentation using portal venous phase CT images in various liver conditions. MATERIALS AND METHODS: A DLA for liver and spleen segmentation was trained using a development dataset of portal venous CT images from 813 patients. Performance of the DLA was evaluated in two separate test datasets: dataset-1 which included 150 CT examinations in patients with various liver conditions (i.e., healthy liver, fatty liver, chronic liver disease, cirrhosis, and post-hepatectomy) and dataset-2 which included 50 pairs of CT examinations performed at ours and other institutions. The performance of the DLA was evaluated using the dice similarity score (DSS) for segmentation and Bland-Altman 95% limits of agreement (LOA) for measurement of the volumetric indices, which was compared with that of ground truth manual segmentation. RESULTS: In test dataset-1, the DLA achieved a mean DSS of 0.973 and 0.974 for liver and spleen segmentation, respectively, with no significant difference in DSS across different liver conditions (p = 0.60 and 0.26 for the liver and spleen, respectively). For the measurement of volumetric indices, the Bland-Altman 95% LOA was -0.17 ± 3.07% for liver volume and -0.56 ± 3.78% for spleen volume. In test dataset-2, DLA performance using CT images obtained at outside institutions and our institution was comparable for liver (DSS, 0.982 vs. 0.983; p = 0.28) and spleen (DSS, 0.969 vs. 0.968; p = 0.41) segmentation. CONCLUSION: The DLA enabled highly accurate segmentation and volume measurement of the liver and spleen using portal venous phase CT images of patients with various liver conditions.


Assuntos
Aprendizado Profundo , Fígado/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Baço/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Algoritmos , Feminino , Hepatectomia , Humanos , Hepatopatias/diagnóstico , Hepatopatias/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão
11.
Ann Hematol ; 99(9): 1967-1977, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32621178

RESUMO

Thalassemia is characterized by a defect in the synthesis of one or more of the globin subunits of hemoglobin. This defect results in imbalance in the α/ß-globin chain ratio, ineffective erythropoiesis, chronic hemolytic anemia, and iron overload. With advances in diagnosis, treatment, and transfusion support, the prognosis of patients with thalassemia has improved over the past few decades. An increasing number of patients with thalassemia is living with long-term complications, including cardiomyopathy, chronic liver disease, endocrinopathy, and infections. In this paper, we review common complications that bring the patient with thalassemia to urgent or emergent medical attention. We also discuss the aspects of emergency care that are most relevant while caring for the patient with thalassemia in the emergency department.


Assuntos
Serviços Médicos de Emergência/tendências , Serviço Hospitalar de Emergência/tendências , Doenças Raras/diagnóstico por imagem , Doenças Raras/terapia , Talassemia/diagnóstico por imagem , Talassemia/terapia , Betacoronavirus , Transfusão de Sangue/métodos , Transfusão de Sangue/tendências , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/epidemiologia , Cardiomiopatias/terapia , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Diagnóstico Diferencial , Serviços Médicos de Emergência/métodos , Humanos , Hepatopatias/diagnóstico por imagem , Hepatopatias/epidemiologia , Hepatopatias/terapia , Pandemias , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Doenças Raras/epidemiologia , Talassemia/epidemiologia
13.
Nat Biomed Eng ; 4(8): 801-813, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32572196

RESUMO

Monitoring the progression of non-alcoholic fatty liver disease is hindered by a lack of suitable non-invasive imaging methods. Here, we show that the endogenous pigment lipofuscin displays strong near-infrared and shortwave-infrared fluorescence when excited at 808 nm, enabling label-free imaging of liver injury in mice and the discrimination of pathological processes from normal liver processes with high specificity and sensitivity. We also show that the near-infrared and shortwave-infrared fluorescence of lipofuscin can be used to monitor the progression and regression of liver necroinflammation and fibrosis in mouse models of non-alcoholic fatty liver disease and advanced fibrosis, as well as to detect non-alcoholic steatohepatitis and cirrhosis in biopsied samples of human liver tissue.


Assuntos
Lipofuscina/metabolismo , Hepatopatias/diagnóstico por imagem , Hepatopatias/patologia , Animais , Biomarcadores/metabolismo , Doença Crônica , Progressão da Doença , Feminino , Fluorescência , Humanos , Lipodistrofia/diagnóstico por imagem , Lipodistrofia/metabolismo , Lipodistrofia/patologia , Fígado/diagnóstico por imagem , Fígado/metabolismo , Fígado/patologia , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/metabolismo , Cirrose Hepática/patologia , Hepatopatias/metabolismo , Masculino , Camundongos , Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagem , Hepatopatia Gordurosa não Alcoólica/metabolismo , Hepatopatia Gordurosa não Alcoólica/patologia , Imagem Óptica , Espectroscopia de Luz Próxima ao Infravermelho
14.
Ann Hematol ; 99(9): 2065-2072, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32572524

RESUMO

Sickle hepatopathy is a severe and not rare complication of sickle cell disease (SCD), showing mainly a cholestatic pattern. So far, no effective approaches to prevent or treat this condition have been recognized. We conducted a single-center observational study in 68 adult sickle cell patients, encompassing 17 with sickle cell anemia (SCA), 38 with sickle cell thalassemia (HbS/ß-Thal), and 13 with HbSC disease. The aim of our study was to assess liver damage in the three main forms of SCD, through the evaluation of clinical, laboratory, and imaging findings. In our population, the role of hepatotropic viruses, high BMI, and alcohol consumption in liver damage was ruled out. SCA and HbS/ß-Thal patients with lower Hb (p < 0.001), higher HbS (p < 0.001), and frequent vaso-occlusive crises showed functional (GGT values: SCA and HbS/ß-Thal vs HbSC p = 0.047 and p = 0.009, respectively) and structural liver abnormalities, defined by abdominal ultrasound and vibration-controlled transient elastography (liver stiffness values: SCA and HbS/ß-Thal vs HbSC p 0.022 and p 0.19, respectively), more severe than HbSC patients. Through univariate and multivariate analyses, male sex, SCA genotype, lower HbF, frequent transfusions, increased GGT values, and abnormal liver ultrasound and stiffness were identified as potentially early markers of sickle hepatopathy.


Assuntos
Anemia Falciforme/sangue , Anemia Falciforme/diagnóstico por imagem , Genótipo , Hepatopatias/sangue , Hepatopatias/diagnóstico por imagem , Adulto , Anemia Falciforme/genética , Feminino , Humanos , Hepatopatias/genética , Masculino , Pessoa de Meia-Idade , Fatores de Risco
15.
Can Assoc Radiol J ; 71(4): 437-447, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32515993

RESUMO

The Canadian Association of Radiologists Incidental Findings Working Group consists of both academic subspecialty and general radiologists and is tasked with adapting and expanding upon the American College of Radiology incidental findings white papers to more closely apply to Canadian practice patterns, particularly more comprehensively dealing with the role of ultrasound and pursuing more cost-effective approaches to the workup of incidental findings without compromising patient care. Presented here are the 2020 Canadian guidelines for the management of hepatobiliary incidental findings. Topics covered include initial assessment of hepatic steatosis and cirrhosis, the workup of incidental liver masses identified on ultrasound and computed tomography (with algorithms presented), incidental gallbladder findings (wall thickening, calcification, and polyps), and management of incidental biliary dilatation.


Assuntos
Doenças Biliares/diagnóstico por imagem , Diagnóstico por Imagem/normas , Achados Incidentais , Hepatopatias/diagnóstico por imagem , Adulto , Algoritmos , Canadá , Humanos , Sociedades Médicas
16.
Radiología (Madr., Ed. impr.) ; 62(3): 222-228, mayo-jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-194220

RESUMO

OBJETIVO: Comparar la esteatosis pancreática y hepática mediante la determinación de la fracción de grasa por densidad protónica (FGDP) por resonancia magnética (RM) en pacientes con enfermedad hepática crónica. MATERIAL Y MÉTODOS: Estudio transversal de 46 pacientes adultos con biopsia hepática por hepatitis viral crónica (n=19) o por enfermedad hepática crónica no alcohólica (EHNA) (n=27). La biopsia de hígado se utilizó como referencia para la gradación de la esteatosis hepática. Todos los pacientes se sometieron a valoración clínica y estudio de RM con una secuencia eco de gradiente codificado por desplazamiento químico con múltiples ecos (MECSE) para la cuantificación de la FGDP en hígado y páncreas. Se utilizó el coeficiente de correlación de Spearman para calcular el grado de asociación entre la FGDP hepática y los grados de esteatosis por biopsia, y entre la FGDP pancreática y la afectación hepática (grados de esteatosis y FGDP). El T-test se realizó para comparar variables continuas/ordinales en los grupos de hepatitis viral crónica y EHNA. Las variables categóricas se evaluaron mediante la prueba de gi. RESULTADOS: Se observó una correlación significativa entre la FGDP hepática y los grados de esteatosis (Rs=0,875, p < 0,001). También se evidenció una correlación positiva entre la FGDP del páncreas y la afectación hepática: grados de esteatosis (Rs=0,573, p < 0,001) y FGDP (Rs=0,536, p < 0,001). En el subgrupo de pacientes con EHNA crónica se mantuvo la correlación positiva significativa entre la FGDP pancreática y hepática (Rs=0,632, p < 0,001) y con la esteatosis hepática (Rs=0,608, p < 0,001). Estas relaciones se perdieron en el subgrupo de pacientes con hepatitis viral. CONCLUSIÓN: El depósito de grasa pancreática se correlaciona con la esteatosis hepática en pacientes con EHNA crónica. Esta relación se pierde en los pacientes con hepatitis viral crónica


AIM: To compare pancreatic and hepatic steatosis quantified by proton density fat fraction (PDFF) on magnetic resonance imaging (MRI) in patients with chronic liver disease. MATERIAL AND METHODS: This cross-sectional study included 46 adult patients who underwent liver biopsy for chronic viral hepatitis (n=19) or other chronic non-alcoholic liver diseases (NALD) (n=27). Liver biopsy was used as the gold standard for diagnosing and grading hepatic steatosis. All patients underwent clinical evaluation and MRI with a multi-echo chemical shift-encoded (MECSE) gradient-echo sequence for liver and pancreas PDFF quantification. We used Spearman's correlation coefficient to determine the degree of association between hepatic PDFF and steatosis grade, and between pancreatic PDFF and steatosis grade and hepatic PDFF. To compare the chronic viral hepatitis group and the NALD group, we used t-tests for continuous or ordinal variables and chi-square tests for categorical variables. RESULTS: Hepatic PDFF measurements correlated with steatosis grades (RS=0.875, p < 0.001). Pancreatic PDFF correlated with hepatic steatosis grades (RS=0.573, p < 0.001) and hepatic PDFF measurements (RS=0.536, p < 0.001). In the subgroup of patients with chronic NALD, the correlations remained significant between pancreatic PDFF and hepatic PDFF (RS=0.632, p < 0.001) and between pancreatic PDFF and liver steatosis (RS=0.608, p < 0.001); however, in the subgroup of patients with viral hepatitis these correlations were no longer significant. CONCLUSION: Pancreatic fat deposition correlates with hepatic steatosis in patients with chronic NALD, but not in those with chronic viral hepatitis


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Fígado Gorduroso/diagnóstico por imagem , Hepatopatias/diagnóstico por imagem , Espectroscopia de Ressonância Magnética , Imagem por Ressonância Magnética , Biópsia , Fígado/diagnóstico por imagem , Fígado/patologia , Testes de Função Hepática/métodos
17.
Pediatr. aten. prim ; 22(86): 185-188, abr.-jun. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-198536

RESUMO

La enfermedad hepática relacionada con cirugía de Fontan es la afectación estructural y funcional del hígado tras realizar una cirugía de Fontan. Como en otras hepatopatías, el curso puede ser progresivo, y abocar potencialmente a la aparición de complicaciones, algunas de ellas importantes, como cirrosis, ascitis, varices esofágicas o encefalopatía. Su origen no es inflamatorio, sino congestivo. Entre las pruebas complementarias, destacan la ecografía Doppler, la elastografía y la biopsia hepática. Su tratamiento es multidisciplinar e incluye optimizar la función cardiaca, prevención y manejo de las complicaciones hepáticas y prevención del hígado graso


Liver disease related to Fontan's surgery is a structural and functional liver disease after performing the Fontan procedure. As in other liver diseases, the course can be progressive, potentially leading to the appearance of complications, such as cirrhosis, ascites, esophageal varices or encephalopathy. Its origin is not inflammatory, but congestive. Among the complementary tests, the Doppler ultrasound, elastography and liver biopsy stand out. Its treatment is multidisciplinary, and includes optimizing cardiac function, prevention and management of liver complications, and prevention of fatty liver disease


Assuntos
Humanos , Feminino , Adolescente , Técnica de Fontan/efeitos adversos , Hepatopatias/etiologia , Síndrome do Coração Esquerdo Hipoplásico/complicações , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Hepatopatias/diagnóstico por imagem , Ultrassonografia/métodos
18.
AJR Am J Roentgenol ; 215(2): 398-405, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32406776

RESUMO

OBJECTIVE. This study assessed a machine learning-based dual-energy CT (DECT) tumor analysis prototype for semiautomatic segmentation and radiomic analysis of benign and malignant liver lesions seen on contrast-enhanced DECT. MATERIALS AND METHODS. This institutional review board-approved study included 103 adult patients (mean age, 65 ± 15 [SD] years; 53 men, 50 women) with benign (60/103) or malignant (43/103) hepatic lesions on contrast-enhanced dual-source DECT. Most malignant lesions were histologically proven; benign lesions were either stable on follow-up CT or had characteristic benign features on MRI. Low- and high-kilovoltage datasets were deidentified, exported offline, and processed with the DECT tumor analysis for semiautomatic segmentation of the volume and rim of each liver lesion. For each segmentation, contrast enhancement and iodine concentrations as well as radiomic features were derived for different DECT image series. Statistical analyses were performed to determine if DECT tumor analysis and radiomics can differentiate benign from malignant liver lesions. RESULTS. Normalized iodine concentration and mean iodine concentration in the benign and malignant lesions were significantly different (p < 0.0001-0.0084; AUC, 0.695-0.856). Iodine quantification and radiomic features from lesion rims (AUC, ≤ 0.877) had higher accuracy for differentiating liver lesions compared with the values from lesion volumes (AUC, ≤ 0.856). There was no difference in the accuracies of DECT iodine quantification (AUC, 0.91) and radiomics (AUC, 0.90) for characterizing liver lesions. CONCLUSION. DECT radiomics were more accurate than iodine quantification for differentiating solid benign and malignant hepatic lesions.


Assuntos
Hepatopatias/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Diagnóstico Diferencial , Processamento Eletrônico de Dados , Feminino , Humanos , Compostos de Iodo , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Imagem Radiográfica a Partir de Emissão de Duplo Fóton , Estudos Retrospectivos
19.
Br J Radiol ; 93(1112): 20190989, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32462892

RESUMO

A variety of patterns of enhancement of liver lesions and liver parenchyma is observed in the hepatobiliary phase (HBP) of gadoxetic acid-enhanced MRI. It is becoming increasingly apparent that many lesions may exhibit HBP enhancement. Much of the literature regarding the role of gadoxetic acid-enhanced MRI in characterising liver lesions is dichotomous, focusing on whether lesions are enhancing or non-enhancing in the HBP, rather than examining the patterns of enhancement. We provide a pattern-based description of HBP enhancement of liver parenchyma and of liver lesions. The role of OATP1B3 transporters, hepatocyte function and lesion composition in influencing patterns of HBP hyperintensity are discussed.


Assuntos
Sistema Biliar/diagnóstico por imagem , Meios de Contraste , Gadolínio DTPA , Fígado/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Doenças Biliares/diagnóstico por imagem , Humanos , Aumento da Imagem/métodos , Hepatopatias/diagnóstico por imagem , Tecido Parenquimatoso/diagnóstico por imagem
20.
Khirurgiia (Mosk) ; (3): 5-12, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32271731

RESUMO

AIM: To improve the results of treatment of patients with focal liver formations by preventing the development of postoperative complications after liver resections. METHODS: The study included 304 patients with benign and malignant liver lesions. In 196 (64.4%) patients, resections were performed for malignant liver damage, in 108 (35.6%) - for a benign process. To assess the impact of ongoing measures to prevent the development of postoperative complications, patients were divided into two time periods: from 2007 to 2012 and from 2013 to 2018. RESULTS: The introduction of a protocol of preoperative examination of patients for whom resection of 3 or more liver segments is planned, with the inclusion of SPECT/CT, which allows determining the volume of the remaining functioning liver parenchyma, allowed to reduce the percentage of development of acute post-resection liver failure from 11.6% to 3.6% during the second time period (p=0.0064). The use of modern suture material, surgical binocular loops, as well as the use of the concept of predominantly performing parenchyma-saving resections, reduced the number of biliary complications from 8.1% to 5.7% (p=0.1). The use of a proprietary dissection algorithm for the liver parenchyma significantly reduced hemorrhagic complications from 5.3% to 1.04% (p=0.0074). CONCLUSION: The use of modern pre- and intraoperative technologies has reduced the number of postoperative complications after liver resections from 38.3% to 20.9% (p=0.018) and mortality from 2.6% to 0.5% (p=0.004), thereby improving the results of liver resections.


Assuntos
Hepatectomia/efeitos adversos , Hepatectomia/métodos , Neoplasias Hepáticas/cirurgia , Fígado/cirurgia , Algoritmos , Doenças Biliares/etiologia , Doenças Biliares/prevenção & controle , Perda Sanguínea Cirúrgica/prevenção & controle , Protocolos Clínicos , Dissecação/efeitos adversos , Dissecação/métodos , Hepatectomia/instrumentação , Hepatectomia/mortalidade , Humanos , Fígado/diagnóstico por imagem , Hepatopatias/diagnóstico por imagem , Hepatopatias/cirurgia , Falência Hepática/etiologia , Falência Hepática/prevenção & controle , Falência Hepática Aguda/etiologia , Falência Hepática Aguda/prevenção & controle , Neoplasias Hepáticas/diagnóstico por imagem , Tamanho do Órgão , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/prevenção & controle , Cuidados Pré-Operatórios , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Técnicas de Sutura/instrumentação
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