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Ekiz F, Yuksel İ, Arikök AT, Yilmaz B, Altinbas A, Aktas B, Deveci M, Basar O, Coban S, Yuksel O. Will a second biopsy sample affect treatment decisions in patients with chronic hepatitis B? Hepatol Int 2016; 10:602-5. [PMID: 26416085 DOI: 10.1007/s12072-015-9666-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 08/22/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Liver biopsy is the gold standard for assessment of fibrosis in patients with hepatitis B. However, it has some disadvantages, including inter-observer and intra-observer variability in biopsy interpretation and specimen variation. A standard biopsy specimen represents only about 0.0002 % of the whole liver. It has been shown that two biopsy samples collected during a procedure have significant influence on the diagnostic performance of interpretation in patients with hepatitis C or non-alcoholic steatohepatitis. Therefore, we aimed to assess the influence of collecting two liver biopsy samples during a single procedure for staging and grading chronic hepatitis B. PATIENTS AND METHODS 27 patients were included in the study. The median age of the patients was 43.51 ± 11.69. Fifteen patients were female, 12 patients were male. In the biopsy procedure, two samples of liver lobes were obtained. Grade and stage scores were compared between the two samples. Fibrosis staging and grading were assessed according to the Ishak scoring system. RESULTS Numbers of portal tract and biopsy size were equal in the two samples. There was a significant difference between the samples in terms of histological activity index (p value = 0.04). However, the difference was not enough to distinguish the mild and moderate stages. On the other hand, no significant difference in fibrosis staging between the two samples was found. CONCLUSIONS With this relatively small size of patients, in this study, we showed that a proper liver biopsy size is sufficient to predict treatment decisions in chronic hepatitis B patients. However, further studies are needed to show the association of sampling variability in patients with hepatitis B.
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Affiliation(s)
- Fuat Ekiz
- Department of Gastroenterology, Hatay Antakya State Hospital, Saraykent mh. 20.sk, Antakya, Hatay, Turkey.
| | - İlhami Yuksel
- Department of Gastroenterology, School of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Ata Turker Arikök
- Department of Pathology, Diskapi Yildirim Beyazit Educational and Research Hospital, Ankara, Turkey
| | - Baris Yilmaz
- Department of Gastroenterology, Osmaniye State Hospital, Osmaniye, Turkey
| | - Akif Altinbas
- Department of Gastroenterology, Ankara Numune Educational and Research Hospital, Ankara, Turkey
| | - Bora Aktas
- Department of Gastroenterology, Ankara Kecioren Educational and Research Hospital, Ankara, Turkey
| | - Murat Deveci
- Department of Gastroenterology, Yozgat State Hospital, Yozgat, Turkey
| | - Omer Basar
- Department of Gastroenterology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Sahin Coban
- Department of Gastroenterology, Diskapi Yildirim Beyazit Educational and Research Hospital, Ankara, Turkey
| | - Osman Yuksel
- Department of Gastroenterology, School of Medicine, Hacettepe University, Ankara, Turkey
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102
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Ebrahimi H, Naderian M, Sohrabpour AA. New Concepts on Pathogenesis and Diagnosis of Liver Fibrosis; A Review Article. Middle East J Dig Dis 2016; 8:166-178. [PMID: 27698966 PMCID: PMC5045669 DOI: 10.15171/mejdd.2016.29] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Liver fibrosis is a potentially reversible response to hepatic insults, triggered by different chronic diseases most importantly viral hepatitis, alcoholic, and nonalcoholic fatty liver disease. In the course of the chronic liver disease, hepatic fibrogenesis may develop, which is attributed to various types of cells, molecules, and pathways. Activated hepatic stellate cell (HSC), the primary source of extracellular matrix (ECM), is fundamental in pathophysiology of fibrogenesis, and thus is the most attractable target for reversing liver fibrosis. Although, liver biopsy has long been considered as the gold standard for diagnosis and staging of hepatic fibrosis, assessing progression and regression by biopsy is hampered by its limitations. We provide recent views on noninvasive approaches including serum biomarkers and radiologic techniques.
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Affiliation(s)
- Hedyeh Ebrahimi
- Liver and Pancreaticobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Naderian
- Liver and Pancreaticobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Ali Sohrabpour
- Assistant Professor, Liver and Pancreaticobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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103
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Chin JL, Pavlides M, Moolla A, Ryan JD. Non-invasive Markers of Liver Fibrosis: Adjuncts or Alternatives to Liver Biopsy? Front Pharmacol 2016; 7:159. [PMID: 27378924 PMCID: PMC4913110 DOI: 10.3389/fphar.2016.00159] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 05/31/2016] [Indexed: 12/13/2022] Open
Abstract
Liver fibrosis reflects sustained liver injury often from multiple, simultaneous factors. Whilst the presence of mild fibrosis on biopsy can be a reassuring finding, the identification of advanced fibrosis is critical to the management of patients with chronic liver disease. This necessity has lead to a reliance on liver biopsy which itself is an imperfect test and poorly accepted by patients. The development of robust tools to non-invasively assess liver fibrosis has dramatically enhanced clinical decision making in patients with chronic liver disease, allowing a rapid and informed judgment of disease stage and prognosis. Should a liver biopsy be required, the appropriateness is clearer and the diagnostic yield is greater with the use of these adjuncts. While a number of non-invasive liver fibrosis markers are now used in routine practice, a steady stream of innovative approaches exists. With improvement in the reliability, reproducibility and feasibility of these markers, their potential role in disease management is increasing. Moreover, their adoption into clinical trials as outcome measures reflects their validity and dynamic nature. This review will summarize and appraise the current and novel non-invasive markers of liver fibrosis, both blood and imaging based, and look at their prospective application in everyday clinical care.
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Affiliation(s)
- Jun L Chin
- School of Medicine and Medical Science, University College Dublin Dublin, Ireland
| | - Michael Pavlides
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford Oxford, UK
| | - Ahmad Moolla
- Radcliffe Department of Medicine, University of Oxford Oxford, UK
| | - John D Ryan
- Translational Gastroenterology Unit, University of Oxford Oxford, UK
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104
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Yu H, Touret AS, Li B, O'Brien M, Qureshi MM, Soto JA, Jara H, Anderson SW. Application of texture analysis on parametricT1andT2maps for detection of hepatic fibrosis. J Magn Reson Imaging 2016; 45:250-259. [DOI: 10.1002/jmri.25328] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/18/2016] [Accepted: 05/18/2016] [Indexed: 12/21/2022] Open
Affiliation(s)
- HeiShun Yu
- Department of Radiology; Boston University Medical Center; Boston Massachusetts USA
| | - Anne-Sophie Touret
- Department of Radiology; Boston University Medical Center; Boston Massachusetts USA
| | - Baojun Li
- Department of Radiology; Boston University Medical Center; Boston Massachusetts USA
| | - Michael O'Brien
- Department of Pathology and Laboratory Medicine; Boston University Medical Center; Boston Massachusetts USA
| | - Muhammad M. Qureshi
- Department of Radiology; Boston University Medical Center; Boston Massachusetts USA
| | - Jorge A. Soto
- Department of Radiology; Boston University Medical Center; Boston Massachusetts USA
| | - Hernan Jara
- Department of Radiology; Boston University Medical Center; Boston Massachusetts USA
| | - Stephan W. Anderson
- Department of Radiology; Boston University Medical Center; Boston Massachusetts USA
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105
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Lewindon PJ, Balouch F, Pereira TN, Puertolas-Lopez MV, Noble C, Wixey JA, Ramm GA. Transient liver elastography in unsedated control children: Impact of age and intercurrent illness. J Paediatr Child Health 2016; 52:637-42. [PMID: 27203205 DOI: 10.1111/jpc.13151] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 10/26/2015] [Accepted: 01/27/2016] [Indexed: 12/23/2022]
Abstract
AIM Transient elastography (TE) is a rapid, non-invasive, reproducible assessment of liver fibrosis by liver stiffness measurement (LSM). Uncertainty remains regarding utility in children, unsedated and <6 years of age. The importance of general health at the time of study has not been addressed. We report our experience of TE in unsedated control children, impact of intercurrent illness and using new published reliability criteria. METHODS From April 2011 to March 2013, 173 studies were performed in unsedated, healthy control children and children with intercurrent illness without detectable liver disease presenting to the Royal Children's Hospital, Brisbane, Australia. LSM reliability was assessed using interquartile range/median (IQR/M ≤ 30%) of 10 valid measurements. RESULTS A total of 123 (F:M, 52:71) of 173 studies (71.1%) gave reliable results. In children 0-2 years reliability was 36%, and >2 years reliable results were obtained in ~80%. LSM increased with age; 0-2 years (3.5 ± 0.5 kPa), 3-5 years (3.8 ± 0.3 kPa) and 6-11 years (4.1 ± 0.2 kPa) with healthy older children 12-18 years similar to adults (4.5 ± 0.2 kPa). LSM did not vary with gender (female, 4.5 ± 0.2 vs. male, 4.8 ± 0.2 kPa). Children with intercurrent, non-hepatological illnesses had higher LSM (5.2 ± 0.2 kPa (range, 2.8-11.1 kPa)) compared to healthy children ((4.1 ± 0.1 kPa, range, 2.1-6.3 kPa); P = 0.0001). CONCLUSIONS TE in unsedated children is feasible from infancy but most reliable after 2 years. Intercurrent illness increases LSM; hence, study context is important when interpreting results.
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Affiliation(s)
- Peter J Lewindon
- Department of Gastroenterology, Lady Cilento Children's Hospital, Brisbane, Australia.,Hepatic Fibrosis Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Fariha Balouch
- Department of Gastroenterology, Lady Cilento Children's Hospital, Brisbane, Australia
| | - Tamara N Pereira
- Hepatic Fibrosis Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - Charlton Noble
- Department of Gastroenterology, Lady Cilento Children's Hospital, Brisbane, Australia
| | - Julie A Wixey
- Hepatic Fibrosis Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Grant A Ramm
- Hepatic Fibrosis Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Queensland, Australia
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106
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Diktas H, Karacaer Z, Özturk II, Cicek H. Comparison of relationship between histopathological, serological and biochemical parameters in patients with chronic hepatitis B infection. Postgrad Med J 2016; 92:693-696. [PMID: 27170311 DOI: 10.1136/postgradmedj-2016-134069] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 04/18/2016] [Accepted: 04/24/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To demonstrate the relationship between liver histology, alanine aminotransferase (ALT)/aspartate aminotransferase (AST) and hepatitis B virus (HBV) DNA levels based on hepatitis B e antigen (HBeAg) seropositivity status in naive patients with chronic hepatitis B (CHB). MATERIALS AND METHOD Naive patients with CHB admitted to our hospital between January 2012 and April 2014 were evaluated retrospectively. The patients were allocated into one of two groups based on HBeAg-seropositivity status. RESULTS Two hundred and fourteen patients were enrolled in the study. Of these 214 patients, 103 (48.1%) were HBeAg-positive and 111 (51.9%) were HBeAg-negative. In the HBeAg-positive group, positive correlations were found between histologic activity index (HAI) scores and ALT (t=3.3, r=0.31, p=0.001), AST (t=2.8, r=0.27, p=0.005) and HBV DNA load (t=2.5, r=0.24, p=0.014). Additionally, in this group, fibrosis scores had positive correlations with ALT (t=3.3, r=0.32, p=0.001) and AST (t=2.7, r=0.26, p=0.008). In the HBeAg-negative group, positive correlations were found between HAI scores and ALT (t=3, r=0. 28, p=0.003), AST (t=3, r=0. 28, p=0.003) and HBV DNA (t=5.3, r=0. 45, p=0). In this same group, fibrosis scores had a positive correlation with HBV DNA (t=2.2, r=0. 21, p=0.024). Multivariate logistic regression analysis showed a positive relationship between fibrosis and ALT in the HBeAg-positive group and a positive relationship between fibrosis and HBV DNA load in the HBeAg-negative group. CONCLUSIONS This study showed that HBV DNA load is an independent predictive factor for evaluating HAI and fibrosis in the HBeAg-negative group. Also, ALT is an independent predictive factor for evaluating fibrosis in the HBeAg-positive group.
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Affiliation(s)
- Husrev Diktas
- Department of Infectious Diseases and Clinical Microbiology, Tatvan Military Hospital, Bitlis, Turkey
| | - Zehra Karacaer
- Department of Infectious Diseases and Clinical Microbiology, Etimesgut Military Hospital, Ankara, Turkey
| | - I Ilker Özturk
- Department of Infectious Diseases and Clinical Microbiology, Beytepe Military Hospital, Ankara, Turkey
| | - Huseyin Cicek
- Department of Infectious Diseases and Clinical Microbiology, Etimesgut Military Hospital, Ankara, Turkey
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107
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Zhang D, Guo Z, Zhang P, Li Y, Su X, You L, Gao M, Liu C, Wu H, Zhang X. Simplified quantification method for in vivo SPECT/CT imaging of asialoglycoprotein receptor with (99m)Tc-p(VLA-co-VNI) to assess and stage hepatic fibrosis in mice. Sci Rep 2016; 6:25377. [PMID: 27150943 PMCID: PMC4858650 DOI: 10.1038/srep25377] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 04/15/2016] [Indexed: 12/23/2022] Open
Abstract
The goal of this study is to develop a noninvasive method of SPECT imaging to quantify and stage liver fibrosis with an Asialoglycoprotein receptor (ASGP-R) targeting tracer-(99m)Tc-p(VLA-co-VNI). ASGP-Rs are well known to specifically express in the mammalian liver. Here, we demonstrated ASGP-R expression decreased in carbon tetrachloride (CCl4)-induced mouse model. ASGP-R expression correlated with liver fibrosis progression. ASGP-R could be a useful marker in the stage of liver fibrosis. Liver uptake value (LUV) derived by SPECT imaging was used to assess liver fibrosis in the CCl4-induced mouse model. LUV = [radioactivity (liver uptake)/radioactivity (injected)] × 100/liver volume. The LUV decreased along with the disease progression. The relationships between LUV and liver hydroxyproline (i.e. collagen), as well as Sirius Red were established and verified. A strong negative linear correlation was found between LUV and hydroxyproline levels (r = -0.83) as well as LUV and Sirius Red quantification (r = -0.83). In conclusion, SPECT imaging with (99m)Tc-p(VLA-co-VNI) is useful in evaluating and staging liver fibrosis in vivo.
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Affiliation(s)
- Deliang Zhang
- Center for Molecular Imaging and Translational Medicine, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Zhide Guo
- Center for Molecular Imaging and Translational Medicine, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen 361102, China
- Department of Isotope, China Institute of Atomic Energy, P. O. Box 2108, Beijing 102413, PR China
| | - Pu Zhang
- Center for Molecular Imaging and Translational Medicine, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Yesen Li
- Center for Molecular Imaging and Translational Medicine, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen 361102, China
- Department of Nuclear Medicine, The First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Xinhui Su
- Department of Nuclear Medicine, Zhongshan Hospital affiliated to Xiamen University, Xiamen 361004, Fujian, China
| | - Linyi You
- Center for Molecular Imaging and Translational Medicine, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Mengna Gao
- Center for Molecular Imaging and Translational Medicine, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Chang Liu
- Center for Molecular Imaging and Translational Medicine, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Hua Wu
- Department of Nuclear Medicine, The First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Xianzhong Zhang
- Center for Molecular Imaging and Translational Medicine, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen 361102, China
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108
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Kaswala DH, Lai M, Afdhal NH. Fibrosis Assessment in Nonalcoholic Fatty Liver Disease (NAFLD) in 2016. Dig Dis Sci 2016; 61:1356-64. [PMID: 27017224 DOI: 10.1007/s10620-016-4079-4] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/04/2016] [Indexed: 02/06/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a spectrum of liver pathologies characterized by hepatic steatosis with a history of little to no alcohol consumption or secondary causes of hepatic steatosis. The prevalence of NAFLD is 20-25 % of the general population in the Western countries and is associated with metabolic risk factors such as obesity, diabetes mellitus, and dyslipidemia. The spectrum of disease ranges from simple steatosis to nonalcoholic steatohepatitis, fibrosis, and cirrhosis. Advanced fibrosis is the most significant predictor of mortality in NAFLD. It is crucial to assess for the presence and degree of hepatic fibrosis in order to make therapeutic decisions and predict clinical outcomes. Liver biopsy, the current gold standard to assess the liver fibrosis, has a number of drawbacks such as invasiveness, sampling error, cost, and inter-/intra-observer variability. There are currently available a number of noninvasive tests as an alternative to liver biopsy for fibrosis staging. These noninvasive fibrosis tests are increasingly used to rule out advanced fibrosis and help guide disease management. While these noninvasive tests perform relatively well for ruling out advanced fibrosis, they also have limitations. Understanding the strengths and limitations of liver biopsy and the noninvasive tests is necessary for deciding when to use the appropriate tests in the evaluation of patients with NAFLD.
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Affiliation(s)
- Dharmesh H Kaswala
- Liver Center, Department of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center and Harvard Medical School, 110 Francis St #8e, Boston, MA, 0221, USA
| | - Michelle Lai
- Liver Center, Department of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center and Harvard Medical School, 110 Francis St #8e, Boston, MA, 0221, USA
| | - Nezam H Afdhal
- Liver Center, Department of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center and Harvard Medical School, 110 Francis St #8e, Boston, MA, 0221, USA.
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109
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Pharmacokinetic Analysis of Dynamic Contrast-Enhanced Magnetic Resonance Imaging for Distinguishing Hepatocellular Carcinoma From Cholangiocarcinoma in Pre–Liver Transplantation Evaluation. Transplant Proc 2016; 48:1041-4. [DOI: 10.1016/j.transproceed.2015.11.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 11/11/2015] [Indexed: 12/17/2022]
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110
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Oshaghi EA, Khodadadi I, Tavilani H, Goodarzi MT. Effect of dill tablet (Anethum graveolens L) on antioxidant status and biochemical factors on carbon tetrachloride-induced liver damage on rat. Int J Appl Basic Med Res 2016; 6:111-4. [PMID: 27127740 PMCID: PMC4830149 DOI: 10.4103/2229-516x.179019] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Liver damage induced by carbon tetrachloride (CCl4) has been presented as an experimental model for research in hepatoprotective effects of natural product. A commercial medicine prepared from Anethum graveolens L (dill) is being used as dill tablet (DT) as a hypolipidemic agent. This experiment aimed to investigate the protective effect of DT against hepatic damage. Materials and Methods: Male Wistar rats were randomly divided into four groups (n = 6) as following for a 10 days experiments. (1) Normal animals; (2) normal animals +CCl4 1 ml/kg (1:1 of CCl4 in olive oil, by gastric tube); (3) CCl4 treated animals +100 mg DT/kg; (4) CCl4 treated animals +300 mg DT/kg. After 10 days of treatment, biochemical factors were measured; also antioxidant tests such as thiol group, malondialdehyde (MDA), total antioxidant capacity (TAC), and catalase (CAT) activity in the liver samples were carried out. Results: In dill treated animals, a significant decrease in liver enzymes lactate dehydrogenase, alkaline phosphatase, aspartate transaminase, alanine transaminase, γ-glutamyl transferase, total bilirubin, direct bilirubin, as well as triglyceride, total cholesterol (P < 0.05) were observed. Total protein and albumin concentrations were significantly increased in dill treated groups (P < 0.05). Furthermore, treatment with dill declined liver cholesterol, triglyceride, MDA, and increased TAC and CAT activity compared with untreated group (P < 0.05). Conclusion: Dill displayed a potential hepatoprotective effect against CCl4-induced liver damage based on both biochemical markers and antioxidant status.
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Affiliation(s)
- Ebrahim Abbasi Oshaghi
- Department of Clinical Biochemistry, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Iraj Khodadadi
- Department of Clinical Biochemistry, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Heidar Tavilani
- Department of Clinical Biochemistry, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Taghi Goodarzi
- Department of Clinical Biochemistry, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran; Research Center for Molecular Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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111
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Kim KE, Park MS, Chung S, An C, Axel L, Ergashovna RG. Magnetization-tagged MRI is a simple method for predicting liver fibrosis. Clin Mol Hepatol 2016; 22:140-5. [PMID: 27044764 PMCID: PMC4825163 DOI: 10.3350/cmh.2016.22.1.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 01/18/2016] [Accepted: 01/25/2016] [Indexed: 01/06/2023] Open
Abstract
Background/Aims: To assess the usefulness of magnetization-tagged magnetic resonance imaging (MRI) in quantifying cardiac-induced liver motion and deformation in order to predict liver fibrosis. Methods: This retrospective study included 85 patients who underwent liver MRI including magnetization-tagged sequences from April 2010 to August 2010. Tagged images were acquired in three coronal and three sagittal planes encompassing both the liver and heart. A Gabor filter bank was used to measure the maximum value of displacement (MaxDisp) and the maximum and minimum values of principal strains (MaxP1 and MinP2, respectively). Patients were divided into three groups (no fibrosis, mild-to-moderate fibrosis, and significant fibrosis) based on their aspartate-aminotransferase-to-platelet ratio index (APRI) score. Group comparisons were made using ANOVA tests. Results: The patients were divided into three groups according to APRI scores: no fibrosis (≤0.5; n=41), moderate fibrosis (0.5–1.5; n=23), and significant fibrosis (>1.5; n=21). The values of MaxDisp were 2.9±0.9 (mean±SD), 2.3±0.7, and 2.1±0.6 in the no fibrosis, moderate fibrosis, and significant fibrosis groups, respectively (P<0.001); the corresponding values of MaxP1 were 0.05±0.2, 0.04±0.02, and 0.03±0.01, respectively (P=0.002), while those of MinP2 were –0.07±0.02, –0.05±0.02, and –0.04±0.01, respectively (P<0.001). Conclusions: Tagged MRI to quantify cardiac-induced liver motion can be easily incorporated in routine liver MRI and may represent a helpful complementary tool in the diagnosis of early liver fibrosis.
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Affiliation(s)
- Kyung-Eun Kim
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Mi-Suk Park
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sohae Chung
- Center for Biomedical Imaging, Department of Radiology, New York University Langone Medical Center, New York, USA
| | - Chansik An
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Leon Axel
- Center for Biomedical Imaging, Department of Radiology, New York University Langone Medical Center, New York, USA
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112
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Sheen V, Nguyen H, Jimenez M, Agopian V, Vangala S, Elashoff D, Saab S. Routine Laboratory Blood Tests May Diagnose Significant Fibrosis in Liver Transplant Recipients with Chronic Hepatitis C: A 10 Year Experience. J Clin Transl Hepatol 2016; 4:20-5. [PMID: 27047768 PMCID: PMC4807139 DOI: 10.14218/jcth.2015.00034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND AIMS The aims of our study were to determine whether routine blood tests, the aspartate aminotransferase (AST) to Platelet Ratio Index (APRI) and Fibrosis 4 (Fib-4) scores, were associated with advanced fibrosis and to create a novel model in liver transplant recipients with chronic hepatitis C virus (HCV). METHODS We performed a cross sectional study of patients at The University of California at Los Angeles (UCLA) Medical Center who underwent liver transplantation for HCV. We used linear mixed effects models to analyze association between fibrosis severity and individual biochemical markers and mixed effects logistic regression to construct diagnostic models for advanced fibrosis (METAVIR F3-4). Cross-validation was used to estimate a receiving operator characteristic (ROC) curve for the prediction models and to estimate the area under the curve (AUC). RESULTS The mean (± standard deviation [SD]) age of our cohort was 55 (±7.7) years, and almost three quarter were male. The mean (±SD) time from transplant to liver biopsy was 19.9 (±17.1) months. The mean (±SD) APRI and Fib-4 scores were 3 (±12) and 7 (±14), respectively. Increased fibrosis was associated with lower platelet count and alanine aminotransferase (ALT) values and higher total bilirubin and Fib-4 scores. We developed a model that takes into account age, gender, platelet count, ALT, and total bilirubin, and this model outperformed APRI and Fib-4 with an AUC of 0.68 (p < 0.001). CONCLUSIONS Our novel prediction model diagnosed the presence of advanced fibrosis more reliably than APRI and Fib-4 scores. This noninvasive calculation may be used clinically to identify liver transplant recipients with HCV with significant liver damage.
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Affiliation(s)
- Victoria Sheen
- Departments of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Heajung Nguyen
- Departments of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Melissa Jimenez
- Departments of Surgery, University of California at Los Angeles, Los Angeles, California, USA
| | - Vatche Agopian
- Departments of Surgery, University of California at Los Angeles, Los Angeles, California, USA
| | - Sitaram Vangala
- Departments of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - David Elashoff
- Departments of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Sammy Saab
- Departments of Medicine, University of California at Los Angeles, Los Angeles, California, USA
- Departments of Surgery, University of California at Los Angeles, Los Angeles, California, USA
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Willner M, Viermetz M, Marschner M, Scherer K, Braun C, Fingerle A, Noël P, Rummeny E, Pfeiffer F, Herzen J. Quantitative Three-Dimensional Imaging of Lipid, Protein, and Water Contents via X-Ray Phase-Contrast Tomography. PLoS One 2016; 11:e0151889. [PMID: 27003308 PMCID: PMC4803315 DOI: 10.1371/journal.pone.0151889] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 03/04/2016] [Indexed: 02/07/2023] Open
Abstract
X-ray phase-contrast computed tomography is an emerging imaging technology with powerful capabilities for three-dimensional (3D) visualization of weakly absorbing objects such as biological soft tissues. This technique is an extension of existing X-ray applications because conventional attenuation-contrast images are simultaneously acquired. The complementary information provided by both the contrast modalities suggests that enhanced material characterization is possible when performing combined data analysis. In this study, we describe how protein, lipid, and water concentrations in each 3D voxel can be quantified by vector decomposition. Experimental results of dairy products, porcine fat and rind, and different human soft tissue types are presented. The results demonstrate the potential of phase-contrast imaging as a new analysis tool. The 3D representations of protein, lipid, and water contents open up new opportunities in the fields of biology, medicine, and food science.
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Affiliation(s)
- Marian Willner
- Department of Physics and Institute of Medical Engineering, Technische Universität München, Garching, Germany
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
- * E-mail:
| | - Manuel Viermetz
- Department of Physics and Institute of Medical Engineering, Technische Universität München, Garching, Germany
| | - Mathias Marschner
- Department of Physics and Institute of Medical Engineering, Technische Universität München, Garching, Germany
| | - Kai Scherer
- Department of Physics and Institute of Medical Engineering, Technische Universität München, Garching, Germany
| | - Christian Braun
- Institute of Forensic Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Alexander Fingerle
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
| | - Peter Noël
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
| | - Ernst Rummeny
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
| | - Franz Pfeiffer
- Department of Physics and Institute of Medical Engineering, Technische Universität München, Garching, Germany
| | - Julia Herzen
- Department of Physics and Institute of Medical Engineering, Technische Universität München, Garching, Germany
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Song P, Mellema DC, Sheedy SP, Meixner DD, Karshen RM, Urban MW, Manduca A, Sanchez W, Callstrom MR, Greenleaf JF, Chen S. Performance of 2-Dimensional Ultrasound Shear Wave Elastography in Liver Fibrosis Detection Using Magnetic Resonance Elastography as the Reference Standard: A Pilot Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:401-12. [PMID: 26782164 PMCID: PMC4724277 DOI: 10.7863/ultra.15.03036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/15/2015] [Indexed: 05/12/2023]
Abstract
OBJECTIVES To investigate the correlation between 2-dimensional (2D) ultrasound shear wave elastography (SWE) and magnetic resonance elastography (MRE) in liver stiffness measurement and the diagnostic performance of 2D SWE for liver fibrosis when imaging from different intercostal spaces and using MRE as the reference standard. METHODS Two-dimensional SWE was performed on 47 patients. One patient was excluded from the study. Each of the remaining 46 patients underwent same-day MRE for clinical purposes. The study was compliant with the Health Insurance Portability and Accountability Act and approved by the Institutional Review Board. Informed consent was obtained from each patient. Two-dimensional SWE measurements were acquired from the ninth, eighth, and seventh intercostal spaces. The correlation with MRE was calculated at each intercostal space and multiple intercostal spaces combined. The performance of 2D SWE in diagnosing liver fibrosis was evaluated by receiver operating characteristic curve analysis using MRE as the standard. RESULTS The 47 patients who initially underwent 2D SWE included 22 female and 25 male patients (age range, 19-77 years). The highest correlation between 2D SWE and MRE was from the eighth and seventh intercostal spaces (r = 0.68-0.76). The ranges of the areas under the receiver operating characteristic curves for separating normal or inflamed livers from fibrotic livers using MRE as the clinical reference were 0.84 to 0.92 when using the eighth and seventh intercostal spaces individually and 0.89 to 0.90 when combined. CONCLUSIONS The results suggest that 2D SWE and MRE are well correlated when SWE is performed at the eighth and seventh intercostal spaces. The ninth intercostal space is less reliable for diagnosing fibrosis with 2D SWE. Combining measurements from multiple intercostal spaces does not significantly improve the performance of 2D SWE for detection of fibrosis.
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Affiliation(s)
- Pengfei Song
- Departments of Radiology (P.S., S.P.S., D.D.M., R.M.K., M.R.C., S.C.), Physiology and Biomedical Engineering (D.C.M., M.W.U., A.M., J.F.G.), and Gastroenterology (W.S.), Mayo Clinic, Rochester, Minnesota USA
| | - Daniel C Mellema
- Departments of Radiology (P.S., S.P.S., D.D.M., R.M.K., M.R.C., S.C.), Physiology and Biomedical Engineering (D.C.M., M.W.U., A.M., J.F.G.), and Gastroenterology (W.S.), Mayo Clinic, Rochester, Minnesota USA
| | - Shannon P Sheedy
- Departments of Radiology (P.S., S.P.S., D.D.M., R.M.K., M.R.C., S.C.), Physiology and Biomedical Engineering (D.C.M., M.W.U., A.M., J.F.G.), and Gastroenterology (W.S.), Mayo Clinic, Rochester, Minnesota USA
| | - Duane D Meixner
- Departments of Radiology (P.S., S.P.S., D.D.M., R.M.K., M.R.C., S.C.), Physiology and Biomedical Engineering (D.C.M., M.W.U., A.M., J.F.G.), and Gastroenterology (W.S.), Mayo Clinic, Rochester, Minnesota USA
| | - Ryan M Karshen
- Departments of Radiology (P.S., S.P.S., D.D.M., R.M.K., M.R.C., S.C.), Physiology and Biomedical Engineering (D.C.M., M.W.U., A.M., J.F.G.), and Gastroenterology (W.S.), Mayo Clinic, Rochester, Minnesota USA
| | - Matthew W Urban
- Departments of Radiology (P.S., S.P.S., D.D.M., R.M.K., M.R.C., S.C.), Physiology and Biomedical Engineering (D.C.M., M.W.U., A.M., J.F.G.), and Gastroenterology (W.S.), Mayo Clinic, Rochester, Minnesota USA
| | - Armando Manduca
- Departments of Radiology (P.S., S.P.S., D.D.M., R.M.K., M.R.C., S.C.), Physiology and Biomedical Engineering (D.C.M., M.W.U., A.M., J.F.G.), and Gastroenterology (W.S.), Mayo Clinic, Rochester, Minnesota USA
| | - William Sanchez
- Departments of Radiology (P.S., S.P.S., D.D.M., R.M.K., M.R.C., S.C.), Physiology and Biomedical Engineering (D.C.M., M.W.U., A.M., J.F.G.), and Gastroenterology (W.S.), Mayo Clinic, Rochester, Minnesota USA
| | - Matthew R Callstrom
- Departments of Radiology (P.S., S.P.S., D.D.M., R.M.K., M.R.C., S.C.), Physiology and Biomedical Engineering (D.C.M., M.W.U., A.M., J.F.G.), and Gastroenterology (W.S.), Mayo Clinic, Rochester, Minnesota USA
| | - James F Greenleaf
- Departments of Radiology (P.S., S.P.S., D.D.M., R.M.K., M.R.C., S.C.), Physiology and Biomedical Engineering (D.C.M., M.W.U., A.M., J.F.G.), and Gastroenterology (W.S.), Mayo Clinic, Rochester, Minnesota USA
| | - Shigao Chen
- Departments of Radiology (P.S., S.P.S., D.D.M., R.M.K., M.R.C., S.C.), Physiology and Biomedical Engineering (D.C.M., M.W.U., A.M., J.F.G.), and Gastroenterology (W.S.), Mayo Clinic, Rochester, Minnesota USA.
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Non-invasive assessment of liver fibrosis using acoustic structure quantification: comparison with transient elastography in chronic viral hepatitis. Abdom Radiol (NY) 2016; 41:239-47. [PMID: 26867905 DOI: 10.1007/s00261-015-0597-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the diagnostic efficacy of acoustic structure quantification (ASQ) parameters [mode, average, and focal distribution (FD) ratio] in the staging of hepatic fibrosis in patients with chronic viral hepatitis and to compare it with transient elastography (TE) by using liver biopsy as reference standard. METHODS We studied 62 patients with chronic viral hepatitis. Each patient underwent ASQ evaluation and liver biopsy; 54 of these patients received TE. Thirty-six participants without any liver disease were enrolled as normal group, who also underwent ASQ evaluation and TE. All three parameters of ASQ were compared with the histologic fibrosis grade according to the METAVIR scoring (F0-F4). Statistical analysis was performed to investigate the correlations and the diagnostic values of ASQ parameters and compare them to TE. RESULTS All three ASQ parameters and TE were significantly correlated with liver fibrosis stage. Of the ASQ parameters, the mode parameter showed the best correlation (P < 0.001). On the area under the receiver operating characteristic curve (AUROC), the mode parameter of ASQ analysis showed both significant correlation and good accuracy for diagnosis of F ≥ 1, F ≥ 2, and F ≥ 3. These values were significantly better than those of the average and FD ratio parameters in F ≥ 1 and F ≥ 2 (P < 0.05). There was no statistically significant difference in AUROC between the mode parameter and TE in diagnosis of F ≥ 1, F ≥ 2, or F ≥ 3. CONCLUSIONS The mode parameter is the most reliable ASQ parameter, comparable to TE, as a non-invasive method for the detection and grading of liver fibrosis in patients with chronic viral hepatitis.
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Valva P, Ríos DA, De Matteo E, Preciado MV. Chronic hepatitis C virus infection: Serum biomarkers in predicting liver damage. World J Gastroenterol 2016; 22:1367-1381. [PMID: 26819506 PMCID: PMC4721972 DOI: 10.3748/wjg.v22.i4.1367] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 08/04/2015] [Accepted: 10/13/2015] [Indexed: 02/06/2023] Open
Abstract
Currently, a major clinical challenge in the management of the increasing number of hepatitis C virus (HCV) infected patients is determining the best means for evaluating liver impairment. Prognosis and treatment of chronic hepatitis C (CHC) are partly dependent on the assessment of histological activity, namely cell necrosis and inflammation, and the degree of liver fibrosis. These parameters can be provided by liver biopsy; however, in addition to the risks related to an invasive procedure, liver biopsy has been associated with sampling error mostly due to suboptimal biopsy size. To avoid these pitfalls, several markers have been proposed as non-invasive alternatives for the diagnosis of liver damage. Distinct approaches among the currently available non-invasive methods are (1) the physical ones based on imaging techniques; and (2) the biological ones based on serum biomarkers. In this review, we discuss these approaches with special focus on currently available non-invasive serum markers. We will discuss: (1) class I serum biomarkers individually and as combined panels, particularly those that mirror the metabolism of liver extracellular matrix turnover and/or fibrogenic cell changes; (2) class II biomarkers that are indirect serum markers and are based on the evaluation of common functional alterations in the liver; and (3) biomarkers of liver cell death, since hepatocyte apoptosis plays a significant role in the pathogenesis of HCV infection. We highlight in this review the evidence behind the use of these markers and assess the diagnostic accuracy as well as advantages, limitations, and application in clinical practice of each test for predicting liver damage in CHC.
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117
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Oh JS, Ali AK, Kim S, Corsi DJ, Cooper CL, Lee SH. NK cells lacking FcεRIγ are associated with reduced liver damage in chronic hepatitis C virus infection. Eur J Immunol 2016; 46:1020-9. [PMID: 26712042 DOI: 10.1002/eji.201546009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 10/09/2015] [Accepted: 12/23/2015] [Indexed: 12/13/2022]
Abstract
A novel subset of human natural killer (NK) cells, which displays potent and broad antiviral responsiveness in concert with virus-specific antibodies, was recently uncovered in cytomegalovirus (CMV)+ individuals. This NK-cell subset (g-NK) was characterized by a deficiency in the expression of FcεRIγ adaptor protein and the long-lasting memory-like NK-cell phenotype, suggesting a role in chronic infections. This study investigates whether the g-NK-cell subset is associated with the magnitude of liver disease during chronic hepatitis C virus (HCV) infection. Analysis of g-NK-cell proportions and function in the PBMCs of healthy controls and chronic HCV subjects showed that chronic HCV subjects had slightly lower proportions of the g-NK-cell subset having similarly enhanced antibody-dependent cellular cytotoxicity responses compared to conventional NK cells. Notably, among CMV+ chronic HCV patients, lower levels of liver enzymes and fibrosis were found in those possessing g-NK cells. g-NK cells were predominant among the CD56(neg) NK cell population often found in chronic HCV patients, suggesting their involvement in immune response during HCV infection. For the first time, our findings indicate that the presence of the g-NK cells in CMV+ individuals is associated with amelioration of liver disease in chronic HCV infection, suggesting the beneficial roles of g-NK cells during a chronic infection.
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Affiliation(s)
- Jun S Oh
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Canada
| | - Alaa K Ali
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Canada
| | - Sungjin Kim
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI, USA
| | | | - Curtis L Cooper
- Ottawa Hospital Research Institute, Ottawa, Canada.,Division of Infectious Diseases, Ottawa Hospital-General Campus, Ottawa, Canada.,School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Canada
| | - Seung-Hwan Lee
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Canada
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Orasan OH, Ciulei G, Cozma A, Sava M, Dumitrascu DL. Hyaluronic acid as a biomarker of fibrosis in chronic liver diseases of different etiologies. ACTA ACUST UNITED AC 2016; 89:24-31. [PMID: 27004022 PMCID: PMC4777465 DOI: 10.15386/cjmed-554] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 09/17/2015] [Indexed: 12/27/2022]
Abstract
Chronic liver diseases represent a significant public health problem worldwide. The degree of liver fibrosis secondary to these diseases is important, because it is the main predictor of their evolution and prognosis. Hyaluronic acid is studied as a non-invasive marker of liver fibrosis in chronic liver diseases, in an attempt to avoid the complications of liver puncture biopsy, considered the gold standard in the evaluation of fibrosis. We review the advantages and limitations of hyaluronc acid, a biomarker, used to manage patients with chronic viral hepatitis B or C infection, non-alcoholic fatty liver disease, HIV-HCV coinfection, alcoholic liver disease, primary biliary cirrhosis, biliary atresia, hereditary hemochromatosis and cystic fibrosis.
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Affiliation(s)
- Olga Hilda Orasan
- 4th Medical Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - George Ciulei
- 4th Medical Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Angela Cozma
- 4th Medical Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Madalina Sava
- 4th Medical Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dan Lucian Dumitrascu
- 2nd Medical Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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119
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de Souza-Cruz S, Victória MB, Tarragô AM, da Costa AG, Pimentel JPD, Pires EF, Araújo LDP, Coelho-dos-Reis JG, Gomes MDS, Amaral LR, Teixeira-Carvalho A, Martins-Filho OA, Victória FDS, Malheiro A. Liver and blood cytokine microenvironment in HCV patients is associated to liver fibrosis score: a proinflammatory cytokine ensemble orchestrated by TNF and tuned by IL-10. BMC Microbiol 2016; 16:3. [PMID: 26742960 PMCID: PMC4705620 DOI: 10.1186/s12866-015-0610-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 12/01/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In this study, we have evaluated the immunological status of hepatitis C virus (HCV)-infected patients aiming at identifying putative biomarkers associated with distinct degrees of liver fibrosis. Peripheral blood and tissue T-cells as well as cytokine levels were quantified by flow cytometry. RESULTS Data analysis demonstrated higher frequency of circulating CD8(+) T-cells and Tregs along with a mixed proinflammatory/IL-10-modulated cytokine pattern in HCV patients. Patients with severe liver fibrosis presented lower frequency of circulating CD8(+) T-cells, higher levels of proinflammatory cytokines, but lower levels of IL-10, in addition to the higher viral load. Despite the lower frequency of intrahepatic T-cells and scarce frequency of Tregs, patients with severe liver fibrosis showed higher levels of proinflammatory cytokines (TNF and IFN-γ). The tissue proinflammatory cytokine pattern supported further studies of serum cytokines as relevant biomarkers associated with different liver fibrosis scores. Serum cytokine signature showed that mild liver fibrosis is associated with higher IL-10 serum levels as compared to severe liver disease. There was a clear positive connection of IL-10 with the TNF node in patients with mild liver fibrosis, whereas there is an evident inverse correlation between IL-10 with all other cytokine nodes. CONCLUSIONS These results suggest the absence of modulatory events in patients with severe liver damage as opposed to mild fibrosis. Machine-learning data mining pointed out TNF and IL-10 as major attributes to differentiate HCV patients from non-infected individuals with highest performance. In conclusion, our findings demonstrated that HCV infection triggers a local and systemic cytokine ensemble orchestrated by TNF and tuned by IL-10 in such a manner that mirrors the liver fibrosis score, which highly suggests the relevance of these set of biomarkers for clinical investigations.
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Affiliation(s)
- Soriane de Souza-Cruz
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Universidade Federal do Amazonas - UFAM, Manaus, AM, Brazil. .,Departamento de Ensino e Pesquisa, Fundação de Hematologia e Hemoterapia do Amazonas - Hemoam, Manaus, AM, Brazil.
| | - Marilú Barbieri Victória
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas - UEA, Manaus, AM, Brazil. .,Fundação de Medicina Tropical Doutor Heitor Vieira Dourado - FMT-HVD, Manaus, AM, Brazil.
| | - Andréa Monteiro Tarragô
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Universidade Federal do Amazonas - UFAM, Manaus, AM, Brazil. .,Departamento de Ensino e Pesquisa, Fundação de Hematologia e Hemoterapia do Amazonas - Hemoam, Manaus, AM, Brazil.
| | - Allyson Guimarães da Costa
- Departamento de Ensino e Pesquisa, Fundação de Hematologia e Hemoterapia do Amazonas - Hemoam, Manaus, AM, Brazil. .,Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas - UEA, Manaus, AM, Brazil. .,Fundação de Medicina Tropical Doutor Heitor Vieira Dourado - FMT-HVD, Manaus, AM, Brazil.
| | - João Paulo Diniz Pimentel
- Departamento de Ensino e Pesquisa, Fundação de Hematologia e Hemoterapia do Amazonas - Hemoam, Manaus, AM, Brazil.
| | - Ericka Florêncio Pires
- Departamento de Ensino e Pesquisa, Fundação de Hematologia e Hemoterapia do Amazonas - Hemoam, Manaus, AM, Brazil.
| | - Lorene de Paula Araújo
- Departamento de Ensino e Pesquisa, Fundação de Hematologia e Hemoterapia do Amazonas - Hemoam, Manaus, AM, Brazil.
| | - Jordana Grazziela Coelho-dos-Reis
- Grupo Integrado de Pesquisas em Biomarcadores, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brazil. .,Laboratory of Biomarkers for Diagnosis and Monitoring, René Rachou Research Center - FIOCRUZ/MG, Av. Augusto de Lima 1715, Barro Preto, Belo Horizonte, CEP 30190-002, Minas Gerais, Brazil.
| | - Matheus de Souza Gomes
- Laboratory of Bioinformatics and Molecular Analysis - INGEB / FACOM, Federal University of Uberlandia, Campus Patos de Minas, Major Jerônimo, 566, Lab 602, Patos de Minas, CEP 38700-002, MG, Brazil.
| | - Laurence Rodrigues Amaral
- Laboratory of Bioinformatics and Molecular Analysis - INGEB / FACOM, Federal University of Uberlandia, Campus Patos de Minas, Major Jerônimo, 566, Lab 602, Patos de Minas, CEP 38700-002, MG, Brazil.
| | - Andréa Teixeira-Carvalho
- Grupo Integrado de Pesquisas em Biomarcadores, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brazil. .,Laboratory of Biomarkers for Diagnosis and Monitoring, René Rachou Research Center - FIOCRUZ/MG, Av. Augusto de Lima 1715, Barro Preto, Belo Horizonte, CEP 30190-002, Minas Gerais, Brazil.
| | - Olindo Assis Martins-Filho
- Grupo Integrado de Pesquisas em Biomarcadores, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brazil. .,Laboratory of Biomarkers for Diagnosis and Monitoring, René Rachou Research Center - FIOCRUZ/MG, Av. Augusto de Lima 1715, Barro Preto, Belo Horizonte, CEP 30190-002, Minas Gerais, Brazil.
| | - Flamir da Silva Victória
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas - UEA, Manaus, AM, Brazil. .,Fundação de Medicina Tropical Doutor Heitor Vieira Dourado - FMT-HVD, Manaus, AM, Brazil.
| | - Adriana Malheiro
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Universidade Federal do Amazonas - UFAM, Manaus, AM, Brazil. .,Departamento de Ensino e Pesquisa, Fundação de Hematologia e Hemoterapia do Amazonas - Hemoam, Manaus, AM, Brazil.
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Stankovic Z. Four-dimensional flow magnetic resonance imaging in cirrhosis. World J Gastroenterol 2016; 22:89-102. [PMID: 26755862 PMCID: PMC4698511 DOI: 10.3748/wjg.v22.i1.89] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/08/2015] [Accepted: 10/13/2015] [Indexed: 02/06/2023] Open
Abstract
Since its introduction in the 1970’s, magnetic resonance imaging (MRI) has become a standard imaging modality. With its broad and standardized application, it is firmly established in the clinical routine and an essential element in cardiovascular and abdominal imaging. In addition to sonography and computer tomography, MRI is a valuable tool for diagnosing cardiovascular and abdominal diseases, for determining disease severity, and for assessing therapeutic success. MRI techniques have improved over the last few decades, revealing not just morphologic information, but functional information about perfusion, diffusion and hemodynamics as well. Four-dimensional (4D) flow MRI, a time-resolved phase contrast-MRI with three-dimensional (3D) anatomic coverage and velocity encoding along all three flow directions has been used to comprehensively assess complex cardiovascular hemodynamics in multiple regions of the body. The technique enables visualization of 3D blood flow patterns and retrospective quantification of blood flow parameters in a region of interest. Over the last few years, 4D flow MRI has been increasingly performed in the abdominal region. By applying different acceleration techniques, taking 4D flow MRI measurements has dropped to a reasonable scanning time of 8 to 12 min. These new developments have encouraged a growing number of patient studies in the literature validating the technique’s potential for enhanced evaluation of blood flow parameters within the liver’s complex vascular system. The purpose of this review article is to broaden our understanding of 4D flow MRI for the assessment of liver hemodynamics by providing insights into acquisition, data analysis, visualization and quantification. Furthermore, in this article we highlight its development, focussing on the clinical application of the technique.
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121
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Rókusz A, Nagy E, Gerlei Z, Veres D, Dezső K, Paku S, Szücs A, Hajósi-Kalcakosz S, Pávai Z, Görög D, Kóbori L, Fehérvári I, Nemes B, Nagy P. Quantitative morphometric and immunohistochemical analysis and their correlates in cirrhosis--A study on explant livers. Scand J Gastroenterol 2016; 51:86-94. [PMID: 26166621 DOI: 10.3109/00365521.2015.1067902] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Reproducible structural analysis was made on cirrhotic human liver samples in order to reveal potential connections between morphological and laboratory parameters. MATERIAL AND METHODS Large histological samples were taken from segment VII of 56 cirrhotic livers removed in connection with liver transplantation. Picro Sirius red and immunohistochemically (smooth muscle actin [SMA], cytokeratin 7 [CK7], Ki-67) stained sections were digitalized and morphometric evaluation was performed. RESULTS The Picro Sirius-stained fibrotic area correlated with the average thickness of the three broadest septa, extent of SMA positivity, alkaline phosphatase (ALP) values and it was lower in the viral hepatitis related cirrhoses than in samples with non-viral etiology. The extent of SMA staining increased with the CK7-positive ductular reaction. The proliferative activity of the hepatocytes correlated positively with the Ki-67 labeling of the ductular cells and inversely with the septum thickness. These data support the potential functional connection among different structural components, for example, myofibroblasts, ductular reaction and fibrogenesis but challenges the widely proposed role of ductular cells in regeneration. CONCLUSION Unbiased morphological characterization of cirrhotic livers can provide valuable, clinically relevant information. Similar evaluation of routine core biopsies may increase the significance of this 'Gold Standard' examination.
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Affiliation(s)
- András Rókusz
- a 1 First Department of Pathology and Experimental Cancer Research, Semmelweis University , 1085, Üllői út 26, Budapest, Hungary
| | - Eszter Nagy
- a 1 First Department of Pathology and Experimental Cancer Research, Semmelweis University , 1085, Üllői út 26, Budapest, Hungary
| | - Zsuzsanna Gerlei
- b 2 Department of Transplantation and Surgery, Semmelweis University , 1085, Baross utca 23, Budapest, Hungary
| | - Dániel Veres
- c 3 Department of Biophysics and Radiation Biology, Semmelweis University , 1094, Tűzoltó utca 37-47, Budapest, Hungary
| | - Katalin Dezső
- a 1 First Department of Pathology and Experimental Cancer Research, Semmelweis University , 1085, Üllői út 26, Budapest, Hungary
| | - Sándor Paku
- a 1 First Department of Pathology and Experimental Cancer Research, Semmelweis University , 1085, Üllői út 26, Budapest, Hungary.,d 4 Tumor Progression Research Group, Joint Research Organization of the Hungarian Academy of Sciences and Semmelweis University , 1051, Nádor utca 7, Budapest, Hungary
| | - Armanda Szücs
- a 1 First Department of Pathology and Experimental Cancer Research, Semmelweis University , 1085, Üllői út 26, Budapest, Hungary
| | - Szofia Hajósi-Kalcakosz
- a 1 First Department of Pathology and Experimental Cancer Research, Semmelweis University , 1085, Üllői út 26, Budapest, Hungary
| | - Zoltán Pávai
- e 5 Department of Anatomy and Embryology, University of Medicine and Pharmacy Targu Mures , 540139, Gh. Marinescu 38, Targu Mures, Romania
| | - Dénes Görög
- b 2 Department of Transplantation and Surgery, Semmelweis University , 1085, Baross utca 23, Budapest, Hungary
| | - László Kóbori
- b 2 Department of Transplantation and Surgery, Semmelweis University , 1085, Baross utca 23, Budapest, Hungary
| | - Imre Fehérvári
- b 2 Department of Transplantation and Surgery, Semmelweis University , 1085, Baross utca 23, Budapest, Hungary
| | - Balázs Nemes
- b 2 Department of Transplantation and Surgery, Semmelweis University , 1085, Baross utca 23, Budapest, Hungary
| | - Péter Nagy
- a 1 First Department of Pathology and Experimental Cancer Research, Semmelweis University , 1085, Üllői út 26, Budapest, Hungary
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Assessment of Liver Stiffness in Pediatric Fontan Patients Using Transient Elastography. Can J Gastroenterol Hepatol 2016; 2016:7125193. [PMID: 27656638 PMCID: PMC5021462 DOI: 10.1155/2016/7125193] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 08/11/2016] [Indexed: 01/09/2023] Open
Abstract
Background. Hepatic fibrosis is a potential complication following Fontan surgery and heralds long-term risk for cirrhosis. Transient elastography (TE) is a rapid, noninvasive method to assess liver fibrosis by measuring liver stiffness. Objectives. To compare liver stiffness and liver biochemistries in pediatric Fontan patients with age- and sex-matched controls and to determine patients' acceptance of TE. Methods. Patients were recruited from British Columbia Children's Hospital. Twenty-two Fontan patients (15 males) were identified. Demographic information and cardiac data were collected. TE was measured using size-appropriate probes. Results. The median age of the Fontan cohort was 13.7 (5.9-16.8) years. Time from Fontan surgery to TE was 9.6 (1.0-12.9) years. The median Fontan circuit pressure was 13 (11-14) mmHg. TE values were higher in Fontan patients versus controls (18.6 versus 4.7 kPa, p < 0.001). There was no association between TE values and patient age (r = 0.41, p = 0.058), time since Fontan surgery (r = 0.40, p = 0.062), or median Fontan circuit pressure (CVP) (r = 0.35, p = 0.111). Patients found TE to be nonpainful, convenient, and safe. Conclusions. TE is feasible to assess liver stiffness in children following Fontan surgery. Pediatric Fontan patients have markedly elevated liver stiffness values. TE may have important utility in liver care follow-up of pediatric Fontan patients.
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Batheja M, Vargas H, Silva AM, Walker F, Chang YH, De Petris G, Silva AC. Magnetic resonance elastography (MRE) in assessing hepatic fibrosis: performance in a cohort of patients with histological data. ACTA ACUST UNITED AC 2015; 40:760-5. [PMID: 25542217 DOI: 10.1007/s00261-014-0321-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The purpose of this study was to compare fibrosis seen on liver biopsy to MR elastography (MRE) stiffness measurements in normal controls and patients with abnormal transaminases and chronic liver disease. METHODS The control group consisted of 22 healthy liver transplant donors who by definition had normal transaminases. The patient group (32 patients) was recruited from the Mayo Clinic Arizona hepatobiliary clinic over a 3-year span. All subjects underwent a liver biopsy as part of their evaluation and agreed to MRE within 35 days of biopsy. Non-parametric tests were used to compare the MRE-predicted liver fibrosis to the fibrosis noted on liver biopsy. RESULTS Analysis included 54 subjects (32 patients with chronic liver disease and 22 healthy liver donor candidates). MRE median liver stiffness measurements increased per histologic liver fibrosis stage (one-way ANOVA p = 0.001), with significant correlation between increasing fibrosis stage and stiffness values. Median MRE for control group (2.13 kPa; mean = 2.3 ± 0.6 kPa) was significantly lower than for patient group (3.7 kPa; mean = 4.1 ± 2.1 kPa) (p = 0.003). Significantly, lower median stiffness was seen in zero-to-moderate (F0-2, n = 22) vs. severe fibrosis stages (F3-4, n = 10) 2.80 vs. 5.9 kPa, respectively (p < 0.05). Using a 3.7-kPa cut-off value, the predicted sensitivity and specificity for detecting F0-2 from F3-4 were 91% and 80%, respectively. CONCLUSIONS Our analysis supports previous findings that MRE is a non-invasive and effective method for detection and assessment of liver fibrosis, particularly for discrimination between F0-2 stages and F3-4 stages. MRE may represent a valuable tool to finely discern hepatic fibrosis non-invasively.
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Affiliation(s)
- Mashal Batheja
- Department of Gastroenterology, Mayo Clinic in Arizona, Scottsdale, AZ, USA
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Guo Y, Parthasarathy S, Goyal P, McCarthy RJ, Larson AC, Miller FH. Magnetic resonance elastography and acoustic radiation force impulse for staging hepatic fibrosis: a meta-analysis. ACTA ACUST UNITED AC 2015; 40:818-34. [PMID: 24711064 DOI: 10.1007/s00261-014-0137-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Elastography is a non-invasive method to quantify fibrosis based on tissue mechanical properties. We performed a meta-analysis to assess the diagnostic accuracy of two such techniques: Acoustic Radiation Force Impulse Imaging (ARFI) or Magnetic Resonance Elastography (MRE) for staging hepatic fibrosis. MATERIALS AND METHODS Literature databases were searched until June 2013. Inclusion criteria were evaluation of MRE or ARFI, liver biopsy, and reported sensitivity and specificity. A random effects model was used to combine sensitivity and specificity, from which positive (LR+) and negative (LR-) likelihood ratios, diagnostic odds ratios, and area under receiver operating characteristics curve (AUROC) were derived. Differences between MRE and ARFI were compared with t tests (P < 0.05 considered significant). RESULTS Eleven MRE studies including 982 patients and fifteen ARFI studies including 2,128 patients were selected. AUROC for MRE staging fibrosis were 0.94, 0.97, 0.96, and 0.97 for F1-F4, respectively, whereas AUROC for ARFI staging were 0.82, 0.85, 0.94, and 0.94 for F1-F4, respectively. Significance was found in AUROC between MRE and ARFI for the diagnosis of stage 1 and 2 fibrosis. CONCLUSION MRE is more accurate than ARFI with a higher combination of sensitivity, specificity, LR, and AUROC particularly in diagnosing early stages of hepatic fibrosis.
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Affiliation(s)
- Yang Guo
- Department of Radiology, Northwestern University Feinberg School of Medicine, NMH/Arkes Family Pavilion Suite 800, 676 N Saint Clair, Chicago, IL, 60611, USA
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Zhang GB, Song YN, Chen QL, Dong S, Lu YY, Su MY, Liu P, Su SB. Actions of Huangqi decoction against rat liver fibrosis: a gene expression profiling analysis. Chin Med 2015; 10:39. [PMID: 26691002 PMCID: PMC4683959 DOI: 10.1186/s13020-015-0066-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 11/03/2015] [Indexed: 01/18/2023] Open
Abstract
Background Huangqi decoction (HQD) is used for liver fibrosis and cirrhosis treatment in Chinese medicine. This study aims to investigate the pharmacological actions of HQD against liver fibrosis in rats by high-throughput gene expression profiling, network analysis and real-time qRT-PCR. Methods We analyzed the profiles of differentially expressed genes (DEGs) in dimethylnitrosamine (DMN)-induced liver fibrosis in rat. The liver tissue samples of control group (n = 3), model group (n = 3) and HQD group (n = 3) were examined by microarrays. Pathways were analyzed by KEGG. Pathway-gene and protein–protein interaction (PPI) networks were constructed with Cytoscape software. The expression of candidate genes was verified by qRT-PCR. P values less than 0.05 indicated statistical significance. Results Collagen deposition and hydroxyproline (Hyp) content were decreased in the HQD group compared with the model group (P < 0.001), while that of Hyp in the model group were increased compared with the control group (P < 0.001). In comparison with the model group, 1085 DEGs (all P < 0.05, |fold change| >1.5) and 52 pathways in the HQD group were identified. TGF-beta, ECM-receptor interaction, and the cell adhesion molecules pathways were significantly recovered by HQD (P < 0.001). A pathway-gene network was constructed, including 303 DEGs and 52 pathways, and 514 nodes and 2602 edges, among 142 genes with node degrees greater than 10. The expressions of PDGFra, PDGFrb, PDGFb, PDGFd, COL1A1, COL1A2, COL5A2, and THBS1 were significantly down-regulated by HQD (P < 0.001). Conclusion HQD down-regulated the expressions of PDGFra, PDGFrb, PDGFb, PDGFd, COL1A1, COL1A2, COL5A2 and THBS1, and TGF-β and PDGF signaling pathways in the DMN-induced liver fibrosis in rats. Electronic supplementary material The online version of this article (doi:10.1186/s13020-015-0066-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gui-Biao Zhang
- Research Center for Traditional Chinese Medicine Complexity System, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203 China
| | - Ya-Nan Song
- Research Center for Traditional Chinese Medicine Complexity System, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203 China
| | - Qi-Long Chen
- Research Center for Traditional Chinese Medicine Complexity System, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203 China
| | - Shu Dong
- Research Center for Traditional Chinese Medicine Complexity System, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203 China
| | - Yi-Yu Lu
- Research Center for Traditional Chinese Medicine Complexity System, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203 China
| | - Ming-Yu Su
- Liver Disease Institute, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203 China
| | - Ping Liu
- Liver Disease Institute, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203 China
| | - Shi-Bing Su
- Research Center for Traditional Chinese Medicine Complexity System, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203 China
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Wild Edible Fruit of Prunus nepalensis Ser. (Steud), a Potential Source of Antioxidants, Ameliorates Iron Overload-Induced Hepatotoxicity and Liver Fibrosis in Mice. PLoS One 2015; 10:e0144280. [PMID: 26633891 PMCID: PMC4669143 DOI: 10.1371/journal.pone.0144280] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 10/27/2015] [Indexed: 12/17/2022] Open
Abstract
The antioxidant and restoration potentials of hepatic injury by Prunus nepalensis Ser. (Steud), a wild fruit plant from the Northeastern region of India, were investigated. The fruit extract (PNME) exhibited excellent antioxidant and reducing properties and also scavenged the 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical (IC50 = 30.92 ± 0.40 μg/ml). PNME demonstrated promising scavenging potency, as assessed by the scavenging of different reactive oxygen and nitrogen species. Moreover, the extract revealed an exceptional iron chelation capacity with an IC50 of 25.64 ± 0.60 μg/ml. The extract induced significant improvement of hepatic injury and liver fibrosis against iron overload induced hepatotoxicity in mice in a dose-dependent manner, and this effect was supported by different histopathological studies. The phytochemical constitutions and their identification by HPLC confirmed the presence of purpurin, tannic acid, methyl gallate, reserpine, gallic acid, ascorbic acid, catechin and rutin. The identified compounds were investigated for their individual radical scavenging and iron chelation activity; some compounds exhibited excellent radical scavenging and iron chelation properties, but most were toxic towards normal cells (WI-38). On the other hand, crude PNME was found to be completely nontoxic to normal cells, suggesting its feasibility as a safe oral drug. The above study suggests that different phytochemicals in PNME contributed to its free radical scavenging and iron chelation activity; however, further studies are required to determine the pathway in which PNME acts to treat iron-overload diseases.
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Lin CL, Kao JH. Can noninvasive biomarkers replace liver biopsy for chronic hepatitis B? Hepatology 2015; 62:1924-5. [PMID: 25914237 DOI: 10.1002/hep.27865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 03/09/2015] [Indexed: 12/24/2022]
Affiliation(s)
- Chih-Lin Lin
- Department of Gastroenterology, Ren-Ai branch, Taipei City Hospital, Taipei, Taiwan.,Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Jia-Horng Kao
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.,Hepatitis Research Center, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.,Department of Medical Research, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
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Oztas E, Kuzu UB, Zengin NI, Kalkan IH, Saygili F, Yildiz H, Celik HT, Akdogan M, Kilic MY, Koksal AS, Odemis B, Suna N, Kayacetin E. Can Serum ST2 Levels Be Used as a Marker of Fibrosis in Chronic Hepatitis B Infection? Medicine (Baltimore) 2015; 94:e1889. [PMID: 26632683 PMCID: PMC5058952 DOI: 10.1097/md.0000000000001889] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/27/2015] [Accepted: 09/29/2015] [Indexed: 12/13/2022] Open
Abstract
Interleukin 33 (IL-33) is a cytokine belonging to the IL-1 superfamily. Soluble ST2 (sST2) binds to IL-33 and by functioning as trap receptor inhibits signal sending to Th2 via transmembrane ST2. Because Th2-type cytokines play an important role in fibrosis, the aim of this study is to determine whether sST2 can be used as a marker of fibrosis in chronic hepatitis B (CHB) patients or not.The study included 19 healthy controls, 54 patients with CHB, and 14 patients with cirrhosis because of CHB. The aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis index based on the 4 factors (FIB-4) scores also calculated, and correlations between liver biopsies, sST2 levels, and these scores were analyzed in CHB and cirrhosis patients.The sST2 levels in patients with CHB were significantly higher than those in the control group subjects (median: 1133 pg/mL vs 762.5 pg/mL, respectively [P = 0.035]). In CHB patients, the METAVIR fibrosis score (stages from 0 to 4) showed a moderate correlation with serum sST2 level (r = 0.396, P = 0.004) and a weak correlation with FIB-4 score (r = 0.359, P = 0.008), but no correlation with APRI score (r = 0.253, P = 0.06). The under the curve value of serum sST2 was 0.68, and its prediction of significant fibrosis (METAVIR score ≥2) in values >674 pg/mL had a sensitivity of 91.7% and specificity of 40% (P = 0.009). According to multiple logistic regression analysis, only METAVIR fibrosis stage was found to be an independent predictor of serum sST2 elevation in CHB patients (P = 0.04).The sST2 level can be used for differentiating significant fibrosis from mild fibrosis in CHB patients. However, the efficacy of this marker should be verified by larger studies in the future.
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Affiliation(s)
- Erkin Oztas
- From the Department of Gastroenterology (EO, UBK, IHK, FS, FOO, HY, MA, MYK, AŞK, SK, BO, NS, EK), Turkiye Yuksek Ihtisas Education and Research Hospital; Department of Pathology (NIZ), Turkiye Yuksek Ihtisas Education and Research Hospital; and Department of Biochemistry (HTÇ), Turgut Ozal University, Ankara, Turkey
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Diagnostic usefulness of FibroMeter VCTE for hepatic fibrosis in patients with nonalcoholic fatty liver disease. Eur J Gastroenterol Hepatol 2015; 27:1149-53. [PMID: 26049712 DOI: 10.1097/meg.0000000000000409] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Liver fibrosis is an important prognostic determinant in patients with nonalcoholic fatty liver disease (NAFLD). The FibroMeter VCTE is a diagnostic tool comprising both biochemical markers and transient elastography (TE) originally developed for the diagnosis of fibrosis in patients with chronic viral hepatitis. In this pilot study, we investigated the diagnostic performance of the FibroMeter VCTE tool for determining fibrosis in patients with biopsy-proven NAFLD. Its diagnostic accuracy was also compared with those of the NAFLD fibrosis score (NFSA) and TE alone. PATIENTS AND METHODS FibroMeter VCTE, NFSA, and TE were determined in 52 patients with NAFLD. The results of liver biopsies were considered the gold standard. Areas under the receiver operating characteristic curve were used to express the diagnostic accuracy of each test. RESULTS Significant (F≥2) and severe (F≥3) fibrosis were detected in 20 (38%) and 10 (19%) patients, respectively. The sensitivity of FibroMeter VCTE, NFSA, and TE for detecting significant fibrosis was 70, 65, and 75%, respectively, whereas specificity was 88, 81, and 78%. The sensitivity of FibroMeter VCTE, NFSA, and TE for diagnosing severe fibrosis was 90, 90, and 100%, respectively, whereas specificity was 93, 78, and 76%. Receiver operating characteristic analysis showed that FibroMeter VCTE had a significantly larger areas under the receiver operating characteristic curve (0.968) compared with both NFSA (0.833, P<0.001) and TE (0.922, P<0.05) for the detection of severe fibrosis. CONCLUSION Our preliminary findings indicate that FibroMeter VCTE is superior to both NFSA and TE for the diagnosis of severe fibrosis in patients with NAFLD.
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Will a second biopsy sample affect treatment decisions in patients with chronic hepatitis B? Hepatol Int 2015. [PMID: 26416085 DOI: 10.1007/s12072-015-9666-5.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
BACKGROUND AND AIM Liver biopsy is the gold standard for assessment of fibrosis in patients with hepatitis B. However, it has some disadvantages, including inter-observer and intra-observer variability in biopsy interpretation and specimen variation. A standard biopsy specimen represents only about 0.0002 % of the whole liver. It has been shown that two biopsy samples collected during a procedure have significant influence on the diagnostic performance of interpretation in patients with hepatitis C or non-alcoholic steatohepatitis. Therefore, we aimed to assess the influence of collecting two liver biopsy samples during a single procedure for staging and grading chronic hepatitis B. PATIENTS AND METHODS 27 patients were included in the study. The median age of the patients was 43.51 ± 11.69. Fifteen patients were female, 12 patients were male. In the biopsy procedure, two samples of liver lobes were obtained. Grade and stage scores were compared between the two samples. Fibrosis staging and grading were assessed according to the Ishak scoring system. RESULTS Numbers of portal tract and biopsy size were equal in the two samples. There was a significant difference between the samples in terms of histological activity index (p value = 0.04). However, the difference was not enough to distinguish the mild and moderate stages. On the other hand, no significant difference in fibrosis staging between the two samples was found. CONCLUSIONS With this relatively small size of patients, in this study, we showed that a proper liver biopsy size is sufficient to predict treatment decisions in chronic hepatitis B patients. However, further studies are needed to show the association of sampling variability in patients with hepatitis B.
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Shimizu M, Miyamoto K, Nishihara Y, Izumi G, Sakai S, Inai K, Nishikawa T, Nakanishi T. Risk factors and serological markers of liver cirrhosis after Fontan procedure. Heart Vessels 2015; 31:1514-21. [PMID: 26386570 DOI: 10.1007/s00380-015-0743-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 09/04/2015] [Indexed: 01/06/2023]
Abstract
Liver cirrhosis (LC), which may result in hepatic failure or cancer, has been reported in patients after Fontan procedure. The purpose of this study was to clarify the frequency and histological characteristics of LC, and to evaluate the risk factors and serological markers of LC with Fontan circulation. Retrospective review of contrast-enhanced CT scans (CT) of the liver was carried out in 57 patients after Fontan procedure. Patients were divided into two groups: LC group (n = 31) and no LC group (n = 26). Age at Fontan procedure, duration after Fontan procedure, catheterization data, and history of failing Fontan circulation were compared between groups. Serological data including γ-GTP and hyaluronic acid were compared. Histology of autopsy specimens was assessed when available. Duration after Fontan procedure was significantly longer in LC group than no LC group. History of failing Fontan circulation was more frequent in LC group than in no LC group. There was no correlation between type of procedure (APC/Bjork/lateral tunnel/TCPC) and LC in this series. Serum hyaluronic acid, γ-GTP, and Forns index were significantly higher in LC group. Significant risk factors for LC were duration after Fontan procedure (>20 years). In autopsy specimens, histopathological changes of LC were observed predominantly in the central venous area. LC diagnosed with CT is frequent in patients long after Fontan procedure, especially after 20 years. Hyaluronic acid and γ-GTP could be useful markers to monitor the progression of liver fibrosis in Fontan patients.
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Affiliation(s)
- Mikiko Shimizu
- Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Kenji Miyamoto
- Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | | | - Gaku Izumi
- Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Shuji Sakai
- Department of Radiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kei Inai
- Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Toshio Nishikawa
- Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshio Nakanishi
- Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan.
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Abstract
The aim of this study was to evaluate the effect of liver diseases of different etiologies and clinical severity of liver cirrhosis on the serum level of hyaluronic acid. The results were compared with noninvasive markers of liver fibrosis: APRI, GAPRI, HAPRI, FIB-4 and Forn’s index. Serum samples were obtained from 20 healthy volunteers and patients suffering from alcoholic cirrhosis (AC)—57 patients, non-alcoholic cirrhosis (NAC)—30 and toxic hepatitis (HT)—22. Cirrhotic patients were classified according to Child–Pugh score. Hyaluronic acid concentration was measured by the immunochemical method. Non-patented indicators were calculated using special formulas. The mean serum hyaluronic acid concentration was significantly higher in AC, NAC and HT group in comparison with the control group. There were significant differences in the serum hyaluronic acid levels between liver diseases, and in AC they were significantly higher than those in NAC and HT group. The serum hyaluronic acid level differs significantly due to the severity of cirrhosis and was the highest in Child–Pugh class C. The sensitivity, specificity, accuracy, positive and negative predictive values and the area under the ROC curve for hyaluronic acid and all non-patented algorithms were high and similar to each other. We conclude that the concentration of hyaluronic acid changes in liver diseases and is affected by the severity of liver cirrhosis. Serum hyaluronic acid should be considered as a good marker for noninvasive diagnosis of liver damage, but the combination of markers is more useful.
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Kim TY, Kim JY, Sohn JH, Lee HS, Bang SY, Kim Y, Kim MY, Jeong WK. Assessment of Substantial Liver Fibrosis by Real-time Shear Wave Elastography in Methotrexate-Treated Patients With Rheumatoid Arthritis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:1621-1630. [PMID: 26269292 DOI: 10.7863/ultra.15.14.10035] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 12/07/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES A concern about methotrexate (MTX)-related liver fibrosis in patients with rheumatoid arthritis (RA) is still unresolved. This study investigated the correlation between liver stiffness and the cumulative MTX dose and the risk factors associated with substantial liver fibrosis assessed by real-time shear wave elastography (SWE), a recently introduced technique to evaluate liver stiffness in patients with RA. METHODS Data from 185 patients with RA were prospectively collected. Patients were divided into 3 groups according to cumulative MTX dose (group 1, total dose <1500 mg; group 2, 1500-4000 mg, and group 3, >4000 mg) and compared with healthy control participants. A Pearson correlation analysis was performed to evaluate correlations between liver stiffness and other clinical and laboratory variables. Substantial liver fibrosis was defined as liver stiffness of greater than 8.6 kPa by SWE. Associated factors were tested in a multivariate logistic analysis. RESULTS The mean liver stiffness value in healthy controls was significantly lower than in patients with RA treated with MTX (P< .006), but there was no significant difference among the MTX groups. Liver stiffness and the cumulative MTX dose was not correlated. Substantial liver fibrosis was detected only in 9 patients (4.9%). Multivariate analysis adjusted by age and sex revealed that only a high body mass index (odds ratio, 1.79; 95% confidence interval, 1.34-2.39; P < .001) was associated with liver stiffness of greater than 8.6 kPa. CONCLUSIONS Substantial liver fibrosis on SWE was observed in about 5% of MTX-treated patients with RA and was associated with only a high body mass index but not with the cumulative MTX dose, suggesting that other comorbidities might have a more important role in liver fibrosis.
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Affiliation(s)
- Tae Yeob Kim
- Departments of Internal Medicine (T.Y.K., J.Y.K., J.H.S., H.-S.L., S.-Y.B.) and Radiology (Y.K.), Hanyang University Guri Hospital and Hanyang University College of Medicine, Seoul, Korea; Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea (M.Y.K.); and Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea (W.K.J.)
| | - Ji Yeoun Kim
- Departments of Internal Medicine (T.Y.K., J.Y.K., J.H.S., H.-S.L., S.-Y.B.) and Radiology (Y.K.), Hanyang University Guri Hospital and Hanyang University College of Medicine, Seoul, Korea; Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea (M.Y.K.); and Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea (W.K.J.)
| | - Joo Hyun Sohn
- Departments of Internal Medicine (T.Y.K., J.Y.K., J.H.S., H.-S.L., S.-Y.B.) and Radiology (Y.K.), Hanyang University Guri Hospital and Hanyang University College of Medicine, Seoul, Korea; Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea (M.Y.K.); and Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea (W.K.J.).
| | - Hye-Soon Lee
- Departments of Internal Medicine (T.Y.K., J.Y.K., J.H.S., H.-S.L., S.-Y.B.) and Radiology (Y.K.), Hanyang University Guri Hospital and Hanyang University College of Medicine, Seoul, Korea; Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea (M.Y.K.); and Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea (W.K.J.)
| | - So-Young Bang
- Departments of Internal Medicine (T.Y.K., J.Y.K., J.H.S., H.-S.L., S.-Y.B.) and Radiology (Y.K.), Hanyang University Guri Hospital and Hanyang University College of Medicine, Seoul, Korea; Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea (M.Y.K.); and Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea (W.K.J.)
| | - Yongsoo Kim
- Departments of Internal Medicine (T.Y.K., J.Y.K., J.H.S., H.-S.L., S.-Y.B.) and Radiology (Y.K.), Hanyang University Guri Hospital and Hanyang University College of Medicine, Seoul, Korea; Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea (M.Y.K.); and Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea (W.K.J.)
| | - Min Yeong Kim
- Departments of Internal Medicine (T.Y.K., J.Y.K., J.H.S., H.-S.L., S.-Y.B.) and Radiology (Y.K.), Hanyang University Guri Hospital and Hanyang University College of Medicine, Seoul, Korea; Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea (M.Y.K.); and Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea (W.K.J.)
| | - Woo Kyoung Jeong
- Departments of Internal Medicine (T.Y.K., J.Y.K., J.H.S., H.-S.L., S.-Y.B.) and Radiology (Y.K.), Hanyang University Guri Hospital and Hanyang University College of Medicine, Seoul, Korea; Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea (M.Y.K.); and Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea (W.K.J.)
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Abstract
GOALS/BACKGROUND Aspartate aminotransferase to platelet ratio index (APRI) and FIB-4 index are noninvasive biomarkers to evaluate hepatic fibrosis. However, their usefulness in chronic hepatitis B (CHB) patients remains unclear. METHODS A total of 631 CHB patients were enrolled and randomly divided into a training set (n=420) and a validation set (n=211). Areas under receiver operating characteristic (AUROC) curves for FIB-4 index and APRI were compared to evaluate their diagnostic values in identifying significant fibrosis and cirrhosis. RESULTS The AUROC of FIB-4 index for the diagnosis of significant fibrosis and cirrhosis in the entire cohort was higher than that of APRI (0.769 vs. 0.704, P=0.0003 and 0.869 vs. 0.706, P<0.0001). By using cutoff APRI of 0.38 and 4.04 in the validation set, the diagnostic accuracy for absence of significant fibrosis and presence of cirrhosis was 67.7% and 76.8%. At cutoff FIB-4 index of 0.87 and 3.40 in the validation set, the diagnostic accuracy for absence of significant fibrosis and presence of cirrhosis was 69.2% and 84.4%. Compared with patients with concordance, patients with overestimated score by FIB-4 index had a significantly higher serum alanine aminotransferase (ALT) level (299±245 vs. 168±196 U/L, P=0.001) as well as a higher ratio of hepatitis flare (ALT>400 U/L) (25% vs. 7.9%, P=0.008). CONCLUSIONS FIB-4 index proves to be more reliable than APRI in predicting significant fibrosis and cirrhosis in CHB patients. By using FIB-4 index, a substantial proportion of patients could be identified correctly as significant fibrosis and cirrhosis without further invasive liver biopsy.
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135
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Abstract
Objective: The present mini-review updated the progress in methodologies based on using liver biopsy. Data Sources: Articles for study of liver fibrosis, liver biopsy or fibrosis assessment published on high impact peer review journals from 1980 to 2014. Study Selection: Key articles were selected mainly according to their levels of relevance to this topic and citations. Results: With the recently mounting progress in chronic liver disease therapeutics, comes by a pressing need for precise, accurate, and dynamic assessment of hepatic fibrosis and cirrhosis in individual patients. Histopathological information is recognized as the most valuable data for fibrosis assessment. Conventional histology categorical systems describe the changes of fibrosis patterns in liver tissue; but the simplified ordinal digits assigned by these systems cannot reflect the fibrosis dynamics with sufficient precision and reproducibility. Morphometric assessment by computer assist digital image analysis, such as collagen proportionate area (CPA), detects change of fibrosis amount in tissue section in a continuous variable, and has shown its independent diagnostic value for assessment of advanced or late-stage of fibrosis. Due to its evident sensitivity to sampling variances, morphometric measurement is feasible to be taken as a reliable statistical parameter for the study of a large cohort. Combining state-of-art imaging technology and fundamental principle in Tissue Engineering, structure-based quantitation was recently initiated with a novel proof-of-concept tool, qFibrosis. qFibrosis showed not only the superior performance to CPA in accurately and reproducibly differentiating adjacent stages of fibrosis, but also the possibility for facilitating analysis of fibrotic regression and cirrhosis sub-staging. Conclusions: With input from multidisciplinary innovation, liver biopsy assessment as a new “gold standard” is anticipated to substantially support the accelerated progress of Hepatology medicine.
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Affiliation(s)
- Yan Wang
- Department of Infectious Diseases, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515; Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510280, China
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136
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Wang Y, Zhang X, Yang Y, Yang X, Ye B. Study on the Antifibrotic Effects of Recombinant Shark Hepatical Stimulator Analogue (r-sHSA) in Vitro and in Vivo. Mar Drugs 2015; 13:5201-18. [PMID: 26295240 PMCID: PMC4557020 DOI: 10.3390/md13085201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 05/21/2015] [Accepted: 08/10/2015] [Indexed: 12/18/2022] Open
Abstract
Hepatic fibrosis is an effusive wound healing process, characterized by an excessive deposition of extracellular matrix (ECM), as the consequence of chronic liver injury of any etiology. Current therapeutic repertoire for hepatic fibrosis is limited to withdrawal of the noxious agent, which is not always feasible. Hence, in this article, the antifibrotic effects and possible mechanisms of r-sHSA, a recombinant protein with hepatoprotection potential, were investigated. Using NIH/3T3 (mouse embro-fibroblast cell line), skin fibroblasts (human skin fibroblasts, SFBs) and HSC-T6 (rat hepatic stellate cell line), the in vitro effect of r-sHSA was evaluated by measuring the expression levels of alpha-1 Type I collagen (Col1A1) and α-smooth muscle actin (α-SMA). It turned out those fibrosis indicators were typically inhibited by r-sHSA, suggesting its capacity in HSCs inactivation. The antifibrotic activity of r-sHSA was further investigated in vivo on CCl4-induced hepatic fibrosis, in view of significant improvement of the biochemical and histological indicators. More specifically, CCl4-intoxication induced a significant increase in serological biomarkers, e.g., transaminase (AST, ALT), and alkaline phosphatase (ALP), as well as disturbed hepatic antioxidative status; most of the parameters were spontaneously ameliorated to a large extent by withdrawal of CCl4, although the fibrotic lesion was observed histologically. In contrast, r-sHSA treatment markedly eliminated fibrous deposits and restored architecture of the liver in a dose dependent manner, concomitantly with the phenomena of inflammation relief and HSCs deactivation. To sum up, these findings suggest a therapeutic potential for r-sHSA in hepatic fibrosis, though further studies are required.
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Affiliation(s)
- Ying Wang
- School of Life Science and Technology, China Pharmaceutical University, Nanjing 210009, China.
| | - Xiaoyuan Zhang
- School of Life Science and Technology, China Pharmaceutical University, Nanjing 210009, China.
| | - Yang Yang
- School of Life Science and Technology, China Pharmaceutical University, Nanjing 210009, China.
| | - Xiaohong Yang
- School of Life Science and Technology, China Pharmaceutical University, Nanjing 210009, China.
| | - Boping Ye
- School of Life Science and Technology, China Pharmaceutical University, Nanjing 210009, China.
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137
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Gaia S, Campion D, Evangelista A, Spandre M, Cosso L, Brunello F, Ciccone G, Bugianesi E, Rizzetto M. Non-invasive score system for fibrosis in chronic hepatitis: proposal for a model based on biochemical, FibroScan and ultrasound data. Liver Int 2015; 35:2027-35. [PMID: 25495478 DOI: 10.1111/liv.12761] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 12/02/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS We elaborate a non-invasive score system for liver fibrosis (NISF), exploring its diagnostic performance and comparing its accuracy to FibroScan in patients with chronic viral hepatitis (CH) and non-alcoholic fatty liver disease (NAFLD). METHODS Clinical, biochemical, elastographic and ultrasound parameters derived from patients with CH (n = 83) or NAFLD (n = 58), undergoing liver biopsy for fibrosis assessment, were prospectively collected as potential predictors of fibrosis. Each parameter was evaluated for its correlation with the liver biopsy (Gold Standard). Candidate predictors with good interobserver agreement and correlation with histological stages were combined into two algorithms (NISF) to predict fibrosis in chronic viral hepatitis and NAFLD. RESULTS The CH-NISF included six parameters: bluntness of liver edges, irregularity of left lobe surface, diameter of segment 4, liver stiffness measurement, platelet count and ALT values. The ability of the model to discriminate F3-F4 vs F0-F1 stages and F2 vs F0-F1 was high (AUROC of 0.95 and 0.83 respectively) and better than FibroScan alone, especially in intermediate stages (F2 vs F0-F1), AUROC 0.83 vs 0.57 (P = 0.003). The resulting algorithm is available as mathematical formula, nomogram or free online link. [http://health.mafservizi.it/NISF_Calculator/liver.htm] The NAFLD-NISF included liver stiffness, platelet count and AST levels, had good ability to discriminate F0-F1 vs F2-F3-F4 stages (AUROC 0.86), however, not significantly higher than FibroScan. CONCLUSIONS CH-NISF can be proposed as preliminary and easily available staging tool, superior to FibroScan alone in predicting histological fibrosis, especially in intermediate stages. Further validations are needed to improve NISF accuracy in NAFLD.
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Affiliation(s)
- Silvia Gaia
- Department of Gastroenterology, Città della Salute e della Scienza - University Hospital, Turin, Italy
| | - Daniela Campion
- Department of Gastroenterology, Città della Salute e della Scienza - University Hospital, Turin, Italy
| | - Andrea Evangelista
- Department of Epidemiology, Città della Salute e della Scienza - University Hospital, Turin, Italy
| | - Maurizio Spandre
- Department of Gastroenterology, Città della Salute e della Scienza - University Hospital, Turin, Italy
| | - Loretta Cosso
- Department of Gastroenterology, Città della Salute e della Scienza - University Hospital, Turin, Italy
| | - Franco Brunello
- Department of Gastroenterology, Città della Salute e della Scienza - University Hospital, Turin, Italy
| | - Giovannino Ciccone
- Department of Epidemiology, Città della Salute e della Scienza - University Hospital, Turin, Italy
| | - Elisabetta Bugianesi
- Department of Gastroenterology, Città della Salute e della Scienza - University Hospital, Turin, Italy
| | - Mario Rizzetto
- Department of Gastroenterology, Città della Salute e della Scienza - University Hospital, Turin, Italy
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138
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Reshetnyak VI. Primary biliary cirrhosis: Clinical and laboratory criteria for its diagnosis. World J Gastroenterol 2015; 21:7683-708. [PMID: 26167070 PMCID: PMC4491957 DOI: 10.3748/wjg.v21.i25.7683] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 04/07/2015] [Accepted: 06/10/2015] [Indexed: 02/06/2023] Open
Abstract
Primary biliary cirrhosis (PBC) is a chronic progressive cholestatic granulomatous, and destructive inflammatory lesion of small intralobular and septal bile ducts, which is likely to be caused by an autoimmune mechanism with a the presence of serum antimitochondrial antibodies and a potential tendency to progress to cirrhosis. Despite the fact that the etiology of this disease has been unknown so far, there has been a considerable body of scientific evidence that can reveal the clinical and laboratory signs of PBC and the individual components of its pathogenesis and elaborate diagnostic criteria for the disease and its symptomatic therapy. Deficiencies in autoimmune tolerance are critical factors for the initiation and perpetuation of the disease. The purpose of this review is to summarize the data available in the literature and the author’s findings on clinical and laboratory criteria for the diagnosis of PBC. This review describes the major clinical manifestations of the disease and the mechanisms of its development. It presents the immunological, biochemical, and morphological signs of PBC and their significance for its diagnosis. A great deal of novel scientific evidence for the problem of PBC has been accumulated. However, the inadequate efficiency of therapy for the disease lends impetus to the quest for its etiological factors and to further investigations of its pathogenetic mechanisms and, on this basis, to searches for new methods for its early diagnosis.
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139
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Efficacy and Accessibility of a Novel Liver Fibrosis Evaluation Program: Limited Abdominal Ultrasound with Concurrent Transient Elastography. Acad Radiol 2015; 22:814-9. [PMID: 25857940 DOI: 10.1016/j.acra.2015.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/09/2015] [Accepted: 02/16/2015] [Indexed: 01/04/2023]
Abstract
RATIONALE AND OBJECTIVES To review sustainability and fair access related to setting up a centralized transient elastography (TE) program in the radiology department and to perform a quality assessment of a novel liver fibrosis evaluation program that combines TE with limited abdominal ultrasound (US). MATERIAL AND METHODS As part of a quality assessment, a retrospective chart review was performed on 758 patients who underwent TE immediately after limited abdominal US of the liver over a 12-month period. The elastography results and sonographic findings were documented, including the number and type of lesions identified. In terms of fair access evaluation, the indication for TE and referring service was reviewed for each case. RESULTS Most referrals were initiated by infectious disease (52.2% [396 of 758]) or gastroenterology (46.3% [351 of 758]) for patients with viral hepatitis (29.8% [226 of 758] for HBV and 52.2% [396 of 758] for HCV) and nonalcoholic steatohepatitis (11.9% [90 of 758]). Only 3.2% (24 of 758) of indications were outside the usual indications for which standardized values of TE were available. Most studies demonstrated minimal fibrosis (66.6% [510 of 766] ≤F1) or more advanced fibrosis (21.1% [162 of 766] ≥F3). Liver nodularity was observed in 63 cases, correlating to F2 fibrosis and above in 81.0% (51 of 63). US screening detected five new cases of hepatocellular carcinoma (HCC). CONCLUSIONS This unique program allows fair access and ensures that referrals are requested for appropriate indications. Concurrent US confers many advantages including proper TE probe placement to optimize measurement success, characterization of sonographic features that correlate with advanced fibrosis, and provides an opportunity to screen for HCC, in a population which may not otherwise have access to standardized screening.
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140
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Yeh CL, Chen BR, Tseng LY, Jao P, Su TH, Li PC. Shear-wave elasticity imaging of a liver fibrosis mouse model using high-frequency ultrasound. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2015; 62:1295-1307. [PMID: 26168176 DOI: 10.1109/tuffc.2014.006953] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The objective of this study was to develop a high-frequency imaging platform for evaluating liver fibrosis in mice based on shear-wave elasticity imaging (SWEI). Although SWEI has been used to diagnose hepatic fibrosis clinically, it is performed at relatively low frequencies (<20 MHz). For preclinical ultrasound imaging in small animals, a high-frequency (>30 MHz) single-element transducer with mechanical scanning is often used. In this study we developed a new SWEI system based on a 40-MHz single-element transducer for imaging and a separate 20-MHz excitation transducer for producing the radiation force and the associated shear waves. Liver fibrosis was induced in ten C57BL/6 (B6) mice using carbon tetrachloride; the other ten mice served as the control group. Synchronizing the excitation beam (i.e., the beam from the excitation transducer) and the detection beam sequence (i.e., the beam from the imaging transducer) allows this mechanical-scanning setup to analyze the shear-wave dispersion relation. The liver viscoelastic properties were determined in vivo by measuring the shear-wave dispersion curve followed by fitting to the Voigt model. The mice were then killed and the fibrosis stage was evaluated (from F0 to F4) based on the METAVIR score. The measured mean values of liver elasticity and viscosity, respectively, ranged from 1.06 to 1.89 kPa and from 1.29 to 1.75 Pa∙s for normal F0 and fibrosis stages of F3 and F4. The Spearman coefficients for the correlations between the measured elasticity and viscosity at various fibrosis stages as assessed by the METAVIR score were 0.73 (p < 0.001) and 0.634 (p = 0.0013), respectively. We also found that the collagen content in the liver was linearly correlated with the measured elasticity (r(2) = 0.54, p < 0.001) and less strongly with the viscosity (r2 = 0.26, p = 0.022). Finally, the diagnosis performance of high-frequency SWEI was evaluated using multivariate receiver operating characteristic curve (ROC) analysis. The areas under the multivariate ROC curve for diagnosing fibrosis stages of F ≥ 3, F = 4, F0 vs. F3, F0 vs. F4, and F3 vs. F4 were 0.9, 0.98, 0.83, 1.0, and 0.96, respectively. Compared with traditional ROC analysis, an improved diagnosis performance was found for diagnosing fibrosis stages of F ≥ 3 and F0 vs. F3. These results demonstrate that the developed high-frequency SWEI platform can yield quantitative viscoelastic properties for diagnosing various fibrosis stages in mice. It is a promising tool for studying the progression of liver fibrosis in preclinical animal models both noninvasively and quantitatively.
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141
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Ergelen R, Akyuz U, Aydin Y, Eren F, Yilmaz Y. Measurements of serum procollagen-III peptide and M30 do not improve the diagnostic accuracy of transient elastography for the detection of hepatic fibrosis in patients with nonalcoholic fatty liver disease. Eur J Gastroenterol Hepatol 2015; 27:667-71. [PMID: 25923941 DOI: 10.1097/meg.0000000000000342] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Transient elastography (TE) has recently emerged as an accurate noninvasive imaging method for the diagnosis of liver fibrosis in nonalcoholic fatty liver disease (NAFLD). Here, we tested whether adding serum measures of serum procollagen-III peptide (PIIIP) and caspase-cleaved cytokeratin 18 fragment (M30) to TE could improve its diagnostic accuracy in patients with biopsy-proven NAFLD. PATIENTS AND METHODS TE was performed in 87 patients with NAFLD. Serum PIIIP and M30 levels were determined by enzyme-linked immunosorbent assay. Liver histology was considered the gold standard. The diagnostic accuracies were assessed by measuring the area under the receiver operating curve. RESULTS At histopathological examination, 34 patients (39.1%) had significant fibrosis (F2-F4) and 19 patients (21.8%) had advanced fibrosis (F3-F4). Both TE and serum M30 levels were independent predictors of fibrosis, whereas no association was found with PIIIP. No significant differences in terms of sensitivity and specificity for both significant and advanced fibrosis were evident for TE, serum M30, or their combination. Moreover, the area under the receiver operating curves of serum M30 combined with TE did not differ significantly from those of either test alone. CONCLUSION Both TE and serum M30 levels are accurate for the noninvasive diagnosis of fibrosis in NAFLD. However, their combination did not improve the overall diagnostic accuracy.
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Affiliation(s)
- Rabia Ergelen
- Departments of aRadiology bGastroenterology, School of Medicine cLiver Research Unit, Institute of Gastroenterology, Marmara University dDepartment of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
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Hepatic ADC map as an adjunct to conventional abdominal MRI to evaluate hepatic fibrotic and clinical cirrhotic severity in biliary atresia patients. Eur Radiol 2015; 25:2992-3002. [PMID: 25921590 DOI: 10.1007/s00330-015-3716-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 03/11/2015] [Accepted: 03/12/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Hepatic apparent diffusion coefficient (ADC) values and ADC-related indices were correlated with the Mayo risk score for primary biliary cirrhosis (MRSPBC) and METAVIR scores of liver specimens to determine the clinical and pathological significance of diffusion-weighted magnetic resonance imaging (DWMRI). METHODS Thirty-two patients with biliary atresia (BA; mean age 461 days, range 11-4616 days) received magnetic resonance examinations from March 2009 to August 2013. A free-breathing DWMRI sequence was performed with the single-shot echo-planar imaging technique with b = 0 and 500 s/mm(2) in all 32 BA patients and 24 controls. We used the ordinal logistic regression test and Spearman rank correlation test to analyse the relationships between the MRSPBC and METAVIR fibrosis scores and right liver-to-psoas ADC ratios (LTPARs). RESULTS BA patients had significantly lower LTPARs in both hepatic lobes than controls (p < 0.01). Right LTPARs, showing moderate intraobserver agreement (intraclass correlation coefficient = 0.736) and interobserver reliability (intraclass correlation coefficient = 0.659), were negatively correlated with MRSPBC and METAVIR fibrosis scores (R(2) = 0.398, p = 0.024 and R(2) = 0.628, p < 0.001, respectively). CONCLUSION Right LTPARs may be used for long-term follow-up of cirrhosis severity in BA patients. KEY POINTS • Hepatic ADC values by DWI correlates well with clinical/pathologic fibrosis scores • Periodic, non-invasive, quantitative imaging follow-up of patients with biliary cirrhosis is feasible • Information on cirrhosis severity could help decide on management options in children with BA • ADC values may be useful in this regard.
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143
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Utility of texture analysis for quantifying hepatic fibrosis on proton density MRI. J Magn Reson Imaging 2015; 42:1259-65. [DOI: 10.1002/jmri.24898] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 03/11/2015] [Indexed: 12/31/2022] Open
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144
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Estimation of Hepatic Extracellular Volume Fraction Using Multiphasic Liver Computed Tomography for Hepatic Fibrosis Grading. Invest Radiol 2015; 50:290-6. [DOI: 10.1097/rli.0000000000000123] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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145
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Pellot-Barakat C, Lefort M, Chami L, Labit M, Frouin F, Lucidarme O. Automatic assessment of shear wave elastography quality and measurement reliability in the liver. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:936-943. [PMID: 25701517 DOI: 10.1016/j.ultrasmedbio.2014.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 11/06/2014] [Accepted: 11/12/2014] [Indexed: 06/04/2023]
Abstract
A strategy is proposed that accesses the quality of individual shear wave elastography (SWE) exams and the reliability of elasticity measurements in clinical practice. For that purpose, a confidence index based on temporal stability and SWE filling was defined to provide an automatic estimation of each scan quality: high (HG) or low (LG) grade. With this index, the intra-observer acquisition variability assessed by comparing consecutive scans of the same patient was 17% and 32% for HG and LG clips, respectively. The measurement quantification variability assessed by comparing the measurements of a radiologist with those of a trained operator and of two automatic measurements on a same clip averaged 13% and 22% for HG and LG exams, respectively. It was found that SWE measurements depend greatly on the quality of the acquired data. The proposed quality index (HG or LG) provides objective input on the accuracy and diagnostic reliability of SWE measurements.
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Affiliation(s)
- Claire Pellot-Barakat
- Laboratoire d'Imagerie Biomédicale, Université Pierre et Marie Curie, Sorbonne Universités, CNRS, INSERM, Paris, France.
| | - Muriel Lefort
- Laboratoire d'Imagerie Biomédicale, Université Pierre et Marie Curie, Sorbonne Universités, CNRS, INSERM, Paris, France
| | - Linda Chami
- Radiology Department, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Mickaël Labit
- Laboratoire d'Imagerie Biomédicale, Université Pierre et Marie Curie, Sorbonne Universités, CNRS, INSERM, Paris, France
| | - Frédérique Frouin
- Laboratoire d'Imagerie Biomédicale, Université Pierre et Marie Curie, Sorbonne Universités, CNRS, INSERM, Paris, France
| | - Olivier Lucidarme
- Laboratoire d'Imagerie Biomédicale, Université Pierre et Marie Curie, Sorbonne Universités, CNRS, INSERM, Paris, France; Radiology Department, Hôpital Pitié-Salpêtrière, APHP, Paris, France
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146
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Sun B, Li YG, Lan YH. Fibroscan for diagnosis and treatment of chronic liver disease. Shijie Huaren Xiaohua Zazhi 2015; 23:1433-1439. [DOI: 10.11569/wcjd.v23.i9.1433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Liver biopsy is still the golden standard in the diagnosis of chronic liver diseases, but it is invasive, which limits its application. Therefore, the search for a reliable noninvasive diagnostic method has attracted more and more attention. Since Fibroscan (FS) was launched in 2003, scholars have paid more attention to this modality, because it is non-invasive, painless, rapid and objective. In this paper, we will review the value of FS in the diagnosis and treatment of chronic liver disease.
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147
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Ding H, Ma JJ, Wang WP, Zeng WJ, Jiang T, Huang BJ, Chen SY. Assessment of liver fibrosis: the relationship between point shear wave elastography and quantitative histological analysis. J Gastroenterol Hepatol 2015; 30:553-8. [PMID: 25250854 DOI: 10.1111/jgh.12789] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIM Traditional pathological scoring systems for liver fibrosis progression are predominantly based on the description of architectural changes with no consideration of the amount of collagen fiber deposition. Our purpose was to explore a true histological standard in accordance with the liver stiffness measured by point shear wave elastography (PSWE) in patients with chronic hepatitis B. METHODS A total of 78 patients with liver neoplasms underwent liver stiffness measurements with PSWE as well as biochemical investigations within 3 days before partial hepatectomy. One tissue section of the liver specimens was stained with HE trichrome and evaluated traditionally with the Scheuer scoring system. The other tissue section was stained with picroSirius red and was evaluated according to the semiquantitative Chevallier et al. scoring system. In addition, this second tissue section was evaluated for the collagen proportionate area (CPA) with computer-assisted digital image analysis. The reproducibility of PSWE technology was explored through the intra-class correlation coefficient of a reliability analysis. RESULTS The PSWE technology revealed good reproducibility in liver stiffness measurements, and the PSWE values increased with the pathological severity of liver fibrosis on both the Scheuer scoring system and the semiquantitative Chevallier et al. scoring system. PSWE values exhibited more reasonable relationships with CPA (r = 0.628, P = 0.00 < 0.05) than with the Scheuer scoring system (r = 0.473, P = 0.00 < 0.05) or the Chevallier et al. semiquantitative scoring system (r = 0.487, P = 0.00 < 0.05). CONCLUSION CPA is a better pathological parameter than traditional semiquantitative scoring systems in accordance with liver stiffness measured by PSWE technology.
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Affiliation(s)
- Hong Ding
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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Subasi CF, Aykut UE, Yilmaz Y. Comparison of noninvasive scores for the detection of advanced fibrosis in patients with nonalcoholic fatty liver disease. Eur J Gastroenterol Hepatol 2015; 27:137-41. [PMID: 25486027 DOI: 10.1097/meg.0000000000000255] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The presence of advanced liver fibrosis portends a poor prognosis in nonalcoholic fatty liver disease (NAFLD). We aimed to compare the diagnostic performance of five noninvasive scores [aspartate aminotransferase/platelet ratio (APRI), BARD, FIB-4, NAFLD fibrosis score (NFSA), and FibroMeter] for the assessment of advanced stages of fibrosis (F ≥ 3) in patients with biopsy-proven NAFLD. METHODS APRI, BARD, FIB-4, NFSA, and FibroMeter scores were determined in 142 patients with NAFLD. The histopathological analysis of liver biopsies was considered the gold standard. Sensitivity and specificity were calculated for each noninvasive test using receiver operating characteristic (ROC) curve analysis, with a cut-off value of F ≥ 3 for advanced fibrosis. The diagnostic accuracies were assessed by measuring the area under the ROC curve (AUROC). The AUROCs for different noninvasive tests were compared using paired significance tests. RESULTS At histopathological examination, 40 patients (28.2%) had a fibrosis stage F0, 50 patients (35.2%) had F1, 22 patients (15.5%) had F2, 20 patients (14.1%) had F3, and 10 patients (7.0%) had F4. The sensitivity of APRI, BARD, FIB-4, NFSA, and FibroMeter scores for advanced fibrosis was 70.0, 73.3, 70.0, 66.7, and 66.7%, respectively, and the specificity was 74.5, 66.4, 71.8, 71.8, and 74.5%, respectively. No significant differences in terms of sensitivity and specificity were evident for the five noninvasive scores. Moreover, the AUROCs did not differ significantly for all scores. CONCLUSION Our study suggests that different noninvasive scores have similar accuracy for the diagnosis of advanced hepatic fibrosis in NAFLD.
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Affiliation(s)
- Cemal F Subasi
- aDepartment of Internal Medicine, School of Medicine bInstitute of Gastroenterology cDepartment of Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey
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Kocakoc E, Bakan AA, Poyrazoglu OK, Dagli AF, Gul Y, Cicekci M, Bahcecioglu IH. Assessment of Liver Fibrosis with Diffusion-Weighted Magnetic Resonance Imaging Using Different b-values in Chronic Viral Hepatitis. Med Princ Pract 2015; 24:522-6. [PMID: 26183515 PMCID: PMC5588272 DOI: 10.1159/000434682] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 06/01/2015] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To examine the effectiveness of apparent diffusion coefficient (ADC) values and to compare the reliability of different b-values in detecting and identifying significant liver fibrosis. SUBJECTS AND METHODS There were 44 patients with chronic viral hepatitis (CVH) in the study group and 30 healthy participants in the control group. Diffusion-weighted magnetic resonance imaging (DWI) was performed before the liver biopsy in patients with CVH. The values of ADC were measured with 3 different b-values (100, 600, 1,000 s/mm2). In addition, liver fibrosis was classified using the modified Ishak scoring system. Liver fibrosis stages and ADC values were compared using areas under the receiver-operating characteristic (ROC) curve. RESULTS The study group's mean ADC value was not statistically significantly different from the control group's mean ADC value at b = 100 s/mm2 (3.69 ± 0.5 × 10-3 vs. 3.7 ± 0.3 × 10-3 mm2/s) and b = 600 s/mm2 (2.40 ± 0.3 × 10-3 vs. 2.5 ± 0.5 × 10-3 mm2/s). However, the study group's mean ADC value (0.99 ± 0.3 × 10-3 mm2/s) was significantly lower than that of the control group (1.2 ± 0.1 × 10-3 mm2/s) at b = 1,000 s/mm2. With b = 1,000 s/mm2 and the cutoff ADC value of 0.0011 mm2/s for the diagnosis of liver fibrosis, the mean area under the ROC curve was 0.702 ± 0.07 (p = 0.0015). For b = 1,000 s/mm2 and the cutoff ADC value of 0.0011 mm2/s to diagnose significant liver fibrosis (Ishak score = 3), the mean area under the ROC curve was 0.759 ± 0.07 (p = 0.0001). CONCLUSION Measurement of ADC values by DWI was effective in detecting liver fibrosis and accurately identifying significant liver fibrosis when a b-value of 1,000 s/mm2 was used.
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Affiliation(s)
- Ercan Kocakoc
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Elazig, Turkey
| | - Ayse Ahsen Bakan
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Elazig, Turkey
- *Ayse Ahsen Bakan, Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, TR-34093 Fatih, Istanbul (Turkey), E-Mail
| | | | - Adile Ferda Dagli
- Department of Pathology, Faculty of Medicine, Inonu University, Malatya, and Departments of, Elazig, Turkey
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Park HS, Kim YJ, Yu MH, Choe WH, Jung SI, Jeon HJ. Three-Tesla magnetic resonance elastography for hepatic fibrosis: Comparison with diffusion-weighted imaging and gadoxetic acid-enhanced magnetic resonance imaging. World J Gastroenterol 2014; 20:17558-17567. [PMID: 25516671 PMCID: PMC4265618 DOI: 10.3748/wjg.v20.i46.17558] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 06/09/2014] [Accepted: 07/11/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the feasibility of 3-Tesla magnetic resonance elastography (MRE) for hepatic fibrosis and to compare that with diffusion-weighted imaging (DWI) and gadoxetic acid-enhanced magnetic resonance (MR) imaging.
METHODS: Forty-two patients were included in the study. On MRE, mean stiffness values were measured on the elastograms in kilopascals. The apparent diffusion coefficient (ADC) of the liver was measured using DWI. On gadoxetic acid enhanced MR, the contrast enhancement index (CEI) was calculated as signal intensity (SI)post/SIpre, where SIpost is liver-to-muscle SI ratio on hepatobiliary phase images and SIpre is that on nonenhanced images. Correlation between aspartate aminotransferase to the platelet ratio index (APRI) and three MR parameters was assessed. Each MR parameter was compared between a hepatic fibrosis (HF) group and non-hepatic fibrosis (nHF) group.
RESULTS: Liver stiffness showed strong positive correlation with APRI [Spearman correlation coeffiecient (r) = 0.773, P < 0.0001], while ADC and CEI showed weak or prominent negative correlation (r = -0.28 and -0.321, respectively). In the HF group, only liver stiffness showed strong correlation with APRI (r = 0.731, P < 0.0001). Liver stiffness, ADC, and APRI were significantly different between the HF group and nHF group.
CONCLUSION: MRE at 3-Tesla could be a feasible method for the assessment of hepatic fibrosis.
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