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Santoro S, Khalil M, Abdallah H, Farella I, Noto A, Dipalo GM, Villani P, Bonfrate L, Di Ciaula A, Portincasa P. Early and accurate diagnosis of steatotic liver by artificial intelligence (AI)-supported ultrasonography. Eur J Intern Med 2024; 125:57-66. [PMID: 38490931 DOI: 10.1016/j.ejim.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVES Steatotic liver disease is the most frequent chronic liver disease worldwide. Ultrasonography (US) is commonly employed for the assessment and diagnosis. Few information is available on the possible use of artificial intelligence (AI) to ameliorate the diagnostic accuracy of ultrasonography. MATERIALS AND METHODS An AI-based algorithm was developed using a dataset of US images. We prospectively enrolled 134 patients for algorithm validation. Patients underwent abdominal US and Proton Density Fat Fraction MRI scans (MRI-PDFF), assumed as reference technique. The hepatorenal index was manually calculated (HRIM) by 4 operators. An automatic hepatorenal index (HRIA) was obtained by the algorithm. The accuracy of HRIA to discriminate steatosis grades was evaluated by ROC analysis using MRI-PDFF cut-offs. RESULTS Overweight was 40 % of subjects (BMI 26.4 kg/cm2). The median HRIA was 1.11 (IQR 0.32) and the average of 4 manually calculated HRIM was 1.08 (IQR 0.26), with a 15 % inter-operator variability. Both HRIA (R = 0.79, P < 0.0001) and HRIM (R = 0.69, P < 0.0001) significantly correlated with liver fat percentage (MRI-PDFF). According to MRI-PDFF, 32 % of enrolled subjects had steatosis. Discrimination capacity by AUC between patient with steatosis and patient without steatosis was better for HRIA than HRIM (AUC: 0.87 vs. 0.82, respectively). ROC analysis showed an AUC = 0.98 for HRIA with 1.64 cut-off in distinguishing between mild and moderate/severe groups. CONCLUSIONS The use of AI improves accuracy and speed of ultrasonography in the diagnosis of liver steatosis. Further studies should evaluate the routine use of this technique in the management of liver steatosis at high cardio-metabolic risk.
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Affiliation(s)
- Sergio Santoro
- PhD Program in Public Health, Clinical Medicine and Oncology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari "Aldo Moro", Bari, Italy; Eurisko Technology srl, Modugno, BA, Italy
| | - Mohamad Khalil
- Clinica Medica "A. Murri", Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Hala Abdallah
- PhD Program in Public Health, Clinical Medicine and Oncology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari "Aldo Moro", Bari, Italy; Clinica Medica "A. Murri", Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Ilaria Farella
- PhD Program in Public Health, Clinical Medicine and Oncology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari "Aldo Moro", Bari, Italy; Clinica Medica "A. Murri", Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Antonino Noto
- Clinica Medica "A. Murri", Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari "Aldo Moro" Medical School, Bari, Italy
| | | | | | - Leonilde Bonfrate
- Clinica Medica "A. Murri", Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Agostino Di Ciaula
- PhD Program in Public Health, Clinical Medicine and Oncology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari "Aldo Moro", Bari, Italy; Clinica Medica "A. Murri", Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Piero Portincasa
- PhD Program in Public Health, Clinical Medicine and Oncology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari "Aldo Moro", Bari, Italy.
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Larose PC, Brisson BA, Foster RA, Monteith G. Comparing 3 mm and 5 mm laparoscopic liver biopsy samples in dogs. Vet Surg 2024; 53:742-753. [PMID: 37530591 DOI: 10.1111/vsu.14006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 06/22/2023] [Accepted: 07/15/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE To determine whether 3 mm cup biopsy forceps (CBF) provide equivalent diagnostic samples to 5 mm CBF for histopathologic diagnosis, bacterial culture, and copper quantification. STUDY DESIGN Clinical prospective study. ANIMALS Ten client-owned dogs, presenting for laparoscopic liver biopsy (LLB). METHODS Dogs underwent LLB, and paired samples were collected using 3 and 5 mm CBF. Portal triad and hepatic lobule counts, crush and fragmentation artifacts, copper concentration, bacterial culture results, and agreement on histopathologic diagnosis were compared. RESULTS Both CBF sizes allowed for easy sample collection and resulted in minimal hemorrhage. An average of 12.13 (confidence limit (CL): 9.4-14.9) and 17.84 (CL: 15.1-20.6) portal triads were obtained using a 3 and 5 mm CBF, respectively (p = .0003). A portal triad count of 11 or more was achieved in 73.3% of the 3 mm and 93.3% of the 5 mm samples. Gwets AC1 coefficient showed a high level of agreement (0.8) for overall histopathologic diagnosis (p < .0001). The 3 mm CBF crush scores were higher (median of the differences: -1; range: -1 to 1) (p = .035). There was no difference in fragmentation scores (p = .935). CONCLUSION The 3 mm CBF yielded smaller samples in terms of size and portal triad count compared with the 5 mm CBF. However, the portal triad count was sufficient in a majority of samples and histologic agreement with the 5 mm CBF was excellent. CLINICAL SIGNIFICANCE In dogs, a 3 mm CBF yields adequate samples for histopathologic interpretation, copper quantification, and bacterial culture.
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Affiliation(s)
- Philippe Chagnon Larose
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Brigitte A Brisson
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Robert A Foster
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Gabrielle Monteith
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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Lemmer P, Rohr LC, Henning M, Bulut K, Manka P, Canbay A, Sowa JP. Liver Stiffness Determined by Transient Elastography Is a Simple and Highly Accurate Predictor for Presence of Liver Cirrhosis in Clinical Routine. Dig Dis 2024; 42:265-275. [PMID: 38527437 DOI: 10.1159/000538426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 03/12/2024] [Indexed: 03/27/2024]
Abstract
INTRODUCTION Early detection of patients with advanced chronic liver disease is critical for the prevention of complications and inclusion in surveillance programs for hepatocellular carcinoma. In daily clinical care, it remains challenging to differentiate early cirrhosis from lower fibrosis grades without performing a liver biopsy. The aim of the present study was to assess the performance of different non-invasive detection tools to differentiate cirrhosis from lower fibrosis grades. METHODS Data of 116 patients (51 male, 65 female) with chronic liver disease of various origins undergoing liver biopsy was analyzed. Routine laboratory values, liver stiffness measurement (LSM) by transient elastography, and histological liver assessment were collected. RESULTS Robust and significant correlations with the histological fibrosis stage were identified for LSM (r = 0.65), the FAST score (0.64), the FIB-4 (0.48), serum aspartate aminotransferase (AST) concentration (0.41), NFS (0.33), international normalized ratio (INR; 0.30), methacetin breath test results (-0.40), and serum albumin concentration (-0.29) by spearman rank correlation. Receiver operating characteristic curves were built for these parameters to separate patients with cirrhosis from those with any other fibrosis stage. The highest AUC was achieved by LSM (0.9130), followed by the FAST score (0.8842), the FIB-4 (0.8644), the NFS (0.8227), INR (0.8142), serum albumin (0.7710), and serum AST (0.7620). The most promising clinical applicability would be an LSM value of 12.2 kPa, achieving 95.7% sensitivity and 75.3% specificity. CONCLUSION LSM and FAST score seem to be robust non-invasive measurements for liver fibrosis. LSM and FAST scores may have the potential to reliably detect patients with liver cirrhosis in clinical routine settings.
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Affiliation(s)
- Peter Lemmer
- Department of Gastroenterology, Hepatology, and Infectious Diseases, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
- Department of Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr University, Bochum, Germany
| | - Lydia Christina Rohr
- Department of Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr University, Bochum, Germany
| | - Marie Henning
- Department of Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr University, Bochum, Germany
| | - Kerem Bulut
- Department of Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr University, Bochum, Germany
| | - Paul Manka
- Department of Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr University, Bochum, Germany
| | - Ali Canbay
- Department of Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr University, Bochum, Germany
| | - Jan-Peter Sowa
- Department of Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr University, Bochum, Germany,
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Dobberstein REA, Brisson BA, Foster RA, Monteith G, Larose PC, Rankovic A, Verbrugghe A, Shoveller AK. Comparison of the diagnostic yield of 3 and 5 mm laparoscopic liver biopsy forceps in cats. Vet Surg 2024; 53:302-310. [PMID: 37935060 DOI: 10.1111/vsu.14049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 10/14/2023] [Accepted: 10/18/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVE To determine whether 3 and 5 mm laparoscopic cup biopsy forceps provide samples of equivalent diagnostic quality in cats. STUDY DESIGN Experimental study. ANIMALS Twelve colony cats undergoing a concurrent nutrition study. METHODS Two biopsy forceps (3 and 5 mm) and three biopsy techniques (twist, pull, and twist + pull) were used to collect 68 laparoscopic liver samples. Biopsies were performed consecutively with the 3 and 5 mm biopsy sites adjacent to each other. Data analyzed included the number of portal triads and hepatic lobules, tissue crush and fragmentation, overall sample area (mm2 ), sample weight, and agreement regarding morphologic diagnosis. RESULTS The 5 mm forceps provided more hepatic lobules, portal triads, and a larger tissue weight and histologic area (mm2 ) (p < .01). The twist and pull techniques provide more hepatic lobules and portal triads compared to the twist + pull technique while the twist + pull technique resulted in greater tissue crush compared to the twist technique (p = .0097). There was good agreement for morphological diagnosis between the 3 and 5 mm samples using the twist + pull technique but not for the twist or pull techniques. CONCLUSION Liver samples can be safely collected with 3 or 5 mm laparoscopic biopsy forceps and provide sufficient tissue for histopathology analysis in cats, with minimal artifact. The diagnostic accuracy of 3 mm samples remains unknown. CLINICAL SIGNIFICANCE Although 3 mm laparoscopic cup biopsy forceps provided samples of sufficient diagnostic quality for histopathologic interpretation in cats, further studies are required to assess their diagnostic accuracy.
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Affiliation(s)
| | - Brigitte A Brisson
- Department of Clinical Studies, University of Guelph, Guelph, Ontario, Canada
| | - Robert A Foster
- Department of Pathobiology, University of Guelph, Guelph, Ontario, Canada
| | - Gabrielle Monteith
- Department of Clinical Studies, University of Guelph, Guelph, Ontario, Canada
| | | | - Alexandra Rankovic
- Department of Biomedical Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Adronie Verbrugghe
- Department of Clinical Studies, University of Guelph, Guelph, Ontario, Canada
| | - Anna Kate Shoveller
- Department of Animal Biosciences, University of Guelph, Guelph, Ontario, Canada
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Prentice KD, Callahan‐Clark JE, Parry NM, Schwarz LA, Webster CRL. Characterization of clinical presentation, histological features, ultrasonographic findings, and survival in 29 dogs with granulomatous hepatitis. J Vet Intern Med 2024; 38:167-175. [PMID: 37994296 PMCID: PMC10800208 DOI: 10.1111/jvim.16937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 11/02/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Granulomatous hepatitis (GH) is a form of chronic hepatitis (CH) in dogs for which limited information is published. HYPOTHESIS Describe the clinical presentation, clinical pathology, ultrasound, and hepatic histopathology findings and to report survival times in dogs with GH. ANIMALS Twenty-nine client-owned dogs with GH. METHODS Retrospective observational study. Pathology records were searched. Inclusion criteria included a histopathologic diagnosis of GH, absence of an identified etiology or evidence of extrahepatic granulomatous disease, and a medical record available for review. Clinical presentation, clinical pathologic findings, treatment protocols, and survival times were recorded. Available hepatic biopsy material was graded and scored, and ultrasound evaluations reviewed. RESULTS The median age was 7 years (range, 0.66-12 years). Nineteen breeds were represented. Decreased appetite (19/29), lethargy (16/29), and fever (13/29) were seen most commonly. All dogs had increased serum transaminase activities, whereas 21/29 and 12/24 had hyperbilirubinemia and neutrophilia, respectively. Ultrasonographic findings included hepatomegaly (12/22), nodular parenchymal lesions (9/22), and hyperechoic parenchymal bands (8/22). Histopathologic necroinflammatory scores were moderate to severe in 16/19 dogs, and fibrosis scores were mild in 14/19 dogs. Treatments varied and included antibiotics, immunosuppressive drugs, and hepatoprotectants. Overall median survival was 635 days (range, 1-2482 days). CONCLUSION AND CLINICAL IMPORTANCE Granulomatous hepatitis in dogs is associated with high histopathologic grade, fever, neutrophilia, and a high incidence of hepatomegaly and focal parenchymal lesions on ultrasound examination. Despite disease severity on presentation, dogs with GH can have a good outcome with prolonged survival.
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Affiliation(s)
- Kayla D. Prentice
- Cummings School of Veterinary Medicine at Tufts UniversityNorth GraftonMassachusettsUSA
| | | | - Nicola M. Parry
- Cummings School of Veterinary Medicine at Tufts UniversityNorth GraftonMassachusettsUSA
- Present address:
CBSET, IncLexingtonMassachusettsUSA
| | - Leslie A. Schwarz
- Cummings School of Veterinary Medicine at Tufts UniversityNorth GraftonMassachusettsUSA
| | - Cynthia R. L. Webster
- Cummings School of Veterinary Medicine at Tufts UniversityNorth GraftonMassachusettsUSA
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Pi J, Foo EW, Zang X, Li S, Zhao Y, Liu Y, Deng Y. Evaluation of the Feasibility of 2D-SWE to Measure Liver Stiffness in Healthy Dogs and Analysis of Possible Confounding Factors. Animals (Basel) 2023; 13:3446. [PMID: 38003063 PMCID: PMC10668773 DOI: 10.3390/ani13223446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: Two-dimensional shear wave elastography (2D-SWE) is a non-invasive method widely used in human medicine to assess the extent of liver fibrosis but only rarely applied to veterinary medicine. This study aimed to measure liver stiffness in healthy dogs and investigate the factors that impacted 2D-SWE measurement. (2) Methods: In total, 55 healthy dogs were enrolled and subjected to 2D-SWE measurements before and after anesthesia administration. Post-anesthesia 2D-SWE measurements and computerized tomography (CT) scans were obtained. (3) Results: The liver stiffness range in healthy dogs was 3.96 ± 0.53 kPa. In a stratified analysis based on confounding factors, liver stiffness was influenced by measurement site and anesthesia, but not by sex. No correlation was observed between liver stiffness and weight or liver CT attenuation. (4) Conclusions: 2D-SWE is feasible for liver stiffness measurement in dogs. Anesthesia and measurement site are sources of variability. Therefore, these factors should be considered while recording 2D-SWE measurements. Our data on liver stiffness in healthy dogs can serve as the basis for future studies on 2D-SWE to assess pathological conditions in dogs.
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Affiliation(s)
- Ji’ang Pi
- Department of Veterinary Clinical Science, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (J.P.); (E.W.F.); (X.Z.); (S.L.)
| | - Eric Wenhao Foo
- Department of Veterinary Clinical Science, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (J.P.); (E.W.F.); (X.Z.); (S.L.)
| | - Xueyu Zang
- Department of Veterinary Clinical Science, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (J.P.); (E.W.F.); (X.Z.); (S.L.)
| | - Shuai Li
- Department of Veterinary Clinical Science, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (J.P.); (E.W.F.); (X.Z.); (S.L.)
| | - Yanbing Zhao
- Teaching Animal Hospital of Nanjing Agricultural University, Nanjing 210095, China; (Y.Z.); (Y.L.)
| | - Yongwang Liu
- Teaching Animal Hospital of Nanjing Agricultural University, Nanjing 210095, China; (Y.Z.); (Y.L.)
| | - Yifeng Deng
- Department of Veterinary Clinical Science, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (J.P.); (E.W.F.); (X.Z.); (S.L.)
- Teaching Animal Hospital of Nanjing Agricultural University, Nanjing 210095, China; (Y.Z.); (Y.L.)
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Angelou V, Fiska A, Tsingotjidou A, Patsikas M, Papazoglou LG. Surgical Anatomy of the Gastrointestinal Tract in Cats. Animals (Basel) 2023; 13:2670. [PMID: 37627461 PMCID: PMC10451872 DOI: 10.3390/ani13162670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
In cats, the gastrointestinal tract is one of the regions in which surgical procedures are most frequently performed by veterinary surgeons; therefore, knowledge of the surgical anatomy of the feline gastrointestinal tract is of high importance. The main surgical procedures performed include gastrotomy, gastrectomy, enterotomy, and enterectomy, as well as procedures in the liver and pancreas. There are also anatomical differences between dogs and cats, increasing the need for deep knowledge of the anatomy treated in the different surgical approaches. The aim of the present review is to describe in detail the anatomy of the gastrointestinal tract in cats highlighting the anatomical regions of significant importance in different surgical procedures.
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Affiliation(s)
- Vasileia Angelou
- Unit of Surgery and Obstetrics, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece; (V.A.); (L.G.P.)
| | - Aliki Fiska
- Department of Anatomy, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Anastasia Tsingotjidou
- Laboratory of Anatomy, Histology and Embryology, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece;
| | - Michael Patsikas
- Laboratory of Diagnostic Imaging, Department of Clinical Studies, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
| | - Lysimachos G. Papazoglou
- Unit of Surgery and Obstetrics, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece; (V.A.); (L.G.P.)
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Gu XL, Cui Y, Zhu HT, Li XT, Pei X, He XX, Yang L, Lu M, Li ZW, Sun YS. Discrimination of Liver Metastases of Digestive System Neuroendocrine Tumors From Neuroendocrine Carcinoma by Computed Tomography-Based Radiomics Analysis. J Comput Assist Tomogr 2023; 47:361-368. [PMID: 36944109 DOI: 10.1097/rct.0000000000001443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVE The aim of the study is to investigate the value of computed tomography (CT) radiomics features to discriminate the liver metastases (LMs) of digestive system neuroendocrine tumors (NETs) from neuroendocrine carcinoma (NECs). METHODS Ninety-nine patients with LMs of digestive system neuroendocrine neoplasms from 2 institutions were included. Radiomics features were extracted from the portal venous phase CT images by the Pyradiomics and then selected by using the t test, Pearson correlation analysis, and least absolute shrinkage and selection operator method. The radiomics score (Rad score) for each patient was constructed by linear combination of the selected radiomics features. The radiological model was constructed by radiological features using the multivariable logistic regression. Then, the combined model was constructed by combining Rad score and the radiological model into logistic regression. The performance of all models was evaluated by the receiver operating characteristic curves with the area under curve (AUC). RESULTS In the radiological model, only the enhancement degree (odds ratio, 8.299; 95% confidence interval, 2.070-32.703; P = 0.003) was an independent predictor for discriminating the LMs of digestive system NETs from those of NECs. The combined model constructed by the Rad score in combination with the enhancement degree showed good discrimination performance, with AUCs of 0.893, 0.841, and 0.740 in the training, testing, and external validation groups, respectively. In addition, it performed better than radiological model in the training and testing groups (AUC, 0.893 vs 0.726; AUC, 0.841 vs 0.621). CONCLUSIONS The CT radiomics might be useful for discrimination LMs of digestive system NECs from NETs.
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Affiliation(s)
- Xiao-Lei Gu
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute
| | - Yong Cui
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute
| | - Hai-Tao Zhu
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute
| | - Xiao-Ting Li
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute
| | - Xiang Pei
- Department of Radiology, Beijing Shunyi District Hospital, Beijing
| | - Xiao-Xiao He
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang
| | - Li Yang
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang
| | - Ming Lu
- Departments of Gastrointestinal Oncology and
| | - Zhong-Wu Li
- Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Ying-Shi Sun
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute
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Nie G, Zhou Y, Song M, Xu J, Cui Z, Feng Y, Wang H, Chen D, Zhang Y, Wang K. NIR-II imaging-guided diagnosis and evaluation of the therapeutic effect on acute alcoholic liver injury via a nanoprobe. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2022; 14:1847-1855. [PMID: 35412537 DOI: 10.1039/d2ay00279e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Acute alcoholic liver injury (AALI) is hard to diagnose on account of no obvious clinical symptoms, and thereby it easily develops into serious liver diseases and threatens people's health. However, traditional methods for detecting AALI are far from satisfactory due to the low sensitivity, invasiveness and non-visualization, and the development of new techniques is in urgent demand. Near-infrared (NIR)-II fluorescence imaging has been widely studied in biochemistry and biomedicine. As the blood flow velocity of the liver is closely related to the progression of AALI, herein, a NIR-II fluorescent nanoprobe, NTPB-NPs, was applied to diagnose AALI by monitoring the fluorescence intensity changes in the liver caused by the variations of the blood flow velocity. More importantly, when medication was applied to alleviate the liver injury of AALI mice, NTPB-NPs could also track the therapeutic effect in situ. In this study, the relationship between hepatic vascular velocity and the progression of AALI was confirmed with NTPB-NPs via NIR-II imaging. To the best of our knowledge, this is the first time that a NIR-II fluorescence imaging technique has been used to diagnose AALI mice and evaluate the therapeutic effect on AALI mice. This study may also provide a potential NIR-II imaging agent for clinical research to improve the management of liver injury related diseases.
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Affiliation(s)
- Gang Nie
- Hubei Key Laboratory of Nature Medicinal Chemistry and Resource Evaluation, Tongji Medical College of Pharmacy, Huazhong University of Science and Technology, Wuhan, China.
| | - Yinxing Zhou
- Hubei Key Laboratory of Nature Medicinal Chemistry and Resource Evaluation, Tongji Medical College of Pharmacy, Huazhong University of Science and Technology, Wuhan, China.
| | - Mengzi Song
- Hubei Key Laboratory of Nature Medicinal Chemistry and Resource Evaluation, Tongji Medical College of Pharmacy, Huazhong University of Science and Technology, Wuhan, China.
| | - Jingya Xu
- Hubei Key Laboratory of Nature Medicinal Chemistry and Resource Evaluation, Tongji Medical College of Pharmacy, Huazhong University of Science and Technology, Wuhan, China.
| | - Zheng Cui
- Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Yangzhen Feng
- Key Laboratory for Green Chemical Process of Ministry of Education, School of Chemical Engineering and Pharmacy, Wuhan Institute of Technology, Wuhan, China.
| | - Huiling Wang
- Key Laboratory of Pesticide and Chemical Biology, Ministry of Education, Chemical Biology Center, College of Chemistry, International Joint Research Center for Intelligent Biosensing Technology and Health, Central China Normal University, Wuhan, China
| | - Dugang Chen
- Key Laboratory for Green Chemical Process of Ministry of Education, School of Chemical Engineering and Pharmacy, Wuhan Institute of Technology, Wuhan, China.
| | - Yu Zhang
- Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Kaiping Wang
- Hubei Key Laboratory of Nature Medicinal Chemistry and Resource Evaluation, Tongji Medical College of Pharmacy, Huazhong University of Science and Technology, Wuhan, China.
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Ambrosini YM, Piedra‐Mora C, Jennings S, Webster CRL. Serum 25-hydroxyvitamin D and C-reactive protein and plasma von Willebrand concentrations in 23 dogs with chronic hepatopathies. J Vet Intern Med 2022; 36:966-975. [PMID: 35420222 PMCID: PMC9151486 DOI: 10.1111/jvim.16424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Serum concentrations of 25-hydroxyvitamin D (25(OH)VD) and C-reactive protein (CRP) and von Willebrand's factor (vWF) concentration correlate with histopathologic disease grade and stage in chronic inflammatory and fibrotic hepatopathies (CH) in humans. OBJECTIVES To evaluate serum 25(OH)VD and serum CRP concentrations and plasma vWF concentration and determine if they correlate with histopathologic and biochemical variables in dog with CH. ANIMALS Twenty-three client-owned dogs with a histopathologic diagnosis of CH were prospectively enrolled. METHODS Blood samples were collected before liver biopsy. Correlations between biomarkers and clinical pathological and histopathologic variables were evaluated using Pearson's or Spearman's test. RESULTS Serum 25(OH)VD concentration (median, 213 nmol/L; range, 42-527 nmol/L) was negatively correlated with serum aspartate aminotransferase activity (AST; rho = -0.59, P < .01), polymorphonuclear neutrophil count (PMN; r = -0.46, P < .05), and positively correlated with serum albumin concentration (r = 0.69, P < .001). Serum CRP concentration (median, 7.4 μg/L; range, 1-44.9 μg/L) was positively correlated with overall histopathologic necroinflammatory activity (r = 0.78, P < .001) and fibrosis score (rho = 0.49, P < .05). Plasma vWF concentration (median, 73.3%; range, 15-141%) was positively correlated with fibrosis score (r = 0.53, P < .05) and prothrombin time (rho = 0.67, P < .01), and negatively correlated with serum albumin concentration (r = -0.73, P < .001). CONCLUSION AND CLINICAL IMPORTANCE In dogs with CH, serum 25(OH)VD concentration was negatively correlated with disease activity, whereas serum CRP concentration and plasma vWF concentration were positively correlated with histopathologic grade and stage. Our results provide preliminary evidence that these biomarkers may be useful to assess grade and stage of CH in dogs in the absence of liver biopsy.
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Affiliation(s)
- Yoko M. Ambrosini
- Washington State UniversityPullmanWashingtonUSA
- Cummings School of Veterinary Medicine at Tufts UniversityGraftonMassachusettsUSA
| | - Cesar Piedra‐Mora
- Cummings School of Veterinary Medicine at Tufts UniversityGraftonMassachusettsUSA
| | - Sam Jennings
- Cummings School of Veterinary Medicine at Tufts UniversityGraftonMassachusettsUSA
- Zoetis Reference LaboratoriesSan DiegoCaliforniaUSA
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11
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Cha J, Kim J, Ko J, Kim J, Eom K. Effects of Confounding Factors on Liver Stiffness in Two-Dimensional Shear Wave Elastography in Beagle Dogs. Front Vet Sci 2022; 9:827599. [PMID: 35155659 PMCID: PMC8830801 DOI: 10.3389/fvets.2022.827599] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/06/2022] [Indexed: 12/12/2022] Open
Abstract
Background Two-dimensional shear wave elastography (2D-SWE) is a powerful technique that can non-invasively measure liver stiffness to assess hepatic fibrosis. Purpose This study aimed to identify the effects of confounding factors, including anesthesia, breathing, and scanning approach, on liver stiffness when performing 2D-SWE in dogs. Materials and Methods Nine healthy Beagle dogs were included in this study. Hepatic 2D-SWE was performed, and liver stiffness was compared between conscious and anesthetized states, free-breathing and breath-holding conditions, and intercostal and subcostal approaches. For the anesthetized state, the breath-holding condition was subdivided into seven phases, which included forced-expiration (5 and 10 mL/kg), end-expiration (0 cm H2O), and forced-inspiration (5, 10, 15, and 20 cm H2O), and liver stiffness was compared among these phases. Changes in liver stiffness were compared between intercostal and subcostal approaches according to breathing phases. Results No significant difference was observed in liver stiffness between the conscious and anesthetized states or between the free-breathing and breath-holding conditions. No significant difference was noted in liver stiffness among the breathing phases, except for forced-inspiration with high airway pressure (15 and 20 cm H2O in the intercostal approach and 10, 15, and 20 cm H2O in the subcostal approach), which was associated with significantly higher liver stiffness (p < 0.05). Liver stiffness was significantly higher in the subcostal approach than in the intercostal approach (p < 0.05). Changes in liver stiffness were significantly higher in the subcostal approach than in the intercostal approach in all forced-inspiratory phases (p < 0.05). Conclusion In conclusion, when performing 2D-SWE in dogs, liver stiffness is unaffected by anesthesia and free-breathing. To avoid inadvertent increases in liver stiffness, the deep inspiratory phase and subcostal approach are not recommended. Thus, liver stiffness should be interpreted considering these confounding factors.
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12
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Shaker R, Wilke C, Ober C, Lawrence J. Machine learning model development for quantitative analysis of CT heterogeneity in canine hepatic masses may predict histologic malignancy. Vet Radiol Ultrasound 2021; 62:711-719. [PMID: 34448312 DOI: 10.1111/vru.13012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 01/24/2023] Open
Abstract
Tumor heterogeneity is a well-established marker of biologically aggressive neoplastic processes and is associated with local recurrence and distant metastasis. Quantitative analysis of CT textural features is an indirect measure of tumor heterogeneity and therefore may help predict malignant disease. The purpose of this retrospective, secondary analysis study was to quantitatively evaluate CT heterogeneity in dogs with histologically confirmed liver masses to build a predictive model for malignancy. Forty dogs with liver tumors and corresponding histopathologic evaluation from a previous prospective study were included. Triphasic image acquisition was standardized across dogs and whole liver and liver mass were contoured on each precontrast and delayed postcontrast dataset. First-order and second-order indices were extracted from contoured regions. Univariate analysis identified potentially significant indices that were subsequently used for top-down model construction. Multiple quadratic discriminatory models were constructed and tested, including individual models using both postcontrast and precontrast whole liver or liver mass volumes. The best performing model utilized the CT features voxel volume and uniformity from postcontrast mass contours; this model had an accuracy of 0.90, sensitivity of 0.67, specificity of 1.0, positive predictive value of 1.0, negative predictive value of 0.88, and precision of 1.0. Heterogeneity indices extracted from delayed postcontrast CT hepatic mass contours were more informative about tumor type compared to indices from whole liver contours, or from precontrast hepatic mass and whole liver contours. Results demonstrate that CT radiomic feature analysis may hold clinical utility as a noninvasive method of predicting hepatic malignancy and may influence diagnostic or therapeutic approaches.
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Affiliation(s)
- Rami Shaker
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, USA.,Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Christopher Wilke
- Department of Radiation Oncology, Medical School, University of Minnesota, Minneapolis, Minnesota, USA.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Christopher Ober
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul, Minnesota, USA
| | - Jessica Lawrence
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul, Minnesota, USA
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13
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Peng W, Cheng S, Bao Z, Wang Y, Zhou W, Wang J, Yang Q, Chen C, Wang W. Advances in the research of nanodrug delivery system for targeted treatment of liver fibrosis. Biomed Pharmacother 2021; 137:111342. [DOI: 10.1016/j.biopha.2021.111342] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/23/2021] [Accepted: 01/27/2021] [Indexed: 02/08/2023] Open
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14
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Burti S, Zotti A, Bonsembiante F, Contiero B, Banzato T. Diagnostic Accuracy of Delayed Phase Post Contrast Computed Tomographic Images in the Diagnosis of Focal Liver Lesions in Dogs: 69 Cases. Front Vet Sci 2021; 8:611556. [PMID: 33748206 PMCID: PMC7969650 DOI: 10.3389/fvets.2021.611556] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/08/2021] [Indexed: 11/13/2022] Open
Abstract
To describe the computed tomographic (CT) features of focal liver lesions (FLLs) in dogs, that could enable predicting lesion histotype. Dogs diagnosed with FLLs through both CT and cytopathology and/or histopathology were retrospectively collected. Ten qualitative and 6 quantitative CT features have been described for each case. Lastly, a machine learning-based decision tree was developed to predict the lesion histotype. Four categories of FLLs - hepatocellular carcinoma (HCC, n = 13), nodular hyperplasia (NH, n = 19), other benign lesions (OBL, n = 18), and other malignant lesions (OML, n = 19) - were evaluated in 69 dogs. Five of the observed qualitative CT features resulted to be statistically significant in the distinction between the 4 categories: surface, appearance, lymph-node appearance, capsule formation, and homogeneity of contrast medium distribution. Three of the observed quantitative CT features were significantly different between the 4 categories: the Hounsfield Units (HU) of the radiologically normal liver parenchyma during the pre-contrast scan, the maximum dimension, and the ellipsoid volume of the lesion. Using the machine learning-based decision tree, it was possible to correctly classify NHs, OBLs, HCCs, and OMLs with an accuracy of 0.74, 0.88, 0.87, and 0.75, respectively. The developed decision tree could be an easy-to-use tool to predict the histotype of different FLLs in dogs. Cytology and histology are necessary to obtain the final diagnosis of the lesions.
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Affiliation(s)
- Silvia Burti
- Department of Animal Medicine, Productions and Health, University of Padua, Padua, Italy
| | - Alessandro Zotti
- Department of Animal Medicine, Productions and Health, University of Padua, Padua, Italy
| | - Federico Bonsembiante
- Department of Animal Medicine, Productions and Health, University of Padua, Padua, Italy.,Department of Comparative Biomedicine and Food Science, University of Padua, Padua, Italy
| | - Barbara Contiero
- Department of Animal Medicine, Productions and Health, University of Padua, Padua, Italy
| | - Tommaso Banzato
- Department of Animal Medicine, Productions and Health, University of Padua, Padua, Italy
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15
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Reece J, Pavlick M, Penninck DG, Webster CRL. Hemorrhage and complications associated with percutaneous ultrasound guided liver biopsy in dogs. J Vet Intern Med 2020; 34:2398-2404. [PMID: 33125175 PMCID: PMC7694835 DOI: 10.1111/jvim.15942] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 10/02/2020] [Accepted: 10/09/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Liver biopsy is often necessary to obtain a diagnosis in dogs with hepatobiliary disease. Hemorrhage after biopsy is a concern. OBJECTIVE To describe the extent of hemorrhage and incidence of complications after percutaneous ultrasound guided liver biopsy (PUGLB) in dogs and to examine risk factors for hemorrhage or complications. ANIMALS One hundred two client owned dogs with suspected hepatobiliary disease that underwent PUGLB. METHODS Medical records were retrospectively reviewed. Using human guidelines, major hemorrhage was defined as an absolute decrease in the PCV (ΔPCV) ≥ 6%. Complications were defined separately as clinically relevant physiologic compromise that necessitated intervention or death. The relationship between ΔPCV and the occurrence of complications and the initial PCV, coagulation variables, serum activity of liver-derived enzymes, serum bilirubin concentration, number of biopsies, biopsy needle gauge, radiologist experience, histological diagnosis, and ultrasound variables were compared. RESULTS Before PUGLB, most aberrations in coagulation variables were mild. After biopsy a decrease in PCV occurred in 87/102 (85.3%) dogs. The mean ΔPCV was -7.2% ± 4.5%. Major hemorrhage occurred in 43/102 (42.2%) dogs and complications in 2/102 (1.9%). ΔPCV was significantly positively correlated with PCV before biopsy (r = .47, P = .004). There was no correlation between ΔPCV or complications with any of the variables examined. CONCLUSION AND CLINICAL IMPORTANCE Percutaneous ultrasound guided liver biopsy in the population of dogs in the current study, with normal or mild abnormalities in coagulation, results in a high incidence of clinically silent, major hemorrhage (42.5%), but few complications (1.9%).
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Affiliation(s)
- Jonjo Reece
- Cummings School of Veterinary Medicine at Tufts University, Grafton, Massachusetts, USA
| | - Michelle Pavlick
- Cummings School of Veterinary Medicine at Tufts University, Grafton, Massachusetts, USA
| | - Dominique G Penninck
- Cummings School of Veterinary Medicine at Tufts University, Grafton, Massachusetts, USA
| | - Cynthia R L Webster
- Cummings School of Veterinary Medicine at Tufts University, Grafton, Massachusetts, USA
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16
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Vilkovyskiy IF, Vatnikov YA, Kulikov EV, Sotnikova ED, Yagnikov SA, Seleznev SB, Krotova EA, Byakhova VM, Grishin VN, Avdotin VP. Influence of hepatic neoplasia on life expectancy in dogs. Vet World 2020; 13:413-418. [PMID: 32367943 PMCID: PMC7183475 DOI: 10.14202/vetworld.2020.413-418] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/16/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIM The present study investigated the influence of liver tumor structure on life expectancy in dogs. Diseases of the liver comprise 5-25% of all non-communicable diseases in dogs, and primary hepatic tumors account for 0.6-1.3% of tumors. This research aimed to study the post-operative life span of animals with primary or metastatic tumors of the liver. MATERIALS AND METHODS During the study period, 7124 oncological operations were performed in our clinic. In total, 128 liver tumors were detected in live animals, while 323 were detected posthumously. Forty animals underwent surgery for various liver tumors. In dogs with primary liver tumors, the average age was 11.9 years and the average body weight was 15.5 kg, while in dogs with liver metastases, the mean age was 11.4 years and the average body weight was 24 kg. RESULTS The ratio of males to females among dogs with primary liver tumors was about 1:1 (ten females and nine males), while that among dogs with metastatic liver damage was clearly predominantly female (14 females and two males) because females often undergo surgery for cancerous mammary glands or ovaries. CONCLUSION The size of tumors and the number of affected lobes had a significant effect on the post-operative life span. With a tumor size of <5 cm and a lesion covering less than two lobes of the liver, life expectancy was significantly longer and the prognosis was more favorable. In cases of large tumors or those affecting more than two lobes, life expectancy was significantly reduced and the prognosis was cautious to unfavorable.
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Affiliation(s)
- I. F. Vilkovyskiy
- Department of Veterinary Medicine, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - Yu A. Vatnikov
- Department of Veterinary Medicine, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - E. V. Kulikov
- Department of Veterinary Medicine, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - E. D. Sotnikova
- Department of Veterinary Medicine, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - S. A. Yagnikov
- Department of Veterinary Medicine, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - S. B. Seleznev
- Department of Veterinary Medicine, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - E. A. Krotova
- Department of Veterinary Medicine, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - V. M. Byakhova
- Department of Veterinary Medicine, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - V. N. Grishin
- Department of Veterinary Medicine, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - V. P. Avdotin
- Department of Veterinary Medicine, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
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17
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A hybrid (iron–fat–water) phantom for liver iron overload quantification in the presence of contaminating fat using magnetic resonance imaging. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2019; 33:385-392. [DOI: 10.1007/s10334-019-00795-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 12/19/2022]
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18
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Xia WY, Gao L, Dai EH, Chen D, Xie EF, Yang L, Zhang SC, Zhang BF, Xu J, Pan SY. Liquid biopsy for non-invasive assessment of liver injury in hepatitis B patients. World J Gastroenterol 2019; 25:3985-3995. [PMID: 31413532 PMCID: PMC6689808 DOI: 10.3748/wjg.v25.i29.3985] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/13/2019] [Accepted: 07/05/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatitis B is a major public health problem in China. Accurate liver injury assessment is essential for clinical evidence-based treatment. Liver biopsy is considered the gold standard method to stage liver disease, but it is not widely used in resource-limited settings. Therefore, non-invasive liquid biopsy tests are needed.
AIM To assess liver injury in hepatitis B patients using quantified cell free DNA combined with other serum biomarker as a liquid biopsy-based method.
METHODS A cohort of 663 subjects including 313 hepatitis B patients and 350 healthy controls were enrolled. Ultrasound-guided liver biopsies followed by histopathological assessments were performed for the 263 chronic hepatitis B patients to determine the degree of liver injury. Cell-free DNA was quantified using a novel duplex real-time polymerase chain reaction assay.
RESULTS Compared with healthy controls, patients with hepatitis B virus (HBV) infection had significantly higher plasma DNA, serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin, and HBV DNA levels (P < 0.01). Serum ALT, AST, bilirubin, and plasma DNA levels of patients with marked-severe inflammation were significantly higher than those with mild-moderate inflammation (P < 0.01). There was a statistically significant correlation between hepatocyte inflammation severity and serum bilirubin (R2 = 0.673, P < 0.01) or plasma DNA (R2 = 0.597, P < 0.01) levels. The areas under the curves of serum ALT, bilirubin, plasma DNA, and their combination to distinguish between patients with mild–moderate and marked-severe inflammation were 0.8059, 0.7910, 0.7921, and 0.9564, respectively.
CONCLUSION The combination of plasma DNA, serum ALT, and bilirubin could be a candidate liquid biopsy for non-invasive assessment of liver injury in hepatitis B patients.
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Affiliation(s)
- Wen-Ying Xia
- Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Li Gao
- Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Er-Hei Dai
- Department of Laboratory Medicine, the Fifth Hospital of Shijiazhuang, Shijiazhuang 050021, Hebei Province, China
| | - Dan Chen
- Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Er-Fu Xie
- Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Li Yang
- Department of Laboratory Medicine, the Fifth Hospital of Shijiazhuang, Shijiazhuang 050021, Hebei Province, China
| | - Shi-Chang Zhang
- Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Bing-Feng Zhang
- Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Jian Xu
- Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Shi-Yang Pan
- Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
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19
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Menard M, Lecoindre A, Cadoré JL, Chevallier M, Pagnon A, Hernandez J, Leal RO, Hugonnard M, Miette V, Destro M, Rannou B, Benchekroun G, Lecoindre P. Use of serum biomarkers in staging of canine hepatic fibrosis. J Vet Diagn Invest 2019; 31:665-673. [PMID: 31347473 DOI: 10.1177/1040638719866881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Accurate staging of hepatic fibrosis (HF) is important for treatment and prognosis of canine chronic hepatitis. HF scores are used in human medicine to indirectly stage and monitor HF, decreasing the need for liver biopsy. We developed a canine HF score to screen for moderate or greater HF. We included 96 dogs in our study, including 5 healthy dogs. A liver biopsy for histologic examination and a biochemistry profile were performed on all dogs. The dogs were randomly split into a training set of 58 dogs and a validation set of 38 dogs. A HF score that included alanine aminotransferase, alkaline phosphatase, total bilirubin, potassium, and gamma-glutamyl transferase was developed in the training set. Model performance was confirmed using the internal validation set, and was similar to the performance in the training set. The overall sensitivity and specificity for the study group were 80% and 70% respectively, with an area under the curve of 0.80 (0.71-0.90). This HF score could be used for indirect diagnosis of canine HF when biochemistry panels are performed on the Konelab 30i (Thermo Scientific), using reagents as in our study. External validation is required to determine if the score is sufficiently robust to utilize biochemical results measured in other laboratories with different instruments and methodologies.
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Affiliation(s)
- Maud Menard
- Internal Medicine Department, Université Paris-Est, École Nationale Vétérinaire d'Alfort, Maisons-Alfort, France (Menard, Benchekroun)
| | - Alexis Lecoindre
- Internal Medicine Department (Lecoindre A, Cadoré, Hugonnard), VetAgro Sup Campus Vétérinaire de Lyon, Marcy l'Étoile, France
| | - Jean-Luc Cadoré
- Internal Medicine Department (Lecoindre A, Cadoré, Hugonnard), VetAgro Sup Campus Vétérinaire de Lyon, Marcy l'Étoile, France
| | | | | | - Juan Hernandez
- Internal Medicine Department, Centre Hospitalier Vétérinaire Frégis, Arcueil, France (Hernandez, Leal)
| | - Rodolpho Oliveira Leal
- Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal (Leal)
| | - Marine Hugonnard
- Internal Medicine Department (Lecoindre A, Cadoré, Hugonnard), VetAgro Sup Campus Vétérinaire de Lyon, Marcy l'Étoile, France
| | | | | | - Benoît Rannou
- Laboratoire de biologie médicale (Rannou), VetAgro Sup Campus Vétérinaire de Lyon, Marcy l'Étoile, France
| | - Ghita Benchekroun
- Internal Medicine Department, Université Paris-Est, École Nationale Vétérinaire d'Alfort, Maisons-Alfort, France (Menard, Benchekroun)
| | - Patrick Lecoindre
- Internal Medicine Department (Lecoindre A, Cadoré, Hugonnard), VetAgro Sup Campus Vétérinaire de Lyon, Marcy l'Étoile, France
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20
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Pavlick M, Webster CRL, Penninck DG. Bleeding risk and complications associated with percutaneous ultrasound-guided liver biopsy in cats. J Feline Med Surg 2019; 21:529-536. [PMID: 30099964 PMCID: PMC10814532 DOI: 10.1177/1098612x18788883] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
OBJECTIVES Liver biopsy is necessary for a diagnosis of liver disease; however, post-biopsy bleeding is a concern. The aim of this study was to describe the extent of bleeding and the occurrence of complications after percutaneous ultrasound-guided liver biopsy (PUGLB) in cats. METHODS The medical records of 30 cats that had a PUGLB were retrospectively reviewed. Using human guidelines, bleeding was classified as minor or major when the absolute change in packed cell volume (ΔPCV) was <0 and >-6% or ≤-6%, respectively. Complications were defined as physiologic compromise necessitating an intervention, or death. The relationship between ΔPCV and the occurrence of complications and the signalment, initial PCV, coagulation parameters, serum liver enzymes and bilirubin, number of biopsies, histological diagnosis, ultrasound findings, radiologist experience, concurrent procedures and vitamin K administration were assessed using Fisher's exact test, ANOVA and Pearson's correlation coefficient, with a P value <0.05 considered significant. RESULTS All cats had a decrease in PCV after biopsy. The mean ΔPCV was -6.9% ± 4.1%. Minor and major bleeding occurred in 13/30 (43.3%) and 17/30 (56.7%) cats, respectively, and non-lethal bleeding complications occurred in 5/30 (16.7%). Cats with complications had a lower pre-biopsy PCV ( P <0.003). Major bleeding was more likely with a diagnosis of hepatic lipidosis ( P = 0.03). There was no correlation between ΔPCV or complications and signalment, coagulation parameters, serum parameters, number of biopsies, ultrasound findings, radiologist experience, concurrent procedures and vitamin K administration. CONCLUSIONS AND RELEVANCE PUGLB is a relatively safe procedure in cats, although many cats have a subclinical decrease in PCV. As conventional coagulation tests did not predict complications or the magnitude of ΔPCV, there is a need for more sensitive indicators of bleeding risk in cats undergoing PUGLB.
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Affiliation(s)
- Michelle Pavlick
- Small Animal Internal Medicine, Cummings School of Veterinary Medicine at Tufts University, Grafton, MA, USA
| | - Cynthia RL Webster
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, Grafton, MA
| | - Dominique G Penninck
- Small Animal Internal Medicine, Cummings School of Veterinary Medicine at Tufts University, Grafton, MA, USA
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21
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Webster CRL, Center SA, Cullen JM, Penninck DG, Richter KP, Twedt DC, Watson PJ. ACVIM consensus statement on the diagnosis and treatment of chronic hepatitis in dogs. J Vet Intern Med 2019; 33:1173-1200. [PMID: 30844094 PMCID: PMC6524396 DOI: 10.1111/jvim.15467] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/14/2019] [Indexed: 12/13/2022] Open
Abstract
This consensus statement on chronic hepatitis (CH) in dogs is based on the expert opinion of 7 specialists with extensive experience in diagnosing, treating, and conducting clinical research in hepatology in dogs. It was generated from expert opinion and information gathered from searching of PubMed for manuscripts on CH, the Veterinary Information Network for abstracts and conference proceeding from annual meetings of the American College of Veterinary Medicine and the European College of Veterinary Medicine, and selected manuscripts from the human literature on CH. The panel recognizes that the diagnosis and treatment of CH in the dog is a complex process that requires integration of clinical presentation with clinical pathology, diagnostic imaging, and hepatic biopsy. Essential to this process is an index of suspicion for CH, knowledge of how to best collect tissue samples, access to a pathologist with experience in assessing hepatic histopathology, knowledge of reasonable medical interventions, and a strategy for monitoring treatment response and complications.
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Affiliation(s)
- Cynthia R. L. Webster
- Department of Clinical SciencesCummings School of Veterinary Medicine at Tufts UniversityGraftonMassachusetts
| | - Sharon A. Center
- Department of Clinical SciencesNew York State College of Veterinary Medicine at Cornell UniversityIthacaNew York
| | - John M. Cullen
- Population Health and PathobiologyNorth Carolina State Veterinary MedicineRaleighNorth Carolina
| | - Dominique G. Penninck
- Department of Clinical SciencesCummings School of Veterinary Medicine at Tufts UniversityGraftonMassachusetts
| | - Keith P. Richter
- Ethos Veterinary Health and Veterinary Specialty Hospital of San DiegoSan DiegoCalifornia
| | - David C. Twedt
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical SciencesColorado State UniversityFort CollinsColorado
| | - Penny J. Watson
- Department of Veterinary MedicineUniversity of CambridgeCambridgeUnited Kingdom
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Shaffer LG, Geretschlaeger A, Ramirez CJ, Ballif BC, Carl C. Quality assurance checklist and additional considerations for canine clinical genetic testing laboratories: a follow-up to the published standards and guidelines. Hum Genet 2019; 138:501-508. [PMID: 30982136 PMCID: PMC6536464 DOI: 10.1007/s00439-019-02013-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 04/08/2019] [Indexed: 12/11/2022]
Abstract
There is currently no oversight for canine clinical genetic testing laboratories. We published an initial set of standards and guidelines with the goal of providing a basis for which canine testing laboratories could evaluate their quality assurance programs. To further those standards and guidelines, we have developed a checklist that can be used as a self-evaluation to identify gaps in their programs for continual quality improvement over time. Because there is currently no organization willing to oversee an external proficiency program, the checklist provides the first step toward an internal, self-assessment that can be used periodically to monitor improvements. In addition, we attempt to address concerns from the canine community regarding rare or private mutations, genetic screening using array-based technologies, non-peer reviewed tests that are being offered, and the clinical validity of certain mutations in particular breeds. Through coordination, conversation and hard work, the canine genetic testing community can strive to organize to improve testing and to provide more transparency to consumers and better outcomes for dogs.
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Affiliation(s)
- Lisa G Shaffer
- Paw Print Genetics, Genetic Veterinary Sciences, Inc., 220 E Rowan, Suite 220, Spokane, WA, 99207, USA.
| | | | - Christina J Ramirez
- Paw Print Genetics, Genetic Veterinary Sciences, Inc., 220 E Rowan, Suite 220, Spokane, WA, 99207, USA
| | - Blake C Ballif
- Paw Print Genetics, Genetic Veterinary Sciences, Inc., 220 E Rowan, Suite 220, Spokane, WA, 99207, USA
| | - Casey Carl
- Paw Print Genetics, Genetic Veterinary Sciences, Inc., 220 E Rowan, Suite 220, Spokane, WA, 99207, USA
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Oramas A, Case JB, Toskich BB, Fox-Alvarez WA, Boston SE, Giglio RF, Dark MJ. Laparoscopic access to the liver and application of laparoscopic microwave ablation in 2 dogs with liver neoplasia. Vet Surg 2019; 48:O91-O98. [DOI: 10.1111/vsu.13153] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/02/2018] [Accepted: 12/06/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Alberto Oramas
- Department of Small Animal Clinical Sciences, Veterinary Medical Center; University of Florida; Gainesville Florida
| | - J. Brad Case
- Department of Small Animal Clinical Sciences, Veterinary Medical Center; University of Florida; Gainesville Florida
| | - Beau B. Toskich
- Department of Interventional Radiology; Mayo Clinic; Jacksonville Florida
| | - W. Alexander Fox-Alvarez
- Department of Small Animal Clinical Sciences, Veterinary Medical Center; University of Florida; Gainesville Florida
| | - Sarah E. Boston
- Department of Small Animal Clinical Sciences, Veterinary Medical Center; University of Florida; Gainesville Florida
| | - Robson F. Giglio
- Department of Small Animal Clinical Sciences, Veterinary Medical Center; University of Florida; Gainesville Florida
| | - Michael J. Dark
- Department of Small Animal Clinical Sciences, Veterinary Medical Center; University of Florida; Gainesville Florida
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24
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Akar T. Is serum angiotensin converting enzyme level a useful non-invasive marker for liver fibrosis in patients with chronic hepatitis C? ACTA ACUST UNITED AC 2018; 64:224-229. [PMID: 29641775 DOI: 10.1590/1806-9282.64.03.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 07/17/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Chronic hepatitis C (CHC) continues to be a critical problem. The liver fibrosis score is the most valuable tool in determining treatment and prognosis. Liver biopsy is still considered a gold method but, due to unmet needs, new non-invasive markers are required. The aim of this study was to investigate any possible relationship between serum angiotensin-converting enzyme (ACE) levels and the stages of liver fibrosis in patients with CHC. METHOD A total 100 CHC and 100 healthy subjects were enrolled in this study. The relationship between serum ACE level and the stages liver fibrosis was investigated using three different formats, as follows: (group [G]-I, classic Ishak's Score from F1 to F6; G-II, mild [F1-2], moderate [F3-4] and severe [F5-6]; G-III, mild [≤ F2] and advanced [F > 2]). The clinical usability of serum ACE level for both groups was also investigated. RESULTS Median serum ACE levels were higher in the healthy group than in CHC (42.5 [7-119] vs. 36 [7-91] U/I, p=0.002). There was no statistical difference among the three different fibrosis groups (G-I, G-II, G-III, p=0.797, p=0.986, and p=0.874) and no correlation between serum ACE level and the stages of liver fibrosis (r=0.026, p=0.923). The usability of serum ACE for evaluated patients with CHC and healthy subjects were calculated as 47% and 64%, respectively. CONCLUSION Our study indicated that there is no relationship or correlation between serum ACE levels and stages of liver fibrosis in patients with CHC. The assessment of serum ACE level using genetically corrected reference values may provide more accurate results.
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Affiliation(s)
- Tarik Akar
- Department of Gastroenterology, School of Medicine, Bülent Ecevit University, Zonguldak, Turkey
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25
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Association between serum S100A9 levels and liver necroinflammation in chronic hepatitis B. J Transl Med 2018; 16:83. [PMID: 29615081 PMCID: PMC5883874 DOI: 10.1186/s12967-018-1462-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 03/27/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND S100A9 protein, which is recently classified as a novel damage associated molecular pattern, is released from stressed cells undergoing necrosis or secreted by living cells undergoing a stress that act as endogenous danger signal associated with infection, tissue damage and cancer. Here, we evaluated the relationship of serum S100A9 with viral replication and liver necroinflammation in patients with chronic hepatitis B (CHB) infection. METHODS A total of one hundred and eighty-three recruited patients with CHB infection underwent liver biopsy for grading of necroinflammation (G) and staging of fibrosis (S). Forty-nine healthy individuals were included as healthy controls (HCs). Serum S100A9 levels were determined by enzyme-linked immunosorbent assay. Correlations of serum S100A9 with viral replication and liver necroinflammation were analyzed. The receiver operating characteristic curve was used to assess the discriminating power of serum S100A9 to grade liver necroinflammation (G). Liver normal L02 cells were transfected with a HBV plasmid, and S100A9 levels were determined. RESULTS Serum S100A9 levels were increased in CHB patients compared to HCs. Intrahepatic immunoreactivity for S100A9 was enhanced in liver sample from CHB patients. Infection of HBV also resulted in an elevated S100A9 expression in L02 cells. Serum S100A9 was correlated with the serum HBV DNA levels. CHB patients with moderate-to-severe liver necroinflammation (G ≥ 2) showed significantly higher serum S100A9 levels than those without or with mild necroinflammation (G < 2). In patients with normal ALT levels, the area under the curve (AUC) of S100A9 for discriminating patients with moderate-to-severe necroinflammation (G ≥ 2) was 0.791 [95% confidence interval (CI), 0.670-0.913] with 91.7% sensitivity, 65.0% specificity and 78.3% accuracy. In patients with an alanine aminotransferase (ALT) < 2 upper limit of normal, the AUC of S100A9 for discriminating patients with moderate-to-severe necroinflammation (G ≥ 2) was 0.826 (95% CI, 0.729-0.923) with 87.9% sensitivity, 72.5% specificity and 80.2% accuracy. CONCLUSIONS HBV infection may enhance S100A9 expression. Serum S100A9 levels are correlated with viral load. Serum S100A9 has potential to discriminate the grades of liver necroinflammation, particularly in CHB patients with normal or mildly increased ALT levels.
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26
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Eulenberg VM, Lidbury JA. Hepatic Fibrosis in Dogs. J Vet Intern Med 2017; 32:26-41. [PMID: 29194760 PMCID: PMC5787209 DOI: 10.1111/jvim.14891] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/17/2017] [Accepted: 10/31/2017] [Indexed: 12/19/2022] Open
Abstract
Hepatic fibrosis is commonly diagnosed in dogs, often as a sequela to chronic hepatitis (CH). The development of fibrosis is a crucial event in the progression of hepatic disease that is of prognostic value. The pathophysiology of hepatic fibrosis in human patients and rodent models has been studied extensively. Although less is known about this process in dogs, evidence suggests that fibrogenic mechanisms are similar between species and that activation of hepatic stellate cells is a key step. Diagnosis and staging of hepatic fibrosis in dogs requires histopathological examination of a liver biopsy specimen. However, performing a liver biopsy is invasive and assessment of fibrotic stage is complicated by the absence of a universally accepted staging scheme in veterinary medicine. Serum biomarkers that can discriminate among different fibrosis stages are used in human patients, but such markers must be more completely evaluated in dogs before clinical use. When successful treatment of its underlying cause is feasible, reversal of hepatic fibrosis has been shown to be possible in rodent models and human patients. Reversal of fibrosis has not been well documented in dogs, but successful treatment of CH is possible. In human medicine, better understanding of the pathomechanisms of hepatic fibrosis is leading to the development of novel treatment strategies. In time, these may be applied to dogs. This article comparatively reviews the pathogenesis of hepatic fibrosis, its diagnosis, and its treatment in dogs.
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Affiliation(s)
- V M Eulenberg
- Gastrointestinal Laboratory, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX
| | - J A Lidbury
- Gastrointestinal Laboratory, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX
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