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Hennedige TP, Wang G, Leung FP, Alsaif HS, Teo LL, Lim SG, Wee A, Venkatesh SK. Magnetic Resonance Elastography and Diffusion Weighted Imaging in the Evaluation of Hepatic Fibrosis in Chronic Hepatitis B. Gut Liver 2018; 11:401-408. [PMID: 27965475 PMCID: PMC5417783 DOI: 10.5009/gnl16079] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 06/05/2016] [Accepted: 06/30/2016] [Indexed: 12/18/2022] Open
Abstract
Background/Aims Comparison of the accuracy of magnetic resonance elastography (MRE) and diffusion weighted imaging (DWI) for the diagnosis of liver fibrosis in patients with chronic hepatitis B (CHB). Methods In this retrospective analysis, we investigated 63 patients with CHB and liver fibrosis. DWI was performed with both breath-hold (DWI-BH) and free-breathing (DWI-FB) sequences (b=0, 500). The mean liver stiffness and apparent diffusion coefficient (ADC) were calculated by drawing regions of interest maps. Fibrosis staging according to the METAVIR system was independently performed by an experienced pathologist. A receiver operating curve (ROC) analysis was conducted to determine the accuracy of MRE, DWI-BH and DWI-FB in the detection and stratification of liver fibrosis. The performance of the detection of significant fibrosis (≥F2), advanced fibrosis (≥F3), and cirrhosis (F4) was also evaluated by comparing areas under the ROC. Results There was a moderate and significantly negative correlation between the ADC values and liver stiffness. The accuracies for the detection of ≥F2/≥F3/F4 stage fibrosis with DWI-FB, DWI-BH and MRE were 0.84/0.76/0.72, 0.72/0.83/0.79 and 0.99/0.99/0.98, respectively. The performance of MRE was significantly better than DWI-FB and DWI-BH. There were no significant differences between the performance of DWI-FB and DWI-BH. Conclusions MRE is more accurate than DWI for the detection and stratification of liver fibrosis in CHB.
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Affiliation(s)
- Tiffany P Hennedige
- Department of Diagnostic Imaging, National University of Singapore, Singapore
| | - Gang Wang
- Department of Diagnostic Imaging, National University of Singapore, Singapore.,Department of Biomedical Engineering, University of Calgary, Calgary, Canada
| | - Fiona P Leung
- Department of Diagnostic Imaging, National University of Singapore, Singapore.,Department of Radiology, King Fahd Hospital of the University, Dammam University College of Medicine, Al Khobar, Saudi Arabia
| | - Hind S Alsaif
- Department of Diagnostic Imaging, National University of Singapore, Singapore.,South West Radiology, Liverpool, Australia
| | - Lynette Ls Teo
- Department of Diagnostic Imaging, National University of Singapore, Singapore
| | - Seng Gee Lim
- Department of Gastroenterology and Hepatology, National University of Singapore, Singapore
| | - Aileen Wee
- Department of Pathology, National University of Singapore, Singapore
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Kim SU. Can Magnetic Resonance Elastography Fill a Niche in the Market for Noninvasive Assessment of Liver Fibrosis? Gut Liver 2017; 11:321-322. [PMID: 28452209 PMCID: PMC5417773 DOI: 10.5009/gnl16616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Seung Up Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
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Feasibility of Preoperative FDG PET/CT Total Hepatic Glycolysis in the Remnant Liver for the Prediction of Postoperative Liver Function. AJR Am J Roentgenol 2016; 208:624-631. [PMID: 28026972 DOI: 10.2214/ajr.16.16450] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The objective of our study was to investigate the prognostic value of total glycolysis of the remnant liver, which reflects both metabolic and anatomic liver function, for predicting postoperative hepatic insufficiency. MATERIALS AND METHODS Patients who underwent 18F-FDG PET/CT and abdominal CT within 1 month of major hepatectomy were retrospectively analyzed. Total liver volume, remnant liver volume, the ratio of the remnant hepatic volume to the preoperative hepatic volume (RFRHV), and mean standardized uptake value (SUVmean) were measured, and total glycolysis of the remnant liver was calculated. Clinical hepatic function reserve values, including the indocyanine green retention rate at 15 minutes, the model for end-stage liver disease (MELD) score, and aspartate aminotransferase to platelet ratio index (APRI), were calculated. Univariate and multivariate analyses were performed, and an optimal model for predicting hepatic insufficiency was developed. ROC curves were used to compare diagnostic performance. RESULTS Of 149 patients, seven patients had hepatic insufficiency. The SUVmean showed the highest sensitivity (100%; specificity, 31.7%) for predicting hepatic insufficiency, and total glycolysis of the remnant liver showed the highest specificity (96.5%; sensitivity, 57.1%) for predicting hepatic insufficiency. On multivariate analysis, the odds ratio of APRI (> 5.4) and total glycolysis of the remnant liver (≤ 625.6) was 46.3 and 82.9, respectively, for predicting hepatic insufficiency. On ROC curve analysis, a new model composed of APRI and total glycolysis of the remnant liver showed a higher area under the ROC curve (Az) value (Az = 0.899) than SUVmean (0.659), MELD score (0.618), APRI (0.693), RFRHV (0.797), and remnant liver volume (0.762). CONCLUSION The total glycolysis of the remnant liver has moderate sensitivity and high specificity for predicting hepatic insufficiency. Combining the total glycolysis of the remnant liver and APRI yielded the best diagnostic performance for predicting hepatic insufficiency.
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Ünal E, Akata D, Karcaaltincaba M. Liver Function Assessment by Magnetic Resonance Imaging. Semin Ultrasound CT MR 2016; 37:549-560. [DOI: 10.1053/j.sult.2016.08.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Ding Y, Rao SX, Chen C, Li R, Zeng MS. Assessing liver function in patients with HBV-related HCC: a comparison of T₁ mapping on Gd-EOB-DTPA-enhanced MR imaging with DWI. Eur Radiol 2014; 25:1392-8. [PMID: 25523455 DOI: 10.1007/s00330-014-3542-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 11/21/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To compare the potential of T1 mapping on gadoxetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) for assessing liver function in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). METHODS One hundred consecutive patients with known HBV-related HCCs were included. T1 relaxation time and apparent diffusion coefficient (ADC) of the liver were measured, and the reduction rate of T1 relaxation time (∆%) was calculated. T1 relaxation time measurements were compared with ADC values according to the Model for End-Stage Liver Disease (MELD) score. RESULTS Hepatobiliary phase (HBP) and ∆% of T1 relaxation time measurements showed significant correlations with MELD score (rho = 0.571, p < 0.0001; rho = -0.573, p < 0.0001, respectively). HBP and ∆% of T1 relaxation time were significantly different between good (MELD ≤8) and poor liver function (MELD ≥9) (p < 0.0001 for both). Areas under the receiver operating characteristic curves (AUCs) of T1 relaxation time for HBP (AUC 0.84) and ∆% (AUC 0.82) were significantly better than for ADC (AUC 0.53; p < 0.0001). CONCLUSIONS T1 mapping on Gd-EOB-DTPA-enhanced MRI showed promise for evaluating liver function in patients with HBV-related HCC, while DWI was not reliable. HBP T1 relaxation time measurement was equally accurate as ∆% measurement. KEY POINTS • T 1 mapping on Gd-EOB-DTPA MRI was accurate for assessing liver function. • HBP T 1 relaxation time measurement was as accurate as ∆% T 1 • T 1 mapping on Gd-EOB-DTPA MRI was more accurate than DWI-ADC measurement.
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Affiliation(s)
- Ying Ding
- Department of Radiology, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, China, 200032,
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Kim SU, Jung KS, Lee S, Park JY, Kim DY, Ahn SH, Choi GH, Kim KS, Choi JS, Han KH, Park YN. Histological subclassification of cirrhosis can predict recurrence after curative resection of hepatocellular carcinoma. Liver Int 2014; 34:1008-17. [PMID: 24483989 DOI: 10.1111/liv.12475] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 01/26/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Recurrence of hepatocellular carcinoma (HCC) after curative resection continues to be a major cause of death. This prospective study is designed to investigate whether histological subclassification of cirrhosis using the Laennec system could predict recurrence in patients with hepatitis B virus (HBV)-related HCC after curative resection. METHODS Patients with HBV-related HCC who underwent curative resection and showed Laennec stage 3 to 4 were enrolled and the cases with stage 4 were subclassified histologically into three groups (stages 4A, 4B and 4C) according to the Laennec system. Between February 2006 and August 2009, 92 patients were recruited. RESULTS Stage 3, 4A, 4B and 4C were identified in 24 (26.1%), 15 (16.3%), 43 (46.7%) and 10 (10.9%) patients respectively. The cumulative incidence rates of recurrence at 1, 2 and 3 years were 24.2%, 40.5% and 55.1% respectively. On multivariate analysis, serum albumin [hazard ratio (HR), 0.528; 95% confidence interval (CI), 0.312-0.891; P=0.017] and Edmondson-Steiner grade III-IV (HR, 3.456; 95% CI, 1.123-10.517; P=0.031) were significantly correlated with early recurrence (<1 year), whereas stage 4C (HR, 5.426; 95% CI, 1.030-28.598; P=0.046) was the only independent risk factor for late recurrence (≥1 year). CONCLUSIONS Histological subclassification of cirrhosis using the Laennec system is a significant predictor of late recurrence in patients with HBV-related HCC after curative resection.
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Affiliation(s)
- Seung Up Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea; Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea; Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea; Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, Seoul, Korea
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Inoue Y, Kokudo N. Elastography for hepato-biliary-pancreatic surgery. Surg Today 2013; 44:1793-800. [PMID: 24292652 PMCID: PMC4162976 DOI: 10.1007/s00595-013-0799-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 09/03/2013] [Indexed: 12/11/2022]
Abstract
Palpation is a subjective and non-sharable diagnostic method. Recently, palpation has been supported and replaced by elastography, which provides a novel parameter of “stiffness” as a visual representation or quantified value. Today, elastography is performed using two major modalities: strain elastography and shear wave elastography. Strain elastography converts the extent of deformation during external compression into colors, displaying these colors as a strain map in a motion picture representing the relative elasticity inside the region of interest. Shear wave elastography can quantify the elasticity of a target by calculating the velocity of shear waves generated by a probe. In addition to superficial organs, elastography has also been applied to upper abdominal organs, including the liver, pancreas and spleen. The visualization of the stiffness of focal lesions in the liver or the pancreas has enabled a more sensitive and specific depiction of small, non-palpable nodules, which are difficult to depict using B-mode ultrasonography. The quantification of stiffness also enables non-invasive estimates of liver fibrosis, the risk of postoperative liver insufficiency and the risk of recurrence of viral hepatitis after transplantation. In this article, we review the major reports that have recently been published describing the effective application of elastography to solid upper abdominal organs in a clinical setting.
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Affiliation(s)
- Yosuke Inoue
- Department of Gastrointestinal Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Kim BK, Fung J, Yuen MF, Kim SU. Clinical application of liver stiffness measurement using transient elastography in chronic liver disease from longitudinal perspectives. World J Gastroenterol 2013; 19:1890-1900. [PMID: 23569334 PMCID: PMC3613104 DOI: 10.3748/wjg.v19.i12.1890] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 09/28/2012] [Indexed: 02/06/2023] Open
Abstract
Accurate determination of the presence and degree of fibrosis in liver is of great importance, because the prognosis and management strategies for chronic liver disease depend mainly on these factors. To date, liver biopsy (LB) remains the “gold standard” for assessing the severity of liver fibrosis; however, LB is often limited by its invasiveness, sampling error, and intra/inter-observer variability in histological interpretation. Furthermore, repeated LB examinations within a short time interval are indeed ineligible in a real clinical practice. Thus, due to the pressing need for non-invasive surrogates for liver fibrosis, transient elastography (TE), as a novel ultrasound based technology, has allowed a noninvasive measurement of liver stiffness and has gained in popularity over recent years. In the past few years, additional roles for transient TE beyond the initial purpose of a non-invasive surrogate for LB have included the prediction of the most two critical consequences of fibrosis progression: the development of portal hypertension-related complications and hepatocellular carcinoma. This indicates that the role of transient TE is not merely limited to reducing the need for LB, but transient TE can enable the establishment of tailored management strategies by providing more detailed prognostic information. In particular, under the concept in which the clinical course of liver fibrosis is dynamic and bidirectional, especially when appropriate intervention is commenced, transient TE can be used to track the dynamic changes in fibrotic burden during antiviral or antifibrotic treatment. This review discussed extended applications of transient TE in prediction of the development of real clinical endpoints from a longitudinal perspective.
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Optimal time for restoring the reliability of liver stiffness measurement in patients with chronic hepatitis B experiencing acute exacerbation. J Clin Gastroenterol 2012; 46:602-7. [PMID: 22772739 DOI: 10.1097/mcg.0b013e3182582a31] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS Liver stiffness measurement (LSM) using transient elastography (FibroScan) is influenced by major changes in aminotransferase. We aimed to determine the optimal time for restoring the reliability of LSM for assessing liver fibrosis in patients with chronic hepatitis B experiencing acute exacerbation. METHODS Twenty-one patients with acute exacerbation of chronic hepatitis B [alanine aminotransferase (ALT)>5× upper limit of normal (ULN)] were prospectively recruited. Serial LSM and biochemical tests were performed at the time of admission and after 1, 3, 6, 9, and 12 months. The ULN of ALT was defined as 40 IU/L. The cutoff LSM value for cirrhosis was defined as 10.3 kPa. RESULTS The median age (9 male) was 49 years. The median ALT and LSM in the baseline were 522 IU/L and 15.1 kPa, respectively. Three months after acute exacerbation, ALT had decreased significantly below 2× ULN and stabilized (median: 522, 43, 21, 19, 18, and 16 IU/L at baseline, 1, 3, 6, 9, and 12 mo, respectively). However, LSM needed 3 more months (6 mo after exacerbation) for stabilization (median: 15.1, 10.0, 7.4, 7.1, 6.3, and 5.8 kPa at baseline, 1, 3, 6, 9, and 12 mo, respectively). CONCLUSIONS LSM should be postponed for at least 3 months after stabilization of ALT below 2× ULN to restore the reliability of LSM in assessing liver fibrosis.
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Jung KS, Kim SU, Choi GH, Park JY, Park YN, Kim DY, Ahn SH, Chon CY, Kim KS, Choi EH, Choi JS, Han KH. Prediction of recurrence after curative resection of hepatocellular carcinoma using liver stiffness measurement (FibroScan®). Ann Surg Oncol 2012; 19:4278-86. [PMID: 22752370 DOI: 10.1245/s10434-012-2422-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND The purpose of this study was to investigate whether preoperative liver stiffness measurement (LSM) can predict recurrence after curative resection of hepatocellular carcinoma (HCC). LSM using FibroScan(®) can assess the severity of liver fibrosis, which is significantly associated with recurrence after curative resection of HCC. METHODS Between February 2006 and March 2009, 133 patients who underwent preoperative LSM and curative resection for HCC were enrolled in this prospective study. LSM values were analyzed for association with recurrence, together with other clinical variables. RESULTS The mean age of the patients (117 men and 16 women) was 57 years. During the follow-up period (median, 25.0 (range, 3.0-54.6) months), HCC recurred in 62 (46.6 %) patients. In multivariate analysis, together with satellite nodule and Edmonson-Steiner grade III-IV, LSM was selected as an independent predictor of recurrence (P < 0.05; hazard ratio, 1.034; 95 % confidence interval, 1.007-1.061). When the study population was stratified into two groups using the optimal cutoff value (13.4 kPa) that maximized the sum of sensitivity (64.7 %) and specificity (76.1 %) from time-dependent receiver operating characteristic curves (area under the receiver operating characteristic curve = 0.676), patients with LSM values >13.4 kPa were at a significantly greater risk for recurrence with a hazard ratio of 1.925 (P = 0.01; 95 % confidence interval, 1.17-3.168) compared with those with LSM values ≤ 13.4 kPa. CONCLUSIONS Our data suggest that LSM can be a useful predictor of recurrence after curative resection of HCC.
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Affiliation(s)
- Kyu Sik Jung
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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Abstract
Chronic liver disease represents a major public health problem, accounting for significant morbidity and mortality worldwide. As prognosis and management depend mainly on the amount and progression of liver fibrosis, accurate quantification of liver fibrosis is essential for therapeutic decision-making and follow-up of chronic liver diseases. Even though liver biopsy is the gold standard for evaluation of liver fibrosis, non-invasive methods that could substitute for invasive procedures have been investigated during past decades. Transient elastography (TE, FibroScan®) is a novel non-invasive method for assessment of liver fibrosis with chronic liver disease. TE can be performed in the outpatient clinic with immediate results and excellent reproducibility. Its diagnostic accuracy for assessment of liver fibrosis has been demonstrated in patients with chronic viral hepatitis; as a result, unnecessary liver biopsy could be avoided in some patients. Moreover, due to its excellent patient acceptance, TE could be used for monitoring disease progression or predicting development of liver-related complications. This review aims at discussing the usefulness of TE in clinical practice.
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Affiliation(s)
- Kyu Sik Jung
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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Pesce A, Scilletta R, Branca A, Nigro L, Montineri A, Larocca L, Fatuzzo F, Castaing M, Puleo S. Does transient elastography (FibroScan®) have a role in decision making in hepatocellular carcinoma? HPB (Oxford) 2012; 14:403-8. [PMID: 22568417 PMCID: PMC3384865 DOI: 10.1111/j.1477-2574.2012.00465.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Portal hypertension has been reported as a negative prognostic factor and a relative contraindication for liver resection. This study considers a possible role of fibrosis evaluation by transient elastography (FibroScan(®)) and its correlation with portal hypertension in patients with cirrhosis, and discusses the use of this technique in planning therapeutic options in patients with hepatocellular carcinoma (HCC). METHODS A total of 77 patients with cirrhosis, 42 (54.5%) of whom had HCC, were enrolled in this study during 2009-2011. The group included 46 (59.7%) men. The mean age of the sample was 65.2 years. The principle aetiology of disease was hepatitis C virus (HCV)-related cirrhosis (66.2%). Liver function was assessed according to Child-Pugh classification. In all patients liver stiffness (LS) was measured using FibroScan(®). The presence of portal hypertension was indirectly defined as: (i) oesophageal varices detectable on endoscopy; (ii) splenomegaly (increased diameter of the spleen to ≥ 12 cm), or (iii) a platelet count of <100,000 platelets/mm(3). RESULTS Median LS in all patients was 27.9 kPa. Portal hypertension was recorded as present in 37 patients (48.1%) and absent in 40 patients (51.9%). Median LS values in HCC patients with and without portal hypertension were 29.1 kPa and 19.6 kPa, respectively (r = 0.26, P < 0.04). Liver stiffness was used to implement the Barcelona Clinic Liver Cancer algorithm in decisions about treatment. CONCLUSIONS The evaluation of liver fibrosis by transient elastography may be useful in the follow-up of patients with cirrhosis and a direct correlation with portal hypertension may aid in the evaluation of surgical risk in patients with HCC and in the choice of alternative therapies.
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Affiliation(s)
- Antonio Pesce
- Unit of General Surgery, Policlinico-Vittorio Emanuele, University Hospital Complex, University of Catania, Catania, Italy.
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Kim SU, Kim JK, Park YN, Han KH. Discordance between liver biopsy and Fibroscan® in assessing liver fibrosis in chronic hepatitis b: risk factors and influence of necroinflammation. PLoS One 2012; 7:e32233. [PMID: 22384189 PMCID: PMC3285687 DOI: 10.1371/journal.pone.0032233] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 01/25/2012] [Indexed: 12/15/2022] Open
Abstract
Background Few studies have investigated predictors of discordance between liver biopsy (LB) and liver stiffness measurement (LSM) using FibroScan®. We assessed predictors of discordance between LB and LSM in chronic hepatitis B (CHB) and investigated the effects of necroinflammatory activity. Methods In total, 150 patients (107 men, 43 women) were prospectively enrolled. Only LSM with ≥10 valid measurements was considered reliable. Liver fibrosis was evaluated using the Laennec system. LB specimens <15 mm in length were considered ineligible. Reference cutoff LSM values to determine discordance were calculated from our cohort (6.0 kPa for ≥F2, 7.5 kPa for ≥F3, and 9.4 kPa for F4). Results A discordance, defined as a discordance of at least two stages between LB and LSM, was identified in 21 (14.0%) patients. In multivariate analyses, fibrosis stages F3–4 and F4 showed independent negative associations with discordance (P = 0.002; hazard ratio [HR], 0.073; 95% confidence interval [CI], 0.014–0.390 for F3–4 and P = 0.014; HR, 0.067; 95% CI, 0.008–0.574 for F4). LSM values were not significantly different between maximal activity grades 1–2 and 3–4 in F1 and F2 fibrosis stages, whereas LSM values were significantly higher in maximal activity grade 3–4 than 1–2 in F3 and F4 fibrosis stage (median 8.6 vs. 11.3 kPa in F3, P = 0.049; median 11.9 vs. 19.2 kPa in F4, P = 0.009). Conclusion Advanced fibrosis stage (F3–4) or cirrhosis (F4) showed a negative correlation with discordance between LB and LSM in patients with CHB, and maximal activity grade 3–4 significantly influenced LSM values in F3 and F4.
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Affiliation(s)
- Seung Up Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
- Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Ja Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
- Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Young Nyun Park
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
- Center for Chronic Metabolic Disease, Yonsei University College of Medicine, Seoul, Korea
- Liver Cirrhosis Clinical Research Center, Seoul, Korea
- Brain Korea 21 Project for Medical Science, Seoul, Korea
- * E-mail: (YNP); (K-HH)
| | - Kwang-Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
- Liver Cirrhosis Clinical Research Center, Seoul, Korea
- Brain Korea 21 Project for Medical Science, Seoul, Korea
- * E-mail: (YNP); (K-HH)
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The value of gadoxetate disodium-enhanced MR imaging for predicting posthepatectomy liver failure after major hepatic resection: a preliminary study. Eur J Radiol 2011; 80:e195-200. [PMID: 21908121 DOI: 10.1016/j.ejrad.2011.08.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Revised: 08/15/2011] [Accepted: 08/17/2011] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate whether preoperative gadoxetate-disodium-enhanced MR imaging predicts posthepatectomy liver failure (PHLF) in patients who underwent major hepatic resection. MATERIALS AND METHODS Twenty nine patients who underwent preoperative gadoxetate-disodium-enhanced MR imaging and following major hepatic resection were enrolled. Hepatic parenchymal signal intensity (SI) on pre-contrast T1-weighted imaging and 20min hepatocyte phase was measured at each of the four liver segments by two observers using region of interest measurements. The mean value was calculated and used at each phase. The relative contrast enhancement index (RCEI) was calculated: (20min hepatocyte phase SI-pre-contrast SI)/pre-contrast SI. PHLF was determined by the International Study Group of Liver Surgery 2011 guidelines. Correlation analysis was performed between preoperative liver function test and RCEI. Diagnostic accuracy of RCEI for predicting PHLF was calculated with receiver operating characteristic curve analysis. The reproducibility of the RCEI measurement was evaluated. RESULTS There was a significant correlation between preoperative albumin (r=0.496, P=0.006), T-bilirubin (r=-0.383, P=0.041), and RCEI. Seven patients (24%) experienced PHLF, and one of these patients (3%) died. The diagnostic accuracy of RCEI was 0.838 (sensitivity 85.7%, specificity 77.3%, cut-off value: 0.7508, 95% confidence interval: 0.654, 0.947). The 95% limits of agreement and ICC between repeated RCEI measurements were 18.4% of the mean and 0.94, respectively, and between RCEI measurements by the two observers were 21.7% and 0.929, respectively. CONCLUSION Our results show that preoperative gadoxetate-disodium-enhanced MR imaging can predict PHLF in patients who underwent major hepatic resection.
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