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MA M, CHEN W, CAO HL, PAN J, ZHOU Q, TANG XL, WANG DJ. The diagnostic value of tenascin-C in acute aortic syndrome. J Geriatr Cardiol 2024; 21:359-368. [PMID: 38665282 PMCID: PMC11040054 DOI: 10.26599/1671-5411.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES Misdiagnosis of acute aortic syndrome (AAS) significantly increases mortality. Tenascin-C (TN-C) is an extracellular matrix glycoprotein related to cardiovascular injury. The elevation of TN-C in AAS and whether it can discriminate sudden-onset of acute chest pain in Chinese remains unclear. METHODS We measured the plasma concentration of TN-C by ELISA in a cohort of 376 patients with chest or back pain. Measures to discriminate AAS from acute coronary syndrome (ACS) were compared and calculated. RESULTS From October 2016 to September 2021, 376 undiagnosed patients with chest or back pain were enrolled. 166 of them were finally diagnosed as AAS, 100 were ACS and 110 without cardiovascular diseases (NCV). TN-C was significantly elevated in AAS at 18.18 ng/mL (IQR: 13.10-27.68) compared with 7.51 ng/mL (IQR: 5.67-11.38) in ACS (P < 0.001) and 3.68 ng/mL (IQR: 2.50-5.29) in NCV (P < 0.001). There was no significant difference in TN-C level among the subtypes of AAS. Of the 166 AAS patients, the peaked level of TN-C was at acute stage (P = 0.012), then a slight of decrease was observed at subacute stage. The area under receiver operating characteristic curve for AAS patients versus NCV was 0.979 (95% CI: 0.964-0.994) for TN-C. At a cutoff level of 11.474 ng/mL, TN-C has a sensitivity of 76.0%, specificity of 85.5%, accuracy of 82.0%, positive predictive value (PPV) of 76.0%, negative predictive value (NPV) of 85.5%. Diagnostic performance of TN-C was superior to D-dimer and hs-cTnT. CONCLUSIONS The concentration of serum TN-C in AAS patients was significantly higher than that in ACS patients and NCV. TN-C could be a new biomarker to distinguish AAS patients in the early stage after symptoms onset from other pain diseases.
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Affiliation(s)
- Ming MA
- Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
- Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Wei CHEN
- Department of Thoracic surgery, Kunshan Hospital of Traditional Chinese Medicine, Jiangsu, China
| | - Hai-Long CAO
- Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
- Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jun PAN
- Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
- Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Qing ZHOU
- Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
- Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xin-Long TANG
- Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
- Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Dong-Jin WANG
- Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
- Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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Grzych G, Bernard L, Lestrelin R, Tailleux A, Staels B. [State of the art on the pathophysiology, diagnosis and treatment of non-alcoholic steatohepatitis (NASH)]. ANNALES PHARMACEUTIQUES FRANÇAISES 2023; 81:183-201. [PMID: 36126753 DOI: 10.1016/j.pharma.2022.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/13/2022] [Indexed: 11/15/2022]
Abstract
NAFLD or non-alcoholic fatty liver disease is one of the complications of obesity and diabetes, the prevalence of which is increasing. The causes of the pathology and its development towards its severe form, NASH or non-alcoholic steatohepatitis, are multiple and still poorly understood. Many different pharmacological classes are being tested in clinical trials to treat NASH, but no pharmaceutical treatment is currently on the market. Moreover, the diagnosis of certainty is only possible by liver biopsy and histological analysis, an invasive procedure with high risk for the patient. It is therefore necessary to better understand the natural history of the disease in order to identify therapeutic targets, but also to identify markers for the diagnosis and monitoring of the disease using a blood sample, which will allow an improvement in patient management.
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Affiliation(s)
- G Grzych
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, Lille, France.
| | - L Bernard
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, Lille, France
| | - R Lestrelin
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, Lille, France
| | - A Tailleux
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, Lille, France
| | - B Staels
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, Lille, France
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Nam D, Chapiro J, Paradis V, Seraphin TP, Kather JN. Artificial intelligence in liver diseases: improving diagnostics, prognostics and response prediction. JHEP REPORTS : INNOVATION IN HEPATOLOGY 2022; 4:100443. [PMID: 35243281 PMCID: PMC8867112 DOI: 10.1016/j.jhepr.2022.100443] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/26/2021] [Accepted: 01/11/2022] [Indexed: 12/18/2022]
Abstract
Clinical routine in hepatology involves the diagnosis and treatment of a wide spectrum of metabolic, infectious, autoimmune and neoplastic diseases. Clinicians integrate qualitative and quantitative information from multiple data sources to make a diagnosis, prognosticate the disease course, and recommend a treatment. In the last 5 years, advances in artificial intelligence (AI), particularly in deep learning, have made it possible to extract clinically relevant information from complex and diverse clinical datasets. In particular, histopathology and radiology image data contain diagnostic, prognostic and predictive information which AI can extract. Ultimately, such AI systems could be implemented in clinical routine as decision support tools. However, in the context of hepatology, this requires further large-scale clinical validation and regulatory approval. Herein, we summarise the state of the art in AI in hepatology with a particular focus on histopathology and radiology data. We present a roadmap for the further development of novel biomarkers in hepatology and outline critical obstacles which need to be overcome.
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Neuberger J, Cain O. The Need for Alternatives to Liver Biopsies: Non-Invasive Analytics and Diagnostics. Hepat Med 2021; 13:59-69. [PMID: 34163263 PMCID: PMC8214024 DOI: 10.2147/hmer.s278076] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/19/2021] [Indexed: 12/15/2022] Open
Abstract
Histology remains essential for the diagnosis and management of many disorders affecting the liver. However, the biopsy procedure itself is associated with a low risk of harm to the patient and cost to the health services; samples may not be adequate and are subject to sampling variation. Furthermore, interpretation often depends on the skill of the pathologist. Increasingly, new techniques are becoming available that are altering the indications for liver biopsy. Many diseases of the liver can be diagnosed and managed using serological and radiological techniques; the degree of fibrosis and fat can often be assessed by serological or imaging techniques and the nature of space occupying lesions defined by serology, imaging and use of liquid biopsy. However, these techniques, too, are subject to limitations: sensitivity and specificity is not always adequate for diagnosis or management; some techniques are expensive and often also require expert interpretation. Although there may be less need for liver biopsy today, histology remains the gold standard as well as an essential tool for the diagnosis and management of many conditions, especially where there are multiple pathologies, or where a diagnosis cannot or has not been made by alternative approaches. Until less invasive techniques become more reliable and accessible, liver histology will remain a key investigation.
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Affiliation(s)
- James Neuberger
- Liver Unit, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK
| | - Owen Cain
- Department of Cellular Pathology, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK
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5
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Silva CF, Nardelli MJ, Barbosa FA, Galizzi HO, Cal TCMF, Ferrari TCA, Faria LC, Couto CA. Liver stiffness is able to differentiate hepatosplenic Schistosomiasis mansoni from liver cirrhosis and spleen stiffness may be a predictor of variceal bleeding in hepatosplenic schistosomiasis. Trans R Soc Trop Med Hyg 2021; 116:26-33. [PMID: 33728472 DOI: 10.1093/trstmh/trab041] [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: 09/28/2020] [Revised: 01/18/2021] [Accepted: 03/09/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Ultrasonography is limited for differentiating portal hypertension due to liver cirrhosis from that secondary to hepatosplenic schistosomiasis (HSS). We aimed to investigate the role of transient elastography (TE) in differentiating HSS mansoni from cirrhosis and the factors associated with liver and spleen stiffness (LS and SS) in HSS. METHOD A cross-sectional study was conducted including patients with HSS mansoni (n=29) and liver cirrhosis due to non-alcoholic steatohepatitis (n=23). All patients underwent TE and those with HSS were assessed by the Niamey protocol. RESULTS HSS subjects presented lower median LS (9.6 vs 21.3 Kpa, p<0.001) and liver controlled attenuation parameter (229 vs 274 dB/m, p=0.010) than cirrhosis subjects, in addition to higher SS (73.5 vs 42.2 Kpa, p=0.002). The area under the receiver operating characteristic curve for detecting cirrhosis by LS was 0.947 (95% CI 0.89 to 1.00, p<0.001), with an optimal cut-off of 11.75 Kpa. In HSS subjects, higher SS was associated with the presence of the following: diabetes mellitus (p=0.036), metabolic syndrome (p=0.043), esophageal varices (p=0.001), portal vein thrombosis (p=0.047) and previous variceal bleeding (p=0.011). In HSS patients without portal vein thrombosis, variceal bleeding was associated with higher SS (p=0.018). Niamey categories were not associated with LS (p=0.676) or SS (p=0.504). CONCLUSION TE can play a role in differentiating HSS from cirrhosis, especially by LS. SS may be further investigated for predicting complications in HSS.
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Affiliation(s)
- Catherine F Silva
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena 190, 30130-100, Belo Horizonte, Brazil
| | - Mateus J Nardelli
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena 190, 30130-100, Belo Horizonte, Brazil
| | - Fernanda A Barbosa
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena 190, 30130-100, Belo Horizonte, Brazil
| | - Humberto O Galizzi
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena 190, 30130-100, Belo Horizonte, Brazil
| | - Tereza C M F Cal
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos 6627, 31270-901, Belo Horizonte, Brazil
| | - Teresa C A Ferrari
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena 190, 30130-100, Belo Horizonte, Brazil.,Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena 110, 30130-100, Belo Horizonte, Brazil
| | - Luciana C Faria
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena 190, 30130-100, Belo Horizonte, Brazil.,Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena 110, 30130-100, Belo Horizonte, Brazil
| | - Claudia A Couto
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena 190, 30130-100, Belo Horizonte, Brazil.,Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena 110, 30130-100, Belo Horizonte, Brazil
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Kalra S, Tizhoosh HR, Shah S, Choi C, Damaskinos S, Safarpoor A, Shafiei S, Babaie M, Diamandis P, Campbell CJV, Pantanowitz L. Pan-cancer diagnostic consensus through searching archival histopathology images using artificial intelligence. NPJ Digit Med 2020; 3:31. [PMID: 32195366 PMCID: PMC7064517 DOI: 10.1038/s41746-020-0238-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 02/11/2020] [Indexed: 02/07/2023] Open
Abstract
The emergence of digital pathology has opened new horizons for histopathology. Artificial intelligence (AI) algorithms are able to operate on digitized slides to assist pathologists with different tasks. Whereas AI-involving classification and segmentation methods have obvious benefits for image analysis, image search represents a fundamental shift in computational pathology. Matching the pathology of new patients with already diagnosed and curated cases offers pathologists a new approach to improve diagnostic accuracy through visual inspection of similar cases and computational majority vote for consensus building. In this study, we report the results from searching the largest public repository (The Cancer Genome Atlas, TCGA) of whole-slide images from almost 11,000 patients. We successfully indexed and searched almost 30,000 high-resolution digitized slides constituting 16 terabytes of data comprised of 20 million 1000 × 1000 pixels image patches. The TCGA image database covers 25 anatomic sites and contains 32 cancer subtypes. High-performance storage and GPU power were employed for experimentation. The results were assessed with conservative "majority voting" to build consensus for subtype diagnosis through vertical search and demonstrated high accuracy values for both frozen section slides (e.g., bladder urothelial carcinoma 93%, kidney renal clear cell carcinoma 97%, and ovarian serous cystadenocarcinoma 99%) and permanent histopathology slides (e.g., prostate adenocarcinoma 98%, skin cutaneous melanoma 99%, and thymoma 100%). The key finding of this validation study was that computational consensus appears to be possible for rendering diagnoses if a sufficiently large number of searchable cases are available for each cancer subtype.
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Affiliation(s)
- Shivam Kalra
- Huron Digital Pathology, St. Jacobs, ON Canada
- Kimia Lab, University of Waterloo, Waterloo, ON Canada
| | - H. R. Tizhoosh
- Kimia Lab, University of Waterloo, Waterloo, ON Canada
- Vector Institute, MaRS Centre, Toronto, ON Canada
| | | | | | | | | | | | | | | | - Clinton J. V. Campbell
- Stem Cell and Cancer Research Institute, McMaster University, Hamilton, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
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Stafylidou M, Paschos P, Katsoula A, Malandris K, Ioakim K, Bekiari E, Haidich AB, Akriviadis E, Tsapas A. Performance of Baveno VI and Expanded Baveno VI Criteria for Excluding High-Risk Varices in Patients With Chronic Liver Diseases: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2019; 17:1744-1755.e11. [PMID: 31077823 DOI: 10.1016/j.cgh.2019.04.062] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 04/23/2019] [Accepted: 04/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We aimed to assess the accuracy of Baveno VI criteria for identification of high-risk varices (HRVs) and varices of any size in patients with compensated advanced chronic liver disease (cACLD). METHODS We performed a systematic search of publications through December 2018 for studies that assessed the accuracy of Baveno VI criteria for screening for varices in patients with cACLD. We used hierarchical models to synthesize evidence. We also conducted a post hoc analysis to assess the accuracy of Εxpanded Baveno VI criteria. We appraised the confidence in estimates using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS We identified 30 studies (8469 participants). Pooled values of Baveno VI criteria for HRVs (26 studies) were a sensitivity of 0.97 (95% CI, 0.95-0.98) and a specificity of 0.32 (95% CI, 0.26-0.39). Pooled sensitivity of Εxpanded Baveno VI criteria for HRVs (12 studies) was 0.90 (95% CI, 0.85-0.93) and specificity was 0.51 (95% CI, 0.45-0.57). In 1000 patients with cACLD, with a prevalence of HRVs of 20%, Baveno VI criteria would prevent endoscopy in 262 patients, but 6 patients with HRVs would be missed. Instead, use of the Εxpanded Baveno VI criteria would result in 428 patients avoiding endoscopy, but 20 patients with HRVs would be missed. The credibility of our findings is moderate or low, mainly owing to the retrospective design of most studies. CONCLUSIONS Baveno VI criteria have high diagnostic accuracy as a triage test for screening for HRVs in patients with cACLD. Expanded Baveno VI criteria could reduce the proportion of unnecessary endoscopies further, nevertheless with a higher rate of missed HRVs.
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Affiliation(s)
- Maria Stafylidou
- First Department of Internal Medicine, Papageorgiou Hospital, Thessaloniki, Greece.
| | - Paschalis Paschos
- First Department of Internal Medicine, Papageorgiou Hospital, Thessaloniki, Greece; Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Anastasia Katsoula
- Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Konstantinos Malandris
- Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Konstantinos Ioakim
- First Department of Internal Medicine, Papageorgiou Hospital, Thessaloniki, Greece
| | - Eleni Bekiari
- Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Anna-Bettina Haidich
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Evangelos Akriviadis
- Fourth Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Apostolos Tsapas
- Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece; Harris Manchester College, University of Oxford, Oxford, United Kingdom
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8
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Sami SS, Harman D, Ragunath K, Böhning D, Parkes J, Guha IN. Non-invasive tests for the detection of oesophageal varices in compensated cirrhosis: systematic review and meta-analysis. United European Gastroenterol J 2018; 6:806-818. [PMID: 30023058 PMCID: PMC6047293 DOI: 10.1177/2050640618767604] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 02/27/2018] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Conclusive data on the accuracy and clinical applicability of non-invasive screening tests for oesophageal varices (OV) in patients with compensated cirrhosis remain lacking. We conducted this study to identify currently available tests, estimate their diagnostic performance and then exemplify how these could be utilized in clinical practice. MATERIALS AND METHODS A systematic literature search was performed to identify all primary studies that reported accuracy using oesophagogastroduodenoscopy (OGD) as the gold standard. Sources searched included Ovid MEDLINE, Ovid EMBASE and The Cochrane Library databases. RESULTS Twenty-one studies with a total of 2471 patients were identified. Several tests were evaluated in more than three studies. Platelet count/spleen diameter ratio (PSR) had the highest summary area under the curve for detection of any size OV of 0.85 (95% confidence interval 0.78-0.92). At a cut-off of 909 (n = 4 studies) and prevalence rates of 10, 20, 30, 40 and 50% for OV, PSR screening correctly avoided the need for OGD in 70, 62, 55, 47 and 39% of patients, respectively. CONCLUSIONS PSR appears to be the most accurate and validated non-invasive screening test for OV in patients with compensated cirrhosis. At a cut-off of 909, PSR could be clinically useful to avoid OGDs in a significant proportion of patients.
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Affiliation(s)
- Sarmed S. Sami
- NIHR Nottingham Digestive Diseases
Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the
University of Nottingham, Nottingham, United Kingdom
| | - David Harman
- NIHR Nottingham Digestive Diseases
Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the
University of Nottingham, Nottingham, United Kingdom
| | - Krish Ragunath
- NIHR Nottingham Digestive Diseases
Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the
University of Nottingham, Nottingham, United Kingdom
| | - Dankmar Böhning
- Statistical Sciences Research Institute,
University of Southampton, Southampton, United Kingdom
| | - Julie Parkes
- Public Health Sciences & Medical
Statistics, University of Southampton, Southampton, United Kingdom
| | - Indra Neil Guha
- NIHR Nottingham Digestive Diseases
Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the
University of Nottingham, Nottingham, United Kingdom
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9
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Brandt AH, Moshavegh R, Hansen KL, Bechsgaard T, Lönn L, Jensen JA, Nielsen MB. Vector Flow Imaging Compared with Pulse Wave Doppler for Estimation of Peak Velocity in the Portal Vein. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:593-601. [PMID: 29223701 DOI: 10.1016/j.ultrasmedbio.2017.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 10/25/2017] [Accepted: 10/30/2017] [Indexed: 06/07/2023]
Abstract
The study described here investigated whether angle-independent vector flow imaging (VFI) technique estimates peak velocities in the portal vein comparably to pulsed wave Doppler (PWD). Furthermore, intra- and inter-observer agreement was assessed in a substudy. VFI and PWD peak velocities were estimated with from intercostal and subcostal views for 32 healthy volunteers, and precision analyses were conducted. Blinded to estimates, three physicians rescanned 10 volunteers for intra- and inter-observer agreement analyses. The precision of VFI and PWD was 18% and 28% from an intercostal view and 23% and 77% from a subcostal view, respectively. Bias between VFI and PWD was 0.57 cm/s (p = 0.38) with an intercostal view and 9.89 cm/s (p <0.001) with a subcostal view. Intra- and inter-observer agreement was highest for VFI (inter-observer intra-class correlation coefficient: VFI 0.80, PWD 0.3; intra-observer intra-class correlation coefficient: VFI 0.90, PWD 0.69). Regardless of scan view, VFI was more precise than PWD.
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Affiliation(s)
- Andreas Hjelm Brandt
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Ramin Moshavegh
- Center for Fast Ultrasound Imaging, Technical University of Denmark, Lyngby, Denmark
| | | | - Thor Bechsgaard
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Lönn
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jørgen Arendt Jensen
- Center for Fast Ultrasound Imaging, Technical University of Denmark, Lyngby, Denmark
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10
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Pateu E, Oberti F, Calès P. The noninvasive diagnosis of esophageal varices and its application in clinical practice. Clin Res Hepatol Gastroenterol 2018; 42:6-16. [PMID: 28870440 DOI: 10.1016/j.clinre.2017.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 07/31/2017] [Indexed: 02/04/2023]
Abstract
Here, we review recent improvements made to different noninvasive tests used for the diagnosis of esophageal varices (EV) in the light of the recent Baveno VI recommendation and with an emphasis on clinical application. Like for fibrosis tests, these noninvasive EV tests can be classified as direct markers when they provide a visualization of EV (including all imaging procedures like endoscopy or radiology) and as indirect markers when they do not (blood markers or elastometry). Clinical descriptors expressed as percentages, especially the spared endoscopy rate and the missed high-risk esophageal varices (HREV) rate, are more eloquent in this setting than classical statistical descriptors like accuracy. Single biomarkers are insufficient, generally due to a missed HREV rate exceeding the acceptable limit of 5% indicated in the Baveno VI consensus. Thus, biomarker combinations are currently garnering the most interest. The Baveno VI recommendation states that in alcoholic and viral cirrhoses, screening endoscopy can be safely set aside for patients with liver stiffness<20kPa and platelets>150G/L. The Baveno rule's mean missed HREV rate is<5% but its spared endoscopy rate is<20%. New combinations or stepwise algorithms show promise but must be validated. Going forward, the Baveno rule provides a simple noninvasive method to rule out HREV in clinical practice but the need for further research continues. The noninvasive diagnosis of HREV will be significantly improved by new, simple and affordable combinations.
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Affiliation(s)
- Etienne Pateu
- Hepato-Gastroenterology Department, University Hospital, 49933 Angers, France
| | - Frédéric Oberti
- Hepato-Gastroenterology Department, University Hospital, 49933 Angers, France; HIFIH Laboratory, University Angers, Bretagne-Loire University, 49045 Angers, France
| | - Paul Calès
- Hepato-Gastroenterology Department, University Hospital, 49933 Angers, France; HIFIH Laboratory, University Angers, Bretagne-Loire University, 49045 Angers, France.
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11
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Giannini EG, Savarino V. Noninvasive assessment of varices needing treatment in patients with advanced chronic liver disease: No one should be left behind. Hepatology 2017; 65:2131. [PMID: 28142192 DOI: 10.1002/hep.29087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 12/09/2016] [Indexed: 02/01/2023]
Affiliation(s)
- Edoardo G Giannini
- Dipartimento di Medicina Interna Unità di Gastroenterologia IRCCS-Azienda Ospedaliera Universitaria San Martino-IST, Università di Genova, Genova, Italy
| | - Vincenzo Savarino
- Dipartimento di Medicina Interna Unità di Gastroenterologia IRCCS-Azienda Ospedaliera Universitaria San Martino-IST, Università di Genova, Genova, Italy
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12
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Organ Procurement Organization Survey of Practices and Beliefs Regarding Prerecovery Percutaneous Liver Biopsy in Donation After Neurologic Determination of Death. Transplantation 2017; 101:821-825. [PMID: 28072757 DOI: 10.1097/tp.0000000000001632] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prerecovery liver biopsy (PLB) allows histological evaluation of the organ before procurement. The opinions and what factors might influence PLB use within Organ Procurement Organizations (OPOs) are unknown. METHODS A survey instrument was distributed by the Association of OPOs to the clinical directors of all 58 OPOs. Descriptive statistics were calculated. Results were also stratified based on OPO characteristics. RESULTS Forty-nine (84.5%) of 58 OPOs responded to the survey; 40 (81.6%) of 49 currently perform PLB. This did not vary based on land mass, population, livers discarded, transplanted, donor age, or recipient MELD scores. Donor age, obesity, alcohol abuse, hepatitis serology, liver only donor, imaging results, and transplant center request were the most common indications for PLB in over 80% of OPOs. The median rate of performance is 5% to 10% of donors. Most use interventional radiologists to perform and the donor hospital pathologist/s to interpret PLB. Most OPOs believe PLBs are safe, reliable, useful, and performed often enough. Most say they did not believe they are easy to obtain. Beliefs were mixed regarding accuracy. The topics likely to influence PLB use were utility and accuracy of PLB, and availability of staff to perform PLB. OPOs that perform PLB more often were more likely to have favorable opinions of safety and pathologist availability, and more influenced by safety, reliability, availability, and a national consensus on the use of PLB. CONCLUSIONS Considerable variability exists in the use of PLB. Additional information on the utility, accuracy, and safety of PLB are needed to optimize its use.
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Colli A, Gana JC, Yap J, Adams‐Webber T, Rashkovan N, Ling SC, Casazza G. Platelet count, spleen length, and platelet count-to-spleen length ratio for the diagnosis of oesophageal varices in people with chronic liver disease or portal vein thrombosis. Cochrane Database Syst Rev 2017; 4:CD008759. [PMID: 28444987 PMCID: PMC6478276 DOI: 10.1002/14651858.cd008759.pub2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Current guidelines recommend screening of people with oesophageal varices via oesophago-gastro-duodenoscopy at the time of diagnosis of hepatic cirrhosis. This requires that people repeatedly undergo unpleasant invasive procedures with their attendant risks, although half of these people have no identifiable oesophageal varices 10 years after the initial diagnosis of cirrhosis. Platelet count, spleen length, and platelet count-to-spleen length ratio are non-invasive tests proposed as triage tests for the diagnosis of oesophageal varices. OBJECTIVES Primary objectives To determine the diagnostic accuracy of platelet count, spleen length, and platelet count-to-spleen length ratio for the diagnosis of oesophageal varices of any size in paediatric or adult patients with chronic liver disease or portal vein thrombosis, irrespective of aetiology. To investigate the accuracy of these non-invasive tests as triage or replacement of oesophago-gastro-duodenoscopy. Secondary objectives To compare the diagnostic accuracy of these same tests for the diagnosis of high-risk oesophageal varices in paediatric or adult patients with chronic liver disease or portal vein thrombosis, irrespective of aetiology.We aimed to perform pair-wise comparisons between the three index tests, while considering predefined cut-off values.We investigated sources of heterogeneity. SEARCH METHODS The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Hepato-Biliary Group Diagnostic Test Accuracy Studies Register, the Cochrane Library, MEDLINE (OvidSP), Embase (OvidSP), and Science Citation Index - Expanded (Web of Science) (14 June 2016). We applied no language or document-type restrictions. SELECTION CRITERIA Studies evaluating the diagnostic accuracy of platelet count, spleen length, and platelet count-to-spleen length ratio for the diagnosis of oesophageal varices via oesophago-gastro-duodenoscopy as the reference standard in children or adults of any age with chronic liver disease or portal vein thrombosis, who did not have variceal bleeding. DATA COLLECTION AND ANALYSIS Standard Cochrane methods as outlined in the Cochrane Handbook for Diagnostic Test of Accuracy Reviews. MAIN RESULTS We included 71 studies, 67 of which enrolled only adults and four only children. All included studies were cross-sectional and were undertaken at a tertiary care centre. Eight studies reported study results in abstracts or letters. We considered all but one of the included studies to be at high risk of bias. We had major concerns about defining the cut-off value for the three index tests; most included studies derived the best cut-off values a posteriori, thus overestimating accuracy; 16 studies were designed to validate the 909 (n/mm3)/mm cut-off value for platelet count-to-spleen length ratio. Enrolment of participants was not consecutive in six studies and was unclear in 31 studies. Thirty-four studies assessed enrolment consecutively. Eleven studies excluded some included participants from the analyses, and in only one study, the time interval between index tests and the reference standard was longer than three months. Diagnosis of varices of any size. Platelet count showed sensitivity of 0.71 (95% confidence interval (CI) 0.63 to 0.77) and specificity of 0.80 (95% CI 0.69 to 0.88) (cut-off value of around 150,000/mm3 from 140,000 to 150,000/mm3; 10 studies, 2054 participants). When examining potential sources of heterogeneity, we found that of all predefined factors, only aetiology had a role: studies including participants with chronic hepatitis C reported different results when compared with studies including participants with mixed aetiologies (P = 0.036). Spleen length showed sensitivity of 0.85 (95% CI 0.75 to 0.91) and specificity of 0.54 (95% CI 0.46 to 0.62) (cut-off values of around 110 mm, from 110 to 112.5 mm; 13 studies, 1489 participants). Summary estimates for detection of varices of any size showed sensitivity of 0.93 (95% CI 0.83 to 0.97) and specificity of 0.84 (95% CI 0.75 to 0.91) in 17 studies, and 2637 participants had a cut-off value for platelet count-to-spleen length ratio of 909 (n/mm3)/mm. We found no effect of predefined sources of heterogeneity. An overall indirect comparison of the HSROCs of the three index tests showed that platelet count-to-spleen length ratio was the most accurate index test when compared with platelet count (P < 0.001) and spleen length (P < 0.001). Diagnosis of varices at high risk of bleeding. Platelet count showed sensitivity of 0.80 (95% CI 0.73 to 0.85) and specificity of 0.68 (95% CI 0.57 to 0.77) (cut-off value of around 150,000/mm3 from 140,000 to 160,000/mm3; seven studies, 1671 participants). For spleen length, we obtained only a summary ROC curve as we found no common cut-off between studies (six studies, 883 participants). Platelet count-to-spleen length ratio showed sensitivity of 0.85 (95% CI 0.72 to 0.93) and specificity of 0.66 (95% CI 0.52 to 0.77) (cut-off value of around 909 (n/mm3)/mm; from 897 to 921 (n/mm3)/mm; seven studies, 642 participants). An overall indirect comparison of the HSROCs of the three index tests showed that platelet count-to-spleen length ratio was the most accurate index test when compared with platelet count (P = 0.003) and spleen length (P < 0.001). DIagnosis of varices of any size in children. We found four studies including 277 children with different liver diseases and or portal vein thrombosis. Platelet count showed sensitivity of 0.71 (95% CI 0.60 to 0.80) and specificity of 0.83 (95% CI 0.70 to 0.91) (cut-off value of around 115,000/mm3; four studies, 277 participants). Platelet count-to-spleen length z-score ratio showed sensitivity of 0.74 (95% CI 0.65 to 0.81) and specificity of 0.64 (95% CI 0.36 to 0.84) (cut-off value of 25; two studies, 197 participants). AUTHORS' CONCLUSIONS Platelet count-to-spleen length ratio could be used to stratify the risk of oesophageal varices. This test can be used as a triage test before endoscopy, thus ruling out adults without varices. In the case of a ratio > 909 (n/mm3)/mm, the presence of oesophageal varices of any size can be excluded and only 7% of adults with varices of any size would be missed, allowing investigators to spare the number of oesophago-gastro-duodenoscopy examinations. This test is not accurate enough for identification of oesophageal varices at high risk of bleeding that require primary prophylaxis. Future studies should assess the diagnostic accuracy of this test in specific subgroups of patients, as well as its ability to predict variceal bleeding. New non-invasive tests should be examined.
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Affiliation(s)
- Agostino Colli
- A Manzoni Hospital ASST LeccoDepartment of Internal MedicineVia dell'Eremo, 9/11LeccoItaly23900
| | - Juan Cristóbal Gana
- Division of Pediatrics, Escuela de Medicina, Pontificia Universidad Católica de ChileGastroenterology and Nutrition Department85 LiraSantiagoRegion MetropolitanaChile8330074
| | - Jason Yap
- University of AlbertaDivision of Pediatric Gastroenterology, Hepatology and Nutrition, Dept. of Pediatrics, Stollery Children's Hospital, Faculty of MedicineAberhart Centre 111402 University AveEdmontonABCanadaT6G 2J3
| | | | - Natalie Rashkovan
- Sunnybrook Health Sciences CentreDepartment of Neurology2075 Bayview ave., room A448TorontoONCanadaM4N 3M5
| | - Simon C Ling
- The Hospital for Sick ChildrenDivision of Gastroenterology, Hepatology and Nutrition555 University AvenueTorontoONCanadaM5G 1X8
| | - Giovanni Casazza
- Università degli Studi di MilanoDipartimento di Scienze Biomediche e Cliniche "L. Sacco"via GB Grassi 74MilanItaly20157
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Gao L, Meng F, Cheng J, Li H, Han J, Zhang W. Prediction of oesophageal varices in patients with primary biliary cirrhosis by non-invasive markers. Arch Med Sci 2017; 13:370-376. [PMID: 28261290 PMCID: PMC5332465 DOI: 10.5114/aoms.2017.65450] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 02/25/2015] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Preliminary data suggested that non-invasive methods could be useful to assess presence of oesophageal varices (OV) in liver cirrhosis. The primary objectives were to investigate non-invasive markers for diagnosing and grading OV in patients with primary biliary cirrhosis. MATERIAL AND METHODS This study included a total of 106 consecutive treatment-naive patients with primary biliary cirrhosis (PBC). Results of physical examination, blood tests, and abdominal ultrasound scan (USS) were measured. Performance of non-invasive markers for OV was expressed as sensitivity, specificity, positive, and negative predictive values (PPV, NPV), accuracy, and area under the curve (AUC). RESULTS Oesophageal varices were found in 54 (50.9%) and large OV in 28 of the 106 patients. Variables found to differ significantly between patients with any grade or large and without OV included increased spleen length, increased portal vein diameter, low platelet count, and low levels of albumin or low γ-glutamyltranspeptidase (γ-GTP) values. Area under the receiver operating characteristic curve showed that spleen length (cutoff = 156.0) had AUC 0.753 (95% CI: 0.657-0.849), and high NPV (82.1%) to exclude any grade OV. Large OV could be excluded with NPV 70.6% by spleen length. CONCLUSIONS Predictive risk factors that use readily available laboratory results and ultrasound scan results may reliably identify esophageal varices in patients with PBC.
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Affiliation(s)
- Lili Gao
- Department of General Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Emerging Infectious Diseases, Beijing, China
| | - Fanping Meng
- Center for Liver Cirrhosis, Beijing 302 Hospital, Beijing, China
| | - Jun Cheng
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Emerging Infectious Diseases, Beijing, China
| | - Hanwei Li
- Center for Liver Cirrhosis, Beijing 302 Hospital, Beijing, China
| | - Jun Han
- Center for Liver Cirrhosis, Beijing 302 Hospital, Beijing, China
| | - Weihui Zhang
- Center for Liver Cirrhosis, Beijing 302 Hospital, Beijing, China
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Burlin S, Favaro LR, Bretas EAS, Taniguchi LS, Loch AP, Argollo MC, Ambrogini Junior O, D'Ippolito G. Using computed tomography enterography to evaluate patients with Crohn's disease: what impact does examiner experience have on the reproducibility of the method? Radiol Bras 2017; 50:13-18. [PMID: 28298727 PMCID: PMC5347498 DOI: 10.1590/0100-3984.2015.0131] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Objective To assess the impact that examiner experience has on the reproducibility and
accuracy of computed tomography (CT) enterography in the detection of
radiological signs in patients with Crohn's disease. Materials and Methods This was a retrospective, cross-sectional observational study involving the
analysis of CT enterography scans of 20 patients with Crohn's disease. The
exams were analyzed independently by two radiologists in their last year of
residence (duo I) and by two abdominal imaging specialists (duo II). The
interobserver agreement of each pair of examiners in identifying the main
radiological signs was calculated with the kappa test. The accuracy of the
examiners with less experience was quantified by using the consensus among
three experienced examiners as a reference. Results Duo I and duo II obtained a similar interobserver agreement, with a moderate
to good correlation, for mural hyperenhancement, parietal thickening, mural
stratification, fat densification, and comb sign (kappa: 0.45-0.64). The
less experienced examiners showed an accuracy > 80% for all signs, except
for lymph nodes and fistula, for which it ranged from 60% to 75%. Conclusion Less experienced examiners have a tendency to present a level of
interobserver agreement similar to that of experienced examiners in
evaluating Crohn's disease through CT enterography, as well as showing
satisfactory accuracy in identifying most radiological signs of the
disease.
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Affiliation(s)
- Stênio Burlin
- MD, Radiologist in the Department of Diagnostic Imaging of the Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Larissa Rossini Favaro
- MD, Radiologist, Specialist in Abdominal Imaging in the Department of Diagnostic Imaging of the Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Elisa Almeida Sathler Bretas
- MD, Radiologist, Graduate Student in Abdominal Imaging in the Department of Diagnostic Imaging of the Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Lincoln Seiji Taniguchi
- MD, Radiologist, Specialist in Abdominal Imaging in the Department of Diagnostic Imaging of the Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Ana Paula Loch
- Pharmacist, Graduate Student in Preventive Medicine at the Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Marjorie Costa Argollo
- MD, Graduate Student in Clinical Gastroenterology, Discipline of Clinical Medicine, Department of Medicine of the Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Orlando Ambrogini Junior
- PhD, Affiliate Professor, Discipline of Clinical Medicine, Department of Medicine of the Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Giuseppe D'Ippolito
- Tenured Adjunct Professor in the Department of Diagnostic Imaging of the Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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Sami SS, Ragunath K, Wilkes EA, James M, Mansilla-Vivar R, Ortiz-Fernández-Sordo J, White J, Khanna A, Coletta M, Samuel S, Aithal GP, Guha IN. The detection of oesophageal varices using a novel, disposable, probe-based transnasal endoscope: a prospective diagnostic pilot study. Liver Int 2016; 36:1639-1648. [PMID: 27125510 DOI: 10.1111/liv.13152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/17/2016] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Screening for oesophageal varices (OV) using conventional oesophagogastroduodenoscopy (C-OGD) is invasive and requires costly monitoring, recovery, and decontamination facilities. We aimed to evaluate the technical feasibility, acceptability and accuracy of a novel, portable and disposable office-based transnasal endoscope (EG Scan™ ) compared to C-OGD as the reference standard. METHODS This was a prospective cohort study. Consecutive adult patients with cirrhosis were invited to participate. All subjects underwent the two procedures on the same day performed by two endoscopists in a blinded design. Patients completed preference and validated tolerability (10-point visual analogue scale (VAS)) questionnaires on day 0 and day 14 post procedures. RESULTS Forty-five of 50 patients (90%) completed both interventions. Mean age was 59 years and OV prevalence was 49%. Patients reported higher preference (percentage) and better experience (mean VAS) with EG Scan compared to C-OGD on day 0 (76.5% vs. 23.5%, P < 0.001; 7.8 vs. 6.8, P = 0.058, respectively) and day 14 (77.8% vs. 22.2%, P < 0.001; 7.0 vs. 5.5, P = 0.0013 respectively). Sensitivity and specificity of the EG Scan for the diagnosis of any size OV were 0.82 (95% confidence interval (CI) 0.60-0.95), and 0.78 (95% CI 0.56-0.93) respectively. Corresponding values for the diagnosis of clinically significant (medium/large) OV were 0.92 (95% CI 0.62-1.0), 0.97 (95% CI 0.84-1.0) respectively. No serious adverse events occurred. CONCLUSIONS EG Scan accuracy was higher for the diagnosis of medium/large OV compared to any size OV. Patients' preference and overall experience of the EG Scan was favourable compared to C-OGD 14 days after procedures.
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Affiliation(s)
- Sarmed S Sami
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Krish Ragunath
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Emilie A Wilkes
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Martin James
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Rodrigo Mansilla-Vivar
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Jacobo Ortiz-Fernández-Sordo
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Jonathan White
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Amardeep Khanna
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Marina Coletta
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Sunil Samuel
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Guruprasad P Aithal
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Indra Neil Guha
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK.
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Calès P, Chaigneau J, Hunault G, Michalak S, Cavaro-Menard C, Fasquel JB, Bertrais S, Rousselet MC. Automated morphometry provides accurate and reproducible virtual staging of liver fibrosis in chronic hepatitis C. J Pathol Inform 2015; 6:20. [PMID: 26110088 PMCID: PMC4466784 DOI: 10.4103/2153-3539.157782] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 03/16/2015] [Indexed: 12/15/2022] Open
Abstract
Background: Liver fibrosis staging provides prognostic value, although hampered by observer variability. We used digital analysis to develop diagnostic morphometric scores for significant fibrosis, cirrhosis and fibrosis staging in chronic hepatitis C. Materials and Methods: We automated the measurement of 44 classical and new morphometric descriptors. The reference was histological METAVIR fibrosis (F) staging (F0 to F4) on liver biopsies. The derivation population included 416 patients and liver biopsies ≥20 mm-length. Two validation population included 438 patients. Results: In the derivation population, the area under the receiver operating characteristic (AUROC) for clinically significant fibrosis (F stage ≥2) of a logistic score combining 5 new descriptors (stellar fibrosis area, edge linearity, bridge thickness, bridge number, nodularity) was 0.957. The AUROC for cirrhosis of 6 new descriptors (edge linearity, nodularity, portal stellar fibrosis area, portal distance, granularity, fragmentation) was 0.994. Predicted METAVIR F staging combining 8 morphometric descriptors agreed well with METAVIR F staging by pathologists: κ = 0.868. Morphometric score of clinically significant fibrosis had a higher correlation with porto-septal fibrosis area (rs = 0.835) than METAVIR F staging (rs = 0.756, P < 0.001) and the same correlations with fibrosis biomarkers, e.g., serum hyaluronate: rs = 0.484 versus rs = 0.476 for METAVIR F (P = 0.862). In the validation population, the AUROCs of clinically significant fibrosis and cirrhosis scores were, respectively: 0.893 and 0.993 in 153 patients (biopsy < 20 mm); 0.955 and 0.994 in 285 patients (biopsy ≥ 20 mm). The three morphometric diagnoses agreed with consensus expert reference as well as or better than diagnoses by first-line pathologists in 285 patients, respectively: significant fibrosis: 0.733 versus 0.733 (κ), cirrhosis: 0.900 versus 0.827, METAVIR F: 0.881 versus 0.865. Conclusion: The new automated morphometric scores provide reproducible and accurate diagnoses of fibrosis stages via “virtual expert pathologist.”
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Affiliation(s)
- Paul Calès
- HIFIH Laboratory, Unité Propre de Recherche de l'Enseignement Supérieur 3859, Sructure Fédérative de Recherche 4208, LUNAM University, Angers, France ; Department of Liver-Gastroenterology, LUNAM University, Angers, France
| | - Julien Chaigneau
- HIFIH Laboratory, Unité Propre de Recherche de l'Enseignement Supérieur 3859, Sructure Fédérative de Recherche 4208, LUNAM University, Angers, France
| | - Gilles Hunault
- HIFIH Laboratory, Unité Propre de Recherche de l'Enseignement Supérieur 3859, Sructure Fédérative de Recherche 4208, LUNAM University, Angers, France
| | - Sophie Michalak
- HIFIH Laboratory, Unité Propre de Recherche de l'Enseignement Supérieur 3859, Sructure Fédérative de Recherche 4208, LUNAM University, Angers, France ; Department of Cellular and Tissue Pathology, CHU Angers, LUNAM University, Angers, France
| | - Christine Cavaro-Menard
- Department of LARIS Laboratory, Unité Propre de Recherche de l'Enseignement Supérieur 7315, LUNAM University, Angers, France
| | - Jean-Baptiste Fasquel
- Department of LARIS Laboratory, Unité Propre de Recherche de l'Enseignement Supérieur 7315, LUNAM University, Angers, France
| | - Sandrine Bertrais
- HIFIH Laboratory, Unité Propre de Recherche de l'Enseignement Supérieur 3859, Sructure Fédérative de Recherche 4208, LUNAM University, Angers, France
| | - Marie-Christine Rousselet
- HIFIH Laboratory, Unité Propre de Recherche de l'Enseignement Supérieur 3859, Sructure Fédérative de Recherche 4208, LUNAM University, Angers, France ; Department of Cellular and Tissue Pathology, CHU Angers, LUNAM University, Angers, France
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Mura VL, Nicolini A, Tosetti G, Primignani M. Cirrhosis and portal hypertension: The importance of risk stratification, the role of hepatic venous pressure gradient measurement. World J Hepatol 2015; 7:688-695. [PMID: 25866605 PMCID: PMC4388996 DOI: 10.4254/wjh.v7.i4.688] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 11/11/2014] [Accepted: 01/12/2015] [Indexed: 02/06/2023] Open
Abstract
Portal hypertension is the main prognostic factor in cirrhosis. The recent emergence of potent antiviral drugs and new algorithm of treatment for the management of complications due to portal hypertension have sensibly changed our perception of cirrhosis that can be now considered as a multistage liver disease whose mortality risk can be reduced by a tailored approach for any stage of risk. Experts recommend to move toward a pathophysiological classification of cirrhosis that considers both structural and functional changes. The hepatic venous pressure gradient HVPG, is the reference gold standard to estimate the severity of portal hypertension in cirrhosis. It correlates with both structural and functional changes that occur in cirrhosis and carries valuable prognostic information to stratify the mortality risk. This article provides a general overview of the pathophysiology and natural course of cirrhosis and portal hypertension. We propose a simplified classification of cirrhosis based on low, intermediate and high mortality stage. The prognostic information provided by HVPG is presented according to each stage. A comparison with prognostic models based on clinical and endoscopic variables is discussed in order to evidence the additional contribute given by HVPG on top of other clinical and instrumental variables widely used in clinical practice.
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Colli A, Gana JC, Turner D, Yap J, Adams‐Webber T, Ling SC, Casazza G. Capsule endoscopy for the diagnosis of oesophageal varices in people with chronic liver disease or portal vein thrombosis. Cochrane Database Syst Rev 2014; 2014:CD008760. [PMID: 25271409 PMCID: PMC7173747 DOI: 10.1002/14651858.cd008760.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Current guidelines recommend performance of oesophago-gastro-duodenoscopy at the time of diagnosis of hepatic cirrhosis to screen for oesophageal varices. These guidelines require people to undergo an unpleasant invasive procedure repeatedly with its attendant risks, despite the fact that half of the people do not have identifiable oesophageal varices 10 years after the initial diagnosis of cirrhosis. Video capsule endoscopy is a non-invasive test proposed as an alternative method for the diagnosis of oesophageal varices. OBJECTIVES To determine the diagnostic accuracy of capsule endoscopy for the diagnosis of oesophageal varices in children or adults with chronic liver disease or portal vein thrombosis, irrespective of the aetiology. To investigate the accuracy of capsule endoscopy as triage or replacement of oesophago-gastro-duodenoscopy. SEARCH METHODS We searched the Cochrane Hepato-Biliary Group Diagnostic Test Accuracy Studies Register (October 2013), MEDLINE (Ovid SP) (1950 to October 2013), EMBASE (Ovid SP) (1980 to October 2013), ACP Journal Club (Ovid SP) (1991 to October 2013), Database of Abstracts of Reviews of Effects (DARE) (Ovid SP) (third quarter), Health Technology Assessment (HTA) (Ovid SP) (third quarter), NHS Economic Evaluation Database (NHSEED) (Ovid SP) (third quarter), and Science Citation Index Expanded (SCI-EXPANDED) (ISI Web of Knowledge) (1955 to October 2013). We applied no language or document type restrictions. SELECTION CRITERIA Studies that evaluated the diagnostic accuracy of capsule endoscopy for the diagnosis of oesophageal varices using oesophago-gastro-duodenoscopy as the reference standard in children or adults of any age, with chronic liver disease or portal vein thrombosis. DATA COLLECTION AND ANALYSIS We followed the available guidelines provided in the Cochrane Handbook for Diagnostic Test of Accuracy Reviews. We calculated the pooled estimates of sensitivity and specificity using the bivariate model due to the absence of a negative correlation in the receiver operating characteristic (ROC) space and of a threshold effect. MAIN RESULTS The search identified 16 eligible studies, in which only adults with cirrhosis were included. In one study, people with portal thrombosis were also included. We classified most of the studies at high risk of bias for the 'Participants selection' and the 'Flow and timing' domains. One study assessed the accuracy of capsule endoscopy for the diagnosis of large (high-risk) oesophageal varices. In the remaining15 studies that assessed the accuracy of capsule endoscopy for the diagnosis of oesophageal varices of any size in people with cirrhosis, 936 participants were included; the pooled estimate of sensitivity was 84.8% (95% confidence interval (CI) 77.3% to 90.2%) and of specificity 84.3% (95% CI 73.1% to 91.4%). Eight of these studies included people with suspected varices or people with already diagnosed or even treated varices, or both, introducing a selection bias. Seven studies including only people with suspected but unknown varices were at low risk of bias; the pooled estimate of sensitivity was 79.7% (95% CI 73.1% to 85.0%) and of specificity 86.1% (95% CI 64.5% to 95.5%). Six studies assessed the diagnostic accuracy of capsule endoscopy for the diagnosis of large oesophageal varices, associated with a higher risk of bleeding; the pooled sensitivity was 73.7% (95% CI 52.4% to 87.7%) and of specificity 90.5% (95% CI 84.1% to 94.4%). Two studies also evaluated the presence of red marks, which are another marker of high risk of bleeding; the estimates of sensitivity and specificity varied widely. Two studies obtained similar results with the use of a modified device as index test (string capsule). Due to the absence of data, we could not perform all planned subgroup analyses. Interobserver agreement in the interpretation of capsule endoscopy results and any adverse event attributable to capsule endoscopy were poorly assessed and reported. Only four studies evaluated the interobserver agreement in the interpretation of capsule endoscopy results: the concordance was moderate. The participants' preferences for capsule endoscopy or oesophago-gastro-duodenoscopy were reported differently but seemed in favour of capsule endoscopy in nine of 10 studies. In 10 studies, participants reported some minor discomfort on swallowing the capsule. Only one study identified other significant adverse events, including impaction of the capsule due to previously unidentified oesophageal strictures in two participants. No adverse events were reported as a consequence of the reference standard. AUTHORS' CONCLUSIONS We cannot support the use of capsule endoscopy as a triage test in adults with cirrhosis, administered before oesophago-gastro-duodenoscopy, despite the low incidence of adverse events and participant reports of being better tolerated. Thus, we cannot conclude that oesophago-gastro-duodenoscopy can be replaced by capsule endoscopy for the detection of oesophageal varices in adults with cirrhosis. We found no data assessing capsule endoscopy in children and in people with portal thrombosis.
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Affiliation(s)
- Agostino Colli
- Ospedale "A Manzoni" LeccoDepartment of Internal MedicineVia dell'Eremo, 9/11LeccoItaly23900
| | - Juan Cristóbal Gana
- Division of Paediatrics, Escuela de Medicina, Pontificia Universidad Católica de ChileGastroenterology, Hepatology, and Nutrition Unit85 LiraSantiagoRegion MetropolitanaChile8330074
| | - Dan Turner
- Shaare Zedek Medical CenterPediatric Gastroenterology UnitP.O.B 3235JerusalemIsrael91031
| | - Jason Yap
- University of AlbertaDivision of Pediatric Gastroenterology, Hepatology and Nutrition, Dept. of Pediatrics, Stollery Children's Hospital, Faculty of MedicineAberhart Centre 111402 University AveEdmontonABCanadaT6G 2J3
| | | | - Simon C Ling
- The Hospital for Sick ChildrenDivision of Gastroenterology, Hepatology & Nutrition555 University AvenueTorontoONCanadaM5G 1X8
| | - Giovanni Casazza
- Università degli Studi di MilanoDipartimento di Scienze Biomediche e Cliniche "L. Sacco"via GB Grassi 74MilanItaly20157
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Lee JY, Kim TY, Jeong WK, Kim Y, Kim J, Kim KW, Kim YH, Sohn JH. Clinically severe portal hypertension: role of multi-detector row CT features in diagnosis. Dig Dis Sci 2014; 59:2333-43. [PMID: 24723070 DOI: 10.1007/s10620-014-3149-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 03/30/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIM To explore the CT signs which permit estimation of clinically severe portal hypertension (PH) [≥ 12 of hepatic vein pressure gradient (HVPG)]. METHODS One-hundred and seven consecutive patients who underwent HVPG measurement in the PH group and 52 controls were included. The diameters of main portal vein (øMPV), superior mesenteric vein (øSMV), splenic vein (øSV), and left gastric vein, øMPV/øSV, øSMV/øSV, as well as estimated spleen volumes were evaluated on the CT scan. The grade of varix and ascites were also evaluated semi-quantitatively. We explored the statistically significant CT features related to severe PH and performed a logistic regression analysis for an estimation model for severe PH. RESULTS øMPV/øSV and øSMV/øSV tended to gradually increase as the PH became severer, and the difference between severe and not severe groups was statistically significant (p = 0.015 and 0.038, respectively). According to the regression analysis, øSMV/øSV and the grade of esophageal varix and ascites were finally included as related variables for predicting severe PH. The odds ratio (OR) of øSMV/øSV was 4.596, and large esophageal varix (OR 4.135) and mild (OR 3.051) and large amount of ascites (OR 21.781) were statistically significantly related to severe PH. CONCLUSION Changing diameters of portal system, the grades of esophageal varices and ascites on multi-detector row computed tomography might be indicative features for clinically severe PH.
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Affiliation(s)
- Ji Young Lee
- Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Gyeongchun-ro 153, Guri-si, Gyeonggi-do, 471-701, Republic of Korea
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Oliver JB, Peters S, Bongu A, Beidas AK, Dikdan G, Brown L, Koneru B. Prerecovery liver biopsy in the brain-dead donor: a case-control study of logistics, safety, precision, and utility. Liver Transpl 2014; 20:237-44. [PMID: 24382833 DOI: 10.1002/lt.23786] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 10/27/2013] [Indexed: 02/07/2023]
Abstract
Prerecovery liver biopsy (PLB) can potentially to decrease futile recovery and increase utilization of marginal brain-dead donor (BDD) livers. A case-control study was conducted to examine the logistics, safety, histological precision, and liver utilization associated with PLB in BDDs. Twenty-three cases between January 2008 and January 2013 were compared to 2 groups: 48 sequential and 69 clinically matched controls. Compared to the sequential controls, the cases were older (53 versus 46 years), heavier (30.2 versus 25.8 kg/m2), had higher prevalences of hypertension (78.3% versus 44.7%) and alcohol use (56.5% versus 23.4%), and a lower United Network for Organ Sharing expected organ yield (0.73 versus 0.81 livers/donor; P < 0.05 for all). Baseline characteristics were similar between cases and clinical controls. Donor management time was longer for the cases (22.4 hours) versus sequential controls (16.5 hours, P = 0.01) and clinical controls (15.9 hours, P = 0.01). Complications for cases (8.7%) were not different from either group of controls (18.8% for sequential controls, P = 0.46; 17.4% for clinical controls, P = 0.50). The agreement between the donor hospital and study pathologists was substantial regarding evaluation of steatosis (κ = 0.623) and fibrosis (κ = 0.627) and moderate regarding inflammation (κ = 0.495). The proportions of livers that were transplanted were similar for the cases and the clinical controls (60.9% versus 59.4%). In contrast, the proportion of donors for whom liver recovery was not attempted was higher (30.4% versus 8.7%), and the proportion of attempted liver recoveries that did not result in transplantation was lower (8.7% versus 31.9%). These differences were significant at P = 0.009. Overall, PLB is logistically feasible with only a minimal delay and is safe, its interpretation at donor hospitals is reproducible, and it appears to decrease futile liver recovery.
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Cha SW, Jeong WK, Kim Y, Kim MY, Kim J, Kim SY, Ryu JA, Kim TY, Sohn JH, Kim YH. Nondiseased liver stiffness measured by shear wave elastography: a pilot study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:53-60. [PMID: 24371099 DOI: 10.7863/ultra.33.1.53] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the value of liver stiffness in patients without liver disease using shear wave elastography and to determine the liver stiffness threshold value for identifying patients with chronic liver diseases. METHODS A total of 150 patients who underwent liver sonography coupled with shear wave elastography were enrolled. On the basis of clinical and pathologic criteria, they were assigned to 1 of 2 groups: nondiseased liver (n = 97) and noncirrhotic chronic liver disease (n = 53). Liver stiffness was measured in the right liver, and the median value of 10 measurements was calculated. Both mean and median values in the nondiseased liver group were compared with those in the noncirrhotic chronic liver disease group. To validate this comparison, liver stiffness of the patients who underwent liver biopsy revealing either no fibrosis (fibrosis score F0; n = 5) or substantial fibrosis (F2; n = 14) was also investigated and compared. To determine the optimal threshold value for determining chronic liver disease, a receiver operating characteristic curve analysis was performed. RESULTS The mean liver stiffness value in the nondiseased liver group was 5.4 kPa. In the noncirrhotic chronic liver disease group, the mean value was 8.1 kPa. Differences between the nondiseased liver and both noncirrhotic chronic liver disease groups were statistically significant (P < .001). The optimal liver stiffness threshold value for discriminating nondiseased liver from noncirrhotic chronic liver disease was 6.9 kPa. The sensitivity using this threshold was 94%. In the biopsy-proven patients, the mean liver stiffness values were 6.0 kPa in the F0 group and 9.9 kPa in the F2 group. CONCLUSIONS The range of liver stiffness in patients with nondiseased liver and the optimal threshold value for discriminating these patients from those with chronic liver disease were identified.
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Affiliation(s)
- Seung Woo Cha
- current address: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong Gangnam-gu, Seoul 135-710, Korea.
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Saad Y, Said M, Idris MO, Rabee A, Zakaria S. Liver stiffness measurement by fibroscan predicts the presence and size of esophageal varices in egyptian patients with HCV related liver cirrhosis. J Clin Diagn Res 2013; 7:2253-7. [PMID: 24298490 DOI: 10.7860/jcdr/2013/6026.3484] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 06/11/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIM Liver stiffness measured by transient elastgraphy correlates with Hepatic vein pressure gradient, liver Stiffness value of 21 kpa predicts significant portal hypertension. Aim is to predict esophageal varices presence by fibroscan and possible grading by degree of liver stiffness in HCV related cirrhotic patients. MATERIAL AND METHODS Thirty two HCV related cirrhotic patients were recruited, age > 18 years, BMI< 35, no history of: upper GI bleeding, hepatocellular carcinoma, abdominal collaterals, ascites. Patients underwent clinical examination, laboratory investigations, abdominal ultrasonography, upper endoscopy and fibroscan. They divided into (Group I= no varices, Group II =small varices (Grade 1 & 2), Group III = large varices (Grade 3 & 4). RESULTS Age is higher in Group III than I & II (55+6.6 vs 49.5+4.7 & 48.9+4.7, p-value 0.04) respectively, Groups were gender & BMI matched, fibroscan values in Group I vs II & III were 27 Vs 49.4, p value 0.01, cutoff 29.7 Kpa (sensitivity 95% & specificity 67%) while its value in Group II vs III were 38.4 vs 60.4, p value 0.002, cutoff 38.2 Kpa (sensitivity 100% & specificity77.3%). Platelet count, splenic size, platelet count/splenic size in Group I vs II & III were 107.166 vs 72.900, 13.8 vs 15.4, 803.6 vs 478, p value 0.01, 0.008, 0.005, cutoff 80.000, 14.5, 545, sensitivity & specificity (85%&75%, 75%&75%, 85%&84%) respectively. On multivariate analysis fibroscan (OR 1.113; p=0.005) & platelet count/splenic size (OR 0.995; p=0.012) were positive predictors of esophageal varices presence. CONCLUSION Fibroscan is a good non-invasive method to predict esophageal varices presence & possible grading with high sensitivity.
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Affiliation(s)
- Yasmin Saad
- Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University , Cairo, Egypt
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Dessouky BAM, Abdel Aal ESM. Multidetector CT oesophagography: an alternative screening method for endoscopic diagnosis of oesophageal varices and bleeding risk. Arab J Gastroenterol 2013; 14:99-108. [PMID: 24206737 DOI: 10.1016/j.ajg.2013.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 04/21/2013] [Accepted: 08/26/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND STUDY AIMS Variceal bleeding is a frequent and life-threatening complication of portal hypertension. The aim of this study was to evaluate multidetector computed tomographic (MDCT) oesophagography as an alternative to endoscopy for screening oesophageal varices (EVs) and predicting bleeding risk. PATIENTS AND METHODS A total of 137 cirrhotic patients underwent MDCT followed by endoscopy and EVs were graded independently. The screening ability of CT for EV was evaluated by comparing the grades of EV at CT and at endoscopy. Prediction of bleeding risk by CT was determined by correlating the CT variceal grades, diameters and palisade vein dilatation with the endoscopic red colour (RC) sign. Extra-oesophageal findings were assessed by CT. Patients' acceptance for both examinations were compared. RESULTS At endoscopy, 47 (34%) patients had grade 0 EV, 52 (38%) patients had grade 1 EV, 29 (21%) patients had grade 2 EV and nine (7%) patients had grade 3 EV. The sensitivity, specificity, positive and negative predictive values and accuracy of CT oesophagography for defining EV in all grades were 99%, 98%, 99%, 98% and 99%, respectively. The MDCT variceal grades, diameters and palisade vein dilatation were correlated with the severity of the RC sign. Important extra-oesophageal findings were determined by CT only. The acceptance of patients for CT oesophagography was significantly more than that for endoscopy (p<0.001). CONCLUSION MDCT is a reliable, preliminary or adjunctive method that can be used for routine screening for EVs and the prediction of variceal bleeding.
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Addley J, Tham TC, Cash WJ. Use of portal pressure studies in the management of variceal haemorrhage. World J Gastrointest Endosc 2012; 4:281-9. [PMID: 22816007 PMCID: PMC3399005 DOI: 10.4253/wjge.v4.i7.281] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 06/01/2012] [Accepted: 07/01/2012] [Indexed: 02/05/2023] Open
Abstract
Portal hypertension occurs as a complication of liver cirrhosis and complications such as variceal bleeding lead to significant demands on resources. Endoscopy is the gold standard method for screening cirrhotic patients however universal endoscopic screening may mean a lot of unnecessary procedures as the presence of oesophageal varices is variable hence a large time and cost burden on endoscopy units to carry out both screening and subsequent follow up of variceal bleeds. A less invasive method to identify those at high risk of bleeding would allow earlier prophylactic measures to be applied. Hepatic venous pressure gradient (HVPG) is an acceptable indirect measurement of portal hypertension and predictor of the complications of portal hypertension in adult cirrhotics. Varices develop at a HVPG of 10-12 mmHg with the appearance of other complications with HPVG > 12 mmHg. Variceal bleeding does not occur in pressures under 12 mmHg. HPVG > 20 mmHg measured early after admission is a significant prognostic indicator of failure to control bleeding varices, indeed early transjugular intrahepatic portosystemic shunt (TIPS) in such circumstances reduces mortality significantly. HVPG can be used to identify responders to medical therapy. Patients who do not achieve the suggested reduction targets in HVPG have a high risk of rebleeding despite endoscopic ligation and may not derive significant overall mortality benefit from endoscopic intervention alone, ultimately requiring TIPS or liver transplantation. Early HVPG measurements following a variceal bleed can help to identify those at risk of treatment failure who may benefit from early intervention with TIPS. Therefore, we suggest using HVPG measurement as the investigation of choice in those with confirmed cirrhosis in place of endoscopy for intitial variceal screening and, where indicated, a trial of B-blockade, either intravenously during the initial pressure study with assessment of response or oral therapy with repeat HVPG six weeks later. In those with elevated pressures, primary medical prophylaxis could be commenced with subsequent close monitoring of HVPG thus negating the need for endoscopy at this point. All patients presenting with variceal haemorrhage should undergo HVPG measurement and those with a gradient greater than 20 mmHg should be considered for early TIPS. By introducing portal pressure studies into a management algorithm for variceal bleeding, the number of endoscopies required for further intervention and follow up can be reduced leading to significant savings in terms of cost and demand on resources.
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Affiliation(s)
- Jennifer Addley
- Jennifer Addley, William Jonathan Cash, The Liver Unit, Royal Victoria Hospital, Belfast BT7 1NN, United Kingdom
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Stankovic Z, Csatari Z, Deibert P, Euringer W, Blanke P, Kreisel W, Abdullah Zadeh Z, Kallfass F, Langer M, Markl M. Normal and altered three-dimensional portal venous hemodynamics in patients with liver cirrhosis. Radiology 2012; 262:862-73. [PMID: 22357888 DOI: 10.1148/radiol.11110127] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE To compare time-resolved three-dimensional (3D) phase-contrast magnetic resonance (MR) imaging with three-directional velocity encoding (flow-sensitive four-dimensional [4D] MR imaging), with Doppler ultrasonography (US) as standard of reference, for investigating alterations in 3D portal venous hemodynamics in patients with liver cirrhosis compared with healthy age-matched control subjects and healthy young volunteers. MATERIAL & METHODS This prospective study was approved by the local ethics committee, and written informed consent was obtained from all participants. Three-dimensional portal venous hemodynamics was assessed, employing flow-sensitive 4D MR imaging with a 3-T MR system (spatial resolution, approximately 2 mm(3); temporal resolution, approximately 45 msec) in 20 patients with hepatic cirrhosis, 20 healthy age-matched control subjects, and 21 healthy young volunteers. Flow characteristics were analyzed by using 3D streamlines and time-resolved particle traces. Quantitative analyses were performed by retrospectively evaluating regional peak and mean velocities, flow volume, and vessel area. Doppler US was used as standard of reference. Independent-sample t tests or Wilcoxon-Mann-Whitney tests were applied for comparing each subject group. Paired-sample t tests or Wilcoxon tests were applied when comparing MR imaging and US. RESULTS Three-dimensional visualization of portal venous hemodynamics was successful, with complete visualization of the vessels in 18 patients and 35 volunteers, with limitations in the left intrahepatic branches (87%, reader A; 89%, reader B). A moderate but significant correlation was observed between 4D MR imaging and Doppler US in nearly all maximum and mean velocities, flow volumes, and vessel areas (r = 0.24-0.64, P = .001-.044). With MR imaging, significant underestimation was observed of intrahepatic flow velocities and flow volumes, except vessel area, which Doppler US represented as even lower (P < .001 to P = .045). Six patients had collateralization with reopened umbilical vein, while one had flow reversal in the superior mesenteric vein visible at MR imaging only. CONCLUSION Flow-sensitive 4D MR imaging may constitute a promising, alternative technique to Doppler US for evaluating hemodynamics in the portal venous system of patients with liver cirrhosis and may be a means of assessing pathologic changes in flow characteristics.
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Affiliation(s)
- Zoran Stankovic
- Department of Diagnostic Radiology and Medical Physics, University Medical Center Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany.
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Abstract
Current guidelines recommend that all cirrhotic patients should undergo screening endoscopy at diagnosis to identify patients with varices at high risk of bleeding who will benefit from primary prophylaxis. This approach places a heavy burden upon endoscopy units and the repeated testing over time may have a detrimental effect on patient compliance. Noninvasive identification of patients at highest risk for oesophageal varices would limit investigation to those most likely to benefit. Upper GI endoscopy is deemed to be the gold standard against which all other tests are compared, but is not without its limitations. Multiple studies have been performed assessing clinical signs and variables relating to liver function, variables relating to liver fibrosis, and also to portal hypertension and hypersplenism. Whilst some tests are clearly preferable to patients, none appear to be as accurate as upper GI endoscopy in the diagnosis of oesophageal varices. The search for noninvasive tests continues.
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Steatosis degree, measured by morphometry, is linked to other liver lesions and metabolic syndrome components in patients with NAFLD. Eur J Gastroenterol Hepatol 2011; 23:974-81. [PMID: 21904208 DOI: 10.1097/meg.0b013e32834a4d82] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM We carried out morphometric measurements of steatosis to evaluate relationships between steatosis degree and other liver lesions or metabolic syndrome components in nonalcoholic fatty liver disease (NAFLD). PATIENTS AND METHODS We developed an algorithm to measure steatosis area. Two hundred and fourteen patients with NAFLD were included in derivation (10) and validation (204) groups. Controls consisted of patients who were steatosis-free (12), patients with chronic hepatitis C (188), and patients with alcoholic chronic liver disease (94). RESULTS Accuracy of steatosis area was considered as good or very good in at least 72% of cases by three pathologists. Steatosis areas were as follows: NAFLD = 10.3 ± 9.7%, virus = 2.4 ± 3.1%, alcohol = 7.8 ± 8.2% (P<0.0001). Steatosis area was closely related to steatosis grades in NAFLD (P<0.0001 for linear trend). Steatosis area increased from the fibrosis stage F0 to the fibrosis state F2, then decreased in the stages F3 and F4 (cirrhosis) (P<0.0001 for quadratic trend). Fibrosis was present in an average steatosis area of approximately 4% (defining significant steatosis) and in nonalcoholic steatohepatitis by approximately 8% (defining severe steatosis). Steatosis and fibrosis area increased symmetrically until approximately 10%, then steatosis area decreased to null as average fibrosis area reached 32%. Average fasting glycemia (approximately 92 mg/dl) or triglycerides and BMI plateaued before a steatosis area of approximately 4%, then increased thereafter. Significant steatosis was present in 61.3% of NAFLD versus 20.2% of viral hepatitis (P<0.0001) and in 58.7% of alcoholic liver diseases (P=0.674). CONCLUSIONS The average threshold of steatosis area is 4% for the development of fibrosis or metabolic syndrome components and 8% for nonalcoholic steatohepatitis. Steatosis area may contribute to defining the normal range and clinical course of metabolic components.
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Agha A, Abdulhadi MM, Marenco S, Bella A, AlSaudi D, El-Haddad A, Inferrera S, Savarino V, Giannini EG. Use of the platelet count/spleen diameter ratio for the noninvasive diagnosis of esophageal varices in patients with schistosomiasis. Saudi J Gastroenterol 2011; 17:307-11. [PMID: 21912056 PMCID: PMC3178917 DOI: 10.4103/1319-3767.84483] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND/AIM In patients with liver cirrhosis, the platelet count/spleen diameter ratio has been validated as a parameter for the noninvasive diagnosis of esophageal varices. Schistosoma infection is a frequent cause of portal hypertension in Middle Eastern countries, and is associated with the development of esophageal varices. In this study we aimed to evaluate the platelet count/spleen diameter ratio as a noninvasive tool for the prediction of the presence of esophageal varices in patients with schistosoma-related chronic liver disease. PATIENTS AND METHODS Forty-three patients with hepatosplenic schistosomiasis underwent upper digestive endoscopy to check for the presence of esophageal varices. Furthermore, all patients underwent abdominal ultrasonography, and maximum spleen diameter (in mm) was measured. The platelet count/spleen diameter ratio was calculated in all patients. RESULTS Esophageal varices were found in 31 patients (72%). Age and gender were not significantly different between patients with and without varices. In patients with varices, median platelet count (82,000/μL versus 172,000/μL, P < 0.0001) and platelet count/spleen diameter ratio (571 versus 1651, P < 0.0001) were significantly lower, while spleen diameter (147 mm versus 109 mm, P = 0.0006) was significantly larger. In multivariate analysis, the platelet count/spleen diameter ratio was the only parameter independently associated with the presence of varices (P < 0.0001). CONCLUSIONS In this study we have validated the use of the platelet count/spleen diameter ratio for the noninvasive diagnosis of esophageal varices in patients with portal hypertension caused by schistosoma infection. In these patients, the platelet count/spleen diameter ratio might be used to allow better rationalization of medical resources and use of endoscopy.
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Affiliation(s)
- Adnan Agha
- Department of Medicine, King Fahad Hospital, Armed Forces Hospitals Southern Region, Khamis Mushyt, Saudi Arabia
| | - Mamdouh M. Abdulhadi
- Department of Medicine, King Fahad Hospital, Armed Forces Hospitals Southern Region, Khamis Mushyt, Saudi Arabia
| | - Simona Marenco
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Abdelhaleem Bella
- Department of Medicine, King Fahad Hospital, Armed Forces Hospitals Southern Region, Khamis Mushyt, Saudi Arabia
| | - Dib AlSaudi
- Department of Medicine, King Fahad Hospital, Armed Forces Hospitals Southern Region, Khamis Mushyt, Saudi Arabia
| | - Ahmed El-Haddad
- Department of Radiology, King Fahad Hospital, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Simona Inferrera
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | - Edoardo G. Giannini
- Department of Internal Medicine, University of Genoa, Genoa, Italy,Address for correspondence: Prof. Edoardo G. Giannini, Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Viale Benedetto XV, No. 616132, Genoa, Italy. E-mail:
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Leão ARDS, Sales DM, Santos JEM, Nakano E, Shigueoka DC, D'Ippolito G. Avaliação do volume de fluxo portal em pacientes esquistossomóticos: estudo comparativo entre ressonância magnética e ultrassom Doppler. Radiol Bras 2010. [DOI: 10.1590/s0100-39842010000600005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar a concordância entre o ultrassom Doppler e a ressonância magnética e a reprodutibilidade interobservador desses métodos na quantificação do volume de fluxo portal em indivíduos esquistossomóticos. MATERIAIS E MÉTODOS: Foi realizado estudo transversal, observacional e autopareado, avaliando 21 pacientes portadores de esquistossomose hepatoesplênica submetidos a mensuração do fluxo portal por meio de ressonância magnética (utilizando-se a técnica phase-contrast) e ultrassom Doppler. RESULTADOS: Observou-se baixa concordância entre os métodos (coeficiente de correlação intraclasse: 34,5% [IC 95%]). A reprodutibilidade interobservador na avaliação pela ressonância magnética (coeficiente de correlação intraclasse: 99,2% [IC 95%] / coeficiente de correlação de Pearson: 99,2% / média do fluxo portal = 0,806) e pelo ultrassom Doppler (coeficiente de correlação intraclasse: 80,6% a 93,0% [IC 95%] / coeficiente de correlação de Pearson: 81,6% a 92,7% / média do fluxo portal = 0,954, 0,758 e 0,749) foi excelente. CONCLUSÃO: Há uma baixa concordância entre o ultrassom Doppler e a ressonância magnética na mensuração do volume de fluxo na veia porta. A ressonância magnética e o ultrassom Doppler são métodos reprodutíveis na quantificação do fluxo portal em pacientes portadores de hipertensão porta de origem esquistossomótica, apresentando boa concordância interobservador
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Acoustic radiation force impulse: a new ultrasonographic technology for the widespread noninvasive diagnosis of liver fibrosis. Eur J Gastroenterol Hepatol 2010; 22:1074-84. [PMID: 20440210 DOI: 10.1097/meg.0b013e328339e0a1] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND/AIMS As a module of a standard ultrasound imaging device, acoustic radiation force impulse (ARFI) is a new technology for liver stiffness evaluation (LSE). We aimed to evaluate accuracy, feasibility, reproducibility, and training effect of ARFI for liver fibrosis evaluation. METHODS One hundred and one patients with chronic liver disease had LSE by Fibroscan and ARFI. LSE by ARFI was performed in the two liver lobes by two operators: an expert and a novice. Correlation and agreement were evaluated by the Pearson (Rp) and intraclass (Ric) correlation coefficients. The independent reference for liver fibrosis was fibrosis blood tests. RESULTS ARFI results, ranging from 0.7 to 4.6 m/s, were well correlated with Fibroscan results (Rp=0.76). Fibroscan had a significantly higher area under the receiver operating characteristic curve (AUROC) than ARFI for the perprotocol diagnosis of significant fibrosis: 0.890+/-0.034 versus 0.795+/-0.047 (P=0.04). However, LSE failure occurred in zero patients using ARFI versus six patients using Fibroscan (P=0.03). Thus, on an intention-to-diagnose basis, Fibroscan and ARFI AUROCs for the diagnosis of significant fibrosis were not different: 0.791+/-0.049 versus 0.793+/-0.046 (P=0.98). Interobserver agreement was very good (Ric=0.84) and excellent for ARFI interquartile range (IQR)< or =0.30 (Ric=0.91). Indeed, agreement was independently predicted only by ARFI IQR, but not by LSE result as earlier observed for Fibroscan. ARFI AUROC was 0.876+/-0.057 in patients with ARFI IQR ratio< or =0.30, and Fibroscan AUROC was 0.912+/-0.034 in patients with Fibroscan IQR ratio less than 0.21 (P=0.59). Intersite ARFI agreement between the two liver lobes was fair (Ric=0.60). There was no training effect for LSE by ARFI. CONCLUSION ARFI is highly feasible and reproducible, and provides diagnostic accuracy similar to Fibroscan. This new device seems noteworthy for the widespread noninvasive diagnosis of liver fibrosis.
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Noninvasive liver steatosis quantification using MRI techniques combined with blood markers. Eur J Gastroenterol Hepatol 2010; 22:973-82. [PMID: 20665947 DOI: 10.1097/meg.0b013e32833775fb] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIMS To evaluate the accuracy of different techniques of MRI steatosis quantification, based on histological grading and quantification of liver steatosis. PATIENTS AND METHODS Twenty-three patients (21 with nonalcoholic fatty liver disease and two controls) were included. Steatosis was evaluated in liver specimens using histological grading (five grades) and steatosis area (% of liver surface) was computed using an inhouse automated image analysis. The following five MRI quantification techniques were performed: two-point Dixon, three-point Dixon, DUAL, spin echo method and a new technique called multi-echo gradient-echo (MFGRE). Interobserver (two observers) and intersite (three different liver sites) agreements were evaluated for the two best-performing methods. RESULTS Steatosis area was correlated with steatosis grade: Rs (Spearman coefficient) = 0.82, P value of less than 0.001. The steatosis area was significantly different between S0-S2 and S3-S4 grades: 4.2 + or - 2.4 versus 16.4 + or - 8.9% (P< 0.001). Correlations between the MRI techniques and steatosis area (or grading) were: MFGRE, Rs = 0.72 (0.78); spin echo method, Rs = 0.72 (0.76); DUAL, Rs =0.71 (0.76); two-point Dixon, Rs = 0.71 (0.75); three-point Dixon, Rs = 0.67 (0.77). Interobserver (Ric = 0.99) and intersite (Ric = 0.97) agreements were excellent for the liver steatosis measurement by MFGRE. The noninvasive diagnosis of the steatosis area was improved by adding blood markers like ALT and triglycerides to MFGRE (aR2: 0.805). CONCLUSION MRI, and in particular the MFGRE method, provides accurate and automatic quantification for the noninvasive evaluation of liver steatosis, either as a single measurement or in combination with blood variables.
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Sebastianes PM, Sales DM, Santos JEM, Leão ARDS, Costa JDD, Takemoto K, Capobianco J, Bezerra ASDA, D'Ippolito G. Interobserver variability of ultrasound parameters in portal hypertension. Mem Inst Oswaldo Cruz 2010; 105:409-13. [DOI: 10.1590/s0074-02762010000400010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Accepted: 12/09/2009] [Indexed: 11/22/2022] Open
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Albillos A, Peñas B, Zamora J. Role of endoscopy in primary prophylaxis for esophageal variceal bleeding. Clin Liver Dis 2010; 14:231-50. [PMID: 20682232 DOI: 10.1016/j.cld.2010.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cirrhosis is the leading cause of portal hypertension in the Western world. From a clinical standpoint, the most significant consequence of portal hypertension is the development of esophageal varices. Despite the many advances in the management of variceal bleeding, it remains a life-threatening complication of portal hypertension. Primary prophylaxis to prevent the first bleeding episode in patients with cirrhosis and esophageal varices is therefore critically important in the management of patients with cirrhosis.
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Affiliation(s)
- Agustín Albillos
- Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain.
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Derivation of a clinical prediction rule for the noninvasive diagnosis of varices in children. J Pediatr Gastroenterol Nutr 2010; 50:188-93. [PMID: 19966576 DOI: 10.1097/mpg.0b013e3181b64437] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Identification of children who are at high risk for having varices using noninvasive tests would enable the selection of children for future studies of primary prophylaxis of variceal hemorrhage, but this has been inadequately studied. The objective of the study was to derive a noninvasive clinical prediction rule that is able to identify children with esophageal varices. METHODS Fifty-one consecutive children with liver disease or portal hypertension who underwent endoscopy were included in the present retrospective study. At endoscopy, variceal size was graded on a 4-point Likert scale. Results of physical examination, blood tests, and abdominal ultrasound scan (USS) were recorded. Spleen length on USS was expressed as a standard deviation score (z score). A descriptive univariate analysis was performed on variables that were potentially associated with esophageal varices and multivariate logistic regression was then modeled to derive a clinical prediction rule. RESULTS Esophageal varices were found in 17 of the 51 children (33%). Variables found to differ significantly between children with and without varices included platelet/spleen-length z score ratio (P < 0.001), platelet count (P < 0.001), international normalized ratio (P = 0.001), aspartate aminotransferase/alanine aminotransferase ratio (P = 0.002), and albumin (P = 0.003). Using multivariate logistic regression, a model with platelet count, spleen length z score, and albumin as the independent variables had the best fit. Area under the receiver operating characteristic curve for this clinical prediction rule was 0.93 (95% confidence interval 0.85-0.99), sensitivity 94%, specificity 81%, positive predictive value 0.83, negative predictive value 0.94, positive likelihood ratio 5, and negative likelihood ratio 0.06. CONCLUSIONS This clinical prediction rule is a simple noninvasive measure that may identify children at high risk for esophageal varices. A prospective validation study is in progress.
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Koch C, Straub R, Ramseyer A, Widmer A, Robinson NE, Gerber V. Endoscopic scoring of the tracheal septum in horses and its clinical relevance for the evaluation of lower airway health in horses. Equine Vet J 2010; 39:107-12. [PMID: 17378438 DOI: 10.2746/042516407x158764] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY Although endoscopic scoring of the tracheal septum thickness is used as a diagnostic tool for evaluation of lower airway disease, its clinical relevance and reliability have never been critically assessed in the horse. OBJECTIVES To investigate if septum thickness scores (STS) are reliable and serve as a clinically useful indicator of lower airway disease status and/or inflammation. METHODS The variance of STS attributable to the horse, observer and changes over time was determined. The distribution of STS in a population of clinically normal horses and correlations of STS with age, gender, as well as mucus accumulation and cell differentials of tracheobronchial secretions and bronchoalveolar lavage fluid were investigated. Effects of altered pulmonary ventilation, induced by different drugs, on STS were assessed. Finally, STS of horses affected with recurrent airway obstruction (RAO) were compared to those of clinically normal horses. RESULTS Recorded STS showed excellent intra- and satisfactory interobserver agreement Established clinical, endoscopic and cytological measures of lower airway inflammation, i.e. mucus accumulation scores and airway neutrophilia, did not correlate with STS. In horses age > or = 10 years, septum scores were significantly higher (P = 0.022) than in younger horses. Septum thickness scores did not differ significantly between clinically normal and RAO-affected horses both in exacerbation and in remission. Horses with markedly increased breathing effort (i.e. with metacholine- or lobeline hydrochloride-challenge), often differed markedly (up to 1.9 scores), but the average of end-inspiratory and end-expiratory STS did not differ from baseline STS. CONCLUSIONS AND CLINICAL RELEVANCE Endoscopic STS are a reproducible measure, but STS did not correlate with clinical, endoscopic and cytological findings indicative of RAO or inflammatory airway disease.
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Affiliation(s)
- C Koch
- Equine Clinic and Department of Clinical Veterinary Medicine, Vetsuisse-Faculty, University of Berne, Berne, Switzerland
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Boursier J, Konaté A, Gorea G, Reaud S, Quemener E, Oberti F, Hubert-Fouchard I, Dib N, Calès P. Reproducibility of liver stiffness measurement by ultrasonographic elastometry. Clin Gastroenterol Hepatol 2008; 6:1263-9. [PMID: 18995217 DOI: 10.1016/j.cgh.2008.07.006] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 07/09/2008] [Accepted: 07/10/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Fibroscan is a noninvasive device that assesses liver fibrosis by liver stiffness evaluation (LSE) with ultrasonographic elastometry. We evaluated LSE reproducibility and its influencing factors. METHODS LSE was performed by 4 experienced physicians (>100 LSEs) in 46 patients with chronic liver disease at 4 different anatomic sites. Additional LSEs were performed for ancillary aims, so that 534 LSEs were available. RESULTS Overall interobserver agreement for LSE results was considered as excellent, with intraclass coefficient correlation (Ric) of 0.93. Low LSE level, nonrecommended sites, LSE interquartile range >25%, and body mass index > or =25 independently decreased agreement. Thus, agreement was fair (Ric = 0.53) for LSE <9 kilopascals and excellent (Ric = 0.90) beyond. The best measurement site for LSE reproducibility was the median axillary line on the first intercostal space under the liver dullness upper limit, with the patient lying in dorsal decubitus. When LSE results were categorized into fibrosis Metavir stages, interobserver discordance was noticed in about 25% of the cases and was the highest for F2 and F3 stages and the lowest for F4. Intraobserver (Ric = 0.94), intersite (Ric = 0.92-0.98), and interequipment (Ric = 0.92) agreements for LSE results were excellent. Preliminary standard ultrasonography or probe pressure changes did not improve interobserver agreement. CONCLUSIONS The best measurement site for LSE is the one generally used for liver biopsy. Reproducibility of LSE is globally excellent but is fair in patient with low liver stiffness. The fibrosis diagnosis by ultrasonographic elastometry in low stages or categorized into fibrosis Metavir stages must be interpreted with caution.
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Affiliation(s)
- Jérôme Boursier
- University of Angers, IFR 132, HIFIH Laboratory, UPRES 3859, Angers, France
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de Franchis R. Non-invasive (and minimally invasive) diagnosis of oesophageal varices. J Hepatol 2008; 49:520-7. [PMID: 18706733 DOI: 10.1016/j.jhep.2008.07.009] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2008] [Revised: 07/11/2008] [Accepted: 07/11/2008] [Indexed: 12/23/2022]
Abstract
Current guidelines recommend screening all cirrhotic patients by endoscopy, to identify patients at risk of bleeding who should undergo prophylactic treatment. However, since the prevalence of varices in cirrhotic patients is variable, universal screening would imply a large number of unnecessary endoscopies and a heavy burden for endoscopy units. In addition, compliance to screening programs may be hampered by the perceived unpleasantness of endoscopy. Predicting the presence of oesophageal varices by non-invasive means might increase compliance and would permit to restrict the performance of endoscopy to those patients with a high probability of having varices. Over the years, several studies have addressed this issue by assessing the potential of biochemical, clinical and ultrasound parameters, transient elastography, CT scanning and video capsule endoscopy. The platelet count/spleen diameter ratio, CT scanning and video capsule endoscopy have shown promising performance characteristics, although none of them is equivalent to EGD. These methods are perceived by patients as preferable to endoscopy and thus might increase adherence to screening programs. Whether this will compensate for the lower sensitivity of these alternative techniques, and ultimately improve the outcomes if more patients undergo screening, is the crucial question that will have to be answered in the future.
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Affiliation(s)
- Roberto de Franchis
- Department of Medical Sciences, University of Milan, Fondazione Ospedale IRCCS Maggiore Policlinico, Mangiagalli and Regina Elena, Milan, Italy.
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Leão ARDS, Santos JEM, Moulin DS, Shigueoka DC, Colleoni R, D'Ippolito G. Mensuração do volume de fluxo portal em pacientes esquistossomóticos: avaliação da reprodutibilidade do ultra-som Doppler. Radiol Bras 2008. [DOI: 10.1590/s0100-39842008000500007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar a reprodutibilidade do ultra-som Doppler na quantificação do volume de fluxo portal em pacientes esquistossomóticos. MATERIAIS E MÉTODOS: Estudo prospectivo, transversal, observacional e autopareado, avaliando 21 pacientes portadores de esquistossomose hepatoesplênica, submetidos a mensuração do fluxo portal pelo ultra-som Doppler por três observadores, de forma independente, sendo calculada a concordância entre estes, dois a dois, pelo coeficiente de correlação intraclasse, teste t-pareado e grau de linearidade de Pearson. RESULTADOS: A concordância interobservador foi excelente. O coeficiente de correlação intraclasse variou entre 80,6% e 93,0% (IC a 95% [65,3% ; 95,8%]), com coeficiente de correlação de Pearson variando entre 81,6% e 92,7% e sem diferença estatisticamente significante entre os observadores quanto à média do fluxo portal mensurado pelo ultra-som Doppler (p = 0,954 / 0,758 / 0,749). CONCLUSÃO: O ultra-som Doppler é um método confiável para quantificar o fluxo portal em pacientes portadores de hipertensão porta de origem esquistossomótica, apresentando boa concordância interobservador.
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Costa JDD, Leão ARDS, Santos JEM, Moulin DS, Sebastianes PM, D'Ippolito G. Quantificação do fluxo portal em indivíduos sadios: comparação entre ressonância magnética e ultra-som Doppler. Radiol Bras 2008. [DOI: 10.1590/s0100-39842008000400004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJETIVO: Avaliar a concordância entre a ultra-sonografia com Doppler e a ressonância magnética na quantificação do fluxo portal em indivíduos sadios, e avaliar a reprodutibilidade destes métodos diagnósticos. MATERIAIS E MÉTODOS: Foi realizado estudo prospectivo, transversal, observacional e autopareado, avaliando 20 voluntários sadios submetidos a mensuração do fluxo portal por meio de ultra-sonografia com Doppler e por ressonância magnética, executada por dois observadores independentes. Foram calculadas as concordâncias entre os métodos e entre os observadores utilizando-se o coeficiente de correlação intraclasses e o coeficiente de Pearson. RESULTADOS: A concordância entre os exames de ultra-sonografia com Doppler e de ressonância magnética foi baixa (coeficiente intraclasses: 1,9%-18,2%; coeficiente de Pearson: 0,1%-13,7%; p=0,565). Os valores da média de fluxo portal medido pela ultra-sonografia e pela ressonância magnética foram, respectivamente, de 0,768 l/min e 0,742 l/min. A quantificação do fluxo portal medida pela ultra-sonografia e pela ressonância magnética demonstrou, respectivamente, concordância interobservador regular (coeficiente intraclasses: 43,3%; coeficiente de Pearson: 43,0%) e concordância excelente (coeficiente intraclasses: 91,4%; coeficiente de Pearson: 93,4%). CONCLUSÃO: A ressonância magnética é um método confiável para quantificar o fluxo portal, mostrando melhor concordância interobservador do que a ultra-sonografia com Doppler. Os dois métodos apresentam baixa concordância entre si na quantificação do fluxo portal.
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Learning curve and interobserver reproducibility evaluation of liver stiffness measurement by transient elastography. Eur J Gastroenterol Hepatol 2008; 20:693-701. [PMID: 18679074 DOI: 10.1097/meg.0b013e3282f51992] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS Fibroscan allows liver stiffness examination (LSE) that is well correlated with fibrosis stages. Our main objective was to evaluate LSE learning curve. METHODS LSE results of five novice observers with different medical status were compared with those of five expert observers (physicians with >100 examinations) in 250 patients with chronic liver disease. Each novice-expert pair had to blindly examine 50 consecutive patients divided into five consecutive subgroups of 10 patients. RESULTS In each observer group, novice-expert agreement [intraclass correlation coefficient (Ric)] for LSE results was excellent from the first to the last subgroup. Novice-expert agreement for LSE results varied with liver stiffness level: <9 kPa: Ric=0.49; >or=9 kPa: Ric=0.87. Relative difference (%) between novice and expert LSE results was independently associated with the number of valid LSE measurements, and stabilizes around 20-30% after the fourth valid measurement. In each observer group, novice-expert agreement (Ric) for LSE success rate progressively increased as a function of time. CONCLUSION LSE requires no learning curve: a novice is able to obtain a reliable result after a single training session, whatever the professional status. However, success rate will progressively increase. An LSE with less than four valid measurements should not be considered as reliable.
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Diagnosis of liver cirrhosis by transit-time analysis at contrast-enhanced ultrasonography. Radiol Med 2008; 113:860-74. [PMID: 18587531 DOI: 10.1007/s11547-008-0292-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Accepted: 12/26/2007] [Indexed: 12/13/2022]
Abstract
PURPOSE The aims of this prospective study were to evaluate analysis of sulfur-hexafluoride-filled microbubble contrast agent (Sonovue) transit times as a tool for differentiating liver cirrhosis from the noncirrhotic stage of liver disease and to compare its performance with that of conventional B-mode and Doppler ultrasonography (US). MATERIALS AND METHODS Contrast-enhanced hepatic ultrasonography with the US contrast agent Sonovue was performed on 38 patients with diagnoses of hepatic cirrhosis based on unequivocal clinical signs or liver biopsy findings (Child-Pugh classes A in 19, B in 16 and C in three), 31 patients with noncirrhotic diffuse liver disease (biopsy confirmed) and 14 controls without diffuse liver disease. Time curves of hepatic-vein signal intensity were analysed using objective criteria to determine the time of enhancement onset (hepatic-vein arrival time) and peak enhancement (hepatic-vein peak enhancement). Accuracy in diagnosing cirrhosis was compared with that based on B-mode and Doppler data. RESULTS Hepatic-vein arrival time in cirrhotic patients was significantly shorter (p < 0.01) than in noncirrhotic (chronic liver disease and controls) patients. Peak enhancement times in these three groups were not significantly different. An arrival-time cutoff of 17 s distinguished cirrhotic from noncirrhotic patients with high accuracy (100% sensitivity, 93.3% specificity, positive and negative predictive values 92.6% and 100%, respectively) and excellent reproducibility (kappa coefficients of 1.0 and 0.93 for intraand interobserver agreement). Contrast-enhanced US showed better sensitivity than the B-mode and Doppler data. CONCLUSIONS Analysis of the time of onset of US contrast enhancement of the hepatic vein appears to be a potentially useful noninvasive supplement to conventional sonography and Doppler in the follow-up of patients with chronic diffuse liver disease.
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de Franchis R, Eisen GM, Laine L, Fernandez-Urien I, Herrerias JM, Brown RD, Fisher L, Vargas HE, Vargo J, Thompson J, Eliakim R. Esophageal capsule endoscopy for screening and surveillance of esophageal varices in patients with portal hypertension. Hepatology 2008; 47:1595-603. [PMID: 18435461 DOI: 10.1002/hep.22227] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
UNLABELLED Bleeding from esophageal varices (EV) is a serious consequence of portal hypertension. Current guidelines recommend screening patients with cirrhosis with esophagogastroduodenoscopy (EGD) to detect varices. However, the unpleasantness and need for sedation of EGD may limit adherence to screening programs. Pilot studies have shown good performance of esophageal capsule endoscopy in detecting varices. This multicenter trial was designed to assess the diagnostic performance of capsule endoscopy in comparison with EGD. Patients undergoing EGD for screening or surveillance of EV underwent a capsule study previously. The study was designed as an equivalence study, assuming that a difference of <or=10% between capsule endoscopy and EGD in diagnosing EV would demonstrate equivalence. Two hundred eighty-eight patients were enrolled. Endoscopy was for screening in 195 patients and for surveillance of known EV in 93. Overall agreement for detecting EV between EGD and capsule endoscopy was 85.8%; the kappa score was 0.73. Capsule endoscopy had a sensitivity, specificity, positive predictive value, and negative predictive value of 84%, 88%, 92%, and 77%, respectively. The difference in diagnosing EV was 15.6% in favor of EGD. There was complete agreement on variceal grade in 227 of 288 cases (79%). In differentiating between medium/large varices requiring treatment and small/absent varices requiring surveillance, the sensitivity, specificity, positive predictive value, and negative predictive value for capsule endoscopy were 78%, 96%, 87%, and 92%, respectively. Overall agreement on treatment decisions based on EV size was substantial at 91% (kappa = 0.77). CONCLUSION We recommend that EGD be used to screen patients with cirrhosis for large EV. However, the minimal invasiveness, good tolerance, and good agreement of capsule endoscopy with EGD might increase adherence to screening programs. Whether this is the case needs to be determined.
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Affiliation(s)
- Roberto de Franchis
- Department of Medical Sciences, University of Milan, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena, Milan, Italy.
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Differentiating Cirrhosis and Chronic Hepatosplenic Schistosomiasis Using MRI. AJR Am J Roentgenol 2008; 190:W201-7. [DOI: 10.2214/ajr.07.2639] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Talwalkar JA, Yin M, Fidler JL, Sanderson SO, Kamath PS, Ehman RL. Magnetic resonance imaging of hepatic fibrosis: emerging clinical applications. Hepatology 2008; 47:332-42. [PMID: 18161879 DOI: 10.1002/hep.21972] [Citation(s) in RCA: 262] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Chronic liver disease and cirrhosis remains a major public health problem worldwide. While the majority of complications from chronic liver disease result from progressive hepatic fibrosis, the available diagnostic tests used in clinical practice are not sensitive or specific enough to detect occult liver injury at early or intermediate stages. While liver biopsy can stage the extent of fibrosis at diagnosis, its utility as a tool for longitudinal monitoring will be limited at the population level. To date, a number of methods including serum marker panels and ultrasound-based transient elastrography have been proposed for the non-invasive identification of hepatic fibrosis. Novel techniques including magnetic resonance (MR) spectroscopy, diffusion weighted MR, and MR elastography have also emerged for detecting fibrosis. In contrast to other non-invasive methods, MR imaging holds the promise of providing functional and biological information about hepatic pathophysiology as it relates to the natural history and future treatment of hepatic fibrosis. (HEPATOLOGY 2007.).
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Affiliation(s)
- Jayant A Talwalkar
- Advanced Liver Diseases Study Group, Miles and Shirley Fitterman Center for Digestive Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA.
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Kuban K, Adler I, Allred EN, Batton D, Bezinque S, Betz BW, Cavenagh E, Durfee S, Ecklund K, Feinstein K, Fordham LA, Hampf F, Junewick J, Lorenzo R, McCauley R, Miller C, Seibert J, Specter B, Wellman J, Westra S, Leviton A. Observer variability assessing US scans of the preterm brain: the ELGAN study. Pediatr Radiol 2007; 37:1201-8. [PMID: 17901950 PMCID: PMC2803345 DOI: 10.1007/s00247-007-0605-z] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Revised: 07/10/2007] [Accepted: 07/20/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Neurosonography can assist clinicians and can provide researchers with documentation of brain lesions. Unfortunately, we know little about the reliability of sonographically derived diagnoses. OBJECTIVE We sought to evaluate observer variability among experienced neurosonologists. MATERIALS AND METHODS We collected all protocol US scans of 1,450 infants born before the 28th postmenstrual week. Each set of scans was read by two independent sonologists for the presence of intraventricular hemorrhage (IVH) and moderate/severe ventriculomegaly, as well as hyperechoic and hypoechoic lesions in the cerebral white matter. Scans read discordantly for any of these four characteristics were sent to a tie-breaking third sonologist. RESULTS Ventriculomegaly, hypoechoic lesions and IVH had similar rates of positive agreement (68-76%), negative agreement (92-97%), and kappa values (0.62 to 0.68). Hyperechoic lesions, however, had considerably lower values of positive agreement (48%), negative agreement (84%), and kappa (0.32). No sonologist identified all abnormalities more or less often than his/her peers. Approximately 40% of the time, the tie-breaking reader agreed with the reader who identified IVH, ventriculomegaly, or a hypoechoic lesion in the white matter. Only about 25% of the time did the third party agree with the reader who reported a white matter hyperechoic lesion. CONCLUSION Obtaining concordance seems to be an acceptable way to assure reasonably high-quality of images needed for clinical research.
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Affiliation(s)
- Karl Kuban
- Division of Pediatric Neurology, Boston University Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Ira Adler
- Eastern Radiologists, Inc., Grenville, NC, USA
| | - Elizabeth N. Allred
- Neuroepidemiology Unit, Children’s Hospital Boston, Harvard Medical School, Harvard School of Public Health, Boston, MA, USA
| | - Daniel Batton
- Departments of Pediatrics and Neonatology, William Beaumont Hospital, Royal Oak, MI, USA
| | - Steven Bezinque
- Department of Radiology, DeVos Children’s Hospital, Grand Rapids, MI, USA
| | - Bradford W. Betz
- Department of Radiology, DeVos Children’s Hospital, Grand Rapids, MI, USA
| | - Ellen Cavenagh
- Department of Radiology, Sparrow Hospital, Lansing, MI, USA
| | - Sara Durfee
- Department of Radiology, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Kirsten Ecklund
- Department of Radiology, Children’s Hospital Boston, Harvard Medical School, Boston, MA, USA
| | - Kate Feinstein
- Department of Radiology, University of Chicago Hospital, University of Chicago, Chicago, IL, USA
| | - Lynn Ansley Fordham
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Frederick Hampf
- Department of Radiology, Baystate Medical Center, Springfield, MA, USA
| | - Joseph Junewick
- Department of Radiology, DeVos Children’s Hospital, Grand Rapids, MI, USA
| | - Robert Lorenzo
- Department of Radiology, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Roy McCauley
- Department of Radiology, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Cindy Miller
- Department of Radiology, Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Joanna Seibert
- Department of Radiology, Arkansas Children’s Hospital, University of Arkansas Medical School, Little Rock, AR, USA
| | - Barbara Specter
- Department of Radiology, Forsyth Hospital, Baptist Medical Center, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jacqueline Wellman
- Department of Radiology, Milford Regional Medical Center, Milford, MA, USA
| | - Sjirk Westra
- Division of Pediatric Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alan Leviton
- Neuroepidemiology Unit, Children’s Hospital Boston, Harvard Medical School, 1 Autumn St. #720, Boston, MA 02215-5393, USA,
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47
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Alempijević T, Bulat V, Kovacević N, Jegić R, Duranović S, Tomić D, Krstić M. [Noninvasive assessment of oesophageal varices presence and size in patients with liver cirrhosis using right liver lobe/serum albumin concentration]. VOJNOSANIT PREGL 2007; 64:453-7. [PMID: 17821919 DOI: 10.2298/vsp0707453a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND/AIM Liver cirrhosis is a chronic, progressive disease and it is usually accompanied by portal hypertension. The development of oesophageal varices (OV) is one of the major complications of portal hypertension. Cirrhotic patients should be screened for the presence of OV when portal hypertension is diagnozed. In order to reduce the increasing burden that endoscopy units have to bear, some studies have attempted to identify parameters for noninvasive prediction of OV presence. The aim of our study was to evaluate the value of biochemical and ultrasonography parameters for prediction of OV presence. METHODS This study included 58 cirrhotic patients who underwent a complete biochemical workup, ultrasonography examination and upper digestive endoscopy. Right liver lobe diameter/albumin ratio was calculated and its correlation to the presence and degree of OV, and Child-Pugh score of liver cirrhosis explored. RESULTS The mean age of the patients included in the study was 53.07+/-13.09 years; 40 were males and 18 females. In the Child-Pugh class A were 53.4% patients, class B 39.7%, whereas 6.9% were in the class C. In 24.1% of the patients no OV were identified by upper digestive endoscopy, 19% had OV grade I, 34.5% grade II, 20.7% grade III, and 1.7% OV grade IV. The mean value of the right liver lobe diameter/albumin ratio was 5.43+/-1.79 (range of 2.76-11.44). Statistically significant correlation (p < 0.01) was confirm by Spearman's test between OV grade and calculated index (p = 0.441). CONCLUSION The right liver lobe diameter/albumin ratio is a noninvasive parameter which provides an accurate information pertinent to the determination of OV presence and their grading in patients with liver cirrhosis.
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Affiliation(s)
- Tamara Alempijević
- Institut za bolesti digestivnog sistema, Klinika za gastroenterologiju i hepatologiju, Beograd.
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48
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Alempijevic T, Bulat V, Djuranovic S, Kovacevic N, Jesic R, Tomic D, Krstic S, Krstic M. Right liver lobe/albumin ratio: Contribution to non-invasive assessment of portal hypertension. World J Gastroenterol 2007; 13:5331-5. [PMID: 17879402 PMCID: PMC4171322 DOI: 10.3748/wjg.v13.i40.5331] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the value of biochemical and ultraso-nographic parameters in prediction of presence and size of esophageal varices.
METHODS: The study includes selected cirrhotic patients who underwent a complete biochemical workup, upper digestive endoscopic and ultrasonographic examinations. Albumin/right liver lobe diameter and platelet count/spleen diameter ratios were calculated. The correlation between calculated ratio and the presence and degree of esophageal varices was evaluated.
RESULTS: Ninety-four subjects (62 males, 32 females), with a mean age of 52.32 ± 13.60 years, were studied. Child-Pugh class A accounted for 42.6%, class B 37.2%, whereas class C 20.2%. Esophageal varices (OE) were not demonstrated by upper digestive endoscopy in 24.5%, while OE gradeIwas found in 22.3% patients, grade II in 33.0%, grade III in 16.0%, and grade IV in 4.3%. The mean value of right liver lobe diameter/albumin ratio was 5.51 ± 1.82 (range from 2.76 to 11.44), while the mean platelet count/spleen diameter ratio was 1017.75 ± 729.36 (range from 117.39 to 3362.50), respectively. Statistically significant correlation was proved by Spearman's test between OE grade and calculated ratios. The P values were 0.481 and -0.686, respectively.
CONCLUSION: The right liver lobe diameter/albumin and platelet count/spleen diameter ratios are non-invasive parameters providing accurate information pertinent to determination of presence of esophageal varices, and their grading in patients with liver cirrhosis.
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Affiliation(s)
- Tamara Alempijevic
- Clinical Centre of Serbia, Institute for Digestive Diseases, Clinic for Gastroenterology and Hepatology, 6 Dr Koste Todorovica St. 11000 Belgrade, Serbia.
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49
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Calès P, Veillon P, Konaté A, Mathieu E, Ternisien C, Chevailler A, Godon A, Gallois Y, Joubaud F, Hubert-Fouchard I, Oberti F, Réaud S, Hunault G, Mauriat F, Lunel-Fabiani F. Reproducibility of blood tests of liver fibrosis in clinical practice. Clin Biochem 2007; 41:10-8. [PMID: 17988658 DOI: 10.1016/j.clinbiochem.2007.08.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Revised: 07/13/2007] [Accepted: 08/09/2007] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To evaluate the inter-laboratory reproducibility of blood test for liver fibrosis: FibroMeter, Fibrotest, APRI and their composites variables. DESIGN AND METHODS Four studies, including 147 patients, were performed: study #1 included 2 metachronous blood samples and 2 laboratories; studies #2, #3 and #4 included synchronous samples with assays delayed at day 1 in 12 laboratories, at day 0 in 10 laboratories and at day 0 or 1 in 2 laboratories, respectively. Agreement was evaluated by the intraclass correlation coefficient (r(ic)). RESULTS In studies #1, #2 and #4, r(ic) for FibroMeter was 0.893, 0.942 and 0.991, respectively. In study #3, the r(ic) were: FibroMeter: 0.963, Fibrotest: 0.984, APRI: 0.949. Large simulated variations in composite variables had a weak impact on FibroMeter. CONCLUSIONS When blood marker limits are controlled, inter-laboratory agreement of blood tests is excellent in clinical practice conditions. Blood tests are robust against the variability of composite blood variables.
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Affiliation(s)
- Paul Calès
- Laboratoire HIFIH, UPRES 3859, IFR 132, Université d'Angers, 49045 Angers Cedex, France
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50
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Levine RA, Sanderson SO, Ploutz-Snyder R, Murray F, Kay E, Hegarty J, Nolan N, Kelleher D, McDonald G, O'Keane JC, Crowe J. Assessment of fibrosis progression in untreated irish women with chronic hepatitis C contracted from immunoglobulin anti-D. Clin Gastroenterol Hepatol 2006; 4:1271-7. [PMID: 16901770 DOI: 10.1016/j.cgh.2006.05.028] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS In 1996 we initiated a retrospective-prospective study in 184 untreated women infected in 1977 with chronic hepatitis C virus (HCV). To provide insight into the natural history of HCV, we determined liver fibrosis outcomes and any predictors of such. METHODS Baseline 1994 biopsy specimens (size, >or=15 mm; portal areas, >or=5) and sequential biopsy specimens were assessed by Ishak score for grade change (increase or decrease of >or=2 points) and stage progression or regression (increase or reduction of >or=1 point), the latter correlated with digital quantification of fibrosis percentage. RESULTS No baseline biopsy specimens had cirrhosis, therefore all could potentially progress. Grade and stage scores decreased or increased significantly in 28% and 18% and 24% and 27% of patients, respectively. There was a positive correlation between baseline and sequential grade/stage scores (r = .39, P < .001), and between semiquantitative Ishak scores and fibrosis percentage (Spearman rho = .85; P < .01). Baseline alanine transaminase values (mean, 49 U/L; range, 23-363 U/L) correlated positively with changes in grade (r = .41, P < .01) and stage (r = .39, P < .01), and regression analyses indicated that baseline alanine transaminase value was a good predictor of such changes. Confounding variables (alcohol, smoking, and herbal and paracetamol [acetaminophen] use) did not correlate with histologic outcomes. CONCLUSIONS In a follow-up study, 49% of patients showed no change in fibrosis, 24% showed regression, and only 27% showed progression, including 4 patients (2.1%) who developed stage 6 cirrhosis. Unidirectional sequential grade/stage concordance attested to biopsy sample reliability. Given the current age of these women in their fifth decade, some still may have a risk for more advanced liver disease, but for most of these patients it appears unlikely.
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Affiliation(s)
- Robert A Levine
- State University of New York, Upstate Medical University, Syracuse, New York 13210, USA.
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