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Lintrup K, Ipsen DH, Skat-Rørdam J, Lykkesfeldt J, Tveden-Nyborg P, Buelund LE. Validation of computed tomography as a diagnostic tool in guinea pigs with non-alcoholic fatty liver disease. Lab Anim 2024; 58:127-137. [PMID: 37999627 DOI: 10.1177/00236772231182511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) and subsequent steatohepatitis (NASH) is the most common cause of liver disease and liver transplantation in humans. Affecting millions of patients worldwide, diagnosis relies on a biopsy, not without risk to the patient, and emphasises the need for improved diagnostic measures to determine and monitor disease progression. Despite intensive research, approved pharmacological treatment modalities are few, underlining that animal models with increased translational validity are important to advance preclinical drug development. This study validates the applicability of computed tomography (CT) as a non-invasive diagnostic tool for the assessment of liver steatosis in a guinea pig model of NAFLD/NASH. Guinea pigs with induced NAFLD or NASH were compared to healthy controls at two separate time points: week 16, serving as baseline measure, and week 25 to monitor disease progression over time. The animals were subsequently euthanised, and samples were collected to confirm disease stage. The data showed a strong negative correlation between liver triglycerides and Hounsfield unit (HU) values (R2 = 0.8157; p < 0.0001). A significant difference in histopathological scoring and HU values between grade 0 and more advanced stages of steatosis was recorded (p < 0.001), although the degree of liver fibrosis could not be accurately evaluated by differences in HU. In conclusion, the present study validates CT scanning for the determination of hepatic steatosis in guinea pigs, and it strongly supports the technique as a relevant non-invasive diagnostic tool in this species.
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Affiliation(s)
- Kristine Lintrup
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - David Højland Ipsen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Josephine Skat-Rørdam
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Jens Lykkesfeldt
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Pernille Tveden-Nyborg
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Lene Elisabeth Buelund
- Section of Veterinary Imaging, Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Wibulpolprasert P, Subpinyo B, Chirnaksorn S, Shantavasinkul PC, Putadechakum S, Phongkitkarun S, Sritara C, Angkathunyakul N, Sumritpradit P. Correlation between magnetic resonance imaging proton density fat fraction (MRI-PDFF) and liver biopsy to assess hepatic steatosis in obesity. Sci Rep 2024; 14:6895. [PMID: 38519637 PMCID: PMC10960039 DOI: 10.1038/s41598-024-57324-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/18/2024] [Indexed: 03/25/2024] Open
Abstract
Obesity is highly associated with Non-alcoholic fatty liver disease (NAFLD) and increased risk of liver cirrhosis and liver cancer-related death. We determined the diagnostic performance of the complex-based chemical shift technique MRI-PDFF for quantifying liver fat and its correlation with histopathologic findings in an obese population within 24 h before bariatric surgery. This was a prospective, cross-sectional, Institutional Review Board-approved study of PDFF-MRI of the liver and MRI-DIXON image volume before bariatric surgery. Liver tissues were obtained during bariatric surgery. The prevalence of NAFLD in the investigated cohort was as high as 94%. Histologic hepatic steatosis grades 0, 1, 2, and 3 were observed in 3 (6%), 25 (50%), 14 (28%), and 8 (16%) of 50 obese patients, respectively. The mean percentages of MRI-PDFF from the anterior and posterior right hepatic lobe and left lobe vs. isolate left hepatic lobe were 15.6% (standard deviation [SD], 9.28%) vs. 16.29% (SD, 9.25%). There was a strong correlation between the percentage of steatotic hepatocytes and MRI-PDFF in the left hepatic lobe (r = 0.82, p < 0.001) and the mean value (r = 0.78, p < 0.001). There was a strong correlation between MRI-derived subcutaneous adipose tissue volume and total body fat mass by dual-energy X-ray absorptiometry, especially at the L2-3 and L4 level (r = 0.85, p < 0.001). MRI-PDFF showed good performance in assessing hepatic steatosis and was an excellent noninvasive technique for monitoring hepatic steatosis in an obese population.
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Affiliation(s)
- Pornphan Wibulpolprasert
- Department of Diagnostic and Therapeutic Radiology, Mahidol University, Bangkok, 10400, Thailand
| | - Benya Subpinyo
- Department of Diagnostic and Therapeutic Radiology, Mahidol University, Bangkok, 10400, Thailand
| | | | | | | | - Sith Phongkitkarun
- Department of Diagnostic and Therapeutic Radiology, Mahidol University, Bangkok, 10400, Thailand
| | - Chanika Sritara
- Department of Diagnostic and Therapeutic Radiology, Mahidol University, Bangkok, 10400, Thailand
| | | | - Preeda Sumritpradit
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
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Maheshwari S, Gu CN, Caserta MP, Kezer CA, Shah VH, Torbenson MS, Menias CO, Fidler JL, Venkatesh SK. Imaging of Alcohol-Associated Liver Disease. AJR Am J Roentgenol 2024; 222:e2329917. [PMID: 37729554 DOI: 10.2214/ajr.23.29917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Alcohol-associated liver disease (ALD) continues to be a global health concern, responsible for a significant number of deaths worldwide. Although most individuals who consume alcohol do not develop ALD, heavy drinkers and binge drinkers are at increased risk. Unfortunately, ALD is often undetected until it reaches advanced stages, frequently associated with portal hypertension and hepatocellular carcinoma (HCC). ALD is now the leading indication for liver transplant. The incidence of alcohol-associated hepatitis (AH) surged during the COVID-19 pandemic. Early diagnosis of ALD is therefore important in patient management and determination of prognosis, as abstinence can halt disease progression. The spectrum of ALD includes steatosis, steatohepatitis, and cirrhosis, with steatosis the most common manifestation. Diagnostic techniques including ultrasound, CT, and MRI provide useful information for identifying ALD and excluding other causes of liver dysfunction. Heterogeneous steatosis and transient perfusion changes on CT and MRI in the clinical setting of alcohol-use disorder are diagnostic of severe AH. Elastography techniques are useful for assessing fibrosis and monitoring treatment response. These various imaging modalities are also useful in HCC surveillance and diagnosis. This review discusses the imaging modalities currently used in the evaluation of ALD, highlighting their strengths, limitations, and clinical applications.
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Affiliation(s)
- Sharad Maheshwari
- Department of Radiology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
| | - Chris N Gu
- Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Melanie P Caserta
- Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, Jacksonville, FL
| | - Camille A Kezer
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Vijay H Shah
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Michael S Torbenson
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology, Mayo Clinic, Rochester, MN
| | - Christine O Menias
- Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, Scottsdale, AZ
| | - Jeff L Fidler
- Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Sudhakar K Venkatesh
- Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, 200 1st St SW, Rochester, MN 55905
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Mittal RK, Ledgerwood M, Caplin M, Xu P, Marquez-Lavenant W, Zifan A. Impaired sliding between the lower esophageal sphincter and crural diaphragm (esophageal hiatus) in patients with achalasia esophagus. Am J Physiol Gastrointest Liver Physiol 2023; 325:G368-G378. [PMID: 37581423 PMCID: PMC10642994 DOI: 10.1152/ajpgi.00117.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/14/2023] [Accepted: 07/31/2023] [Indexed: 08/16/2023]
Abstract
Swallow-related axial shortening of the esophagus results in the formation of phrenic ampulla in normal subjects; whether it is the case in achalasia esophagus is not known. The goal is to study axial shortening of the esophagus and relative movement between the lower esophageal sphincter (LES) and crural diaphragm (CD) in normal subjects and patients with achalasia. A novel method, isoimpedance contour excursion at the lower edger of LES, as a marker of axial esophageal shortening was validated using X-ray fluoroscopy (n = 5) and used to study axial shortening and separation between the LES and CD during peristalsis in normal subjects (n = 15) and patients with achalasia type 2 esophagus (n = 15). Abdominal CT scan images were used to determine the nature of tissue in the esophageal hiatus of control (n = 15) and achalasia patients (n = 15). Swallow-induced peristalsis resulted in an axial excursion of isoimpedance contours, which was quantitatively similar to the metal clip anchored to the LES on X-ray fluoroscopy (2.3 ± 1.4 vs. 2.1 ± 1.4 cm with deep inspiration and 2.7 ± 0.6 cm vs. 2.7 ± 0.6 cm with swallow-induced peristalsis). Esophageal axial shortening with swallows in patients with achalasia was significantly smaller than normal (1.64 ± 0.5 cm vs. 3.59 ± 0.4 cm, P < 0.001). Gray-level matrix analysis of CT images suggests more "fibrous" and less fat in the hiatus of patients with achalasia. Lack of sliding between the LES and CD explains the low prevalence of hiatus hernia, and low compliance of the LES in achalasia esophagus, which likely plays a role in the pathogenesis of achalasia.NEW & NOTEWORTHY Swallow-related axial shortening of the esophagus is reduced, and there is no separation between the lower esophageal sphincter and crural diaphragm (CD) with swallowing in patients with achalasia esophagus. Fat in the hiatal opening of the esophagus appears to be replaced with fibrous tissue in patients with achalasia, resulting in tight anchoring between the LES and CD. The above findings explain low prevalence of hiatus hernia and the low compliance of the LES in achalasia esophagus.
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Affiliation(s)
- Ravinder K Mittal
- Division of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, California, United States
| | - Melissa Ledgerwood
- Division of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, California, United States
| | - Michelle Caplin
- Division of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, California, United States
| | - Pudan Xu
- Division of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, California, United States
| | - Walter Marquez-Lavenant
- Division of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, California, United States
| | - Ali Zifan
- Division of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, California, United States
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5
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Fetzer DT, Rosado-Mendez IM, Wang M, Robbin ML, Ozturk A, Wear KA, Ormachea J, Stiles TA, Fowlkes JB, Hall TJ, Samir AE. Pulse-Echo Quantitative US Biomarkers for Liver Steatosis: Toward Technical Standardization. Radiology 2022; 305:265-276. [PMID: 36098640 PMCID: PMC9613608 DOI: 10.1148/radiol.212808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 04/07/2022] [Accepted: 04/14/2022] [Indexed: 11/11/2022]
Abstract
Excessive liver fat (steatosis) is now the most common cause of chronic liver disease worldwide and is an independent risk factor for cirrhosis and associated complications. Accurate and clinically useful diagnosis, risk stratification, prognostication, and therapy monitoring require accurate and reliable biomarker measurement at acceptable cost. This article describes a joint effort by the American Institute of Ultrasound in Medicine (AIUM) and the RSNA Quantitative Imaging Biomarkers Alliance (QIBA) to develop standards for clinical and technical validation of quantitative biomarkers for liver steatosis. The AIUM Liver Fat Quantification Task Force provides clinical guidance, while the RSNA QIBA Pulse-Echo Quantitative Ultrasound Biomarker Committee develops methods to measure biomarkers and reduce biomarker variability. In this article, the authors present the clinical need for quantitative imaging biomarkers of liver steatosis, review the current state of various imaging modalities, and describe the technical state of the art for three key liver steatosis pulse-echo quantitative US biomarkers: attenuation coefficient, backscatter coefficient, and speed of sound. Lastly, a perspective on current challenges and recommendations for clinical translation for each biomarker is offered.
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Affiliation(s)
| | | | - Michael Wang
- From the Department of Radiology, University of Texas Southwestern
Medical Center, Dallas, Tex (D.T.F.); Departments of Medical Physics (I.M.R.M.,
T.J.H.) and Radiology (I.M.R.M.), University of Wisconsin, Institutes for
Medical Research, 1111 Highland Ave, Room 1005, Madison, WI 53705; General
Electric Healthcare, Milwaukee, Wis (M.W.); Department of Radiology, University
of Alabama at Birmingham, Birmingham, Ala (M.L.R.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.O.); U.S. Food and Drug
Administration, Silver Spring, Md (K.A.W.); Department of Electrical and
Computer Engineering, University of Rochester, Rochester, NY (J.O.); Department
of Natural Sciences, Kettering University, Flint, Mich (T.A.S.); Departments of
Biomedical Engineering and Radiology, University of Michigan, Ann Arbor, Mich
(J.B.F.); RSNA Quantitative Imaging Biomarkers Alliance (T.J.H.); and Center for
Ultrasound Research & Translation, Department of Radiology, Massachusetts
General Hospital, Harvard Medical School, Boston, Mass (A.E.S.)
| | - Michelle L. Robbin
- From the Department of Radiology, University of Texas Southwestern
Medical Center, Dallas, Tex (D.T.F.); Departments of Medical Physics (I.M.R.M.,
T.J.H.) and Radiology (I.M.R.M.), University of Wisconsin, Institutes for
Medical Research, 1111 Highland Ave, Room 1005, Madison, WI 53705; General
Electric Healthcare, Milwaukee, Wis (M.W.); Department of Radiology, University
of Alabama at Birmingham, Birmingham, Ala (M.L.R.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.O.); U.S. Food and Drug
Administration, Silver Spring, Md (K.A.W.); Department of Electrical and
Computer Engineering, University of Rochester, Rochester, NY (J.O.); Department
of Natural Sciences, Kettering University, Flint, Mich (T.A.S.); Departments of
Biomedical Engineering and Radiology, University of Michigan, Ann Arbor, Mich
(J.B.F.); RSNA Quantitative Imaging Biomarkers Alliance (T.J.H.); and Center for
Ultrasound Research & Translation, Department of Radiology, Massachusetts
General Hospital, Harvard Medical School, Boston, Mass (A.E.S.)
| | - Arinc Ozturk
- From the Department of Radiology, University of Texas Southwestern
Medical Center, Dallas, Tex (D.T.F.); Departments of Medical Physics (I.M.R.M.,
T.J.H.) and Radiology (I.M.R.M.), University of Wisconsin, Institutes for
Medical Research, 1111 Highland Ave, Room 1005, Madison, WI 53705; General
Electric Healthcare, Milwaukee, Wis (M.W.); Department of Radiology, University
of Alabama at Birmingham, Birmingham, Ala (M.L.R.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.O.); U.S. Food and Drug
Administration, Silver Spring, Md (K.A.W.); Department of Electrical and
Computer Engineering, University of Rochester, Rochester, NY (J.O.); Department
of Natural Sciences, Kettering University, Flint, Mich (T.A.S.); Departments of
Biomedical Engineering and Radiology, University of Michigan, Ann Arbor, Mich
(J.B.F.); RSNA Quantitative Imaging Biomarkers Alliance (T.J.H.); and Center for
Ultrasound Research & Translation, Department of Radiology, Massachusetts
General Hospital, Harvard Medical School, Boston, Mass (A.E.S.)
| | - Keith A. Wear
- From the Department of Radiology, University of Texas Southwestern
Medical Center, Dallas, Tex (D.T.F.); Departments of Medical Physics (I.M.R.M.,
T.J.H.) and Radiology (I.M.R.M.), University of Wisconsin, Institutes for
Medical Research, 1111 Highland Ave, Room 1005, Madison, WI 53705; General
Electric Healthcare, Milwaukee, Wis (M.W.); Department of Radiology, University
of Alabama at Birmingham, Birmingham, Ala (M.L.R.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.O.); U.S. Food and Drug
Administration, Silver Spring, Md (K.A.W.); Department of Electrical and
Computer Engineering, University of Rochester, Rochester, NY (J.O.); Department
of Natural Sciences, Kettering University, Flint, Mich (T.A.S.); Departments of
Biomedical Engineering and Radiology, University of Michigan, Ann Arbor, Mich
(J.B.F.); RSNA Quantitative Imaging Biomarkers Alliance (T.J.H.); and Center for
Ultrasound Research & Translation, Department of Radiology, Massachusetts
General Hospital, Harvard Medical School, Boston, Mass (A.E.S.)
| | - Juvenal Ormachea
- From the Department of Radiology, University of Texas Southwestern
Medical Center, Dallas, Tex (D.T.F.); Departments of Medical Physics (I.M.R.M.,
T.J.H.) and Radiology (I.M.R.M.), University of Wisconsin, Institutes for
Medical Research, 1111 Highland Ave, Room 1005, Madison, WI 53705; General
Electric Healthcare, Milwaukee, Wis (M.W.); Department of Radiology, University
of Alabama at Birmingham, Birmingham, Ala (M.L.R.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.O.); U.S. Food and Drug
Administration, Silver Spring, Md (K.A.W.); Department of Electrical and
Computer Engineering, University of Rochester, Rochester, NY (J.O.); Department
of Natural Sciences, Kettering University, Flint, Mich (T.A.S.); Departments of
Biomedical Engineering and Radiology, University of Michigan, Ann Arbor, Mich
(J.B.F.); RSNA Quantitative Imaging Biomarkers Alliance (T.J.H.); and Center for
Ultrasound Research & Translation, Department of Radiology, Massachusetts
General Hospital, Harvard Medical School, Boston, Mass (A.E.S.)
| | - Timothy A. Stiles
- From the Department of Radiology, University of Texas Southwestern
Medical Center, Dallas, Tex (D.T.F.); Departments of Medical Physics (I.M.R.M.,
T.J.H.) and Radiology (I.M.R.M.), University of Wisconsin, Institutes for
Medical Research, 1111 Highland Ave, Room 1005, Madison, WI 53705; General
Electric Healthcare, Milwaukee, Wis (M.W.); Department of Radiology, University
of Alabama at Birmingham, Birmingham, Ala (M.L.R.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.O.); U.S. Food and Drug
Administration, Silver Spring, Md (K.A.W.); Department of Electrical and
Computer Engineering, University of Rochester, Rochester, NY (J.O.); Department
of Natural Sciences, Kettering University, Flint, Mich (T.A.S.); Departments of
Biomedical Engineering and Radiology, University of Michigan, Ann Arbor, Mich
(J.B.F.); RSNA Quantitative Imaging Biomarkers Alliance (T.J.H.); and Center for
Ultrasound Research & Translation, Department of Radiology, Massachusetts
General Hospital, Harvard Medical School, Boston, Mass (A.E.S.)
| | - J. Brian Fowlkes
- From the Department of Radiology, University of Texas Southwestern
Medical Center, Dallas, Tex (D.T.F.); Departments of Medical Physics (I.M.R.M.,
T.J.H.) and Radiology (I.M.R.M.), University of Wisconsin, Institutes for
Medical Research, 1111 Highland Ave, Room 1005, Madison, WI 53705; General
Electric Healthcare, Milwaukee, Wis (M.W.); Department of Radiology, University
of Alabama at Birmingham, Birmingham, Ala (M.L.R.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.O.); U.S. Food and Drug
Administration, Silver Spring, Md (K.A.W.); Department of Electrical and
Computer Engineering, University of Rochester, Rochester, NY (J.O.); Department
of Natural Sciences, Kettering University, Flint, Mich (T.A.S.); Departments of
Biomedical Engineering and Radiology, University of Michigan, Ann Arbor, Mich
(J.B.F.); RSNA Quantitative Imaging Biomarkers Alliance (T.J.H.); and Center for
Ultrasound Research & Translation, Department of Radiology, Massachusetts
General Hospital, Harvard Medical School, Boston, Mass (A.E.S.)
| | - Timothy J. Hall
- From the Department of Radiology, University of Texas Southwestern
Medical Center, Dallas, Tex (D.T.F.); Departments of Medical Physics (I.M.R.M.,
T.J.H.) and Radiology (I.M.R.M.), University of Wisconsin, Institutes for
Medical Research, 1111 Highland Ave, Room 1005, Madison, WI 53705; General
Electric Healthcare, Milwaukee, Wis (M.W.); Department of Radiology, University
of Alabama at Birmingham, Birmingham, Ala (M.L.R.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.O.); U.S. Food and Drug
Administration, Silver Spring, Md (K.A.W.); Department of Electrical and
Computer Engineering, University of Rochester, Rochester, NY (J.O.); Department
of Natural Sciences, Kettering University, Flint, Mich (T.A.S.); Departments of
Biomedical Engineering and Radiology, University of Michigan, Ann Arbor, Mich
(J.B.F.); RSNA Quantitative Imaging Biomarkers Alliance (T.J.H.); and Center for
Ultrasound Research & Translation, Department of Radiology, Massachusetts
General Hospital, Harvard Medical School, Boston, Mass (A.E.S.)
| | - Anthony E. Samir
- From the Department of Radiology, University of Texas Southwestern
Medical Center, Dallas, Tex (D.T.F.); Departments of Medical Physics (I.M.R.M.,
T.J.H.) and Radiology (I.M.R.M.), University of Wisconsin, Institutes for
Medical Research, 1111 Highland Ave, Room 1005, Madison, WI 53705; General
Electric Healthcare, Milwaukee, Wis (M.W.); Department of Radiology, University
of Alabama at Birmingham, Birmingham, Ala (M.L.R.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.O.); U.S. Food and Drug
Administration, Silver Spring, Md (K.A.W.); Department of Electrical and
Computer Engineering, University of Rochester, Rochester, NY (J.O.); Department
of Natural Sciences, Kettering University, Flint, Mich (T.A.S.); Departments of
Biomedical Engineering and Radiology, University of Michigan, Ann Arbor, Mich
(J.B.F.); RSNA Quantitative Imaging Biomarkers Alliance (T.J.H.); and Center for
Ultrasound Research & Translation, Department of Radiology, Massachusetts
General Hospital, Harvard Medical School, Boston, Mass (A.E.S.)
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Näslund-Koch C, Bojesen SE, Gluud LL, Skov L, Vedel-Krogh S. Non-alcoholic fatty liver disease is not a causal risk factor for psoriasis: A Mendelian randomization study of 108,835 individuals. Front Immunol 2022; 13:1022460. [PMID: 36353626 PMCID: PMC9638101 DOI: 10.3389/fimmu.2022.1022460] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/03/2022] [Indexed: 12/03/2022] Open
Abstract
Background Psoriasis is observationally associated with a higher risk of non-alcoholic fatty liver disease (NAFLD); however, the causal relationship between the two diseases remains unclear. Objective We hypothesized that individuals with NAFLD or elevated liver fat content have higher risk of psoriasis and that NAFLD is a causal risk factor for psoriasis. We tested this using a Mendelian randomization approach. Methods We included 108,835 individuals from the Danish general population, including 1,277 individuals with psoriasis and 802 individuals with NAFLD according to ICD codes. To estimate liver fat content, a subset of the participants (N = 7,416) also had a CT scan performed. First, we tested whether a diagnosis of NAFLD or elevated liver fat content was observationally associated with risk of psoriasis. Subsequently, we used the genetic variants PNPLA3 and TM6SF2, both strongly associated with NAFLD and high liver fat content, to test whether NAFLD was causally associated with increased risk of psoriasis. Results Observationally, individuals with vs. without a diagnosis of NAFLD had higher risk of psoriasis with an odds ratio of 2.03 (95% confidence interval 1.28-3.21). The risk of psoriasis increased in a stepwise manner with increasing liver fat content with an odds ratio of 5.00 (2.63-9.46) in individuals in the highest quartile of liver fat content compared to individuals in the lowest quartile. In genetic analyses, PNPLA3 and TM6SF2 were both associated with increased risk of NAFLD but not with increased risk of psoriasis. Conclusion Observationally, a diagnosis of NAFLD or elevated liver fat content was associated with higher risk of psoriasis. However, using genetic variants as a proxy for NAFLD, we did not find evidence of a causal relationship between NAFLD and psoriasis. Thus, the observational association between NAFLD and psoriasis is presumably a result of shared confounding factors or reverse causation.
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Affiliation(s)
- Charlotte Näslund-Koch
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- *Correspondence: Charlotte Näslund-Koch,
| | - Stig Egil Bojesen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Lise Lotte Gluud
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Gastro Unit, Copenhagen University Hospital–Hvidovre, Copenhagen, Denmark
| | - Lone Skov
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Signe Vedel-Krogh
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
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7
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Donners R, Zaugg C, Gehweiler JE, Boldanova T, Heim MH, Terracciano LM, Boll DT. Computed tomography (CT) and magnetic resonance imaging (MRI) of diffuse liver disease: a multiparametric predictive modelling algorithm can aid categorization of liver parenchyma. Quant Imaging Med Surg 2022; 12:1186-1197. [PMID: 35111615 DOI: 10.21037/qims-21-384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/06/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Liver steatosis is common and tracking disease evolution to steatohepatitis and cirrhosis is essential for risk stratification and resultant patient management. Consequently, diagnostic tools allowing categorization of liver parenchyma based on routine imaging are desirable. The study objective was to compare established mono-factorial, dynamic single parameter and iterative multiparametric routine computed tomography (CT) and magnetic resonance imaging (MRI) analyses to distinguish between liver steatosis, steatohepatitis, cirrhosis and normal liver parenchyma. METHODS A total of 285 multi-phase contrast enhanced CT and 122 MRI studies with histopathological correlation of underlying parenchymal condition were retrospectively included. Parenchymal conditions were characterized based on CT Hounsfield units (HU) or MRI signal intensity (SI) measurements and calculated HU or SI ratios between non-contrast and contrast enhanced imaging time points. First, the diagnostic accuracy of mono-factorial analyses using established, static non-contrast HU and in- to opposed phase SI change cut-offs to distinguish between parenchymal conditions was established. Second, single dynamic discriminator analyses, with optimized non-contrast and enhancement HU and SI ratio cut-off values derived from the data, employing receiver operating characteristic (ROC) curve areas under the curve (AUCs) and the Youden index for maximum accuracy, were used for disease diagnosis. Third, multifactorial analyses, employing multiple non-contrast and contrast enhanced HU and SI ratio cut-offs in a nested, predictive-modelling algorithm were performed to distinguish between normal parenchyma, liver steatosis, steatohepatitis and cirrhosis. CT and MRI analyses were performed separately. RESULTS No single CT or MRI parameter showed significant difference between all four parenchymal conditions (each P>0.05). Mono-factorial static-CT-discriminator analyses identified liver steatosis with 75% accuracy. Mono-factorial MRI analyses identified steatosis with 89% accuracy. Single-dynamic CT parameter analyses identified normal parenchyma with 72% accuracy and cirrhosis with 75% accuracy. Single-dynamic MRI parameter analyses identified fatty parenchyma with 90% accuracy. Multifactorial CT analyzes identified normal parenchyma with 84%, liver steatosis with 95%, steatohepatitis with 95% and cirrhosis with 80% accuracy. Multifactorial predictive modelling of MRI parameters identified normal parenchyma with 79%, liver steatosis with 89%, steatohepatitis with 92% and cirrhosis with 89% accuracy. CONCLUSIONS Multiparametric analyses of quantitative measurements derived from routine CT and MRI, utilizing a predictive modelling algorithm, can help to distinguish between normal liver parenchyma, liver steatosis, steatohepatitis and cirrhosis.
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Affiliation(s)
- Ricardo Donners
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Carmen Zaugg
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Julian E Gehweiler
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tuyana Boldanova
- Division of Gastroenterology and Hepatology, University Hospital Basel, Basel, Switzerland.,Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Markus H Heim
- Division of Gastroenterology and Hepatology, University Hospital Basel, Basel, Switzerland.,Department of Biomedicine, University of Basel, Basel, Switzerland
| | | | - Daniel T Boll
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
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Park J, Lee JM, Lee G, Jeon SK, Joo I. Quantitative Evaluation of Hepatic Steatosis Using Advanced Imaging Techniques: Focusing on New Quantitative Ultrasound Techniques. Korean J Radiol 2022; 23:13-29. [PMID: 34983091 PMCID: PMC8743150 DOI: 10.3348/kjr.2021.0112] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 07/26/2021] [Accepted: 08/31/2021] [Indexed: 12/12/2022] Open
Abstract
Nonalcoholic fatty liver disease, characterized by excessive accumulation of fat in the liver, is the most common chronic liver disease worldwide. The current standard for the detection of hepatic steatosis is liver biopsy; however, it is limited by invasiveness and sampling errors. Accordingly, MR spectroscopy and proton density fat fraction obtained with MRI have been accepted as non-invasive modalities for quantifying hepatic steatosis. Recently, various quantitative ultrasonography techniques have been developed and validated for the quantification of hepatic steatosis. These techniques measure various acoustic parameters, including attenuation coefficient, backscatter coefficient and speckle statistics, speed of sound, and shear wave elastography metrics. In this article, we introduce several representative quantitative ultrasonography techniques and their diagnostic value for the detection of hepatic steatosis.
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Affiliation(s)
- Junghoan Park
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
| | - Gunwoo Lee
- Ultrasound R&D 2 Group, Health & Medical Equipment Business, Samsung Electronics Co., Ltd., Seoul, Korea
| | - Sun Kyung Jeon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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9
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Henning Niehoff J, Michael Woeltjen M, Saeed S, Elias Michael A, Boriesosdick J, Borggrefe J, Robert Kroeger J. Assessment of Hepatic Steatosis Based on Virtual Non-Contrast Computed Tomography: Initial Experiences with a Photon Counting Scanner Approved for Clinical Use. Eur J Radiol 2022; 149:110185. [DOI: 10.1016/j.ejrad.2022.110185] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/19/2022] [Accepted: 01/27/2022] [Indexed: 12/19/2022]
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10
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Adrian T, Sørensen IMH, Knop FK, Bro S, Ballegaard ELF, Nordestgaard BG, Fuchs A, Kofoed KF, Kühl JT, Sigvardsen PE, Hornum M, Feldt-Rasmussen B. Prevalence of non-alcoholic fatty liver disease in patients with chronic kidney disease: a case-control study. Nephrol Dial Transplant 2021; 37:1927-1934. [PMID: 34505899 DOI: 10.1093/ndt/gfab266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease and represents a wide spectrum ranging from mild steatosis over non-alcoholic steatohepatitis with and without fibrosis to overt cirrhosis. Patients with NAFLD have a high risk of developing cardiovascular disease and chronic kidney disease (CKD). So far, there is scarce evidence of the prevalence of NAFLD among patients with CKD. We investigated the prevalence of moderate-to-severe hepatic steatosis graded according to the definition of NAFLD in a cohort of patients with CKD. METHODS Hepatic liver fat content was evaluated by computed tomography (CT) scan in 291 patients from the Copenhagen Chronic Kidney Disease Cohort Study and in 866 age- and sex-matched individuals with normal kidney function from the Copenhagen General Population Study. Liver attenuation density <48 Hounsfield units was used as cut-off value for moderate-to-severe hepatic steatosis. RESULTS The prevalence of moderate-to-severe hepatic steatosis was 7.9% and 10.7% (P = 0.177) among patients with CKD and controls, respectively. No association between liver fat content and CKD stage was found. In the pooled data set from both cohorts, adjusted odds ratios for moderate-to-severe hepatic steatosis among persons with diabetes, overweight and obesity amounted to 3.1 (95% confidence interval (CI) 1.6-5.9), 14.8 (95% CI 4.6-47.9) and 42.0 (95% CI 12.9-136.6), respectively. CONCLUSIONS In a cohort of 291 patients with CKD, kidney function was not associated with the prevalence of moderate-to-severe hepatic steatosis as assessed by CT scan.
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Affiliation(s)
- Therese Adrian
- Department of Nephrology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Ida M H Sørensen
- Department of Nephrology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Filip K Knop
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,Center for Clinical Metabolic Research, Copenhagen University Hospital-Gentofte Hospital, Hellerup, Denmark.,Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Susanne Bro
- Department of Nephrology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Ellen L F Ballegaard
- Department of Nephrology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,Department of Clinical Biochemistry, and the Copenhagen General Population Study, Copenhagen University Hospital-Herlev and Gentofte Hospital, Herlev, Denmark.,The Copenhagen City Heart Study, Copenhagen University Hospital-Frederiksberg Hospital, Frederiksberg, Denmark
| | - Andreas Fuchs
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Radiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Klaus F Kofoed
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Radiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Jørgen T Kühl
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Radiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Per E Sigvardsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Radiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Mads Hornum
- Department of Nephrology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Bo Feldt-Rasmussen
- Department of Nephrology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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11
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Comparison of computed tomography hepatic steatosis criteria for identification of abnormal liver function and clinical risk factors, in incidentally noted fatty liver. Eur J Gastroenterol Hepatol 2020; 32:216-221. [PMID: 31584463 DOI: 10.1097/meg.0000000000001502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Hounsfield Units (HU) to compare the various computed tomography (CT) criteria for diagnosing hepatic steatosis with laboratory liver function parameters, and clinical risk factors retrospectively, when hepatic steatosis was incidentally detected. METHODS Institutional review board-approved, Health Insurance Portability and Accountability Act-compliant, retrospective study in 200 randomly selected patients who had either nonenhanced CT (NECT) or contrast-enhanced CT (CECT) studies with reported hepatic steatosis. The participants were matched to age, gender, and ethnicity with 200 patients without hepatic steatosis. For NECT, four different criteria have been proposed in the literature to diagnose fatty liver: (1) liver HU less than 48 HU; (2) ratio of liver to spleen HU less than 0.8; (3) HU difference between liver and spleen less than -10; and (4) hepatic vessel HU ≥ liver HU. For CECT, difference between liver and spleen HU, in portal venous phase, ≤ -20 to -25 HU. Serum glucose, aspartate aminotransferase (AST), amino alanine transferase (ALT), total bilirubin were documented. Clinical history and clinical risk factors were documented from the electronic health records. Matched analyses and Wilcoxon signed rank sum test analysis were performed for matched variables. RESULTS Fatty liver by NECT criteria 1 and 3 has statistically significant correlation with elevated glucose levels (P = 0.02). Similarly, fatty liver by 1, 3, and 4 NECT criteria showed statistically significant associations with higher levels of ALT and AST. There were statistically significant higher prevalence of diabetes mellitus (P = 0.003) and alcohol consumption (P ≤ 0.0001) in cases when compared with the controls. There was marginal significance in CT Dose Index between cases and controls (95% confidence interval: 0.98, 1.00; odds ratio 0.99), reflecting that cases had slightly higher BMI compared to their matched controls, thereby requiring slightly higher mA/mAs for imaging. CONCLUSION Particular NECT criteria for fatty liver are best at identification of abnormal liver function and certain comorbidities, in the setting of incidental fatty liver detection, This creates the potential for benefits of early detection in clinical management.
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12
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Koplay M, Gok M, Sivri M. The association between coronary artery disease and nonalcoholic fatty liver disease and noninvasive imaging methods. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2019. [DOI: 10.29333/ejgm/110689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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13
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Lauridsen BK, Stender S, Kristensen TS, Kofoed KF, Køber L, Nordestgaard BG, Tybjærg-Hansen A. Liver fat content, non-alcoholic fatty liver disease, and ischaemic heart disease: Mendelian randomization and meta-analysis of 279 013 individuals. Eur Heart J 2019; 39:385-393. [PMID: 29228164 DOI: 10.1093/eurheartj/ehx662] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 10/30/2017] [Indexed: 12/17/2022] Open
Abstract
Aims In observational studies, non-alcoholic fatty liver disease (NAFLD) is associated with high risk of ischaemic heart disease (IHD). We tested the hypothesis that a high liver fat content or a diagnosis of NAFLD is a causal risk factor for IHD. Methods and results In a cohort study of the Danish general population (n = 94 708/IHD = 10 897), we first tested whether a high liver fat content or a diagnosis of NAFLD was associated observationally with IHD. Subsequently, using Mendelian randomization, we tested whether a genetic variant in the gene encoding the protein patatin-like phospholipase domain containing 3 protein (PNPLA3), I148M (rs738409), a strong and specific cause of high liver fat content and NAFLD, was causally associated with the risk of IHD. We found that the risk of IHD increased stepwise with increasing liver fat content (in quartiles) up to an odds ratio (OR) of 2.41 (1.28-4.51)(P-trend = 0.004). The corresponding OR for IHD in individuals with vs. without NAFLD was 1.65 (1.34-2.04)(P = 3×10-6). PNPLA3 I148M was associated with a stepwise increase in liver fat content of up to 28% in MM vs. II-homozygotes (P-trend = 0.0001) and with ORs of 2.03 (1.52-2.70) for NAFLD (P = 3×10-7), 3.28 (2.37-4.54) for cirrhosis (P = 4×10-12), and 0.95 (0.86-1.04) for IHD (P = 0.46). In agreement, in meta-analysis (N = 279 013/IHD = 71 698), the OR for IHD was 0.98 (0.96-1.00) per M-allele vs. I-allele. The OR for IHD per M-allele higher genetically determined liver fat content was 0.98 (0.94-1.03) vs. an observational estimate of 1.05 (1.02-1.09)(P for comparison = 0.02). Conclusion Despite confirming the known observational association of liver fat content and NAFLD with IHD, lifelong, genetically high liver fat content was not causally associated with risk of IHD. These results suggest that the observational association is due to confounding or reverse causation.
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Affiliation(s)
- Bo Kobberø Lauridsen
- Department of Clinical Biochemistry, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Copenhagen University Hospitals and Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Stefan Stender
- Department of Clinical Biochemistry, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Copenhagen University Hospitals and Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Thomas Skårup Kristensen
- Copenhagen University Hospitals and Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Radiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Klaus Fuglsang Kofoed
- Copenhagen University Hospitals and Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Lars Køber
- Copenhagen University Hospitals and Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Børge G Nordestgaard
- Copenhagen University Hospitals and Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.,The Copenhagen General Population Study, Herlev and Gentofte Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark.,Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark.,The Copenhagen City Heart Study, Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Anne Tybjærg-Hansen
- Department of Clinical Biochemistry, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Copenhagen University Hospitals and Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.,The Copenhagen General Population Study, Herlev and Gentofte Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark.,The Copenhagen City Heart Study, Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
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14
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Thompson DS, Tennant IA, Soares DP, Osmond C, Byrne CD, Forrester TE, Boyne MS. Nonalcoholic Fatty Liver Disease in Nonobese Subjects of African Origin Has Atypical Metabolic Characteristics. J Endocr Soc 2019; 3:2051-2063. [PMID: 31637346 PMCID: PMC6795019 DOI: 10.1210/js.2019-00138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/15/2019] [Indexed: 12/11/2022] Open
Abstract
Background Nonobese nonalcoholic fatty liver disease is reported in several populations. However, because persons of African origin display unique fat accumulation, insulin resistance, and lipid profiles, we investigated fatty liver in nonobese persons of African origin. Method We recruited 78 urban Jamaican volunteers. CT was used to estimate liver and abdominal fat and dual-energy X-ray absorptiometry to measure body composition. Fasting blood was collected for lipids, alanine aminotransferase (ALT), adiponectin, and fetuin-A. Homeostatic model assessment of insulin resistance (HOMA-IR), whole-body insulin sensitivity index (WBISI), insulinogenic index (IGI), and oral disposition index (oDI) were calculated after a 75-g oral glucose tolerance test. Results Fifty-two percent of participants were male; mean (±SD) age was 28.5 ± 7.8 years, and body mass index was 22.4 ± 3.0 kg/m2. Mean liver attenuation (MLA) and liver/spleen (LS) ratio, both inversely correlated to liver fat, were 62.8 ± 4.3 HU and 1.2 ± 0.1, respectively; 3.8% of participants had liver fat >30% (LS ratio < 1). In age, sex, and BMI-adjusted correlations, MLA was negatively associated with weight (r = −0.30; P = 0.009) and height (r = −0.28; P = 0.017) and was associated with fasting glucose (r = 0.23; P = 0.05), fasting insulin (r = 0.42; P ≤ 0.001) and HOMA-IR (r = 0.35; P = 0.004). Serum lipids, ALT, adiponectin, fetuin-A, WBISI, IGI, and oDI were not associated with liver fat. Conclusions In nonobese Afro-Caribbean participants, greater liver fat was associated with weight and height and lower fasting insulin and hyperinsulinemia appears to be influential in the reduction of NAFLD. These findings may be influenced by ethnicity, body size, and method of estimating liver fat.
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Affiliation(s)
- Debbie S Thompson
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Ingrid A Tennant
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica.,Department of, Surgery, Radiology, Anesthesia and Intensive Care, The University of the West Indies, Kingston, Jamaica
| | - Deanne P Soares
- Department of, Surgery, Radiology, Anesthesia and Intensive Care, The University of the West Indies, Kingston, Jamaica
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Chris D Byrne
- Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Terrence E Forrester
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Michael S Boyne
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica.,Department of Medicine, The University of the West Indies, Kingston, Jamaica
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15
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Zhang Y, Wang C, Duanmu Y, Zhang C, Zhao W, Wang L, Cheng X, Veronese N, Guglielmi G. Comparison of CT and magnetic resonance mDIXON-Quant sequence in the diagnosis of mild hepatic steatosis. Br J Radiol 2018; 91:20170587. [PMID: 30028193 PMCID: PMC6475942 DOI: 10.1259/bjr.20170587] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 07/09/2018] [Accepted: 07/11/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE: To determine the diagnostic performance of CT in the assessment of mild hepatic steatosis by comparison with MR mDIXON-Quant as a reference standard, and to explore their clinical applications. METHODS: In this prospective study 169 volunteers were included. Each subject underwent CT and MR mDIXON-Quant examinations. Hepatic steatosis evaluations were performed via liver attenuation alone (CT L), liver to spleen attenuation ratio (CT L/S), difference between liver and spleen attenuation (CT L-S), and MR mDIXON-Quant imaging. The effectiveness of CT L, CT L/S, and CT L-S in diagnosing hepatic steatosis severity of ≥5%, ≥10%, and ≥15% was compared, using mDIXON-Quant results as standard. RESULTS: 65 subjects exhibited mild hepatic steatosis. Hepatic steatosis measurement with mDIXON-Quant was strongly correlated with the three CT methods. Using cutoff value, the sensitivity and specificity of diagnosing hepatic steatosis ≥5, ≥10, and ≥15% were 64.6, 91.3, 100%, and 90.4, 89.7, 93.0% for CT L; 50.8, 87.0, 100%, and 96.2, 98.6, 97.5% for CT L/S; and 67.7, 87.0, 100%, and 81.7, 98.6, 97.5% for CT L-S, respectively. ROC analysis indicated that 58.9, 56.5, and 52.8 HU for CT L; 1.06, 0.98, and 0.90 HU for CT L/S; and 6.21,-1.04, and -4.93 HU for CT L-S were cutoff values for diagnosing hepatic steatosis ≥5%,≥10%, and ≥15%, respectively. CONCLUSIONS: The three CT methods exhibit better agreements with mDIXON-Quant imaging for diagnosing hepatic steatosis ≥10%. Hence, CT and mDIXON-Quant could serve as suitable tools for the accurate quantification of mild hepatic steatosis. SIGNIFICANT FINDS OF THE STUDY: The close agreement between the three different CT methods (based on our cutoff values) and mDIXON-Quant imaging suggests that CT could accurately diagnose hepatic steatosis ≥10%. Thus, CT and mDIXON-Quant imaging can accurately measure mild hepatic steatosis. WHAT THIS STUDY ADDS: Only few studies have compared hepatic steatosis quantification between CT and mDIXON-Quant. We are the first to determine the diagnostic performance of unenhanced CT for quantitatively assessing mild hepatic steatosis, in reference to magnetic resonance mDIXON-Quant imaging.
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Affiliation(s)
- Yong Zhang
- Radiology Department of The Fourth Clinical Medical College of Peking University (Beijing Jishuitan Hospital), Beijing, China
| | - Chao Wang
- Department of Orthopedics, Beijing Institute of Traumatology and Orthopedics, Beijing, China
| | - Yangyang Duanmu
- Radiology Department of The Fourth Clinical Medical College of Peking University (Beijing Jishuitan Hospital), Beijing, China
| | - Chenxin Zhang
- Radiology Department of The Fourth Clinical Medical College of Peking University (Beijing Jishuitan Hospital), Beijing, China
| | - Wei Zhao
- Radiology Department of The Fourth Clinical Medical College of Peking University (Beijing Jishuitan Hospital), Beijing, China
| | - Ling Wang
- Radiology Department of The Fourth Clinical Medical College of Peking University (Beijing Jishuitan Hospital), Beijing, China
| | - Xiaoguang Cheng
- Radiology Department of The Fourth Clinical Medical College of Peking University (Beijing Jishuitan Hospital), Beijing, China
| | - Nicola Veronese
- Department of Geriatric, National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
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Yu AH, Duan-Mu YY, Zhang Y, Wang L, Guo Z, Yu YQ, Wang YS, Cheng XG. Correlation between Non-Alcoholic Fatty Liver Disease and Visceral Adipose Tissue in Non-Obese Chinese Adults: A CT Evaluation. Korean J Radiol 2018; 19:923-929. [PMID: 30174482 PMCID: PMC6082759 DOI: 10.3348/kjr.2018.19.5.923] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 02/17/2018] [Indexed: 12/14/2022] Open
Abstract
Objective To investigate the correlation between non-alcoholic fatty liver disease and visceral adipose tissue in non-obese Chinese adults using computed tomography (CT). Materials and Methods The study included 454 subjects undergoing abdominal CT scan. Degree of CT attenuation in liver and spleen, and the degree of fat infiltration in liver were evaluated according to three indices: the attenuation value of liver parenchyma (CTLP), the attenuation ratio of liver and spleen (LSratio) and the attenuation difference between liver and spleen (LSdif). Visceral fat area (VFA) and total fat area (TFA) at L2/3 and L4/5 levels were measured, and the abdominal subcutaneous fat area (SFA) was calculated. Bivariate correlation analysis was carried out to determine the correlation among these factors. Results In men, VFA, SFA and TFA at L2/3 and L4/5 levels showed significant differences in terms of the three indices to distinguish fatty liver from non-fatty liver (all, p < 0.001). In men, all the three indices showed negative correlation with TFA, SFA and VFA (all, p < 0.001). The negative correlation between the three indices and VFA at the L2/3 level was higher than at L4/5 level (r = −0.476 vs. r = −0.340 for CTLP, r = −0.502 vs. r = −0.413 for LSratio, r = −0.543 vs. r = −0.422 for LSdif, p < 0.001, respectively). The negative correlation between LSratio, LSdif and VFA at L2/3 and L4/5 levels was higher than SFA at the corresponding level. In women, all the three indices showed negative correlation with VFA and TFA at L2/3 and L4/5 levels, and the negative correlation between CTLP and VFA was higher at L2/3 level than at L4/5 level (r = −0.294 vs. r = −0.254, p < 0.001). Conclusion In non-obese Chinese adults, the degree of hepatic fatty infiltration showed a strong correlation with abdominal fat on CT. VFA at L2/3 level was more closely related to fatty liver compared with VFA at L4/5 level.
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Affiliation(s)
- Ai-Hong Yu
- Department of Radiology, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing 100035, China
| | - Yang-Yang Duan-Mu
- Department of Radiology, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Yong Zhang
- Department of Radiology, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing 100035, China
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing 100035, China
| | - Zhe Guo
- Department of Radiology, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing 100035, China
| | - Yong-Qiang Yu
- Department of Radiology, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Yu-Sheng Wang
- Department of Radiology, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing 100035, China
| | - Xiao-Guang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing 100035, China
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Abstract
Fatty liver disease is characterized histologically by hepatic steatosis, the abnormal accumulation of lipid in hepatocytes. It is classified into alcoholic fatty liver disease and nonalcoholic fatty liver disease, and is an increasingly important cause of chronic liver disease and cirrhosis. Assessing the severity of hepatic steatosis in these conditions is important for diagnostic and prognostic purposes, as hepatic steatosis is potentially reversible if diagnosed early. The criterion standard for assessing hepatic steatosis is liver biopsy, which is limited by sampling error, its invasive nature, and associated morbidity. As such, noninvasive imaging-based methods of assessing hepatic steatosis are needed. Ultrasound and computed tomography are able to suggest the presence of hepatic steatosis based on imaging features, but are unable to accurately quantify hepatic fat content. Since Dixon's seminal work in 1984, magnetic resonance imaging has been used to compute the signal fat fraction from chemical shift-encoded imaging, commonly implemented as out-of-phase and in-phase imaging. However, signal fat fraction is confounded by several factors that limit its accuracy and reproducibility. Recently, advanced chemical shift-encoded magnetic resonance imaging methods have been developed that address these confounders and are able to measure the proton density fat fraction, a standardized, accurate, and reproducible biomarker of fat content. The use of these methods in the liver, as well as in other abdominal organs such as the pancreas, adrenal glands, and adipose tissue will be discussed in this review.
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Haji-Momenian S, Parkinson W, Khati N, Brindle K, Earls J, Zeman R. Single-energy non-contrast hepatic steatosis criteria applied to virtual non-contrast images: is it still highly specific and positively predictive? Clin Radiol 2018. [DOI: 10.1016/j.crad.2018.01.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Allaway SL, Ritchie CD, Robinson D, Seear T, Reznek R, Fry IK, Thompson GR. Detection of Alcohol-Induced Fatty Liver by Computerized Tomography. J R Soc Med 2018; 81:149-51. [PMID: 2895813 PMCID: PMC1291508 DOI: 10.1177/014107688808100310] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Computerized tomographic (CT) scanning of the liver was undertaken in 17 occasional and 19 heavy drinkers undergoing health screening. The median attenuation value of the liver (CT number) in occasional drinkers with normal liver function tests was 54.4 compared with 25.9 in the heavy drinkers (P < 0.001). Fourteen of the heavy drinkers had a CT number below the lowest value observed in occasional drinkers with normal liver function, indicating reduced liver density due to fatty change. Serum gamma-glutamyl transpeptidase was normal in 36% of these individuals. A rise in CT number was observed in 4 out of 5 heavy drinkers who underwent a second scan after decreasing their alcohol consumption. These findings suggest that CT scanning provides a noninvasive and convenient method of screening for a fatty liver, which occurred to a variable degree in over 70% of the men who admitted to regularly taking 8 or more alcoholic drinks per day.
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Comparison of correlations between lipid profile and different computed tomography fatty liver criteria in the setting of incidentally noted fatty liver on computed tomography examinations. Eur J Gastroenterol Hepatol 2017; 29:1389-1396. [PMID: 28957871 DOI: 10.1097/meg.0000000000000972] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE The aim of this study was to compare the correlations between computed tomography (CT) criteria for hepatic steatosis and lipid profile values when hepatic steatosis is incidentally detected. PARTICIPANTS AND METHODS This is an institutional Review Board-approved, HIPPA-compliant, retrospective study of abdominal CT scans in 200 randomly selected patients who had either nonenhanced CT (NECT) or contrast-enhanced CT (CECT) studies with reported fatty liver. The participants were matched for age, sex, and ethnicity with 200 patients with nonfatty liver. For NECT, four different criteria have been proposed in the literature to diagnose fatty liver: (i) liver Hounsfield Units (HU) less than 48 HU, (ii) ratio of liver to spleen HU less than 0.8, (iii) HU difference between liver and spleen less than -10, and (iv) hepatic vessel HU greater than or equal to liver HU. For CECT, the criteria was attenuation difference between liver and spleen HU, in the portal venous phase of up to -20 to -25 HU. Laboratory results (low-density lipoprotein, high-density lipoprotein, triglycerides) were documented. Matched analyses and conditional logistic regression analysis were carried out for matched variables. RESULTS There were statistically significant differences in triglyceride values, between the cases and controls (P=0.02), when all criteria were considered. Also, statistically significant differences were found between cases and controls on the basis of NECT criterion 2 and high-density lipoprotein (P=0.04), as well as CECT criteria and triglyceride levels (P=0.02). In addition, the data indicate that criteria for steatosis on CECT may be more broad than traditionally utilized. CONCLUSION Incidental reporting of fatty liver on NECT/CECT should prompt consideration of clinical follow-up and lipid profile testing in an otherwise asymptomatic patient. Additional metrics for the diagnosis of steatosis in CECT exam should also be considered.
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Nishikawa M, Aosasa S, Moriya T, Noro T, Hase K, Yamamoto J. The impact of postoperative adjuvant chemotherapy on the development of nonalcoholic fatty liver disease after pancreatoduodenectomy. J Surg Res 2015; 205:127-35. [PMID: 27621009 DOI: 10.1016/j.jss.2015.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/01/2015] [Accepted: 12/11/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) after pancreatoduodenectomy (PD) is increasingly being recognized as a late postoperative complication, but the main causes have not been fully investigated. This study aimed to clarify the relationship between NAFLD after PD and postoperative adjuvant chemotherapy, focusing particularly on the adjuvant chemotherapy regimens administered. MATERIALS AND METHODS We retrospectively reviewed the medical records of 154 patients who underwent PD from April 2007 to December 2013, to identify the clinicopathologic factors most strongly influencing NAFLD development after PD. Moreover, the postoperative adjuvant chemotherapeutic regimen and the course after the cessation of adjuvant chemotherapy were examined in detail. RESULTS The incidence of postoperative NAFLD was 26.6% (41/154). The incidence of NAFLD was significantly higher in the patients with than in those without adjuvant chemotherapy: 38% versus 19% (P = 0.016). Multivariate analysis identified postoperative adjuvant chemotherapy (P = 0.021) and remnant pancreatic volume (P < 0.0001) as independent risk factors. The prevalence of NAFLD after PD was higher in patients treated with the S-1 regimen than in those given either regimens such as those containing gemcitabine or no adjuvant chemotherapy. Recovery from NAFLD 1 y after the cessation of adjuvant chemotherapy was observed in 54.5% (12/22) of patients receiving this treatment. In those treated with the S-1 regimen, improvement was more frequent than in those not receiving adjuvant chemotherapy (57.1% versus 11.8%, P = 0.018). CONCLUSIONS Considering the development of NAFLD, adjuvant chemotherapy after PD should be cared for the patients with small remnant pancreas.
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Affiliation(s)
- Makoto Nishikawa
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Suefumi Aosasa
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Tomoyuki Moriya
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Takuji Noro
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Kazuo Hase
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Junji Yamamoto
- Department of Surgery, National Defense Medical College, Saitama, Japan.
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Tappouni R, Mathew P, Connelly TM, Luke F, Messaris E. Measurement of visceral fat on preoperative computed tomography predicts complications after sigmoid colectomy for diverticular disease. Am J Surg 2015; 210:285-90. [DOI: 10.1016/j.amjsurg.2014.10.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 10/11/2014] [Accepted: 10/19/2014] [Indexed: 12/01/2022]
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Connelly TM, Tappouni R, Mathew P, Salgado J, Messaris E. Risk Factors for the Development of an Incisional Hernia after Sigmoid Resection for Diverticulitis: An Analysis of 33 Patient, Operative and Disease-associated Factors. Am Surg 2015. [DOI: 10.1177/000313481508100531] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Incisional hernia (IH) is a relatively common sequelae of sigmoidectomy for diverticulitis. The aim of this study was to investigate factors that may predict IH in diverticulitis patients. Two hundred and one diverticulitis patients undergoing sigmoidectomy between January 2002 and December 2012 were identified (mean follow-up 5.15 ± 2.33 years). Patients with wound infections were excluded. Thirteen patient-associated, three diverticular disease-related, and 17 operative variables were evaluated in patients with and without IH. Volumetric fat was measured on pre-operative CTs. Fischer's exact, χ2, and Mann–Whitney tests and multivariate regression analysis were used for statistics. Thirty-four (17%) patients had an IH. On multivariate analysis, wound packing (OR 3.4, P = 0.017), postoperative nonwound infection (OR 7.4, P = 0.014), and previous hernia (OR 3.6, P = 0.005) were as independent predictors of IH. Fifteen of 34 (44%) patients who developed a hernia had a history of prior hernia. Of 33 potential risk factors analyzed, including smoking, chronic obstructive pulmonary disease, and obesity, the only patient factor present preoperatively associated with increased risk of a postsigmoidectomy hernia after multivariate analysis was a history of a previous hernia. Preoperative identification of patients with a history of hernia offers the opportunity to employ measures to decrease the likelihood of IH.
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Affiliation(s)
- Tara M. Connelly
- Division of Colon and Rectal Surgery, Department of Surgery, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, Pennsylvania and
| | - Rafel Tappouni
- Department of Radiology, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, Pennsylvania
| | - Paul Mathew
- Department of Radiology, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, Pennsylvania
| | - Javier Salgado
- Division of Colon and Rectal Surgery, Department of Surgery, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, Pennsylvania and
| | - Evangelos Messaris
- Division of Colon and Rectal Surgery, Department of Surgery, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, Pennsylvania and
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Goulart AC, de Oliveira IRS, Alencar AP, dos Santos MSC, Santos IS, Martines BMR, Meireles DP, Martines JADS, Misciagna G, Benseñor IM, Lotufo PA. Diagnostic accuracy of a noninvasive hepatic ultrasound score for non-alcoholic fatty liver disease (NAFLD) in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). SAO PAULO MED J 2015; 133:115-24. [PMID: 26018881 PMCID: PMC10496629 DOI: 10.1590/1516-3180.2014.9150812] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 06/23/2014] [Accepted: 10/16/2014] [Indexed: 02/08/2023] Open
Abstract
CONTEXT AND OBJECTIVE Noninvasive strategies for evaluating non-alcoholic fatty liver disease (NAFLD) have been investigated over the last few decades. Our aim was to evaluate the diagnostic accuracy of a new hepatic ultrasound score for NAFLD in the ELSA-Brasil study. DESIGN AND SETTINGS Diagnostic accuracy study conducted in the ELSA center, in the hospital of a public university. METHODS Among the 15,105 participants of the ELSA study who were evaluated for NAFLD, 195 individuals were included in this sub-study. Hepatic ultrasound was performed (deep beam attenuation, hepatorenal index and anteroposterior diameter of the right hepatic lobe) and compared with the hepatic steatosis findings from 64-channel high-resolution computed tomography (CT). We also evaluated two clinical indices relating to NAFLD: the fatty liver index (FLI) and the hepatic steatosis index (HSI). RESULTS Among the 195 participants, the NAFLD frequency was 34.4%. High body mass index, high waist circumference, diabetes and hypertriglyceridemia were associated with high hepatic attenuation and large anteroposterior diameter of the right hepatic lobe, but not with the hepatorenal index. The hepatic ultrasound score, based on hepatic attenuation and the anteroposterior diameter of the right hepatic lobe, presented the best performance for NAFLD screening at the cutoff point ≥ 1 point; sensitivity: 85.1%; specificity: 73.4%; accuracy: 79.3%; and area under the curve (AUC 0.85; 95% confidence interval, CI: 0.78-0.91)]. FLI and HSI presented lower performance (AUC 0.76; 95% CI: 0.69-0.83) than CT. CONCLUSION The hepatic ultrasound score based on hepatic attenuation and the anteroposterior diameter of the right hepatic lobe has good reproducibility and accuracy for NAFLD screening.
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Affiliation(s)
- Alessandra Carvalho Goulart
- MD, PhD. Clinical Epidemiologist and Researcher, Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo (HU-USP), São Paulo, Brazil.
| | - Ilka Regina Souza de Oliveira
- MD, PhD. Professor, Radiology Department, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Airlane Pereira Alencar
- MD, PhD. Professor of Statistics and Mathematics, Institute of Mathematics and Statistics, Universidade de São Paulo (USP), São Paulo, Brazil.
| | - Maira Solange Camara dos Santos
- MD. Researcher, Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo (HU-USP), São Paulo, Brazil.
| | - Itamar Souza Santos
- MD, PhD. Professor, Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo (HU-USP), São Paulo, Brazil. São Paulo, Brazil.
| | - Brenda Margatho Ramos Martines
- MD. Attending Physician, Radiology Department, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Danilo Peron Meireles
- Radiology Technician, Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo (HU-USP), São Paulo, Brazil.
| | | | - Giovanni Misciagna
- MD. Researcher Ethics Committee, University Hospital, University of Bari, Italy.
| | - Isabela Martins Benseñor
- MD, PhD. Professor of Department of Internal Medicine and Director of Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo (HU-USP), São Paulo, Brazil.
| | - Paulo Andrade Lotufo
- MD, PhD. Professor of Department of Internal Medicine and Head of the Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo (HU-USP), São Paulo, Brazil.
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Luersen GF, Bhosale P, Szklaruk J. State-of-the-art cross-sectional liver imaging: beyond lesion detection and characterization. J Hepatocell Carcinoma 2015; 2:101-17. [PMID: 27508199 PMCID: PMC4918289 DOI: 10.2147/jhc.s85201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Cross-sectional imaging with computed tomography or magnetic resonance imaging is routinely used to detect and diagnose liver lesions; however, these examinations can provide additional important information. The improvement of equipment and techniques has allowed outstanding evaluation of the vascular and biliary anatomy, which is practicable in most routine examinations. Anatomical variants may exclude patients from certain therapeutic options and may be the cause of morbidity or mortality after surgery or interventional procedures. Diffuse liver disease, such as steatosis, hemochromatosis, or fibrosis, must be diagnosed and quantified. Usually these conditions are silent until the late stages, and imaging plays an important role in detecting them early. Additionally, a background of diffuse disease may interfere in a focal lesion systematic reasoning. The diagnostic probability of a particular nodule varies according to the background liver disease. Nowadays, most diffuse liver diseases can be easily and accurately quantified by imaging, which has allowed better understanding of these diseases and improved patient management. Finally, cross-sectional imaging can calculate total and partial liver volumes and estimate the future liver remnant after hepatectomy. This information helps to select patients for portal vein embolization and reduces postoperative complications. Use of a specific hepatic contrast agent on magnetic resonance imaging, in addition to improving detection and characterization of focal lesions, provides functional global and segmental information about the liver parenchyma.
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Affiliation(s)
- Gustavo Felipe Luersen
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Priya Bhosale
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Janio Szklaruk
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Connelly TM, Juza RM, Sangster W, Sehgal R, Tappouni RF, Messaris E. Volumetric fat ratio and not body mass index is predictive of ileocolectomy outcomes in Crohn's disease patients. Dig Surg 2014; 31:219-24. [PMID: 25277149 DOI: 10.1159/000365359] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 06/16/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Crohn's disease (CD) patients are typically underweight; however, a growing cohort of overweight CD patients is emerging. The current study investigates whether body mass index (BMI) or volumetric fat parameters can be used to predict morbidity after ileocolectomy for CD. METHODS One hundred and forty-three CD patients who underwent elective ileocolectomy were identified from our Inflammatory Bowel Disease (IBD) Registry. Patient demographics and operative outcomes were recorded. Visceral (VA) and subcutaneous (SA) adiposity and abdominal circumference (AC) were analyzed on preoperative CT scans using Aquarius iNtuition software. A visceral/subcutaneous ratio (VSR) was calculated. RESULTS BMI correlated with SA (p = 0.0001), VA (p = 0.0001) and AC (p = 0.0001) but not VSR (p > 0.05). BMI, VA and AC did not predict surgical morbidity (p > 0.05). In multivariate regression analysis, family history of IBD (p = 0.009), high American Society of Anesthesiologists score (p = 0.02) and increased VSR (p = 0.03) were independent predictors of postoperative morbidity. CONCLUSIONS The visceral/subcutaneous fat ratio is a more reliable predictor of postoperative outcomes in CD patients undergoing ileocolectomy than conventional adiposity markers such as BMI. Preoperative calculation of the visceral/subcutaneous fat ratio offers the opportunity to optimize high-risk surgical patients, thus improving outcomes.
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Affiliation(s)
- Tara M Connelly
- Division of Colon and Rectal Surgery, Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pa., USA
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Inai K, Noriki S, Kinoshita K, Nishijima A, Sakai T, Kimura H, Naiki H. Feasibility of liver weight estimation by postmortem computed tomography images: An autopsy study. Pathol Int 2014; 64:315-24. [DOI: 10.1111/pin.12174] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 05/22/2014] [Indexed: 01/01/2023]
Affiliation(s)
- Kunihiro Inai
- Division of Molecular Pathology School of Medical Sciences University of Fukui Fukui Japan
- Division of Autopsy Imaging Center School of Medical Sciences University of Fukui Fukui Japan
| | - Sakon Noriki
- Division of Tumor Pathology School of Medical Sciences University of Fukui Fukui Japan
- Division of Autopsy Imaging Center School of Medical Sciences University of Fukui Fukui Japan
| | - Kazuyuki Kinoshita
- Division of Radiology School of Medical Sciences University of Fukui Fukui Japan
- Division of Autopsy Imaging Center School of Medical Sciences University of Fukui Fukui Japan
| | - Akihiko Nishijima
- Division of Autopsy Imaging Center School of Medical Sciences University of Fukui Fukui Japan
| | - Toyohiko Sakai
- Division of Radiology School of Medical Sciences University of Fukui Fukui Japan
- Division of Autopsy Imaging Center School of Medical Sciences University of Fukui Fukui Japan
| | - Hirohiko Kimura
- Division of Radiology School of Medical Sciences University of Fukui Fukui Japan
- Division of Autopsy Imaging Center School of Medical Sciences University of Fukui Fukui Japan
| | - Hironobu Naiki
- Division of Molecular Pathology School of Medical Sciences University of Fukui Fukui Japan
- Division of Autopsy Imaging Center School of Medical Sciences University of Fukui Fukui Japan
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Dose-reduced CT with model-based iterative reconstruction in evaluations of hepatic steatosis: How low can we go? Eur J Radiol 2014; 83:1063-1068. [DOI: 10.1016/j.ejrad.2014.03.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/21/2014] [Accepted: 03/22/2014] [Indexed: 01/06/2023]
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Radiographic Features of Potential Donor Livers That Precluded Donation. AJR Am J Roentgenol 2014; 202:W343-8. [DOI: 10.2214/ajr.13.10677] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Detection of hepatic steatosis on contrast-enhanced CT images: diagnostic accuracy of identification of areas of presumed focal fatty sparing. AJR Am J Roentgenol 2012; 199:44-7. [PMID: 22733892 DOI: 10.2214/ajr.11.7838] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this article is to determine the diagnostic accuracy of identifying focal areas of increased density along the gallbladder fossa or in the periphery of segment IV for diagnosing hepatic steatosis. MATERIALS AND METHODS Five hundred consecutive three-phase CT examinations were retrospectively evaluated. Two reference standards for hepatic steatosis were determined using the unenhanced CT examination: a liver-spleen attenuation difference of greater than 10 HU and the absolute attenuation of the liver less than 40 HU. The portal venous phase was independently analyzed by two radiologists. Hepatic steatosis was diagnosed on the contrast-enhanced images if there was increased attenuation in the liver, either at the gallbladder fossa or in the posterior medial aspect of segment IV, when compared with background liver parenchyma. RESULTS The criterion of relative liver-spleen attenuation difference diagnosed 38 cases. The criterion of absolute liver attenuation less than 40 HU diagnosed 44 cases. Of these cases, hepatic steatosis was diagnosed on the portal venous phase in 23 cases (κ = 1.0), with no false-positive cases. The criterion of relative liver-spleen attenuation difference yielded sensitivity, specificity, positive predictive value, and negative predictive value of 60.5%, 100%, 100%, and 96.9%, respectively. The criterion of absolute liver attenuation less than 40 HU yielded sensitivity, specificity, positive predictive value, and negative predictive value of 52.5%, 100%, 100%, and 95.7%, respectively. CONCLUSION Qualitative evaluation of the liver on a portal venous phase contrast-enhanced CT is highly specific for the diagnosis of hepatic steatosis; the sensitivity of the method, however, is rather low.
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Kritikou I, Basta M, Tappouni R, Pejovic S, Fernandez-Mendoza J, Nazir R, Shaffer ML, Liao D, Bixler EO, Chrousos GP, Vgontzas AN. Sleep apnoea and visceral adiposity in middle-aged male and female subjects. Eur Respir J 2012; 41:601-9. [PMID: 22743670 DOI: 10.1183/09031936.00183411] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In obese male subjects, visceral adiposity has been associated with obstructive sleep apnoea (OSA), while studies in overweight males and females are limited. Our goal was to examine the association between OSA and visceral fat in a relatively nonobese population and assess the effects of 2 months placebo-controlled continuous positive airway pressure (CPAP) use on abdominal fat. 81 subjects, 22 middle-aged males and 20 post-menopausal females with OSA, and 19 male and 20 female controls were studied in the sleep laboratory for four nights. Abdominal (visceral (VAT) and subcutaneous (SAT) adipose tissue) and liver fat were assessed with computed tomography. OSA patients were re-assessed post-CPAP and post sham-CPAP. Apnoeic males had significantly higher VAT than controls, while apnoeic females had higher SAT than controls. In both sexes, OSA was associated with increased liver fat. In males, apnoea was associated with VAT whereas in females it was associated with subcutaneous, visceral and total fat. CPAP did not affect abdominal and liver fat. In overweight males, visceral adiposity is associated with OSA whereas in females it is associated with global adiposity. In overweight males, our therapeutic goal should be the reduction of visceral adiposity and its metabolic correlates, whereas, in females, weight loss may be sufficient. Short-term CPAP treatment does not affect general, abdominal or intra-hepatic adiposity.
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Affiliation(s)
- Ilia Kritikou
- Dept of Psychiatry, Pennsylvania State University College of Medicine, PA, USA
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Abstract
OBJECTIVE The purpose of this article is to review the role of diagnostic imaging in the evaluation of women with diabetes. CONCLUSION Diabetic patients present a challenging population for the performance of various imaging studies and special considerations need to be made to obtain adequate studies. Imaging plays a significant role in assessing the multisystem morbidity of diabetes. Furthermore, diabetes in women may have some unique features and consequences and imaging studies can aid in the correct management of these patients.
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Sande EPS, Martinsen ACT, Hole EO, Olerud HM. Interphantom and interscanner variations for Hounsfield units--establishment of reference values for HU in a commercial QA phantom. Phys Med Biol 2010; 55:5123-35. [PMID: 20714048 DOI: 10.1088/0031-9155/55/17/015] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In computer tomography (CT) diagnostics, the measured Hounsfield units (HU) are used to characterize tissue and are in that respect compared to nominal HU values found in the radiological literature. Quality assurance (QA) phantoms are commercially available with a variety of tissue substitutes and materials to test the HU values in CT. It is however recognized from CT physics that the HU for a given material is energy dependent and may vary substantially between scanners. The aim of this study is to analyze the characteristics of a commonly used QA phantom, the Catphan 500/600 (The Phantom Laboratory, NY). Four CT phantoms were scanned on one CT scanner to examine possible interphantom variations in HU values. Secondly, one selected phantom was scanned at three kVp levels on eight different CT scanners. The interphantom variations in HU values were small, in the range 2-5 HU. The interscanner variations were however substantial, in the range 7-56 HU depending on energy and material. Varying the x-ray energy produced a shift in the measured HU of up to 79 HU on one scanner. Reference HU values for the eight sensitometric test materials in Catphan are provided for eight CT scanner models from four vendors. The reference HU values are provided for 80, 120 and 140 kVp. Our results suggest that scanner-independent threshold levels for HU should be used only with extreme caution. Tissue characterization can be used provided that a scanner-specific data set for normal and abnormal is determined.
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Ma X, Holalkere NS, Kambadakone R A, Mino-Kenudson M, Hahn PF, Sahani DV. Imaging-based quantification of hepatic fat: methods and clinical applications. Radiographics 2009; 29:1253-77. [PMID: 19755595 DOI: 10.1148/rg.295085186] [Citation(s) in RCA: 226] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Fatty liver disease comprises a spectrum of conditions (simple hepatic steatosis, steatohepatitis with inflammatory changes, and end-stage liver disease with fibrosis and cirrhosis). Hepatic steatosis is often associated with diabetes and obesity and may be secondary to alcohol and drug use, toxins, viral infections, and metabolic diseases. Detection and quantification of liver fat have many clinical applications, and early recognition is crucial to institute appropriate management and prevent progression. Histopathologic analysis is the reference standard to detect and quantify fat in the liver, but results are vulnerable to sampling error. Moreover, it can cause morbidity and complications and cannot be repeated often enough to monitor treatment response. Imaging can be repeated regularly and allows assessment of the entire liver, thus avoiding sampling error. Selection of appropriate imaging methods demands understanding of their advantages and limitations and the suitable clinical setting. Ultrasonography is effective for detecting moderate or severe fatty infiltration but is limited by lack of interobserver reliability and intraobserver reproducibility. Computed tomography allows quantitative and qualitative evaluation and is generally highly accurate and reliable; however, the results may be confounded by hepatic parenchymal changes due to cirrhosis or depositional diseases. Magnetic resonance (MR) imaging with appropriate sequences (eg, chemical shift techniques) has similarly high sensitivity, and MR spectroscopy provides unique advantages for some applications. However, both are expensive and too complex to be used to monitor steatosis.
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Affiliation(s)
- Xiaozhou Ma
- Division of Abdominal Imaging and Intervention Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114, USA
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Hamer OW, Aguirre DA, Casola G, Lavine JE, Woenckhaus M, Sirlin CB. Fatty Liver: Imaging Patterns and Pitfalls. Radiographics 2006; 26:1637-53. [PMID: 17102041 DOI: 10.1148/rg.266065004] [Citation(s) in RCA: 256] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Fat accumulation is one of the most common abnormalities of the liver depicted on cross-sectional images. Common patterns include diffuse fat accumulation, diffuse fat accumulation with focal sparing, and focal fat accumulation in an otherwise normal liver. Unusual patterns that may cause diagnostic confusion by mimicking neoplastic, inflammatory, or vascular conditions include multinodular and perivascular accumulation. All of these patterns involve the heterogeneous or nonuniform distribution of fat. To help prevent diagnostic errors and guide appropriate work-up and management, radiologists should be aware of the different patterns of fat accumulation in the liver, especially as they are depicted at ultrasonography, computed tomography, and magnetic resonance imaging. In addition, knowledge of the risk factors and the pathophysiologic, histologic, and epidemiologic features of fat accumulation may be useful for avoiding diagnostic pitfalls and planning an appropriate work-up in difficult cases.
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Affiliation(s)
- Okka W Hamer
- Department of Diagnostic Radiology, University Hospital of Regensburg, Regensburg, Germany
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Hamer OW, Aguirre DA, Casola G, Sirlin CB. Imaging Features of Perivascular Fatty Infiltration of the Liver: Initial Observations. Radiology 2005; 237:159-69. [PMID: 16100085 DOI: 10.1148/radiol.2371041580] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE To retrospectively identify and describe the imaging features that represent perivascular fatty infiltration of the liver. MATERIALS AND METHODS The institutional review board approved the study and waived informed consent. The study complied with the Health Insurance Portability and Accountability Act. Ten patients (seven women, three men; mean age, 78 years; range, 31-78 years) with fatty infiltration surrounding hepatic veins and/or portal tracts were retrospectively identified by searching the abdominal imaging teaching file of an academic hospital. The patients' medical records were reviewed by one author. Computed tomographic (CT), magnetic resonance (MR), and ultrasonographic (US) imaging studies were reviewed by three radiologists in consensus. Fatty infiltration of the liver on CT images was defined as absolute attenuation less than 40 HU without mass effect and, if unenhanced images were available, as relative attenuation at least 10 HU less than that of the spleen; on gradient-echo MR images, it was defined as signal loss on opposed-phase images compared with in-phase images; and on US images, it was defined as hyperechogenicity of liver relative to kidney, ultrasound beam attenuation, and poor visualization of intrahepatic structures. Perivascular fatty infiltration of the liver was defined as a clear predisposition to fat accumulation around hepatic veins and/or portal tracts. For multiphase CT images, the contrast-to-noise ratio was calculated for comparison of spared liver with fatty liver in each imaging phase. RESULTS Fatty infiltration surrounded hepatic veins in three, portal tracts in five, and both hepatic veins and portal tracts in two patients. Six of the 10 patients had alcoholic cirrhosis, two reported regular alcohol consumption (one of whom had acquired immunodeficiency syndrome and hepatitis B), one was positive for human immunodeficiency virus, and one had no risk factors for fatty infiltration of the liver. In three of the 10 patients, fatty infiltration was misdiagnosed as vascular or neoplastic disease on initial CT images but was correctly diagnosed on MR images. CONCLUSION Perivascular fatty infiltration of the liver has imaging features that allow its recognition.
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Affiliation(s)
- Okka W Hamer
- Department of Radiology, Division of Body Imaging, UCSD Medical Center San Diego, 200 W Arbor Dr, San Diego, CA 92103-8756, USA
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Nakamura M, Chen HM, Momoi Y, Iwasaki T. Clinical Application of Computed Tomography for the Diagnosis of Feline Hepatic Lipidosis. J Vet Med Sci 2005; 67:1163-5. [PMID: 16327229 DOI: 10.1292/jvms.67.1163] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The usefulness of computed tomography (CT) for the diagnosis of feline hepatic lipidosis (FHL) was evaluated. Liver CT number was 54.7+/-5.6 HU (mean+/-SD) in 26 healthy cats. We fast 6 healthy cats for 72 hr to induced FHL experimentally and the cats were assessed by CT and serum biochemical analysis. Liver CT number of the six cats was 53.8+/-3.0 HU before fasting, 46.8+/-2.4 HU after fasting, and 50.2+/-3.6 HU two weeks after restarted feeding. The decreased CT number was associated with the elevation of serum non-esterified fatty acid (NEFA) and beta-hydroxybutyrate levels. These results indicate that measurement of CT number of the liver is an effective procedure for the diagnosis of FHL.
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Affiliation(s)
- Momoko Nakamura
- Department of Veterinary Internal Medicine, Tokyo University of Agriculture and Technology, Japan
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Buchman AL, Ament ME, Sohel M, Dubin M, Jenden DJ, Roch M, Pownall H, Farley W, Awal M, Ahn C. Choline deficiency causes reversible hepatic abnormalities in patients receiving parenteral nutrition: proof of a human choline requirement: a placebo-controlled trial. JPEN J Parenter Enteral Nutr 2001; 25:260-8. [PMID: 11531217 DOI: 10.1177/0148607101025005260] [Citation(s) in RCA: 150] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Previous studies have shown that plasma free choline concentrations are significantly decreased in many long-term home total parenteral nutrition (TPN) patients. Furthermore, low choline status has been associated with both hepatic morphologic and hepatic aminotransferase abnormalities. A preliminary pilot study suggested choline-supplemented TPN may be useful in reversal of these hepatic abnormalities. METHODS Fifteen patients (10 M, 5 F) who had required TPN for > or =80% of their nutritional needs were randomized to receive their usual TPN (n = 8), or TPN to which 2 g choline chloride had been added (n = 7) for 24 weeks. Baseline demographic data were similar between groups. Patients had CT scans of the liver and spleen, and blood for plasma free and phospholipid-bound choline, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase, gamma glutamyl transferase (GGT), bilirubin, serum lipids, complete blood count (CBC), and chemistry profile obtained at baseline, and weeks 2, 4, 6, 12, 16, 20, 24, and 34. CT scans were analyzed for Hounsfield unit (HU) densities. RESULTS There were no significant differences in any measured parameters after 2 weeks. However, at 4 weeks, a significant difference in liver HU between groups was observed (13.3+/-5.0 HU [choline] vs 5.8+/-5.2 HU [placebo], p = .04). This significant trend continued through week 24. Recurrent hepatic steatosis and decreased HU were observed at week 34, 10 weeks after choline supplementation had been discontinued. A significant increase in the liver-spleen differential HU was also observed in the choline group (10.6+/-6.2 HU [choline] vs 1.3+/-3.3 HU [placebo], p = .01). Serum ALT decreased significantly (p = .01 to .05) in the choline group vs placebo at weeks 6,12, 20, and 24. Serum AST was significantly decreased in the choline group by week 24 (p = .02). The serum alkaline phosphatase was significantly reduced in the choline group at weeks 2, 12, 20, 24, and 34 (p = .02 to 0.07). Total bilirubin was normal in these patients and remained unchanged during the study. Serum GGT tended to decrease more in the choline group, but the greater decrease was not statistically significant. CONCLUSIONS Choline deficiency is a significant contributor to the development of TPN-associated liver disease. The data suggest choline is a required nutrient for long-term home TPN patients.
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Affiliation(s)
- A L Buchman
- Division of Gastroenterology, Northwestern University Medical School, Chicago, IL 60611, USA.
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Jacobs JE, Birnbaum BA, Shapiro MA, Langlotz CP, Slosman F, Rubesin SE, Horii SC. Diagnostic criteria for fatty infiltration of the liver on contrast-enhanced helical CT. AJR Am J Roentgenol 1998; 171:659-64. [PMID: 9725292 DOI: 10.2214/ajr.171.3.9725292] [Citation(s) in RCA: 114] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of the study was to develop quantitative and qualitative criteria for diagnosing fatty liver on contrast-enhanced helical CT. SUBJECTS AND METHODS Differential liver-spleen attenuation was evaluated between 80 and 120 sec after injection in 76 patients who underwent contrast-enhanced helical CT. Unenhanced CT images had earlier established fatty liver when the liver minus spleen attenuation difference was less than or equal to -10 H (n = 18). Four observers who had not seen the unenhanced images used contrast-enhanced CT images to assess the presence of fatty liver on a five-point Likert scale, the presence of geographic areas spared from fatty infiltration, and the relative liver-spleen attenuation. The diagnostic accuracies of various imaging criteria were compared using McNemar's chi-square test (for sensitivity and specificity) and analysis of receiver operating characteristic curves. RESULTS Sensitivity, specificity, and receiver operating characteristic curve areas for observers' qualitative judgments were 54%, 95%, and .91, respectively; for quantitative differential liver-spleen attenuation (80-100 sec; -20.5 H discriminatory value), the values were 86%, 87%, and .94, respectively; and for quantitative differential liver-spleen attenuation (101-120 sec; -18.5 H discriminatory value), the values were 93%, 93%, and .98, respectively. Differential liver-spleen attenuation was time-dependent; overlap was noted between healthy subjects and patients with fatty liver. Qualitatively, geographic sparing was highly specific (94%) for fatty liver, whereas liver attenuation greater than or equal to spleen attenuation excluded fatty liver in all but one case. CONCLUSION Although quantitative and qualitative criteria for diagnosing fatty liver on helical CT can be determined, they are protocol-specific. Limited unenhanced hepatic CT remains the optimal technique for detection of fatty infiltration of the liver.
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Affiliation(s)
- J E Jacobs
- Department of Radiology, University of Pennsylvania Medical Center, Philadelphia 19104, USA
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Abstract
We administered lovastatin to two sisters, aged 4 and 17 years, who had cholesterol ester storage disease, an autosomal recessive disorder manifested by hypercholesterolemia and hypertriglyceridemia. The drug, a competitive inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A reductase, was taken orally for 6 months. Serum lipid concentrations were determined monthly. Computed tomography of the liver was performed before and during therapy to evaluate liver fat content. The younger sister had liver biopsies before and after 6 months of lovastatin therapy to assess hepatic cholesterol stores. Both patients had marked decreases in serum levels of cholesterol, triglycerides, and low-density lipoprotein-cholesterol; high-density lipoprotein-cholesterol levels increased. Computed tomography during treatment demonstrated a significant increase in linear attenuation, suggesting a decreased liver fat content. Liver tissue obtained 6 months after lovastatin therapy was initiated had 13% less esterified cholesterol than the liver sample obtained before treatment. We conclude that lovastatin may be effective in treating children with cholesterol ester storage disease.
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