1
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Shen HC, Wang CH, Yang CW, Lin YH, Yeh HY, Perng DW, Yang YY, Hou MC. Elevated neutrophil-to-lymphocyte ratio combined with decreased lymphocyte-to-monocyte ratio is associated with increased peripheral airway resistance in patients with hepatic steatosis. Medicine (Baltimore) 2024; 103:e38530. [PMID: 38941417 DOI: 10.1097/md.0000000000038530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2024] Open
Abstract
Although the link between hepatic steatosis and lung function has been confirmed, the focus has largely been on central airways. The association between hepatic steatosis and increased peripheral airway resistance has not yet been explored. Hepatic steatosis and increased peripheral resistance are connected with immunity dysregulation. High neutrophil-to-lymphocyte ratio (NLR) and low lymphocyte-to-monocyte ratio (LMR) have been recognized as indicators of immunity dysregulation. In this study, the association between hepatic steatosis and increased peripheral airway resistance was evaluated, and the effect of immunity dysregulation (high NLR/low LMR) on the increased peripheral airway resistance among patients with hepatic steatosis was explored. In this retrospective study, chest or abdomen CT scans and spirometry/impulse oscillometry (IOS) from 2018 to 2019 were used to identify hepatic steatosis and increased central/peripheral airway resistance in patients. Among 1391 enrolled patients, 169 (12.1%) had hepatic steatosis. After 1:1 age and abnormal ALT matching was conducted, clinical data were compared between patients with and without hepatic steatosis. A higher proportion of patients with hepatic steatosis had increased peripheral airway resistance than those without hepatic steatosis (52.7% vs 40.2%, P = .025). Old age, high body mass index, history of diabetes, and high NLR/low LMR were significantly correlated with increased peripheral airway resistance. The presence of hepatic steatosis is associated with increased peripheral airway. High NLR/low LMR is an independent associated factor of increased peripheral airway resistance in patients with hepatic steatosis. It is advisable for patients with hepatic steatosis to regularly monitor their complete blood count/differential count and undergo pulmonary function tests including IOS.
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Affiliation(s)
- Hsiao-Chin Shen
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Chest, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Hsiang Wang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ching-Wen Yang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Hsuan Lin
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Hsiao-Yun Yeh
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Diahn-Warng Perng
- Department of Chest, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ying-Ying Yang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Chih Hou
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan
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2
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Miranda J, Key Wakate Teruya A, Leão Filho H, Lahan-Martins D, Tamura Sttefano Guimarães C, de Paula Reis Guimarães V, Ide Yamauchi F, Blasbalg R, Velloni FG. Diffuse and focal liver fat: advanced imaging techniques and diagnostic insights. Abdom Radiol (NY) 2024:10.1007/s00261-024-04407-4. [PMID: 38896247 DOI: 10.1007/s00261-024-04407-4] [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: 04/16/2024] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024]
Abstract
The fatty liver disease represents a complex, multifaceted challenge, requiring a multidisciplinary approach for effective management and research. This article uses conventional and advanced imaging techniques to explore the etiology, imaging patterns, and quantification methods of hepatic steatosis. Particular emphasis is placed on the challenges and advancements in the imaging diagnostics of fatty liver disease. Techniques such as ultrasound, CT, MRI, and elastography are indispensable for providing deep insights into the liver's fat content. These modalities not only distinguish between diffuse and focal steatosis but also help identify accompanying conditions, such as inflammation and fibrosis, which are critical for accurate diagnosis and management.
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Affiliation(s)
- Joao Miranda
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.
- Department of Radiology, University of São Paulo, R. Dr. Ovídio Pires de Campos, 75-Cerqueira César, São Paulo, SP, 05403-010, Brazil.
| | - Alexandre Key Wakate Teruya
- Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, São Paulo, SP, 06455-010, Brazil
| | - Hilton Leão Filho
- Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, São Paulo, SP, 06455-010, Brazil
| | - Daniel Lahan-Martins
- Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, São Paulo, SP, 06455-010, Brazil
- Departament of Radiology-FCM, State University of Campinas (UNICAMP), R. Tessália Vieira de Camargo, 126 Cidade Universitária, Campinas, SP, 13083-887, Brazil
| | - Cássia Tamura Sttefano Guimarães
- Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, São Paulo, SP, 06455-010, Brazil
| | - Vivianne de Paula Reis Guimarães
- Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, São Paulo, SP, 06455-010, Brazil
| | - Fernando Ide Yamauchi
- Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, São Paulo, SP, 06455-010, Brazil
| | - Roberto Blasbalg
- Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, São Paulo, SP, 06455-010, Brazil
| | - Fernanda Garozzo Velloni
- Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, São Paulo, SP, 06455-010, Brazil
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Maino C, Cereda M, Franco PN, Boraschi P, Cannella R, Gianotti LV, Zamboni G, Vernuccio F, Ippolito D. Cross-sectional imaging after pancreatic surgery: The dialogue between the radiologist and the surgeon. Eur J Radiol Open 2024; 12:100544. [PMID: 38304573 PMCID: PMC10831502 DOI: 10.1016/j.ejro.2023.100544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/29/2023] [Accepted: 12/29/2023] [Indexed: 02/03/2024] Open
Abstract
Pancreatic surgery is nowadays considered one of the most complex surgical approaches and not unscathed from complications. After the surgical procedure, cross-sectional imaging is considered the non-invasive reference standard to detect early and late compilations, and consequently to address patients to the best management possible. Contras-enhanced computed tomography (CECT) should be considered the most important and useful imaging technique to evaluate the surgical site. Thanks to its speed, contrast, and spatial resolution, it can help reach the final diagnosis with high accuracy. On the other hand, magnetic resonance imaging (MRI) should be considered as a second-line imaging approach, especially for the evaluation of biliary findings and late complications. In both cases, the radiologist should be aware of protocols and what to look at, to create a robust dialogue with the surgeon and outline a fitted treatment for each patient.
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Affiliation(s)
- Cesare Maino
- Department of Diagnostic Radiology, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy
| | - Marco Cereda
- Department of Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy
| | - Paolo Niccolò Franco
- Department of Diagnostic Radiology, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy
| | - Piero Boraschi
- Radiology Unit, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy
| | - Roberto Cannella
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, 90127 Palermo, Italy
| | - Luca Vittorio Gianotti
- Department of Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy
- School of Medicine, Università Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20100 Milano, Italy
| | - Giulia Zamboni
- Institute of Radiology, Department of Diagnostics and Public Health, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Federica Vernuccio
- University Hospital of Padova, Institute of Radiology, 35128 Padova, Italy
| | - Davide Ippolito
- Department of Diagnostic Radiology, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy
- School of Medicine, Università Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20100 Milano, Italy
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4
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Matsumoto T, Shiraki T, Tanaka G, Yamaguchi T, Park KH, Mori S, Iso Y, Ishizuka M, Kubota K, Aoki T. Comparative analysis of perioperative and long-term outcomes of patients with hepatocellular carcinoma: Nonalcoholic fatty liver disease versus viral hepatitis. World J Surg 2024; 48:1219-1230. [PMID: 38468392 DOI: 10.1002/wjs.12120] [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: 12/13/2023] [Accepted: 02/18/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Despite the accumulating evidence regarding the oncological differences between nonalcoholic fatty liver disease (NAFLD)-related hepatocellular carcinoma (HCC) and viral infection-related HCC, the short- and long-term outcomes of surgical resection of NAFLD-related HCC remain unclear. While some reports indicate improved postoperative survival in NAFLD-related HCC, other studies suggest higher postoperative complications in these patients. METHODS Patients with NAFLD and those with hepatitis viral infection who underwent hepatectomy for HCC at our department were retrospectively analyzed. The clinical, surgical, pathological, and survival outcomes were compared between the two groups. RESULTS Among the 1047 consecutive patients who underwent hepatectomy for HCC, 57 had NAFLD-related HCC (NAFLD group), and 727 had virus-related HCC (VH group). The body mass index and serum glycated hemoglobin levels were significantly higher in the NAFLD group than in the VH group. There were no significant differences in operative time and bleeding amount. Moreover, the morbidity and the length of postoperative hospital stays were similar across both groups. The pathological results showed that the tumor size was significantly larger in the NAFLD group than in the VH group. No significant differences between the groups in overall or recurrence-free survival were found. In a subgroup analysis with matched tumor diameters, patients in the NAFLD group had a better prognosis after hepatectomy than those in the VH group. CONCLUSION Surgical outcomes after hepatectomy were comparable between the groups. Subgroup analysis reveals early detection and surgical intervention in NAFLD-HCC may improve prognosis.
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Affiliation(s)
- Takatsugu Matsumoto
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Takayuki Shiraki
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Genki Tanaka
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Takamune Yamaguchi
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Kyung-Hwa Park
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Shozo Mori
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Yukihiro Iso
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Mitsuru Ishizuka
- Center of Colorectal Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Keiichi Kubota
- Department of Surgery, Tohto Bunkyo Hospital, Tokyo, Japan
| | - Taku Aoki
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, Tochigi, Japan
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5
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Fourman LT, Tsai LL, Brown RJ, O'Rahilly S. Case 10-2024: A 46-Year-Old Woman with Hyperglycemia Refractory to Insulin Therapy. N Engl J Med 2024; 390:1219-1229. [PMID: 38598578 DOI: 10.1056/nejmcpc2312729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Affiliation(s)
- Lindsay T Fourman
- From the Departments of Medicine (L.T.F.) and Radiology (L.L.T.), Massachusetts General Hospital, and the Departments of Medicine (L.T.F.) and Radiology (L.L.T.), Harvard Medical School - both in Boston; the National Institute of Diabetes and Digestive and Kidney Diseases and the National Institutes of Health - both in Bethesda, MD (R.J.B.); and the Department of Clinical Biochemistry, University of Cambridge, Cambridge, United Kingdom (S.O.)
| | - Leo L Tsai
- From the Departments of Medicine (L.T.F.) and Radiology (L.L.T.), Massachusetts General Hospital, and the Departments of Medicine (L.T.F.) and Radiology (L.L.T.), Harvard Medical School - both in Boston; the National Institute of Diabetes and Digestive and Kidney Diseases and the National Institutes of Health - both in Bethesda, MD (R.J.B.); and the Department of Clinical Biochemistry, University of Cambridge, Cambridge, United Kingdom (S.O.)
| | - Rebecca J Brown
- From the Departments of Medicine (L.T.F.) and Radiology (L.L.T.), Massachusetts General Hospital, and the Departments of Medicine (L.T.F.) and Radiology (L.L.T.), Harvard Medical School - both in Boston; the National Institute of Diabetes and Digestive and Kidney Diseases and the National Institutes of Health - both in Bethesda, MD (R.J.B.); and the Department of Clinical Biochemistry, University of Cambridge, Cambridge, United Kingdom (S.O.)
| | - Stephen O'Rahilly
- From the Departments of Medicine (L.T.F.) and Radiology (L.L.T.), Massachusetts General Hospital, and the Departments of Medicine (L.T.F.) and Radiology (L.L.T.), Harvard Medical School - both in Boston; the National Institute of Diabetes and Digestive and Kidney Diseases and the National Institutes of Health - both in Bethesda, MD (R.J.B.); and the Department of Clinical Biochemistry, University of Cambridge, Cambridge, United Kingdom (S.O.)
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6
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Badawy M, Elsayes KM, Lubner MG, Shehata MA, Fowler K, Kaoud A, Pickhardt PJ. Metabolic syndrome: imaging features and clinical outcomes. Br J Radiol 2024; 97:292-305. [PMID: 38308038 DOI: 10.1093/bjr/tqad044] [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: 05/22/2023] [Revised: 09/19/2023] [Accepted: 11/27/2023] [Indexed: 02/04/2024] Open
Abstract
Metabolic syndrome, which affects around a quarter of adults worldwide, is a group of metabolic abnormalities characterized mainly by insulin resistance and central adiposity. It is strongly correlated with cardiovascular and all-cause mortality. Early identification of the changes induced by metabolic syndrome in target organs and timely intervention (eg, weight reduction) can decrease morbidity and mortality. Imaging can monitor the main components of metabolic syndrome and identify early the development and progression of its sequelae in various organs. In this review, we discuss the imaging features across different modalities that can be used to evaluate changes due to metabolic syndrome, including fatty deposition in different organs, arterial stiffening, liver fibrosis, and cardiac dysfunction. Radiologists can play a vital role in recognizing and following these target organ injuries, which in turn can motivate lifestyle modification and therapeutic intervention.
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Affiliation(s)
- Mohamed Badawy
- Department of Diagnostic Radiology, Wayne State University, Detroit, MI, 48202, United States
| | - Khaled M Elsayes
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, United States
| | - Meghan G Lubner
- Department of Diagnostic Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, United States
| | - Mostafa A Shehata
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, United States
| | - Kathryn Fowler
- Department of Diagnostic Radiology, University of California San Diego, San Diego, CA, 92093, United States
| | - Arwa Kaoud
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, United States
| | - Perry J Pickhardt
- Department of Diagnostic Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, United States
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7
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Arif-Tiwari H, Porter KK, Kamel IR, Bashir MR, Fung A, Kaplan DE, McGuire BM, Russo GK, Smith EN, Solnes LB, Thakrar KH, Vij A, Wahab SA, Wardrop RM, Zaheer A, Carucci LR. ACR Appropriateness Criteria® Abnormal Liver Function Tests. J Am Coll Radiol 2023; 20:S302-S314. [PMID: 38040457 DOI: 10.1016/j.jacr.2023.08.023] [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: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Liver function tests are commonly obtained in symptomatic and asymptomatic patients. Various overlapping lab patterns can be seen due to derangement of hepatocytes and bile ducts function. Imaging tests are pursued to identify underlying etiology and guide management based on the lab results. Liver function tests may reveal mild, moderate, or severe hepatocellular predominance and can be seen in alcoholic and nonalcoholic liver disease, acute hepatitis, and acute liver injury due to other causes. Cholestatic pattern with elevated alkaline phosphatase with or without elevated γ-glutamyl transpeptidase can be seen with various causes of obstructive biliopathy. Acute or subacute cholestasis with conjugated or unconjugated hyperbilirubinemia can be seen due to prehepatic, intrahepatic, or posthepatic causes. We discuss the initial and complementary imaging modalities to be used in clinical scenarios presenting with abnormal liver function tests. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Hina Arif-Tiwari
- University of Arizona, Banner University Medical Center, Tucson, Arizona.
| | | | - Ihab R Kamel
- Panel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Alice Fung
- Oregon Health & Science University, Portland, Oregon
| | - David E Kaplan
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania; American Association for the Study of Liver Diseases
| | - Brendan M McGuire
- University of Alabama at Birmingham, Birmingham, Alabama, Primary care physician
| | | | - Elainea N Smith
- University of Alabama at Birmingham Medical Center, Birmingham, Alabama
| | - Lilja Bjork Solnes
- Johns Hopkins Bayview Medical Center, Baltimore, Maryland; Commission on Nuclear Medicine and Molecular Imaging
| | | | - Abhinav Vij
- New York University Langone Medical Center, New York, New York
| | - Shaun A Wahab
- University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Richard M Wardrop
- Cleveland Clinic, Cleveland, Ohio; American College of Physicians, Hospital Medicine
| | | | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
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8
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Schattenberg JM, Chalasani N, Alkhouri N. Artificial Intelligence Applications in Hepatology. Clin Gastroenterol Hepatol 2023; 21:2015-2025. [PMID: 37088460 DOI: 10.1016/j.cgh.2023.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 03/16/2023] [Accepted: 04/14/2023] [Indexed: 04/25/2023]
Abstract
Over the past 2 decades, the field of hepatology has witnessed major developments in diagnostic tools, prognostic models, and treatment options making it one of the most complex medical subspecialties. Through artificial intelligence (AI) and machine learning, computers are now able to learn from complex and diverse clinical datasets to solve real-world medical problems with performance that surpasses that of physicians in certain areas. AI algorithms are currently being implemented in liver imaging, interpretation of liver histopathology, noninvasive tests, prediction models, and more. In this review, we provide a summary of the state of AI in hepatology and discuss current challenges for large-scale implementation including some ethical aspects. We emphasize to the readers that most AI-based algorithms that are discussed in this review are still considered in early development and their utility and impact on patient outcomes still need to be assessed in future large-scale and inclusive studies. Our vision is that the use of AI in hepatology will enhance physician performance, decrease the burden and time spent on documentation, and reestablish the personalized patient-physician relationship that is of utmost importance for obtaining good outcomes.
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Affiliation(s)
- Jörn M Schattenberg
- Metabolic Liver Research Program, I. Department of Medicine, University Medical Center Mainz, Mainz, Germany
| | - Naga Chalasani
- Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana
| | - Naim Alkhouri
- Arizona Liver Health and University of Arizona, Tucson, Arizona.
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9
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Gong P, Huang C, Lok UW, Tang S, Ling W, Zhou C, Yang L, Watt KD, Callstrom M, Chen S. Improved Ultrasound Attenuation Estimation with Non-uniform Structure Detection and Removal. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:2292-2301. [PMID: 36031504 PMCID: PMC9529831 DOI: 10.1016/j.ultrasmedbio.2022.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/23/2022] [Accepted: 06/26/2022] [Indexed: 06/15/2023]
Abstract
Accurate detection of liver steatosis is important for liver disease management. Ultrasound attenuation coefficient estimation (ACE) has great potential in quantifying liver fat content. The ACE methods commonly assume uniform tissue characteristics. However, in vivo tissues typically contain non-uniform structures, which may bias the attenuation estimation and lead to large standard deviations. Here we propose a series of non-uniform structure detection and removal (NSDR) methods to reduce the impact from non-uniform structures during ACE analysis. The effectiveness of NSDR was validated through phantom and in vivo studies. In a pilot clinical study, ACE with NSDR provided more robust in vivo performance as compared with ACE without NSDR, indicating its potential for in vivo applications.
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Affiliation(s)
- Ping Gong
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Chengwu Huang
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - U-Wai Lok
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Shanshan Tang
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Wenwu Ling
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA; Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Chenyun Zhou
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA; Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Lulu Yang
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA; Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Kymberly D Watt
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Shigao Chen
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
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10
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Individualized Contrast Media Application Based on Body Weight and Contrast Enhancement in Computed Tomography of Livers without Steatosis. Diagnostics (Basel) 2022; 12:diagnostics12071551. [PMID: 35885457 PMCID: PMC9322492 DOI: 10.3390/diagnostics12071551] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 11/16/2022] Open
Abstract
This study analyzes the homogeneity in liver attenuation of a body-weight-based protocol compared to a semi-fixed protocol. Patients undergoing abdominal multiphase computed tomography received 0.500 g of iodine (gI) per kilogram of body weight. Liver attenuation and enhancement were determined using regions of interest on scans in the pre-contrast and portal venous phases. The outcomes were analyzed for interpatient uniformity in weight groups. The subjective image quality was scored using a four-point Likert scale (excellent, good, moderate, and nondiagnostic). A total of 80 patients were included (56.3% male, 64 years, 78.0 kg) and were compared to 80 propensity-score-matched patients (62.5% male, 63 years, 81.7 kg). The liver attenuation values for different weight groups of the TBW-based protocol were not significantly different (p = 0.331): 109.1 ± 13.8 HU (≤70 kg), 104.6 ± 9.70 HU (70−90 kg), and 105.1 ± 11.6 HU (≥90 kg). For the semi-fixed protocol, there was a significant difference between the weight groups (p < 0.001): 121.1 ± 12.1 HU (≤70 kg), 108.9 ± 11.0 HU (70−90 kg), and 105.0 ± 9.8 HU (≥90 kg). For the TBW-based protocol, the enhancement was not significantly different between the weight groups (p = 0.064): 46.2 ± 15.1 HU (≤70 kg), 59.3 ± 6.8 HU (70−90 kg), and 52.1 ± 11.7 HU (≥90 kg). Additionally, for the semi-fixed protocol, the enhancement was not significantly different between the weight groups (p = 0.069): 59.4 ± 11.0 HU (≤70 kg), 53.0 ± 10.3 HU (70−90 kg), and 52.4 ± 7.5 HU (≥90 kg). The mean administered amount of iodine per kilogram was less for the TBW-based protocol compared to the semi-fixed protocol: 0.499 ± 0.012 and 0.528 ± 0.079, respectively (p = 0.002). Of the TBW-based protocol, 17.5% of the scans scored excellent enhancement quality, 76.3% good, and 6.3% moderate. Of the semi-fixed protocol, 70.0% scored excellent quality, 21.3% scored good, and 8.8% scored moderate. In conclusion, the TBW-based protocol increased the interpatient uniformity of liver attenuation but not the enhancement in the portal venous phase compared to the semi-fixed protocol, using an overall lower amount of contrast media and maintaining good subjective image quality.
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11
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Jeon D, Park BH, Lee HC, Park Y, Lee W, Lee JH, Song KB, Hwang DW, Kim SC, Choi J. The Impact of Pylorus Preservation on the Development of Nonalcoholic Fatty Liver Disease after Pancreaticoduodenectomy: A Historical Cohort Study. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022; 29:863-873. [DOI: 10.1002/jhbp.1150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 02/05/2022] [Accepted: 02/08/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Dongsub Jeon
- Department of Gastroenterology, Liver Center, Asan Medical Center University of Ulsan College of Medicine Seoul Republic of Korea
| | | | - Han Chu Lee
- Department of Gastroenterology, Liver Center, Asan Medical Center University of Ulsan College of Medicine Seoul Republic of Korea
| | - Yejong Park
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center University of Ulsan College of Medicine Seoul Republic of Korea
| | - Woohyung Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center University of Ulsan College of Medicine Seoul Republic of Korea
| | - Jae Hoon Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center University of Ulsan College of Medicine Seoul Republic of Korea
| | - Ki Byung Song
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center University of Ulsan College of Medicine Seoul Republic of Korea
| | - Dae Wook Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center University of Ulsan College of Medicine Seoul Republic of Korea
| | - Song Cheol Kim
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center University of Ulsan College of Medicine Seoul Republic of Korea
| | - Jonggi Choi
- Department of Gastroenterology, Liver Center, Asan Medical Center University of Ulsan College of Medicine Seoul Republic of Korea
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Doğan E, Bacaksızlar Sarı F. Is Fat Deposition of Renal Sinus a Concomitant Finding to Fatty Liver Disease? The First Study Regarding the Relationship Between Kidney and Liver Fat Content with Non-Contrast Computed Tomography. Spartan Med Res J 2022; 7:32411. [PMID: 35291709 PMCID: PMC8873428 DOI: 10.51894/001c.32411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/31/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION It has been established that abnormal fat deposits are associated with fat deposition in other abdominal regions and linked to obesity, diabetes mellitus, hypertension, vascular and metabolic diseases. This study aimed to determine whether there was a relationship between fat deposition of the renal (i.e., kidney) sinus (FRS) and fatty liver disease (FLD) in a sample of adults. The authors hypothesized that FRS could be a diagnostic finding associated with Hepatosteatosis (HS) in a sample of younger patients. This study was the first apparent investigation of this possible phenomenon. METHODS A convenience sample of 92 adult patients of which 19 (20.7%) were females and 73 (79.3%) were males, and with a mean age of 30.19 (SD = 6.00) were included. The authors calculated Hounsfield Units (HU) (i.e., relative quantitative measurement of radio density) of patients' livers and spleens on non-contrast computed tomography (CT). Liver and spleen differences < 10 HU were considered steatosis (FLD). The authors stratified sample patients into two analytic subgroups according to the presence of FLD or not and compared them based on their FRS widths. RESULTS In the FLD subgroup (N = 48), the difference of HU values between liver and spleen was -5.19 (SD = 11.32), with a range of -38 - 8 HU, while, in the non-steatosis subgroup (N = 44), the mean difference was 16.36 (SD = 3.90), range of 11 - 26 HU. The average diameter of FRS width was 12.5 mm in those patients with steatosis (FLD subgroup) although 9.3 mm in non-FLD patients. (p = 0.02). CONCLUSIONS Based on these results, FRS may be able to be used by radiologists as an ancillary method in the detection of hepatic steatosis in younger adults. The effectiveness of premedical processes (e.g., exercise and diet modification) can also be increased by non-radiologists after detection of lower-grade HS.
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Chauveau B, Hordonneau C, Magnin B. Douleurs abdominales aiguës, non obstétricales, chez la femme enceinte : place de l’imagerie. IMAGERIE DE LA FEMME 2021. [DOI: 10.1016/j.femme.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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van Cooten VV, de Jong DJ, Wessels FJ, de Jong PA, Kok M. Liver Enhancement on Computed Tomography Is Suboptimal in Patients with Liver Steatosis. J Pers Med 2021; 11:1255. [PMID: 34945727 PMCID: PMC8707755 DOI: 10.3390/jpm11121255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/15/2021] [Accepted: 11/22/2021] [Indexed: 12/15/2022] Open
Abstract
This study's aim was twofold. Firstly, to assess liver enhancement quantitatively and qualitatively in steatotic livers compared to non-steatotic livers on portal venous computed tomography (CT). Secondly, to determine the injection volume of contrast medium in patients with severe hepatic steatosis to improve the image quality of the portal venous phase. We retrospectively included patients with non-steatotic (n = 70), the control group, and steatotic livers (n = 35) who underwent multiphase computed tomography between March 2016 and September 2020. Liver enhancement was determined by the difference in attenuation in Hounsfield units (HU) between the pre-contrast and the portal venous phase, using region of interests during in three different segments. Liver steatosis was determined by a mean attenuation of ≤40 HU on unenhanced CT. Adequate enhancement was objectively defined as ≥50 ΔHU and subjectively using a three-point Likert scale. Enhancement of non-steatotic and steatotic livers were compared and associations between enhancement and patient- and scan characteristics were analysed. Enhancement was significantly higher among the control group (mean 51.9 ± standard deviation 11.5 HU) compared to the steatosis group (40.6 ± 8.4 HU p for difference < 0.001). Qualitative analysis indicated less adequate enhancement in the steatosis group: 65.7% of the control group was rated as good vs. 8.6% of the steatosis group. We observed a significant correlation between enhancement, and presence/absence of steatosis and grams of iodine per total body weight (TBW) (p < 0.001; adjusted R2 = 0.303). Deduced from this correlation, theoretical contrast dosing in grams of Iodine (g I) can be calculated: g I = 0.502 × TBW for non-steatotic livers and g I = 0.658 × TBW for steatotic livers. Objective and subjective enhancement during CT portal phase were significantly lower in steatotic livers compared to non-steatotic livers, which may have consequences for detectability and contrast dosing.
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Affiliation(s)
| | | | | | | | - Madeleine Kok
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; (V.V.v.C.); (D.J.d.J.); (F.J.W.); (P.A.d.J.)
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15
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The associations between coronary artery disease, and non-alcoholic fatty liver disease by computed tomography. Egypt Heart J 2021; 73:96. [PMID: 34718898 PMCID: PMC8557221 DOI: 10.1186/s43044-021-00222-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/21/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is increasing in recognition as a hepatic condition that is unrelated to significant alcoholic consumption, but has rather, been suggested to constitute cardiovascular risk (irrespective of traditional risk factors and high-risk plaque features). Both coronary artery disease and NAFLD share the same pathophysiology and metabolic profile. NAFLD can theoretically be a source/initiator for coronary artery disease (CAD). We aimed to study the association between NAFLD, CAD, the presence of high-risk plaque features, and the severity of stenosis. RESULTS We recruited 800 patients with suspected obstructive CAD and planned for coronary computed tomography angiography (CCTA), Exclusion criteria: heavy alcohol consumption; contraindications to contrast media; unevaluated coronary-artery segments; other known liver disease; and use of oral corticosteroids and/or amiodarone. Non-enhanced Computed Tomography abdomen was performed before the CCTA to detect NAFLD. To study the association between NAFLD and the presence of CAD, patients were classified as to either have, or not have CAD. The CAD group were then further studied for the presence of high-risk plaque features: napkin ring sign, Positive remodelling, Low Hounsfield unit (HU), and Spotty calcium; and their association with NAFLD. Thirty-two per cent of patients had NAFLD and 45% had CAD. A significant association between NAFLD and CAD was found (OR 4.21, 95% CI (confidence interval) (2.83-6.25), p = 0.000). In CAD patients, significant associations were present between NAFLD and high-risk plaque features: Napkin ring sign, Positive remodelling, Low HU, and Spotty calcium (OR 7.88, 95% CI (4.39-14.12), p < 0.001, OR 5.84, 95% (3.85-8.85), p < 0.001, OR 7.25, 95% CI (3.31-15.90), p < 0.001 and OR 6.66, 95% CI (3.75-11.82), p < 0.001), respectively. NAFLD was present in 39.30%, 50.00%, 20.00%, 54.50% and 100.00% of patients with CAD; and 1-24%; 25-49%; 50-69%; 7 = 0-99%, LMD (Left Main Disease) > 50% stenosis or 3V disease, and Total occlusion, respectively, p < 0.001. CONCLUSIONS NAFLD is strongly associated with CAD, high-risk plaque features and higher grade of stenosis.
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Lee MCM, Kachura JJ, Vlachou PA, Dzulynsky R, Di Tomaso A, Samawi H, Baxter N, Brezden-Masley C. Evaluation of Adjuvant Chemotherapy-Associated Steatosis (CAS) in Colorectal Cancer. ACTA ACUST UNITED AC 2021; 28:3030-3040. [PMID: 34436031 PMCID: PMC8395441 DOI: 10.3390/curroncol28040265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/31/2021] [Accepted: 08/04/2021] [Indexed: 11/20/2022]
Abstract
Chemotherapy-associated steatosis is poorly understood in the context of colorectal cancer. In this study, Stage II–III colorectal cancer patients were retrospectively selected to evaluate the frequency of chemotherapy-associated steatosis and to determine whether patients on statins throughout adjuvant chemotherapy develop chemotherapy-associated steatosis at a lower frequency. Baseline and incident steatosis for up to one year from chemotherapy start date was assessed based on radiology. Of 269 patients, 76 (28.3%) had steatosis at baseline. Of the remaining 193 cases, patients receiving adjuvant chemotherapy (n = 135) had 1.57 (95% confidence interval [CI], 0.89 to 2.79) times the adjusted risk of developing steatosis compared to patients not receiving chemotherapy (n = 58). Among patients who underwent chemotherapy, those using statins for pre-existing hyperlipidemia (n = 37) had 0.71 (95% CI, 0.10 to 2.75) times the risk of developing steatosis compared to patients who were not prevalent users of statins (n = 98). Chemotherapeutic treatment of Stage II–III colorectal cancer appears to be consistent with a moderately increased risk of steatosis, although larger studies are necessary to assess the significance of this observation. Prospective trials should be considered to further explore the potential for protective use of statins in this curative patient population.
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Affiliation(s)
- Michelle C. M. Lee
- St. Michael’s Hospital, 30 Bond St, Toronto, ON M5B 1W8, Canada; (M.C.M.L.); (P.A.V.); (R.D.); (H.S.); (N.B.)
- Medical Sciences Building, 1 King’s College Circle, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Jacob J. Kachura
- Mount Sinai Hospital, 1284-600 University Avenue, Toronto, ON M5G 1X5, Canada; (J.J.K.); (A.D.T.)
| | - Paraskevi A. Vlachou
- St. Michael’s Hospital, 30 Bond St, Toronto, ON M5B 1W8, Canada; (M.C.M.L.); (P.A.V.); (R.D.); (H.S.); (N.B.)
- Medical Sciences Building, 1 King’s College Circle, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Raissa Dzulynsky
- St. Michael’s Hospital, 30 Bond St, Toronto, ON M5B 1W8, Canada; (M.C.M.L.); (P.A.V.); (R.D.); (H.S.); (N.B.)
| | - Amy Di Tomaso
- Mount Sinai Hospital, 1284-600 University Avenue, Toronto, ON M5G 1X5, Canada; (J.J.K.); (A.D.T.)
| | - Haider Samawi
- St. Michael’s Hospital, 30 Bond St, Toronto, ON M5B 1W8, Canada; (M.C.M.L.); (P.A.V.); (R.D.); (H.S.); (N.B.)
- Medical Sciences Building, 1 King’s College Circle, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Nancy Baxter
- St. Michael’s Hospital, 30 Bond St, Toronto, ON M5B 1W8, Canada; (M.C.M.L.); (P.A.V.); (R.D.); (H.S.); (N.B.)
- Medical Sciences Building, 1 King’s College Circle, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Christine Brezden-Masley
- St. Michael’s Hospital, 30 Bond St, Toronto, ON M5B 1W8, Canada; (M.C.M.L.); (P.A.V.); (R.D.); (H.S.); (N.B.)
- Mount Sinai Hospital, 1284-600 University Avenue, Toronto, ON M5G 1X5, Canada; (J.J.K.); (A.D.T.)
- Lunenfeld-Tanenbaum Research Institute, 600 University Ave, Toronto, ON M5G 1X5, Canada
- Correspondence: ; Tel.: +416-586-8605; Fax: +416-586-8659
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Ali A, Hasan M, Hamed S, Elhamy A. Hepatic steatosis: a risk factor for increased COVID-19 prevalence and severity-a computed tomography study. EGYPTIAN LIVER JOURNAL 2021; 11:61. [PMID: 34777870 PMCID: PMC8274961 DOI: 10.1186/s43066-021-00131-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/20/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Around 25% of the world population was affected by the metabolic-related fatty liver disorder. Hepatic steatosis is frequently observed in conjunction with hypertension, obesity comorbidities, and diabetes. We evaluate the hepatic steatosis frequency found in chest CT exams of COVID-19-positive cases compared to non-infected controls and evaluate the related increased prevalence and severity of COVID. RESULTS Our research includes 355 subjects, 158 with positive PCR for COVID-19 (case group) and 197 with negative PCR and negative CT chest (control group). The mean age in the positive group was 50.6 ± 16 years, and in the control, it was 41.3 ± 16 years (p < 0.001). Our study consists of 321 men (90.5%) and 34 women (9.5%). The number of males in both cases and control groups was greater. In the case group, 93% men vs. 6.9% women, while in controls, 88.3% men vs.11.6% women, p < 0.001. CT revealed normal results in 55.5% of individuals (i.e., CORADs 1) and abnormal findings in 45.5% of participants (i.e., CORADs 2-5). In abnormal scan, CO-RADs 2 was 13.92%, while CO-RADs 3-4 were 20.89% of cases. CO-RADs 5 comprised 65.19% of all cases. Approximately 42.6% of cases had severe disease (CT score ≥ 20), all of them were CO-RADs 5. The PCR-positive class had a greater prevalence of hepatic steatosis than controls (28.5% vs.12.2%, p < 0.001). CO-RADs 2 represented 11.1%, CO-RADs 3-4 represented 15.6%, and CO-RADs 5 represented 73.3% in the hepatic steatosis cases. The mean hepatic attenuation value in the case group was 46.79 ± 12.68 and in the control group 53.34 ± 10.28 (p < 0.001). When comparing patients with a higher severity score (CT score ≥ 20) to those with non-severe pneumonia, it was discovered that hepatic steatosis is more prevalent (73.2% vs. 26.8%). CONCLUSIONS Steatosis was shown to be substantially more prevalent in COVID-19-positive individuals. There is a relation among metabolic syndrome, steatosis of the liver, and obesity, as well as the COVID-19 severity.
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Affiliation(s)
- Asmaa Ali
- Theodor Bilharz Institute, Kornish Elnil, Embaba, Giza, Egypt
| | - Mona Hasan
- Theodor Bilharz Institute, Kornish Elnil, Embaba, Giza, Egypt
| | - Shaimaa Hamed
- Theodor Bilharz Institute, Kornish Elnil, Embaba, Giza, Egypt
| | - Amir Elhamy
- Theodor Bilharz Institute, Kornish Elnil, Embaba, Giza, Egypt
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18
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Okura H, Yodoshi T, Thapaliya S, Trout AT, Mouzaki M. Under-reporting of Hepatic Steatosis in Children: A Missed Opportunity for Early Detection. J Pediatr 2021; 234:92-98.e2. [PMID: 33745998 DOI: 10.1016/j.jpeds.2021.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/15/2021] [Accepted: 03/11/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine the prevalence of underreporting of hepatic steatosis found incidentally on computed tomography (CT). STUDY DESIGN Retrospective cross-sectional study including patients <18 years of age who had undergone unenhanced abdominal CT for evaluation of nephrolithiasis. Hepatic and splenic attenuation were measured independently by 2 reviewers. Hepatic steatosis was defined using various previously established criteria (4 original criteria designed to detect moderate/severe steatosis and 3 secondary criteria designed to identify mild steatosis). Radiology reports and clinical notes were reviewed for documentation of steatosis. Serum alanine aminotransferase levels were collected. Kappa statistics were used to assess agreement between reviewers. RESULTS A total of 584 patients were included. Agreement between reviewers' measurements for categorical classification of presence of steatosis was excellent (kappa statistic agreement >87%). The prevalence of hepatic steatosis ranged from 3% to 35%, depending on the criterion. Using absolute liver attenuation <48 Hounsfield units (most likely reflective of the truth, given alanine aminotransferase distribution and body mass index data), the prevalence was 7% (n = 42). Steatosis was reported for only 12 of 42 (28%) of these patients and was documented in clinical notes in only 3 of those cases. CONCLUSIONS Hepatic steatosis is underreported as an incidental finding of CT for nephrolithiasis. Given the prevalence and silent nature of nonalcoholic fatty liver disease, a high level of suspicion is needed, so as not to miss the opportunity to identify steatosis in childhood.
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Affiliation(s)
- Hiroko Okura
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Toshifumi Yodoshi
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Samjhana Thapaliya
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Marialena Mouzaki
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
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19
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Tahtabasi M, Hosbul T, Karaman E, Akin Y, Kilicaslan N, Gezer M, Sahiner F. Frequency of hepatic steatosis and its association with the pneumonia severity score on chest computed tomography in adult COVID-19 patients. World J Crit Care Med 2021; 10:47-57. [PMID: 34046310 PMCID: PMC8131933 DOI: 10.5492/wjccm.v10.i3.47] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/19/2021] [Accepted: 04/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Recent studies of the coronavirus disease 2019 (COVID-19) demonstrated that obesity is significantly associated with increased disease severity, clinical outcome, and mortality. The association between hepatic steatosis, which frequently accompanies obesity, and the pneumonia severity score (PSS) evaluated on computed tomography (CT), and the prevalence of steatosis in patients with COVID-19 remains to be elucidated.
AIM To assess the frequency of hepatic steatosis in the chest CT of COVID-19 patients and its association with the PSS.
METHODS The chest CT images of 485 patients who were admitted to the emergency department with suspected COVID-19 were retrospectively evaluated. The patients were divided into two groups as COVID-19-positive [CT- and reverse transcriptase-polymerase chain reaction (RT-PCR)-positive] and controls (CT- and RT-PCR-negative). The CT images of both groups were evaluated for PSS as the ratio of the volume of involved lung parenchyma to the total lung volume. Hepatic steatosis was defined as a liver attenuation value of ≤ 40 Hounsfield units (HU).
RESULTS Of the 485 patients, 56.5% (n = 274) were defined as the COVID-19-positive group and 43.5% (n = 211) as the control group. The average age of the COVID-19-positive group was significantly higher than that of the control group (50.9 ± 10.9 years vs 40.4 ± 12.3 years, P < 0.001). The frequency of hepatic steatosis in the positive group was significantly higher compared with the control group (40.9% vs 19.4%, P < 0.001). The average hepatic attenuation values were significantly lower in the positive group compared with the control group (45.7 ± 11.4 HU vs 53.9 ± 15.9 HU, P < 0.001). Logistic regression analysis showed that after adjusting for age, hypertension, diabetes mellitus, overweight, and obesity there was almost a 2.2 times greater odds of hepatic steatosis in the COVID-19-positive group than in the controls (odds ratio 2.187; 95% confidence interval: 1.336-3.580, P < 0.001).
CONCLUSION The prevalence of hepatic steatosis was significantly higher in COVID-19 patients compared with controls after adjustment for age and comorbidities. This finding can be easily assessed on chest CT images.
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Affiliation(s)
- Mehmet Tahtabasi
- Department of Radiology, University of Health Science, Mehmet Akif Inan Education and Research Hospital, Sanliurfa 63000, Turkey
| | - Tugrul Hosbul
- Department of Medical Microbiology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06100, Turkey
| | - Ergin Karaman
- Department of Radiology, University of Health Science, Mehmet Akif Inan Education and Research Hospital, Sanliurfa 63000, Turkey
| | - Yasin Akin
- Department of Radiology, University of Health Science, Mehmet Akif Inan Education and Research Hospital, Sanliurfa 63000, Turkey
| | - Nihat Kilicaslan
- Department of Radiology, University of Health Science, Mehmet Akif Inan Education and Research Hospital, Sanliurfa 63000, Turkey
| | - Mehmet Gezer
- Department of Radiology, University of Health Science, Mehmet Akif Inan Education and Research Hospital, Sanliurfa 63000, Turkey
| | - Fatih Sahiner
- Department of Medical Microbiology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06100, Turkey
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20
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Han AL. Association of Cardiovascular Risk Factors and Metabolic Syndrome with non-alcoholic and alcoholic fatty liver disease: a retrospective analysis. BMC Endocr Disord 2021; 21:91. [PMID: 33933056 PMCID: PMC8088638 DOI: 10.1186/s12902-021-00758-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/20/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Although many studies on non-alcoholic fatty liver disease (NAFLD) are underway worldwide, and several existing studies have investigated the association between NAFLD and cardiovascular risk factors, studies comparing NAFLD and alcoholic fatty liver disease (AFLD) are scarce. This study aimed to evaluate differences between the incidence of cardiovascular risk factors and metabolic syndrome in NAFLD and AFLD. METHODS A retrospective analysis of 913 patients who underwent abdominal computed tomography (CT) was performed to compare the incidence of cardiovascular risk factors and metabolic syndrome between NAFLD and AFLD. Subjects were divided into three groups based on criteria: healthy (n = 572), NAFLD (n = 295), and AFLD (n = 46). The healthy group had no liver disease. NAFLD was defined as fatty liver diagnosed on CT and drinking less than 140 g/week for men or 70 g/week for women. AFLD was defined as fatty liver diagnosed on CT and drinking more than 140 g/week for men or 70 g/week for women. We compared the incidence of cardiovascular risk factors and metabolic syndrome between the three groups. The relationship between each group and the metabolic syndrome risk was analyzed through multivariate logistic regression analysis. RESULTS No significant differences in several cardiovascular risk factors were observed between the NAFLD and AFLD groups. Upon analyzing the metabolic syndrome status in each group after making appropriate adjustments, the odds ratios (ORs) in the NAFLD (OR = 2.397, P = 0.002) and AFLD groups (OR = 4.445, P = 0.001) were found to be significantly higher than that in the healthy group; the incidence rate of metabolic syndrome was similar in the NAFLD and AFLD groups. CONCLUSIONS Both the NAFLD and AFLD groups had more cardiovascular risk factors and higher metabolic syndrome risk than the healthy group. Thus, the prevention of fatty liver disease, regardless of the specific type, should involve the identification of cardiovascular and metabolic syndrome risk factors. If abdominal CT reveals a fatty liver, whether NAFLD or AFLD, the risk of cardiovascular disease and metabolic syndrome should be assessed.
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Affiliation(s)
- A L Han
- Department of Family Medicine, Wonkwang University Hospital, Sinyong-dong, 344-2, Iksan, Jeollabuk-do, Republic of Korea.
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21
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Seo YB, Han AL. Association of the Serum Uric Acid-to-Creatinine Ratio with Nonalcoholic Fatty Liver Disease Diagnosed by Computed Tomography. Metab Syndr Relat Disord 2020; 19:70-75. [PMID: 33314991 DOI: 10.1089/met.2020.0086] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: Although previous studies have suggested that the serum uric acid-to-creatinine ratio (sUA/Cr) is associated with metabolic syndrome, there is limited evidence of a relationship between sUA/Cr and nonalcoholic fatty liver disease (NAFLD). In this study, we investigated the association between sUA/Cr and NAFLD in healthy adults. Methods: A cross-sectional analysis was performed in 778 subjects who participated in a health examination. The participants were divided according to presence of NAFLD, which was determined by abdominal computed tomography (CT). Logistic regression analysis was performed to investigate the variables associated with NAFLD, and an adjusted odds ratio (OR) of sUA/Cr for NAFLD was estimated. Results: sUA/Cr in participants with NAFLD was significantly higher than in those without NAFLD. Multivariate analysis demonstrated significant association between sUA/Cr and NAFLD, and the adjusted OR of sUA/Cr increase of 1 for NAFLD was 1.182. (95% CI: 1.066-1.311). Conclusions: Elevated sUA/Cr was significantly associated with CT-diagnosed NAFLD in healthy adults. sUA/Cr may be a reliable marker for predicting NAFLD. (The Clinical Trial Registration number: 2020-06-002-002).
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Affiliation(s)
- Yoo Bin Seo
- Department of Family Medicine, Wonkwang University Hospital, Iksan, South Korea
| | - A Lum Han
- Department of Family Medicine, Wonkwang University Hospital, Iksan, South Korea
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Erlichman DB, Lipman JN, In H, Ye K, Lin J, Goldman I. Diagnostic significance of the CT rim sign in cases of gangrenous cholecystitis. Clin Imaging 2020; 73:53-56. [PMID: 33310404 DOI: 10.1016/j.clinimag.2020.11.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/05/2020] [Accepted: 11/21/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE To evaluate the association between the CT rim sign and gangrenous cholecystitis (GC) and increased surgical difficulty. METHOD Patients who had a contrast enhanced CT of the abdomen and pelvis, followed by non-elective cholecystectomy were analyzed. The scans were reviewed for the CT rim sign by radiologists blinded to the pathologic and clinical outcomes. Demographic and clinical characteristics were compared between patients with and without GC using t-tests or Wilcoxon ranked sum test for continuous variables, and Fishers' exact test for categorical variables, when appropriate. A logistic regression model was fitted with multiple risk factors. Odds ratios as well as 95% confidence intervals were then calculated for the risk factors. A secondary analysis predicting increased surgical difficulty, defined as an operative time of greater than 2 h or increased conversion rate to open surgery, was also examined. RESULTS A total of 100 patients were included; 20 of which had GC. On imaging, patients with GC were more likely to have a CT rim sign (65% vs 32.5%, OR = 3.80, 95% CI: 1.24-12.7, p = 0.011). The presence of the CT rim sign did not reach a statistically significant association with an operative time >2 h or conversion to open case (56.52% vs 33.77%, OR = 2.55, p = 0.056). CONCLUSION The CT rim sign can be utilized to raise the possibility of GC, however the presence of the CT rim sign does not demonstrate an association with increased surgical difficulty.
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Affiliation(s)
- David B Erlichman
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America.
| | - Jeffrey N Lipman
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Haejin In
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Kenny Ye
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Juan Lin
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Inessa Goldman
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
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23
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Gong P, Zhou C, Song P, Huang C, Lok UW, Tang S, Watt K, Callstrom M, Chen S. Ultrasound Attenuation Estimation in Harmonic Imaging for Robust Fatty Liver Detection. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:3080-3087. [PMID: 32773254 PMCID: PMC7534411 DOI: 10.1016/j.ultrasmedbio.2020.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/22/2020] [Accepted: 07/09/2020] [Indexed: 02/05/2023]
Abstract
Accurate detection of liver steatosis is important for liver disease management. Ultrasound attenuation coefficient estimation (ACE) has great potential in quantifying liver fat content. The commonly used ACE methods (e.g., spectral shift methods, reference phantom methods) assume linear tissue response to ultrasound and were developed in fundamental imaging. However, fundamental imaging may be vulnerable to reverberation clutters introduced by the body wall. The clutters superimposed on liver echoes may bias the attenuation estimation. Here we propose a new ACE technique, the reference frequency method (RFM), in harmonic imaging to mitigate the reverberation bias. The accuracy of harmonic RFM was validated through a phantom study. In a pilot patient study, harmonic RFM performed more robustly in vivo compared with fundamental RFM, illustrating the potential of ACE in harmonic imaging.
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Affiliation(s)
- Ping Gong
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Chenyun Zhou
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA; Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Pengfei Song
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA; Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA; Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Chengwu Huang
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - U-Wai Lok
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Shanshan Tang
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kymberly Watt
- Department of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Shigao Chen
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
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24
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Maung K, Ramalingam S, Chaudhry M, Ren Y, Jung SH, Romero K, Corbet K, Chao NJ, Choi T, Diehl AM, Diehl L, Gasparetto C, Horwitz M, Long GD, Lopez RD, Rizzieri DA, Sarantopoulos S, Sullivan KM, Bashir MR, Sung AD. Pre-transplant hepatic steatosis (fatty liver) is associated with chronic graft-vs-host disease but not mortality. PLoS One 2020; 15:e0238824. [PMID: 32915853 PMCID: PMC7485815 DOI: 10.1371/journal.pone.0238824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/23/2020] [Indexed: 12/17/2022] Open
Abstract
Allogeneic-HCT (allo-HCT), while potentially curative, can result in significant complications including graft versus host disease (GVHD). Prior studies suggest that metabolic syndrome may be one risk factor for GVHD. We hypothesized that hepatic steatosis on pre-HCT computed tomography (CT) scans may be a marker for development of GVHD and poor outcomes in allo-HCT. In this retrospective study, we reviewed the pre-HCT CT scans and transplant outcome data of patients who underwent allo-HCT at Duke University Medical Center from 2009 to 2017. The presence of steatosis was confirmed using CT attenuation measurements. We then assessed the association between pre-HCT hepatic steatosis and HCT-related outcomes including GVHD. 80 patients who had pre-HCT CT scans were included in the study. Pre-transplant hepatic steatosis was associated with the development of chronic GVHD (OR 4.2, p = 0.02), but was not associated with acute GVHD (OR 1.3, p = 0.7), non-relapse mortality (p = 0.81) or overall survival (p = 0.74). Based on this single center retrospective study, pre-transplant hepatic steatosis is associated with development of chronic GVHD. Further, prospective study with other imaging modalities including non-contrasted CT scans is needed to determine if this association is reproducible.
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Affiliation(s)
- Ko Maung
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Sendhilnathan Ramalingam
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Mohammad Chaudhry
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Yi Ren
- Duke Cancer Institute, Biostatistics Shared Resources, Duke University, Durham, North Carolina, United States of America
| | - Sin-Ho Jung
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Kristi Romero
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Kelly Corbet
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Nelson J. Chao
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - Taewoong Choi
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - Anna Mae Diehl
- Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Louis Diehl
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - Cristina Gasparetto
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - Mitchell Horwitz
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - Gwynn Douglas Long
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - Richard D. Lopez
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - David A. Rizzieri
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - Keith M. Sullivan
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - Mustafa R. Bashir
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Anthony D. Sung
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
- * E-mail:
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25
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Abstract
PRRT (peptide receptor radionuclide therapy) with Lu-DOTATATE for neuroendocrine tumor has some well-known adverse effects, concerning specially the bone marrow and kidneys. Hepatotoxicity has been rarely reported, and there are no data regarding hepatic steatosis secondary to PRRT. We reviewed upper abdomen CT and MRI and applied radiologic criteria for the diagnosis of hepatic steatosis on 62 patients treated between the years of 2010 and 2017. Two patients already showed radiologic signs of steatosis in the middle of the treatment and through follow-up all patients showed improvement of the steatosis.
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26
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Dinani AM, Lewis S, Branch AD, Perumalswami P. Working Up an Incidental Finding of Hepatic Steatosis on Imaging. Clin Liver Dis (Hoboken) 2020; 16:58-62. [PMID: 32922751 PMCID: PMC7474143 DOI: 10.1002/cld.926] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/08/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Amreen M. Dinani
- Division of Liver DiseasesIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Sara Lewis
- Department of RadiologyIcahn School of MedicineNew YorkNY
| | - Andrea D. Branch
- Division of Liver DiseasesIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Ponni Perumalswami
- Division of Liver DiseasesIcahn School of Medicine at Mount SinaiNew YorkNY
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27
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Abstract
There are >1.5 billion people with chronic liver disease worldwide, causing liver diseases to be a significant global health issue. Diffuse parenchymal liver diseases, including hepatic steatosis, fibrosis, metabolic diseases, and hepatitis cause chronic liver injury and may progress to fibrosis and eventually hepatocellular carcinoma. As early diagnosis and treatment of these diseases impact the progression and outcome, the need for assessment of the liver parenchyma has increased. While the current gold standard for evaluation of the hepatic parenchymal tissue, biopsy has disadvantages and limitations. Consequently, noninvasive methods have been developed based on serum biomarkers and imaging techniques. Conventional imaging modalities such as ultrasound, computed tomography scan, and magnetic resonance imaging provide noninvasive options for assessment of liver tissue. However, several recent advances in liver imaging techniques have been introduced. This review article focuses on the current status of imaging methods for diffuse parenchymal liver diseases assessment including their diagnostic accuracy, advantages and disadvantages, and comparison between different techniques.
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28
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Medeiros AK, Barbisan CC, Cruz IR, de Araújo EM, Libânio BB, Albuquerque KS, Torres US. Higher frequency of hepatic steatosis at CT among COVID-19-positive patients. Abdom Radiol (NY) 2020; 45:2748-2754. [PMID: 32683613 PMCID: PMC7368629 DOI: 10.1007/s00261-020-02648-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/01/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023]
Abstract
Purpose Recent studies have demonstrated that obesity is significantly associated with increased disease severity, hospitalizations and mortality in COVID-19, with a potential role in the pathogenesis and prevalence in the new pandemic. The association with hepatic steatosis, however, a condition closely related to obesity within the spectrum of systemic metabolic dysfunctions, remains to be elucidated. We aimed to evaluate the frequency of hepatic steatosis as incidentally detected in chest CT examinations of COVID-19 positive patients in comparison to non-infected controls. Methods A retrospective study was performed with 316 patients (204 RT-PCR positive; 112 RT-PCR negative and chest CT negative). Steatosis was measured with placement of a single ROI in the right lobe of the liver (segments VI-VII) and defined as a liver attenuation value ≤ 40 HU. Results The frequency of hepatic steatosis was higher in the RT-PCR positive group in comparison to controls (31.9% vs. 7.1%, p < 0.001). Logistic linear regression analysis showed a 4.7 times odds of steatosis in the COVID-19 positive group as compared to controls after adjusting for age and sex (OR 4.698; 95% IC 2.12–10.41, p < 0.001). Conclusion A significantly higher prevalence of steatosis was found among COVID-19 positive individuals. These findings are in accordance with other recent studies linking obesity and COVID-19 infection, as there is an intricate relationship between liver steatosis, metabolic syndrome and obesity. Further studies are required to confirm if such association remains after accounting for multiple variables, as well as possible relationships with disease severity and worst clinical outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Ulysses S Torres
- Grupo Fleury, Rua Cincinato Braga, 282, Bela Vista, São Paulo, SP, 01333-010, Brazil.
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29
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Ponnoprat D, Inkeaw P, Chaijaruwanich J, Traisathit P, Sripan P, Inmutto N, Na Chiangmai W, Pongnikorn D, Chitapanarux I. Classification of hepatocellular carcinoma and intrahepatic cholangiocarcinoma based on multi-phase CT scans. Med Biol Eng Comput 2020; 58:2497-2515. [PMID: 32794015 DOI: 10.1007/s11517-020-02229-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/07/2020] [Indexed: 02/07/2023]
Abstract
Liver and bile duct cancers are leading causes of worldwide cancer death. The most common ones are hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). Influencing factors and prognosis of HCC and ICC are different. Precise classification of these two liver cancers is essential for treatment and prevention plans. The aim of this study is to develop a machine-based method that differentiates between the two types of liver cancers from multi-phase abdominal computerized tomography (CT) scans. The proposed method consists of two major steps. In the first step, the liver is segmented from the original images using a convolutional neural network model, together with task-specific pre-processing and post-processing techniques. In the second step, by looking at the intensity histograms of the segmented images, we extract features from regions that are discriminating between HCC and ICC, and use them as an input for classification using support vector machine model. By testing on a dataset of labeled multi-phase CT scans provided by Maharaj Nakorn Chiang Mai Hospital, Thailand, we have obtained 88% in classification accuracy. Our proposed method has a great potential in helping radiologists diagnosing liver cancer.
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Affiliation(s)
- Donlapark Ponnoprat
- Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Papangkorn Inkeaw
- Advanced Research Center for Computational Simulation, Chiang Mai University, Chiang Mai, 50200, Thailand.
| | - Jeerayut Chaijaruwanich
- Data Science Research Center, Department of Computer Science, Faculty of Science, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Patrinee Traisathit
- Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Patumrat Sripan
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Nakarin Inmutto
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Wittanee Na Chiangmai
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Donsuk Pongnikorn
- Cancer Registry Unit, Lampang Cancer Hospital, Lampang, 52000, Thailand
| | - Imjai Chitapanarux
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
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30
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Turankova T, Blyuss O, Brazhnikov A, Svistunov A, Gurusamy KS, Pavlov CS. Transient elastography with controlled attenuation parameter (CAP) for diagnosis of moderate or severe steatosis in people with suspected non-alcoholic fatty liver disease. Hippokratia 2020. [DOI: 10.1002/14651858.cd013670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Taisiia Turankova
- Department of Therapy; I.M. Sechenov First Moscow State Medical University; Moscow Russian Federation
| | - Oleg Blyuss
- School of Physics, Astronomy and Mathematics; University of Hertfordshire; Hatfield UK
- Department of Paediatrics and Paediatric Infectious Diseases; I.M. Sechenov First Moscow State Medical University; Moscow Russian Federation
- Department of Applied Mathematics; Lobachevsky State University of Nizhny Novgorod; Nizhny Novgorod Russian Federation
| | - Alexey Brazhnikov
- Department of Epidemiology and Evidence-Based Medicine; I.M. Sechenov First Moscow State Medical University; Moscow Russian Federation
| | - Andrey Svistunov
- I.M. Sechenov First Moscow State Medical University; Moscow Russian Federation
| | - Kurinchi Selvan Gurusamy
- Department of Therapy; I.M. Sechenov First Moscow State Medical University; Moscow Russian Federation
- Division of Surgery and Interventional Science; University College London; London UK
| | - Chavdar S Pavlov
- Department of Therapy; I.M. Sechenov First Moscow State Medical University; Moscow Russian Federation
- Cochrane Hepato-Biliary Group; Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
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31
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Bird JR, Brahm GL, Fung C, Sebastian S, Kirkpatrick IDC. Recommendations for the Management of Incidental Hepatobiliary Findings in Adults: Endorsement and Adaptation of the 2017 and 2013 ACR Incidental Findings Committee White Papers by the Canadian Association of Radiologists Incidental Findings Working Group. Can Assoc Radiol J 2020; 71:437-447. [DOI: 10.1177/0846537120928349] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The Canadian Association of Radiologists Incidental Findings Working Group consists of both academic subspecialty and general radiologists and is tasked with adapting and expanding upon the American College of Radiology incidental findings white papers to more closely apply to Canadian practice patterns, particularly more comprehensively dealing with the role of ultrasound and pursuing more cost-effective approaches to the workup of incidental findings without compromising patient care. Presented here are the 2020 Canadian guidelines for the management of hepatobiliary incidental findings. Topics covered include initial assessment of hepatic steatosis and cirrhosis, the workup of incidental liver masses identified on ultrasound and computed tomography (with algorithms presented), incidental gallbladder findings (wall thickening, calcification, and polyps), and management of incidental biliary dilatation.
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Affiliation(s)
- Jeffery R. Bird
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Gary L. Brahm
- Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Christopher Fung
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Sunit Sebastian
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
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32
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Moreno CC, Mittal PK, Miller FH. Nonfetal Imaging During Pregnancy: Acute Abdomen/Pelvis. Radiol Clin North Am 2019; 58:363-380. [PMID: 32044012 DOI: 10.1016/j.rcl.2019.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Abdominal pain is a common occurrence in pregnant women and may have a variety of causes, including those that are specific to pregnancy (eg, round ligament pain in the first trimester) and the wide range of causes of abdominal pain that affect men and women who are not pregnant (eg, appendicitis, acute cholecystitis). Noncontrast magnetic resonance (MR) imaging is increasingly performed to evaluate pregnant women with abdominal pain, either as the first-line test or as a second test following ultrasonography. The imaging appearance of causes of abdominal pain in pregnant women are reviewed with an emphasis on noncontrast MR imaging.
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Affiliation(s)
- Courtney C Moreno
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364-A Clifton Road Northeast Suite AT-627, Atlanta, GA 30327, USA.
| | - Pardeep K Mittal
- Department of Radiology, Medical College of Georgia, 1120 15th Street, BA-1411, Augusta, GA 30912, USA
| | - Frank H Miller
- Body Imaging Section and Fellowship, MRI, Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North Saint Clair, Suite 800, Chicago, IL 60611, USA
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33
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Cahill D, Zamboni F, Collins MN. Radiological Advances in Pancreatic Islet Transplantation. Acad Radiol 2019; 26:1536-1543. [PMID: 30709732 DOI: 10.1016/j.acra.2019.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/17/2019] [Accepted: 01/20/2019] [Indexed: 12/16/2022]
Abstract
Type 1 diabetes mellitus (T1DM) is characterized by hyperglycemia, owing to the loss of pancreatic β cells in response to an autoimmune reaction leading to a state of absolute insulin deficiency. T1DM treatment is shifting from exogenous insulin replacement therapy toward pancreatic β-cell replacement, to restore physiologically responsive insulin secretion to variations in blood glucose levels. β-cell replacement strategies include human whole pancreas transplantation, islet transplantation with cell encapsulation and bioengineered pancreas. Interventional radiology and imaging modalities including positron emission tomography, single-photon emission computed tomography, magnetic resonance imaging, ultrasonography, and molecular imaging are imperative to enable successful β-cell replacement. Herein, the role of radiological modalities in the treatment of T1DM and its prospective use for noninvasive post-transplantation graft monitoring is discussed.
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34
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Şeker M, Erol C, Sevmiş Ş, Saka B, Durur Karakaya A. Comparison of CT methods for determining graft steatosis in living donor liver transplantation. Abdom Radiol (NY) 2019; 44:2418-2429. [PMID: 30937504 DOI: 10.1007/s00261-019-01993-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate and compare the diagnostic performance of non-enhanced computed tomography (NECT) and contrast-enhanced CT (CECT) attenuation indices in the assessment of hepatic steatosis by using biopsy as the reference standard. MATERIALS AND METHODS This retrospective study was approved by our Institutional Review Board. 55 Potential donors who underwent both NECT and triphasic CECT and core liver biopsy, were included the study. Average attenuation measurements that were obtained from multiple regions in liver, spleen, and psoas muscle on both unenhanced and CECT were used for analysis. Hepatic attenuation measurements were analyzed with and without normalization with the spleen and psoas muscle. Linear regression and receiver operating characteristic (ROC) curve analysis were used to evaluate the statistical association between CT indices and steatosis at histology. RESULTS Linear regression analysis confirmed the strongest correlation between steatosis and normalized measurements of hepatic attenuation with splenic attenuations on hepatic venous phase of CECT scan (R 0.821; R2 0.674 and R 0.816; R2 0.665, respectively). The use of ROC curve analysis also demonstrated that normalized measurements of hepatic attenuation with splenic attenuations on hepatic venous phase of CECT showed high diagnostic performance regarding the qualitative distinction of steatosis (AUC values greater than 0.9). CONCLUSION Attenuation measurements of liver normalized with spleen on hepatic venous phase may be useful in evaluating steatosis in donor candidates with moderate to severe steatosis who are unacceptable for liver donation. In this manner unnecessary liver biopsy may be avoided in those donor candidates.
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Affiliation(s)
- Mehmet Şeker
- Department of Radiology, Faculty of Medicine, Medipol University, Bağcılar, 34214, Istanbul, Turkey.
| | - Cengiz Erol
- Department of Radiology, Faculty of Medicine, Medipol University, Bağcılar, 34214, Istanbul, Turkey
| | - Şinasi Sevmiş
- Department of Surgery, Yeni Yuzyıl University, Gaziosmanpaşa, 34245, Istanbul, Turkey
| | - Burcu Saka
- Department of Pathology, Faculty of Medicine, Medipol University, Bağcılar, 34214, Istanbul, Turkey
| | - Afak Durur Karakaya
- Department of Radiology, Faculty of Medicine, Medipol University, Bağcılar, 34214, Istanbul, Turkey
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35
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Metin NO, Karaosmanoğlu AD, Metin Y, Karçaaltıncaba M. Focal hypersteatosis: a pseudolesion in patients with liver steatosis. ACTA ACUST UNITED AC 2019; 25:14-20. [PMID: 30582571 DOI: 10.5152/dir.2018.17519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE We aimed to describe ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) findings of focal hypersteatosis (FHS). METHODS We retrospectively reviewed our database for patients with hypersteatosis. Over a 5-year period (February 2005 to September 2010) a total of 17 321 patients underwent abdominal CT scan and 28 patients were determined to have FHS. All patients had US, CT, and MRI studies. Size, area, and density measurements were performed on CT images. Fat signal percentage (FSP) was measured on T1-weighted in- and out-of-phase gradient-echo images. FHS was defined based on MRI findings, as an area of greater signal drop on out-of phase images compared with the rest of the fatty liver. RESULTS The period prevelance of focal hypersteatosis was measured as 0.16% over the 5-year period. Cancer was the most common diagnosis (22 of 28 patients, 78.5%), with the breast (32.1%) and colorectal (25%) cancers predominating. FHS was seen in segment 4 (n=26, 92.8%), segment 8 (n=1, 3.6%), and segment 3 (n=1, 3.6%). Shape was nodular in 21 patients (75%), while triangular or amorphous in the remaining 7 patients (25%). FHS was hyperechoic and isoechoic in 5 (17.9%) and 23 (82.1%) patients, respectively. FHS was hypodense on CT of all patients relative to fatty liver. On MRI, the FHS was hyperintense on T1-weighted in-phase images in 17 patients (60.7%). Median liver parenchymal FSP was 21.5% (range, 10%-41.4%) and median FSP of hypersteatotic area was 32.5% (range, 19%-45%). CONCLUSION Focal hypersteatosis is a pseudolesion that can be observed in patients with liver steatosis. It appears hypodense on CT and mostly isoechoic on US relative to fatty liver. It may mimic metastasis in cancer patients with steatosis, due to nodular shape and atypical location. MRI should be used for correct diagnosis in patients with equivocal findings on CT to avoid biopsy.
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Affiliation(s)
- Nurgül Orhan Metin
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | | | - Yavuz Metin
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
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Tisch C, Brencicova E, Schwendener N, Lombardo P, Jackowski C, Zech WD. Hounsfield unit values of liver pathologies in unenhanced post-mortem computed tomography. Int J Legal Med 2019; 133:1861-1867. [DOI: 10.1007/s00414-019-02016-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 02/01/2019] [Indexed: 12/11/2022]
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Ahbab S, Ünsal A, Ataoğlu HE, Can TS, Kayaş D, Savaş Y. Prediabetes and Type 2 Diabetes are Independent Risk Factors for Computed Tomography-Estimated Nonalcoholic Fatty Pancreas Disease. Clinics (Sao Paulo) 2019; 74:e1337. [PMID: 31664423 PMCID: PMC6807690 DOI: 10.6061/clinics/2019/e1337] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/26/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Nonalcoholic fatty pancreas disease (NAFPD) is characterized by excessive fat deposition in the pancreas in the absence of alcohol consumption. In this study, we aimed to detect a possible relationship between adipose tissue accumulation, prediabetes and diabetes. METHODS This cross-sectional and retrospective study included 110 patients. Three groups were classified as controls, patients with prediabetes and patients with type 2 diabetes. The abdominal computed tomography (CT) attenuation measurement results of the pancreas were evaluated independently by two experienced radiologists. CT measurements and biochemical parameters were compared between study groups. The relationship between continuous variables was assessed by using one-way ANOVA. To determine the changes in the dependent variable for the effects on study groups, the independent variable was adjusted using ANCOVA. A p-value less than 0.05 was considered statistically significant. RESULTS The presence of prediabetes and type 2 diabetes was correlated with a decrease in the mean Hounsfield Unit (HU) value of the pancreas (p=0.002). Age was determined to be an independent risk factor and was correlated with NAFPD (p=0.0001). When compared to the controls (p=0.041), 71% of patients with prediabetes and 67% of patients with type 2 diabetes were observed to have an increased incidence of NAFPD. Decreased serum amylase was found to be correlated with the mean HU value of the pancreas (p=0.043). CONCLUSION NAFPD was independently correlated with both prediabetes and type 2 diabetes adjusted for age (p=0.0001) in this study. Additionally, age was determined to be an independent risk factor and was correlated with NAFPD.
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Affiliation(s)
- Süleyman Ahbab
- Internal Medicine Clinic, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
- *Corresponding author. E-mail:
| | - Ahmet Ünsal
- Internal Medicine Clinic, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Hayriye Esra Ataoğlu
- Internal Medicine Clinic, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Tuba Selçuk Can
- Department of Radiology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Derya Kayaş
- Internal Medicine Clinic, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Yıldıray Savaş
- Department of Radiology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Predicting Hepatic Steatosis in Living Liver Donors Via Controlled Attenuation Parameter. Transplant Proc 2018; 50:3533-3538. [DOI: 10.1016/j.transproceed.2018.06.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/27/2018] [Indexed: 12/14/2022]
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Dhaliwal J, Chavhan GB, Lurz E, Shalabi A, Yuen N, Williams B, Martincevic I, Amirabadi A, Wales PW, Lee W, Ling SC, Mouzaki M. Hepatic steatosis is highly prevalent across the paediatric age spectrum, including in pre-school age children. Aliment Pharmacol Ther 2018; 48:556-563. [PMID: 29998462 DOI: 10.1111/apt.14900] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/21/2018] [Accepted: 06/16/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The prevalence of non-alcoholic fatty liver disease (NAFLD) in children is 8% in the general population, and 34% in the context of obesity. There is a paucity of data on the prevalence of hepatic steatosis in healthy children in Ontario. AIMS To determine the prevalence of hepatic steatosis using abdominal computed tomography (CT) scans in a cohort of previously healthy children across the paediatric age spectrum in Ontario, Canada, and to determine any association between measures of abdominal adiposity and hepatic steatosis. METHODS Retrospective review of the SickKids Trauma Database from 2004-2015. Previously healthy children ages 1-17 years having undergone an abdominal CT scan as a part of routine trauma assessment were included, and those with an intra-abdominal injury excluded. Steatosis was defined as a difference between liver and spleen attenuation ≤-25HU. The percentage of the total area occupied by abdominal subcutaneous adipose and visceral adipose tissue was measured. Anthropometrics and baseline demographics were collected. RESULTS A total of 503 (51% male) children with mean (±SD) age 9.5 ± 4.5 years and weight z-score of 0.37 ± 1.05 were studied. Seventy-seven (15%, 95% CI [12%-18%]) had hepatic steatosis; no differences found between sexes or across age quartiles. The abdominal subcutaneous adipose tissue area was greater in those with hepatic steatosis compared to those without (32% [22-42] vs 24% [17-36], P = 0.003). The visceral adipose tissue area was significantly greater in older children ≥9.8 years with hepatic steatosis (7.7% [5.1-10] vs 6.6% (4.9-8.5), P = 0.04). CONCLUSION Hepatic steatosis was highly prevalent in previously healthy children in Ontario, including children of pre-school age. We found an association between hepatic steatosis and abdominal subcutaneous adipose tissue, and in older children with visceral adipose tissue.
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Affiliation(s)
- J Dhaliwal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - G B Chavhan
- The Hospital for Sick Children, Toronto, ON, Canada.,Department of Radiology, University of Toronto, Toronto, ON, Canada
| | - E Lurz
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - A Shalabi
- The Hospital for Sick Children, Toronto, ON, Canada.,Department of Radiology, University of Toronto, Toronto, ON, Canada
| | - N Yuen
- The Hospital for Sick Children, Toronto, ON, Canada.,Department of Radiology, University of Toronto, Toronto, ON, Canada
| | - B Williams
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - I Martincevic
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - A Amirabadi
- The Hospital for Sick Children, Toronto, ON, Canada.,Department of Radiology, University of Toronto, Toronto, ON, Canada
| | - P W Wales
- The Hospital for Sick Children, Toronto, ON, Canada.,Division of Pediatric General and Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - W Lee
- The Hospital for Sick Children, Toronto, ON, Canada.,Department of Radiology, University of Toronto, Toronto, ON, Canada
| | - S C Ling
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - M Mouzaki
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH, USA
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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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Esterson YB, Grimaldi GM. Radiologic Imaging in Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis. Clin Liver Dis 2018; 22:93-108. [PMID: 29128063 DOI: 10.1016/j.cld.2017.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The article reviews the multimodality (ultrasound, computed tomography, and magnetic resonance [MR]) imaging appearance of nonalcoholic fatty liver disease (NAFLD) and discusses the radiologic diagnostic criteria as well as the sensitivity and specificity of these imaging methods. The authors review the role of both ultrasound and MR elastography for the diagnosis of fibrosis and for the longitudinal evaluation of patients following therapeutic intervention. Lastly, the authors briefly discuss the screening and diagnosis of hepatocellular carcinoma in patients with NAFLD, as there are special considerations in this population.
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Affiliation(s)
- Yonah B Esterson
- Department of Radiology, Northwell Health System, Hofstra Northwell School of Medicine, 300 Community Drive, Manhasset, NY 11030, USA.
| | - Gregory M Grimaldi
- Department of Radiology, Northwell Health System, Hofstra Northwell School of Medicine, 300 Community Drive, Manhasset, NY 11030, USA
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Lee DH. Imaging evaluation of non-alcoholic fatty liver disease: focused on quantification. Clin Mol Hepatol 2017; 23:290-301. [PMID: 28994271 PMCID: PMC5760010 DOI: 10.3350/cmh.2017.0042] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 08/17/2017] [Indexed: 12/26/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) has been an emerging major health problem, and the most common cause of chronic liver disease in Western countries. Traditionally, liver biopsy has been gold standard method for quantification of hepatic steatosis. However, its invasive nature with potential complication as well as measurement variability are major problem. Thus, various imaging studies have been used for evaluation of hepatic steatosis. Ultrasonography provides fairly good accuracy to detect moderate-to-severe degree hepatic steatosis, but limited accuracy for mild steatosis. Operator-dependency and subjective/qualitative nature of examination are another major drawbacks of ultrasonography. Computed tomography can be considered as an unsuitable imaging modality for evaluation of NAFLD due to potential risk of radiation exposure and limited accuracy in detecting mild steatosis. Both magnetic resonance spectroscopy and magnetic resonance imaging using chemical shift technique provide highly accurate and reproducible diagnostic performance for evaluating NAFLD, and therefore, have been used in many clinical trials as a non-invasive reference of standard method.
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Affiliation(s)
- Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Qiu T, Ling W, Li J, Lu Q, Lu C, Li X, Zhu C, Luo Y. Can ultrasound elastography identify mass-like focal fatty change (FFC) from liver mass? Medicine (Baltimore) 2017; 96:e8088. [PMID: 28953628 PMCID: PMC5626271 DOI: 10.1097/md.0000000000008088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Focal fatty change (FFC) may mimic liver mass on conventional B-mode ultrasound. Clinical differentiation of mass-like FFC and liver mass is important due to different clinical interventions. Contrast-enhanced imaging (CEI) or biopsy is reliable for this differentiation, but is expensive and invasive. This study aimed to explore utilities of ultrasound elastography for this differentiation.This study enrolled 79 patients with focal liver lesions (FLLs), of which 26 were mass-like FFC confirmed by at least 2 CEI modalities. The other 53 were liver masses, confirmed by pathology (n = 28) or at least 2 CEI modalities (n = 25). Lesion stiffness value (SV), absolute stiffness difference (ASD), and stiffness ratio (SR) of lesion to background were obtained using point shear-wave elastography (pSWE) and compared between FFC group and liver mass group. The performance of SV, ASD, and SR for identifying FFC from liver mass was evaluated.SV was 5.6 ± 2.4 versus 16 ± 12 kPa, ASD was 2.0 ± 1.9 versus 11 ± 12 kPa, and SR was 1.4 ± 0.6 versus 3.0 ± 1.9 for FFC and liver mass group, respectively (P < .0001). The area under the receiver operating characteristic curve of SV, ASD, and SR for discriminating mass-like FFC and liver mass was 0.840, 0.842, and 0.791, respectively (P < .05). Particularly, with cut-off ASD < 1.0 kPa, positive predictive value was 100%, specificity was 100%, and accuracy was 82% for diagnosing FFC.pSWE may be a potential useful modality for identifying mass-like FFC from liver mass, which might help reduce the necessity for further CEI or biopsy for diagnosing mass-like FFC.
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Affiliation(s)
| | | | | | | | - Changli Lu
- Department of Pathology, West China Hospital Sichuan University
| | - Xiaomin Li
- Department of Pathology, West China Hospital Sichuan University
| | - Cairong Zhu
- School of Public Health, Sichuan University, Chengdu, China
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Computed Tomography Measurement of Hepatic Steatosis: Prevalence of Hepatic Steatosis in a Canadian Population. Can J Gastroenterol Hepatol 2016; 2016:4930987. [PMID: 27446844 PMCID: PMC4904663 DOI: 10.1155/2016/4930987] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 05/01/2015] [Indexed: 12/20/2022] Open
Abstract
Background/Aims. Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease that can progress to cirrhosis and hepatocellular carcinoma. This retrospective chart review investigated the incidence of hepatic steatosis in London, Ontario, Canada. Methods. A retrospective chart review was performed on emergency room (ER) patients undergoing nonscheduled computed tomography (CT) imaging over a six-month period in London, Ontario. CT images and reports were examined to determine presence of steatosis. Analyses of the electronic chart for a period of six months following the CT and communication with the patients' family doctors were used to determine if there was follow-up. Waist circumference, subcutaneous fat depth, and abdominal fat volumes were calculated. Results. 48/450 patients meeting inclusion criteria were identified by radiology as having steatosis, with 34/40 (85%) family physicians unaware of the finding. 24.7% (100/405) of patients met standard CT criteria for steatosis, 40 of which were reported by the radiologist. Waist circumference, subcutaneous adipose tissue depth, subcutaneous adipose tissue volume, and visceral adipose tissue volume were significantly associated with steatosis. Conclusions. The hepatic steatosis prevalence we report is the first reported in a Canadian population. Early identification of steatosis will become more important as new pharmacologic therapies arise.
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Olefson S, Jackson M, Grand DJ, Charpentier KP, Makwana N, Promrat K. Identification of Nonalcoholic Fatty Liver Disease following Pancreatic Surgery in a Western Cohort Using a Novel Radiographic Technique. J Clin Transl Hepatol 2015; 3:246-53. [PMID: 26807379 PMCID: PMC4721891 DOI: 10.14218/jcth.2015.00029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/06/2015] [Accepted: 10/08/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND AIMS While traditional risk factors for the development of nonalcoholic fatty liver disease (NAFLD) relate to metabolic syndrome, several Asian studies have suggested a high rate of de novo NAFLD following pancreaticoduodenectomy (PD). The aim of this study is to identify de novo NAFLD after pancreatic surgery and its associated risk factors. METHODS A retrospective cohort of patients at a single center that underwent PD or distal pancreatectomy (DP) over 7 years was identified. Pre- and postoperative contrast-enhanced computed tomography scans of the abdomen were reviewed, including attenuation measurements of the liver, spleen, and muscle. Primary outcomes included hepatic attenuation, liver to muscle ratio (LMR), and liver to spleen ratio (LSR). RESULTS Of the 96 patients (mean age 64.3) included, 70% underwent PD, and 30% underwent DP. The mean LMR decreased significantly from 1.81 to 1.66 (p=0.02), noted only in men. No interaction effect with LMR was observed with surgical type, chemotherapy, blood loss, pancreatic enzyme replacement, or transaminases. LMR decreased in 55% of subjects. CONCLUSIONS Increased fatty infiltration, as evidence by decreased LMR, was found among men that underwent PD and DP within a year of surgery. This may be related to weight loss and malabsorption and deserves further investigation.
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Affiliation(s)
- Sidney Olefson
- Department of Internal Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Melissa Jackson
- Department of Internal Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - David J. Grand
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kevin P. Charpentier
- Department of Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Nirav Makwana
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kittichai Promrat
- Division of Gastroenterology and Hepatology, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Correspondence to: Kittichai Promrat, Division of Gastroenterology and Hepatology, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA. Tel: +1-401-444-3575, Fax: +1-401-444-6316, E-mail:
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Abstract
OBJECTIVES To evaluate the incidence of hepatic steatosis after pancreatectomy and whether pancrelipase improves steatosis more effectively than other conventional digestive enzymes. METHODS Patients who underwent distal pancreatectomy, pancreaticoduodenectomy (PD), or total pancreatectomy (TP) from August 2008 to July 2013 were included. Incidence of newly developed hepatic steatosis recognized by computed tomography and outcomes by treatment with pancrealipase or other enzymes were evaluated. RESULTS A total of 473 patients were evaluated. Among 366 patients who did not take any digestive enzymes until the recognition of steatosis or the last follow-up date, hepatic steatosis was recognized in 3% (4/130), 17% (38/229), and 45% (3/7) of patients after distal pancreatectomy, PD, and TP, respectively, during the median follow-up of 641 days. Seventy patients including 25 patients taking digestive enzymes showed hepatic steatosis and were treated with pancrelipase (20 patients), other enzymes (19 patients), or no enzyme (31 patients). Cumulative improvement rate after 1 year of treatment in the 3 groups was 92%, 51%, and 56%, respectively, and that of the pancrelipase group was significantly better than the other 2 groups. CONCLUSION The risk of hepatic steatosis should be a concern after PD and TP. Treatment with pancrelipase was more effective compared to other enzymes.
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48
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Lee SS, Park SH. Radiologic evaluation of nonalcoholic fatty liver disease. World J Gastroenterol 2014; 20:7392-7402. [PMID: 24966609 PMCID: PMC4064084 DOI: 10.3748/wjg.v20.i23.7392] [Citation(s) in RCA: 274] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 12/21/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a frequent cause of chronic liver diseases, ranging from simple steatosis to nonalcoholic steatohepatitis (NASH)-related liver cirrhosis. Although liver biopsy is still the gold standard for the diagnosis of NAFLD, especially for the diagnosis of NASH, imaging methods have been increasingly accepted as noninvasive alternatives to liver biopsy. Ultrasonography is a well-established and cost-effective imaging technique for the diagnosis of hepatic steatosis, especially for screening a large population at risk of NAFLD. Ultrasonography has a reasonable accuracy in detecting moderate-to-severe hepatic steatosis although it is less accurate for detecting mild hepatic steatosis, operator-dependent, and rather qualitative. Computed tomography is not appropriate for general population assessment of hepatic steatosis given its inaccuracy in detecting mild hepatic steatosis and potential radiation hazard. However, computed tomography may be effective in specific clinical situations, such as evaluation of donor candidates for hepatic transplantation. Magnetic resonance spectroscopy and magnetic resonance imaging are now regarded as the most accurate practical methods of measuring liver fat in clinical practice, especially for longitudinal follow-up of patients with NAFLD. Ultrasound elastography and magnetic resonance elastography are increasingly used to evaluate the degree of liver fibrosis in patients with NAFLD and to differentiate NASH from simple steatosis. This article will review current imaging methods used to evaluate hepatic steatosis, including the diagnostic accuracy, limitations, and practical applicability of each method. It will also briefly describe the potential role of elastography techniques in the evaluation of patients with NAFLD.
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Costa DMC, Salvadori PS, Monjardim RDF, Bretas EAS, Torres LR, Caldana RP, Shigueoka DC, Medeiros RB, D'ippolito G. When the non-contrast-enhanced phase is unnecessary in abdominal computed tomography scans? A retrospective analysis of 244 cases. Radiol Bras 2013. [DOI: 10.1590/s0100-39842013000400004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Objective: To evaluate the necessity of the non contrast-enhanced phase in abdominal computed tomography scans. Materials and Methods: A retrospective, cross-sectional, observational study was developed, evaluating 244 consecutive abdominal computed tomography scans both with and without contrast injection. Initially, the contrast-enhanced images were analyzed (first analysis). Subsequently, the observers had access to the non-contrast-enhanced images for a second analysis. The primary and secondary diagnoses were established as a function of the clinical indications for each study (such as tumor staging, acute abdomen, investigation for abdominal collection and hepatocellular carcinoma, among others). Finally, the changes in the diagnoses resulting from the addition of the non-contrast-enhanced phase were evaluated. Results: Only one (0.4%; p > 0.999; non-statistically significant) out of the 244 reviewed cases had the diagnosis changed after the reading of non-contrast-enhanced images. As the secondary diagnoses are considered, 35 (14%) cases presented changes after the second analysis, as follows: nephrolithiasis (10%), steatosis (3%), adrenal nodule (0.7%) and cholelithiasis (0.3%). Conclusion: For the clinical indications of tumor staging, acute abdomen, investigation of abdominal collections and hepatocellular carcinoma, the non-contrast-enhanced phase can be excluded from abdominal computed tomography studies with no significant impact on the diagnosis.
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Monjardim RDF, Costa DMC, Romano RFT, Salvadori PS, Santos JDVCD, Atzingen ACV, Shigueoka DC, D'Ippolito G. Diagnosis of hepatic steatosis by contrast-enhanced abdominal computed tomography. Radiol Bras 2013. [DOI: 10.1590/s0100-39842013000300005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Objective To evaluate the diagnostic capacity of abdominal computed tomography in the assessment of hepatic steatosis using the portal phase with a simplified calculation method as compared with the non-contrast-enhanced phase. Materials and Methods In the present study, 150 patients were retrospectively evaluated by means of non-contrast-enhanced and contrast-enhanced computed tomography. One hundred patients had hepatic steatosis and 50 were control subjects. For the diagnosis of hepatic steatosis in the portal phase, the authors considered a result of < 104 HU calculated by the formula [L - 0.3 × (0.75 × P + 0.25 × A)] / 0.7, where L, P and A represent the attenuation of the liver, of the main portal vein and abdominal aorta, respectively. Sensitivity, specificity, positive and negative predictive values were calculated, using non-contrast-enhanced computed tomography as the reference standard. Results The simplified calculation method with portal phase for the diagnosis of hepatic steatosis showed 100% sensitivity, 36% specificity, negative predictive value of 100% and positive predictive value of 75.8%. The rate of false positive results was 64%. False negative results were not observed. Conclusion The portal phase presents an excellent sensitivity in the diagnosis of hepatic steatosis, as compared with the non-contrast-enhanced phase of abdominal computed tomography. However, the method has low specificity.
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