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Dietrich CF, Correas JM, Cui XW, Dong Y, Havre RF, Jenssen C, Jung EM, Krix M, Lim A, Lassau N, Piscaglia F. EFSUMB Technical Review - Update 2023: Dynamic Contrast-Enhanced Ultrasound (DCE-CEUS) for the Quantification of Tumor Perfusion. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024; 45:36-46. [PMID: 37748503 DOI: 10.1055/a-2157-2587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Dynamic contrast-enhanced ultrasound (DCE-US) is a technique to quantify tissue perfusion based on phase-specific enhancement after the injection of microbubble contrast agents for diagnostic ultrasound. The guidelines of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) published in 2004 and updated in 2008, 2011, and 2020 focused on the use of contrast-enhanced ultrasound (CEUS), including essential technical requirements, training, investigational procedures and steps, guidance regarding image interpretation, established and recommended clinical indications, and safety considerations. However, the quantification of phase-specific enhancement patterns acquired with ultrasound contrast agents (UCAs) is not discussed here. The purpose of this EFSUMB Technical Review is to further establish a basis for the standardization of DCE-US focusing on treatment monitoring in oncology. It provides some recommendations and descriptions as to how to quantify dynamic ultrasound contrast enhancement, and technical explanations for the analysis of time-intensity curves (TICs). This update of the 2012 EFSUMB introduction to DCE-US includes clinical aspects for data collection, analysis, and interpretation that have emerged from recent studies. The current study not only aims to support future work in this research field but also to facilitate a transition to clinical routine use of DCE-US.
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Affiliation(s)
- Christoph F Dietrich
- Department General Internal Medicine, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
- Zentrum der Inneren Medizin, Johann Wolfgang Goethe Universitätsklinik Frankfurt, Frankfurt, Germany
| | - Jean-Michel Correas
- Department of Adult Radiology, Assistance Publique Hôpitaux de Paris, Necker University Hospital, Paris, France
- Paris Cité University, Paris, France
- CNRS, INSERM Laboratoire d'Imagerie Biomédicale, Sorbonne Université, Paris, France
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Roald Flesland Havre
- Department of Medicine, National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/ Wriezen, Wriezen, Germany
- Brandenburg Institute for Clinical Ultrasound (BICUS), Medical University Brandenburg, Neuruppin, Brandenburg, Germany
| | - Ernst Michael Jung
- Institute of Diagnostic Radiology, Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| | - Martin Krix
- Global Medical & Regulatory Affairs, Bracco Imaging, Konstanz, Germany
| | - Adrian Lim
- Department of Imaging, Imperial College London and Healthcare NHS Trust, Charing Cross Hospital Campus, London, United Kingdom of Great Britain and Northern Ireland
| | - Nathalie Lassau
- Imaging Department. Gustave Roussy cancer Campus. Villejuif, France. BIOMAPS. UMR 1281. CEA. CNRS. INSERM, Université Paris-Saclay, France
| | - Fabio Piscaglia
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Dept of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Maruyama H, Tobari M, Nagamatsu H, Shiina S, Yamaguchi T. Contrast-enhanced ultrasonography for the management of portal hypertension in cirrhosis. Front Med (Lausanne) 2022; 9:1057045. [PMID: 36590972 PMCID: PMC9794740 DOI: 10.3389/fmed.2022.1057045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022] Open
Abstract
Portal hypertension is a major pathophysiological condition in patients with cirrhosis. This accounts for the occurrence and severity of the various manifestations. The degree is determined by the portal pressure or hepatic venous pressure gradients, both of which are obtained by invasive interventional radiological procedures. Ultrasound (US) is a simple and minimally invasive imaging modality for the diagnosis of liver diseases. Owing to the availability of microbubble-based contrast agents and the development of imaging modes corresponding to contrast effects, contrast-enhanced US (CEUS) has become popular worldwide for the detailed evaluation of hepatic hemodynamics, diffuse liver disease, and focal hepatic lesions. Recent advancements in digital technology have enabled contrast-based demonstrations with improved resolution, leading to a wider range of applications. This review article describes the current role, benefits, and limitations of CEUS in the management of portal hypertension.
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Affiliation(s)
- Hitoshi Maruyama
- Department of Gastroenterology, Juntendo University, Tokyo, Japan,*Correspondence: Hitoshi Maruyama
| | - Maki Tobari
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | | | - Suichiro Shiina
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | - Tadashi Yamaguchi
- Center for Frontier Medical Engineering, Chiba University, Chiba, Japan
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Lupușoru R, Sporea I, Rațiu I, Lungeanu D, Popescu A, Dănilă M, Mare R, Marc L, Lascău A, Moga TV, Bende F, Ghiuchici AM, Șirli R. Contrast-Enhanced Ultrasonography with Arrival Time Parametric Imaging as a Non-Invasive Diagnostic Tool for Liver Cirrhosis. Diagnostics (Basel) 2022; 12:diagnostics12123013. [PMID: 36553020 PMCID: PMC9777167 DOI: 10.3390/diagnostics12123013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/23/2022] [Accepted: 11/26/2022] [Indexed: 12/05/2022] Open
Abstract
Liver biopsy is the gold standard method for staging liver fibrosis, but it is an invasive procedure that is associated with some complications. There are also non-invasive techniques for assessing liver fibrosis, such as elastography and biological tests, but these techniques can fail in detection or generate false measurements depending on the subject’s condition. This study aimed to determine whether liver fibrosis can be evaluated using contrast-enhanced ultrasonography with arrival time parametric imaging using the ultrasound machine’s parametric image software, the method being called (CEUS-PAT). CEUS-PAT was performed on each subject using SonoVue as a contrast agent, and images showing liver parenchyma and the right kidney on a single screen were used for analysis in parametric imaging, which was performed using the proprietary software of the ultrasound system. The ratio between the kidney and liver arrival times was calculated. The study included 64 predominantly male (56.3%) subjects, 37 cirrhotic patients, and 27 healthy volunteers, with a mean age of 58.98 ± 8.90 years. Significant differences were found between the liver cirrhosis and healthy groups regarding CEUS-PAT, 0.83 ± 0.09 vs. 0.49 ± 0.11, p < 0.0001. The correlation between CEUS-PAT and VCTE was r = 0.81. The optimal cut-off value for detecting liver cirrhosis was >0.7, with an AUC of 0.98, p < 0.001, Se = 89.19%, Sp = 100%, PPV = 100%, and NPV = 87.1%. We demonstrate that CEUS-PAT achieves excellent performance in diagnosing liver cirrhosis and is a fast method for diagnosing liver cirrhosis that can even be applied in situations where the use of other methods is excluded.
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Affiliation(s)
- Raluca Lupușoru
- Center for Modeling Biological Systems and Data Analysis, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ioan Sporea
- Advanced Regional Research Center in Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Iulia Rațiu
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Advanced Regional Research Center in Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Gastroenterology and Hepatology Clinic, County Emergency Hospital “Pius Brinzeu”, 300723 Timisoara, Romania
- Correspondence: (I.R.); (D.L.); Tel.: +40-722-192-210 (I.R.); +40-073-391-2028 (D.L.)
| | - Diana Lungeanu
- Center for Modeling Biological Systems and Data Analysis, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Correspondence: (I.R.); (D.L.); Tel.: +40-722-192-210 (I.R.); +40-073-391-2028 (D.L.)
| | - Alina Popescu
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Advanced Regional Research Center in Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Gastroenterology and Hepatology Clinic, County Emergency Hospital “Pius Brinzeu”, 300723 Timisoara, Romania
| | - Mirela Dănilă
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Advanced Regional Research Center in Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Gastroenterology and Hepatology Clinic, County Emergency Hospital “Pius Brinzeu”, 300723 Timisoara, Romania
| | - Ruxandra Mare
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Advanced Regional Research Center in Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Gastroenterology and Hepatology Clinic, County Emergency Hospital “Pius Brinzeu”, 300723 Timisoara, Romania
| | - Luciana Marc
- Department of Internal Medicine II, Division of Nephrology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Nephrology Clinic, County Emergency Hospital “Pius Brinzeu”, 300723 Timisoara, Romania
| | - Andrada Lascău
- Discipline of Accounting and Information System, Faculty of Economics and Business Administration, West University of Timisoara, 300115 Timisoara, Romania
| | - Tudor Voicu Moga
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Advanced Regional Research Center in Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Gastroenterology and Hepatology Clinic, County Emergency Hospital “Pius Brinzeu”, 300723 Timisoara, Romania
| | - Felix Bende
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Advanced Regional Research Center in Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Gastroenterology and Hepatology Clinic, County Emergency Hospital “Pius Brinzeu”, 300723 Timisoara, Romania
| | - Ana-Maria Ghiuchici
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Advanced Regional Research Center in Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Gastroenterology and Hepatology Clinic, County Emergency Hospital “Pius Brinzeu”, 300723 Timisoara, Romania
| | - Roxana Șirli
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Advanced Regional Research Center in Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Gastroenterology and Hepatology Clinic, County Emergency Hospital “Pius Brinzeu”, 300723 Timisoara, Romania
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Makhlouf NA, Moustafa EF, Hassany SM. Diagnostic accuracy of hepatic vein arrival time performed with contrast-enhanced ultrasonography for HCV liver cirrhosis. Arab J Gastroenterol 2022; 23:195-200. [PMID: 35688684 DOI: 10.1016/j.ajg.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 04/14/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND STUDY AIMS Contrast-enhanced ultrasonography (CEUS) has increased considerably the use of ultrasound for hemodynamical analyses and quantification. Bolus injection of microbubble agents is used to evaluate transit times. This study aimed to determine the diagnostic accuracy of arrival time (seconds) to the hepatic artery (HAAT), hepatic vein (HVAT), and portal vein (PVAT), based on CEUS used for the diagnosis of cirrhosis, and to correlate these arrival times with the liver stiffness and disease severity. PATIENTS AND METHODS This study evaluated 29 HCV cirrhotic and 19 chronic hepatitis C patients. History, clinical examination, laboratory investigations, abdominal ultrasonography, point shear-wave elastography (pSWE), and CEUS were conducted. RESULTS The mean liver stiffness increased significantly in cirrhotic versus chronic HCV (22.7 versus 5.1; p-value < 0.001). The mean HAAT (p-value = 0.001), PVAT (p-value = 0.002), and HVAT values (p-value: 0.001) were significantly prolonged in cirrhotic compared with chronic HCV. The HVAT cut-off point of cirrhotic patients was 18 s with a sensitivity, specificity, and accuracy of 96.6%, 63.2%, and 83.3%, respectively (area under curve: 0.801). Significant positive correlation was found between liver stiffness (kPa) and HVAT (s) (r = 0.585; p-value = 0.005). No significant correlation was detected between HVAT (s) and the severity of liver disease, as assessed by the Child or MELD scores in cirrhotic patients. CONCLUSION Measuring HVAT by CEUS yielded high-accuracy and correlation outcomes for cirrhosis detection. It could be a valuable noninvasive method for the diagnosis of cirrhosis.
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Affiliation(s)
- Nahed A Makhlouf
- Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Assuit University, Assiut 71515, Egypt.
| | - Ehab F Moustafa
- Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Assuit University, Assiut 71515, Egypt
| | - Sahar M Hassany
- Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Assuit University, Assiut 71515, Egypt
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Chen H, Bao X, Wan L. Application of Contrast-Enhanced Ultrasound Combined with Elastic Imaging Technology in Differential Diagnosis of Salivary Gland Tumors. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:4600751. [PMID: 35449870 PMCID: PMC9018177 DOI: 10.1155/2022/4600751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/07/2022] [Indexed: 11/23/2022]
Abstract
This paper proposes the effect of contrast-enhanced ultrasound combined with real-time elastic imaging technology in the differential diagnosis of salivary gland tumors. 200 patients were selected, including 120 males and 60 females. The age ranged from 9 to 83 years, with an average of 55.4 years. Among the 200 cases, there were 90 cases of single parotid gland on the right, 77 cases of single parotid gland on the left, 2 cases of bilateral (single parotid gland on each side), 2 cases of multiple parotid gland on the right (2 lesions), 1 case of 2 lesions on the left and 1 lesion on the right, and 1 case of multiple parotid gland on the left (4 lesions). 135 cases were located in the superficial lobe (78%) and 38 cases (22%) in the deep lobe of parotid gland. The ARIETTA 70 color Doppler ultrasound diagnostic instrument is used. The equipment is equipped with high-frequency contrast probe, real-time elastic imaging technology, and related software. The results showed that the detection rate of salivary gland tumors by ultrasound was 100% and the diagnostic coincidence rate was 71% (123/173). Ultrasound can not only identify the tumors in and around the parotid gland but also identify the location, size, and internal structure of the tumors. Combined with CDFI, it can make qualitative diagnosis of most benign and malignant salivary gland tumors and provide help for clinical treatment and operation plan. It is proved that contrast-enhanced ultrasound and real-time elastic imaging technology have advantages over gray-scale ultrasound in differentiating benign and malignant superficial enlarged lymph nodes, and the combined use can effectively improve the diagnostic efficiency.
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Affiliation(s)
- Hong Chen
- School of Biomedical Engineering and Medical Imaging, Hubei University of Science and Technology, Xianning 437100, China
| | - Xinyu Bao
- School of Biomedical Engineering and Medical Imaging, Hubei University of Science and Technology, Xianning 437100, China
| | - Long Wan
- The First Affiliated Hospital of Hubei University of Science and Technology, Xianning 437100, China
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Wang W, Xie S, Yuan D, He D, Fang L, Ge F. Systematic Review With Meta-Analysis: Diagnostic, Prognostic and Clinicopathological Significance of CircRNA Expression in Renal Cancer. Front Oncol 2022; 11:773236. [PMID: 35155185 PMCID: PMC8832283 DOI: 10.3389/fonc.2021.773236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/31/2021] [Indexed: 12/12/2022] Open
Abstract
Background Renal cancer (RC) is one of the most common malignant tumors of the urinary system, and molecular targets for the specific diagnosis and treatment of RC have been widely explored. The purpose of this study was to systematically analyze circular RNAs (circRNAs), which may serve as novel tumor markers in terms of the diagnosis, prognosis and clinicopathological characteristics of RC. Methods PubMed and Web of Science were systematically searched for literature as up to July 30, 2021. All included studies were evaluated by the evaluation system, and the results were satisfactory. Hazard ratios (HRs) and odds ratios (ORs) were used to assess the association of circRNAs with diagnostic and clinicopathological indicators. The sensitivity (SEN), specificity (SPE), positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and area under the summary receiver operating characteristic curve (AUC) were combined to evaluate the diagnostic performance of circRNAs in RC. Results We included 22 studies that met the criteria, including 18 that were prognostic, 4 that were diagnostic, and 12 that were clinicopathologically relevant. In terms of prognosis, we found that upregulated circRNAs were positively associated with poor overall survival in patients with RC (HR=1.63, 95% CI=1.43–1.85). In terms of diagnosis, the combined SEN, SPE and AUC of circRNAs in the diagnosis of RC were 0.82, 0.84 and 0.89 (0.86–0.91), respectively. In terms of clinicopathological features, upregulated circRNAs were associated with the Fuhrman grade (OR=0.641, 95% CI=0.471–0.873), T stage (OR=0.236, 95% CI=0.141–0.396), TNM stage (OR=0.225, 95% CI=0.158–0.321) and lymphatic metastasis (OR=0.329, 95% CI=0.193–0.560). Conclusion Our meta-analysis confirms that circRNAs may be candidate biomarkers for the diagnosis, prognosis, and clinicopathological indicators of RC.
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Affiliation(s)
- Wujun Wang
- Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Shengfang Xie
- Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
| | - Dongping Yuan
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Dandan He
- Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
| | - Liming Fang
- Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
- *Correspondence: Liming Fang, ; Fengfeng Ge,
| | - Fengfeng Ge
- Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
- *Correspondence: Liming Fang, ; Fengfeng Ge,
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Chang NW, Wang HK, Liu CS, Loong CC, Lai YC, Chiou HJ, Chou YH. First-Pass Arrival Interval of Ultrasound Contrast Medium in the Hepatic Artery and Portal Vein as a Marker for Assessment of Liver Transplant Recipients. Transplant Proc 2021; 53:2329-2334. [PMID: 34446308 DOI: 10.1016/j.transproceed.2021.07.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/22/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study measures the first-pass arrival times in the hepatic artery and portal vein of the transplanted liver using contrast-enhanced ultrasound (CEUS) and assess its correlation with graft performance in the early posttransplant period. METHODS This study evaluated 35 liver transplant recipients who underwent CEUS examination within 1 month of transplant surgery. CEUS under contrast-specific harmonic imaging mode were recorded for 60 seconds immediately after intravenous administration of microbubble ultrasound contrast medium (Sonazoid, GE Healthcare, Oslo, Norway). The recorded video clips were reviewed by 2 readers to determine the first-pass arrival times in the hepatic artery and portal vein, and the difference between the 2 was defined as the arterial-portal arrival interval (APAI). Laboratory data on the same date of CEUS examination were collected as indicators to correlate with APAI. RESULTS The intra- and inter-rater reliability for APAI measurement were excellent, with intraclass correlation coefficients > .95. The mean APAI was 4.5 ± 1.8 seconds (range, 2.0-10.5 seconds). The APAI was positively correlated with the serum total bilirubin level (r = 0.357, P = .035) and negatively correlated with the platelet count (r = -0.354, P = .037). At the 5 second cutoff point, a total serum bilirubin of >8 mg/dL was reported in 5 of 11 patients (45.4%) with APAI of >5 seconds and in only 3 of 24 patients (12.5%) with APAI of <5 seconds (P < .05). CONCLUSIONS The APAI is a quantitative marker that links the hemodynamics and the clinical status of the liver graft.
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Affiliation(s)
- Nai-Wen Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Kai Wang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Chin-Su Liu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Che-Chuan Loong
- Division of Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Chen Lai
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hong-Jen Chiou
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Hong Chou
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Medical Imaging and Radiological Technology, Yuanpei University of Medical Technology, Hsinchu, Taiwan; Department of Radiology, Yee Zen General Hospital, Taoyuan, Taiwan
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Progress of Interference of Traditional Chinese Medicine on Cirrhosis Treated with Bone Marrow Mesenchymal Stem Cells. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:5569274. [PMID: 34055009 PMCID: PMC8131131 DOI: 10.1155/2021/5569274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/18/2021] [Accepted: 05/04/2021] [Indexed: 11/18/2022]
Abstract
Transplantation of bone marrow mesenchymal stem cells has attracted more and more attention as a regenerative therapy for the treatment of liver diseases. A large number of studies have shown that this kind of cells can inhibit the activation of hepatic stellate cells and regulate tissue homeostasis and immune system via a variety of ways. Meanwhile, bone marrow mesenchymal stem cells can inhibit apoptosis of hepatocyte, improve liver function, and reduce inflammation through multiple pathways. These cells have a broad prospect in the treatment of liver cirrhosis. At present, there are many studies on the specific mechanism of bone marrow mesenchymal stem cells transplantation in the treatment of liver cirrhosis. This paper reviews the pathogenesis of liver cirrhosis and the mechanism of bone marrow mesenchymal stem cells transplantation in the treatment of liver cirrhosis, discusses the effectiveness of traditional Chinese medicine method in enhancing the efficacy of bone marrow mesenchymal stem cells transplantation, and looks forward to its application prospect in the future.
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Lin Y, Liu Y, Jiang B, Li W, Li H, Wang H. Application of Hepatic Transit Time and Shear Wave Velocity in Assessing Portal Pressure in Patients with Cirrhotic Portal Hypertension. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:272-278. [PMID: 33153804 DOI: 10.1016/j.ultrasmedbio.2020.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 06/11/2023]
Abstract
The aim of the study described here was to explore the value of hepatic transit time (HTT) and shear wave velocity (SWV) in diagnosing cirrhotic portal hypertension. Fifty-seven patients had undergone esophagogastric varicose vein embolization (group OBS) and 50 healthy controls (group CON) were retrospectively compared with respect to HTT (arterial-hepatic vein [HA-HVTT], portal vein-hepatic vein [PV-HVTT], liver parenchyma-hepatic vein [PA-HVTT]) and SWV to analyze their efficacy in diagnosing cirrhotic portal hypertension. The correlations between SWV/HTT and free portal pressure (FPP) in group OBS were also analyzed. Compared with group CON, group OBS had a shorter HTT and faster SWV. The area under the curve (AUC) of PV-HVTT (0.93) was higher than those of HA-HVTT (0.75) and PA-HVTT (0.64), the AUCs of PV-HVTT (0.93, threshold 7.9 s) and SWV (0.91, threshold 2.0 cm/s) did not statistically differ (z = 0.35, p = 0.73). HTT and FPP in group OBS had a negative correlation. In conclusion, HTT and SWV can be used to diagnose cirrhotic portal hypertension without difference in diagnostic efficacy, and HTT is more meaningful for assessing the changes in portal pressure.
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Affiliation(s)
- Yuanqiang Lin
- Department of Ultrasound, China-Japan Union Hospital, Jilin University, Changchun, Jilin, China
| | - Yan Liu
- Department of Ultrasound, China-Japan Union Hospital, Jilin University, Changchun, Jilin, China
| | - Bo Jiang
- Department of General Surgery, Nanhu District, China-Japan Union Hospital, Jilin University, Changchun, Jilin, China
| | - Wenhui Li
- Department of Ultrasound, China-Japan Union Hospital, Jilin University, Changchun, Jilin, China
| | - Hequn Li
- Department of Ultrasound, China-Japan Union Hospital, Jilin University, Changchun, Jilin, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital, Jilin University, Changchun, Jilin, China.
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Bashir MR, Horowitz JM, Kamel IR, Arif-Tiwari H, Asrani SK, Chernyak V, Goldstein A, Grajo JR, Hindman NM, Kamaya A, McNamara MM, Porter KK, Solnes LB, Srivastava PK, Zaheer A, Carucci LR. ACR Appropriateness Criteria® Chronic Liver Disease. J Am Coll Radiol 2020; 17:S70-S80. [PMID: 32370979 DOI: 10.1016/j.jacr.2020.01.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 01/25/2020] [Indexed: 12/12/2022]
Abstract
The liver fibrosis stage is the most important clinical determinate of morbidity and mortality in patients with chronic liver diseases. With newer therapies, liver fibrosis can be stabilized and possibly reversed, thus accurate diagnosis and staging of liver fibrosis are clinically important. Ultrasound, CT, and conventional MRI can be used to establish the diagnosis of advanced fibrosis/cirrhosis but have limited utility for assessing earlier stages of fibrosis. Elastography-based ultrasound and MRI techniques are more useful for assessment of precirrhotic hepatic fibrosis. In patients with advanced fibrosis at risk for hepatocellular carcinoma (HCC), ultrasound is the surveillance modality recommended by international guidelines in nearly all circumstances. However, in patients in whom ultrasound does not assess the liver well, including those with severe steatosis or obesity, multiphase CT or MRI may have a role in surveillance for HCC. Both multiphase CT and MRI can be used for continued surveillance in patients with a history of HCC, and contrast-enhanced ultrasound may have an emerging role in this setting. 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 include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Ihab R Kamel
- Panel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hina Arif-Tiwari
- University of Arizona, Banner University Medical Center, Tucson, Arizona
| | - Sumeet K Asrani
- Baylor University Medical Center, Dallas, Texas; American Association for the Study of Liver Diseases
| | | | | | - Joseph R Grajo
- University of Florida College of Medicine, Gainesville, Florida
| | | | - Aya Kamaya
- Stanford University Medical Center, Stanford, California
| | | | | | | | - Pavan K Srivastava
- University of Illinois College of Medicine, Chicago, Illinois; American College of Physicians
| | | | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
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11
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Liu S, Guo R, Hou X, Zhang Y, Jiang X, Wang T, Wu X, Xu K, Pan X, Qiao L. Adipose-tissue derived porcine mesenchymal stem cells efficiently ameliorate CCl 4-induced acute liver failure in mice. Cytotechnology 2020; 72:327-341. [PMID: 32335812 DOI: 10.1007/s10616-020-00370-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 01/09/2020] [Indexed: 01/16/2023] Open
Abstract
Adipose tissue derived mesenchymal stem cells (ADMSCs) may be an attractive therapeutic source for acute liver injury because of their high accessibility and non-invasiveness. Here, we investigated the therapeutic potentials of porcine ADMSCs for acute liver failure (ALF). The morphology, differentiation potential, expression patterns of cell surface markers and liver-specific genes were compared between the ADMSCs derived from the pigs with or without ALF. For therapeutic studies, the expanded porcine ADMSCs from either ALF pig (ALF-ADMSCs) or healthy control pig (Nor-ADMSCs) of passage 3 were transplanted into CCl4-induced ALF mice, and the liver histology and functional tests were performed at days 1, 7, 14, and 21 after cell transplantation. ALF-ADMSCs expressed higher mRNA level of hepatic growth factor (HGF) than the Nor-ADMSCs. Both ALF-ADMSCs and Nor-ADMSCs improved liver histology, functions, and mouse survival rate. Higher level of porcine hepatocyte-specific genes was seen in the livers of ALF-ADMSCs transplanted mice as compared to the Nor-ADMSCs transplanted mice. In particular, ALF-ADMSCs transplanted mice expressed significantly higher level of albumin and cytokeratin 18 in the liver tissues as compared to the Nor-ADMSCs transplanted mice. ALF-ADMSCs might be superior to Nor-ADMSCs in the treatment of ALF as the former possesses stronger hepatic differentiation potential.
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Affiliation(s)
- Shourong Liu
- Department of Liver Diseases, Xixi Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, 310014, China.
| | - Ruihong Guo
- The Fourth Clinical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Xiaoli Hou
- College of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Yue Zhang
- College of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Xiawei Jiang
- College of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Tiantian Wang
- College of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Xiaoyu Wu
- College of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Keyang Xu
- The Fourth Clinical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Xiaoping Pan
- College of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China.
| | - Liang Qiao
- Storr Liver Centre, Westmead Institute for Medical Research, The University of Sydney and Westmead Hospital, Westmead, NSW, 2145, Australia.
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12
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Lee KJ, Jang YO, Cha SK, Kim MY, Park KS, Eom YW, Baik SK. Expression of Fibroblast Growth Factor 21 and β-Klotho Regulates Hepatic Fibrosis through the Nuclear Factor-κB and c-Jun N-Terminal Kinase Pathways. Gut Liver 2018; 12:449-456. [PMID: 29699061 PMCID: PMC6027831 DOI: 10.5009/gnl17443] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 12/03/2017] [Accepted: 12/12/2017] [Indexed: 12/20/2022] Open
Abstract
Background/Aims Fibroblast growth factor (FGF) 21 is associated with hepatic inflammation and fibrosis. However, little is known regarding the effects of inflammation and fibrosis on the β-Klotho and FGF21 pathway in the liver. Methods Enrolled patients had biopsy-confirmed viral or alcoholic hepatitis. FGF19, FGF21 and β-Klotho levels were evaluated using enzyme-linked immunosorbent assay, real-time polymerase chain reaction, and Western blotting. Furthermore, we explored the underlying mechanisms for this process by evaluating nuclear factor-κB (NF-κB) and c-Jun N-terminal kinase (JNK) pathway involvement in Huh-7 cells. Results We observed that the FGF19 and FGF21 serum and mRNA levels in the biopsied liver tissue gradually increased and were correlated with fibrosis stage. Inflammatory markers (interleukin 1β [IL-1β], IL-6, and tumor necrosis factor-α) were positively correlated, while β-Klotho expression was negatively correlated with the degree of fibrosis. In Huh-7 cells, IL-1β increased FGF21 levels and decreased β-Klotho levels. NF-κB and JNK inhibitors abolished the effect of IL-1β on both FGF21 and β-Klotho expression. FGF21 protected IL-1β-induced growth retardation in Huh-7 cells. Conclusions These results indicate that the inflammatory response during fibrogenesis increases FGF21 levels and suppresses β-Klotho via the NF-κB and JNK pathway. In addition, FGF21 likely protects hepatocytes from hepatic inflammation and fibrosis.
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Affiliation(s)
- Kyong Joo Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Yoon Ok Jang
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.,Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seung-Kuy Cha
- Department of Physiology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Moon Young Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.,Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Kyu-Sang Park
- Department of Physiology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Young Woo Eom
- Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Soon Koo Baik
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.,Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine, Wonju, Korea.,Institute of Evidence Based Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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13
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Alfaifi M, Eom YW, Newsome PN, Baik SK. Mesenchymal stromal cell therapy for liver diseases. J Hepatol 2018; 68:1272-1285. [PMID: 29425678 DOI: 10.1016/j.jhep.2018.01.030] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/16/2018] [Accepted: 01/30/2018] [Indexed: 02/08/2023]
Abstract
The therapeutic potential of mesenchymal stromal cells (MSCs) in the treatment of liver fibrosis is predominantly based on their immunosuppressive properties, and their ability to secrete various trophic factors. This potential has been investigated in clinical and preclinical studies. Although the therapeutic mechanisms of MSC transplantation are still not fully characterised, accumulating evidence has revealed that various trophic factors secreted by MSCs play key therapeutic roles in regeneration by alleviating inflammation, apoptosis, and fibrosis as well as stimulating angiogenesis and tissue regeneration in damaged liver. In this review, we summarise the safety, efficacy, potential transplantation routes and therapeutic effects of MSCs in patients with liver fibrosis. We also discuss some of the key strategies to enhance the functionality of MSCs, which include sorting and/or priming with factors such as cytokines, as well as genetic engineering.
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Affiliation(s)
- Mohammed Alfaifi
- Centre for Liver Research, Institute of Immunology and Immunotherapy, University of Birmingham, UK; Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Young Woo Eom
- Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine, Wonju, South Korea; Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Philip N Newsome
- Centre for Liver Research, Institute of Immunology and Immunotherapy, University of Birmingham, UK; National Institute for Health Research Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, UK; Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Soon Koo Baik
- Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine, Wonju, South Korea; Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea.
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14
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Shim KY, Eom YW, Kim MY, Kang SH, Baik SK. Role of the renin-angiotensin system in hepatic fibrosis and portal hypertension. Korean J Intern Med 2018; 33:453-461. [PMID: 29462546 PMCID: PMC5943664 DOI: 10.3904/kjim.2017.317] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 09/05/2017] [Indexed: 02/08/2023] Open
Abstract
The renin-angiotensin system (RAS) is an important regulator of cirrhosis and portal hypertension. As hepatic fibrosis progresses, levels of the RAS components angiotensin (Ang) II, Ang-(1-7), angiotensin-converting enzyme (ACE), and Ang II type 1 receptor (AT1R) are increased. The primary effector Ang II regulates vasoconstriction, sodium homoeostasis, fibrosis, cell proliferation, and inflammation in various diseases, including liver cirrhosis, through the ACE/Ang II/AT1R axis in the classical RAS. The ACE2/Ang-(1-7)/Mas receptor and ACE2/Ang-(1-9)/AT2R axes make up the alternative RAS and promote vasodilation, antigrowth, proapoptotic, and anti-inflammatory effects; thus, countering the effects of the classical RAS axis to reduce hepatic fibrogenesis and portal hypertension. Patients with portal hypertension have been treated with RAS antagonists such as ACE inhibitors, Ang receptor blockers, and aldosterone antagonists, with very promising hemodynamic results. In this review, we examine the RAS, its roles in hepatic fibrosis and portal hypertension, and current therapeutic approaches based on the use of RAS antagonists in patients with portal hypertension.
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Affiliation(s)
- Kwang Yong Shim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Young Woo Eom
- Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Moon Young Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seong Hee Kang
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Soon Koo Baik
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
- Institute of Evidence Based Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
- Correspondence to Soon Koo Baik, M.D. Department of Internal Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 26426, Korea Tel: +82-33-741-1223 Fax: +82-33-745-6782 E-mail:
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15
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Impact of Bacterial Translocation on Hepatopulmonary Syndrome: A Prospective Observational Study. Dig Dis Sci 2018; 63:248-256. [PMID: 29192374 DOI: 10.1007/s10620-017-4868-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/23/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND/AIMS Hepatopulmonary syndrome (HPS) is characterized by a defect in oxygenation induced by pulmonary vascular dilatation in cirrhosis. While severe HPS is responsible for a high rate of mortality, the prevalence and pathophysiology of HPS are not fully elucidated. We evaluated the prevalence and pathophysiology of HPS in patients with cirrhosis. METHODS A total of 142 patients with cirrhosis who underwent saline-agitated contrast echocardiography were enrolled in this prospective observational study. HPS was defined by positive findings on contrast echocardiography, cirrhosis, and the presence of an oxygenation defect (alveolar-arterial oxygen gradient > 15 mmHg). HPS grades from 0 to 3 were assigned based on the density and spatial distribution of microbubbles in the left ventricle. The primary endpoint was the prevalence of HPS. The secondary endpoints included clinical characteristics and levels of lipopolysaccharide (LPS), LPS-binding protein (LBP), nitric oxide, and endothelin-1 in HPS. RESULTS Fifty-nine patients (41.5%) were diagnosed with HPS (grade 1: 24, grade 2: 23, and grade 3: 12 patients). The mean levels of LPS (0.36 ± 0.02, 1.02 ± 0.18, 2.86 ± 0.77, and 6.56 ± 1.46 EU/mL, p < 0.001) and LBP (7026 ± 3336, 11,445 ± 1247, 11,947 ± 1164, and 13,791 ± 2032 ng/mL, p = 0.045) were found to be increased according to HPS grade (negative, grade 1-3). Endothelin-1 levels were significantly elevated according to HPS grade (1.83 ± 0.17, 2.62 ± 0.22, 3.69 ± 0.28, and 4.29 ± 0.34 pg/mL, p < 0.001), demonstrating a significant difference between each grade (p < 0.05). CONCLUSIONS HPS is a common complication with a prevalence of 41.5% in patients with cirrhosis. Bacterial translocation and portal pulmonary vascular dilatation are key mechanism involved in the progression of HPS.
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16
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Qiu T, Wang H, Song J, Ling W, Shi Y, Guo G, Luo Y. Assessment of liver fibrosis by ultrasound elastography and contrast-enhanced ultrasound: a randomized prospective animal study. Exp Anim 2017; 67:117-126. [PMID: 29081454 PMCID: PMC5955743 DOI: 10.1538/expanim.17-0098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This study aimed to assess liver fibrosis by contrast-enhanced ultrasound (CEUS) and point shear-wave elastography (pSWE) in rabbits and compare the performance of the two techniques. Eighty rabbits were divided into experimental (n=60) and control group (n=20). In the experimental group, liver fibrosis (F1-F4) was induced by subcutaneous injection of carbon tetrachloride. CEUS and pSWE of the liver was performed for the two groups at a 4-week interval for 40 weeks. The portal vein rise time (PV-RT), time to peak (PV-TTP), mean transit time (PV-MTT) and the maximum signal intensity (PV-Imax) were analyzed with time-intensity curves (TICs). Liver stiffness value (LSV) was obtained through pSWE. Histologic examination of liver specimens of the rabbits was performed to evaluate the fibrosis stage. PV-RT, PV-TTP, PV-Imax and LSV were significantly different among five liver fibrosis stages (F0-F4) (P<0.01). PV-Imax and LSV displayed better diagnostic performance than PV-RT, PV-TTP, PV-MTT. For diagnosing≥F1 stage fibrosis, the area under the receiver operating characteristic curve (AUROC) of PV-Imax was 0.870, which was similar to that of LSV 0.874 (P=0.94). For diagnosing ≥F2, ≥F3 and ≥F4 stage fibrosis, the AUROC of PV-Imax and LSV was 0.845 vs. 0.956 (P=0.04), 0.789 vs. 0.954 (P=0.01) and 0.707 vs. 0.933 (P=0.03). Both CEUS and pSWE had the potential to be complementary imaging tools in the evaluation of liver fibrosis. The performance of pSWE may be better than CEUS.
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Affiliation(s)
- Tingting Qiu
- Department of Ultrasound, West China Hospital Sichuan University, No.37 Guo Xue Xiang, Wu Hou District, Chengdu 610041, P.R. China
| | - Hong Wang
- Department of Ultrasound, West China Hospital Sichuan University, No.37 Guo Xue Xiang, Wu Hou District, Chengdu 610041, P.R. China
| | - Jinzhen Song
- Department of Ultrasound, West China Hospital Sichuan University, No.37 Guo Xue Xiang, Wu Hou District, Chengdu 610041, P.R. China
| | - Wenwu Ling
- Department of Ultrasound, West China Hospital Sichuan University, No.37 Guo Xue Xiang, Wu Hou District, Chengdu 610041, P.R. China
| | - Yujun Shi
- Research Institute of Pathology, West China Hospital Sichuan University, No.88 Ke Yuan South Road, Wu Hou District, Chengdu 610041, P.R. China
| | - Gang Guo
- Research Institute of Pathology, West China Hospital Sichuan University, No.88 Ke Yuan South Road, Wu Hou District, Chengdu 610041, P.R. China
| | - Yan Luo
- Department of Ultrasound, West China Hospital Sichuan University, No.37 Guo Xue Xiang, Wu Hou District, Chengdu 610041, P.R. China
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17
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Affiliation(s)
- Soung Won Jeong
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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18
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Kim G, Kang SH, Kim MY, Baik SK. Prognostic value of sarcopenia in patients with liver cirrhosis: A systematic review and meta-analysis. PLoS One 2017; 12:e0186990. [PMID: 29065187 PMCID: PMC5655454 DOI: 10.1371/journal.pone.0186990] [Citation(s) in RCA: 213] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/11/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Sarcopenia is a common syndrome in chronic diseases such as liver cirrhosis. The association between sarcopenia and outcomes, such as complications and survival has recently been described in various patient groups. However, study results remain inconclusive. Therefore, the aim of this study was to systematically review the impact of sarcopenia on outcome in patients with cirrhosis. METHODS AND FINDINGS We conducted a systematic review (SR) and meta-analysis (MA) on the impact of sarcopenia on outcome in liver cirrhosis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Of the 312 studies identified, 20 were eligible according to our inclusion criteria. Most of the studies used CT to diagnose sarcopenia. Two studies used bioelectrical impedance analysis (BIA), 10 studies used skeletal muscle index (SMI) and 8 studies used total psoas muscle area (TPA). Seven studies included Asian participants and the remaining 13 studies included Western participants. The prevalence rate of sarcopenia among participants was mean 48.1%, and appeared more among men with a rate of 61.6% whereas the rate was 36% for women. With respect to clinical outcomes, patients with sarcopenia had poorer survival rates and an increased risk of complications such as infection compared to those without sarcopenia. According to the analysis of race subgroup, Asians had a HR 2.45 (95% confidence interval (CI) = 1.44-4.16, P = 0.001) of mortality whereas Westerners had a HR 1.45 (95% CI = 1.002-2.09, P<0.05). CONCLUSIONS Based on this SR and MA, the presence of sarcopenia is related to a poor prognosis and occurrence of cirrhotic complications and could be used for risk assessment. Moreover, Asian participants had higher mortality related to sarcopenia compared to the Western participants.
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Affiliation(s)
- Gaeun Kim
- Department of Nursing, Keimyung University, Daegu, Republic of Korea
| | - Seong Hee Kang
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- * E-mail: (SHK); (SKB)
| | - Moon Young Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- Institute of Evidence based Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Soon Koo Baik
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- Institute of Evidence based Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- * E-mail: (SHK); (SKB)
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Kang SH, Kim MY, Baik SK. Novelties in the pathophysiology and management of portal hypertension: new treatments on the horizon. Hepatol Int 2017; 12:112-121. [DOI: 10.1007/s12072-017-9806-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/08/2017] [Indexed: 02/06/2023]
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20
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Relative Adrenal Insufficiency in Patients with Cirrhosis: A Systematic Review and Meta-Analysis. Dig Dis Sci 2017; 62:1067-1079. [PMID: 28176190 DOI: 10.1007/s10620-017-4471-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 01/20/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Relative adrenal insufficiency (RAI) is frequently observed in patients with cirrhosis. We sought to identify evidence in the literature regarding the impact of RAI on clinical outcomes in cirrhotic patients. METHODS We conducted a systematic review (SR) and meta-analysis (MA) using the Ovid-MEDLINE, EMBASE, and Cochrane Library databases to identify relevant studies in the literature. RESULTS Of the 182 studies identified, 16 were eligible according to our inclusion criteria. The prevalence of RAI was 49.4% (744/1507), and cirrhotic patients with acute critical illnesses such as sepsis were more likely to have RAI compared to those without critical illnesses (P < 0.001). With respect to clinical outcomes, patients with RAI had poorer survival rates and an increased risk of complications such as bleeding and hepatorenal syndrome compared to those without RAI. Corticosteroid therapy had a beneficial effect on critically ill cirrhotic patients in terms of hospital survival rate. CONCLUSIONS Based on this SR and MA, critically ill patients with cirrhosis have a high risk of RAI, and the presence of RAI is related to a poor prognosis and occurrence of cirrhotic complications.
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