Increased Hepatic Arterial Blood Flow Measured by Hepatic Perfusion Index in Hepatosplenic Schistosomiasis: New Concepts for an Old Disease

Carvalho, Bernardo Times de; Domingues, Ana Lúcia Coutinho; Lopes, Edmundo Pessoa; Brandão, Simone Cristina Soares

doi:10.1007/s10620-016-4080-y

Cited by 7 publications

(8 citation statements)

References 40 publications

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“…Thus, certain Zone III localized hepatic diseases such as Budd Chiari syndrome and Schistosomiasis are known to rapidly produce cirrhosis and they are known to strongly increase LS[68-70]. SPH may offer novel possibilities to explain such clinical observations.…”

Section: Important Consequences Of Sphmentioning

confidence: 99%

Does pressure cause liver cirrhosis? The sinusoidal pressure hypothesis

Mueller¹

2016

WJG

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Independent of their etiology, all chronic liver diseases ultimately lead to liver cirrhosis, which is a major health problem worldwide. The underlying molecular mechanisms are still poorly understood and no efficient treatment strategies are available. This paper introduces the sinusoidal pressure hypothesis (SPH), which identifies an elevated sinusoidal pressure (SP) as cause of fibrosis. SPH has been mainly derived from recent studies on liver stiffness. So far, pressure changes have been exclusively seen as a consequence of cirrhosis. According to the SPH, however, an elevated SP is the major upstream event that initiates fibrosis via biomechanic signaling by stretching of perisinusoidal cells such as hepatic stellate cells or fibroblasts (SPH part I: initiation). Fibrosis progression is determined by the degree and time of elevated SP. The SPH predicts that the degree of extracellular matrix eventually matches SP with critical thresholds > 12 mmHg and > 4 wk. Elevated arterial flow and final arterialization of the cirrhotic liver represents the self-perpetuating key event exposing the low-pressure-organ to pathologically high pressures (SPH part II: perpetuation). It also defines the “point of no return” where fibrosis progression becomes irreversible. The SPH is able to explain the macroscopic changes of cirrhotic livers and the uniform fibrotic response to various etiologies. It also opens up new views on the role of fat and disease mechanisms in other organs. The novel concept will hopefully stimulate the search for new treatment strategies.

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Section: Important Consequences Of Sphmentioning

confidence: 99%

Does pressure cause liver cirrhosis? The sinusoidal pressure hypothesis

Mueller¹

2016

WJG

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“…Since liver fibrosis is a major factor in portal hypertension, liver stiffness can be predicted by the presence of portal hypertension in patients with liver fibrosis (12). In several studies, considering the good correlation between hepatic arterial hypertension and LSM, a good diagnostic performance has been reported for advanced liver fibrosis (13)(14)(15)(16)(17). These findings support the hypothesis that hepatic arterial blood flow index (HBI) can be applied in humans and that fibrosis patients show a hepatic arterial blood flow response.…”

Section: Introductionmentioning

confidence: 53%

“…Radiological imaging technologies involving scintigraphy are widely used to provide valuable information for the detection and characterization of liver failure and cirrhosis and identify an appropriate treatment method in clinical practice (18)(19)(20). In addition, the use of scintigraphy to study liver perfusion and its changes in liver stiffness has been reported (14,21). Therefore, Hepatic Arterial Perfusion Scintigraphy (HAPS) facilitates the overall assessment of HBI (hepatic artery blood flow/total hepatic blood flow) and represents the correlation between HBI and liver stiffness to present a diagnostic algorithm for liver fibrosis (22,23).…”

Section: Introductionmentioning

confidence: 99%

Hepatic Arterial Blood Flow Index Is Associated with the Degree of Liver Fibrosis in Patients with Chronic Hepatitis B Virus Infection

Gao

Yin

et al. 2020

Hepat Mon

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Background: Liver fibrosis due to Hepatitis B Virus (HBV) infection is an important public health concern worldwide. An accurate assessment of liver fibrosis is crucial for the identification of susceptible patients to severe clinical conditions and selection of treatment for patients with Chronic Hepatitis B (CHB) infection. Today, the development of simple, accurate, cost-effective, and non-invasive liver fibrosis tests is essential in clinical practice. Methods: According to liver biopsy as the reference standard, we compared the efficacy of hepatic arterial blood flow index (HBI) versus liver stiffness measurement (LSM), aspartate aminotransferase-to-platelet count ratio index (APRI), and fibrosis index based on 4 factors (FIB-4) to predict various degrees of liver fibrosis among 87 patients with CHB infection. Results: Spearman’s rank correlation coefficient of HBI versus the degree of liver fibrosis, according to the METAVIR scoring system, was 0.672 (P < 0.001). The area under the receiver operating characteristic curve (AUROC) of HBI (0.884; 95% CI: 0.806 - 0.961; P = 0.000) was greater than that of LSM (0.807; 95% CI: 0.703 - 0.912; P = 0.00), APRI (0.684; 95% CI: 0.556 - 0.812; P = 0.009), and FIB-4 (0.757; 95% CI: 0.641 - 0.873; P = 0.000) for the diagnostic analysis of significant liver fibrosis (≥ F2); similar results were obtained for the prediction of other liver fibrosis stages. Conclusions: The present findings shed new light on the association of HBI with the degree of liver fibrosis in patients with CHB infection. Hepatic Arterial Perfusion Scintigraphy (HAPS) with the measurement of HBI is a promising diagnostic method of liver fibrosis stage, which can guide therapy in CHB patients, although further large-scale studies are needed.

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“…Preliminary study conducted by our group, with not yet published data, used angioscintigraphy to evaluate hepatic perfusion with findings similar to those described in cirrhotic patients [57][58][59][60] . We observed a rise of radioisotope uptake in arterial phase of hepatic perfusion of patients with HSS [61] . Thus, it is suggested that, in fact, there is an increased arterial component in the total hepatic flow of schistosomal liver, similar to what occurs in cirrhosis.…”

Section: Intrahepatic Vascular Changesmentioning

confidence: 64%