Non-invasive diagnosis of severe alcoholic hepatitis: Usefulness of cross-sectional imaging

Grillet, Franck; Calame, Paul; Cervoni, Jean Paul; Weil, Delphine; Thévenot, Thierry; Ronot, Maxime; Delabrousse, Éric

doi:10.1016/j.diii.2020.09.009

Cited by 6 publications

(12 citation statements)

References 24 publications

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“…In our study, TPAE was the only significant finding in severe AAH, which is consistent with previous reports. 19 Grillet et al 19 showed that TPAE, which was described as a transient perfusion disorder, was more prevalent among patients with severe AAH (35 of 50 [70%]) than in patients with alcoholic liver cirrhosis without AAH (12 of 62 [21%]). The predictive accuracy of transient perfusion disorder for severe AAH was 73% to 77%.…”

Section: Discussionmentioning

confidence: 99%

Correlation Between Computed Tomography Findings and the Laboratory Test-Derived Severity Score in Patients With Severe Acute Alcoholic Hepatitis

Kim

Lee

et al. 2023

J Comput Assist Tomogr

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ObjectiveThis study aimed to compare computed tomography (CT) findings between patients with severe and nonsevere acute alcoholic hepatitis (AAH).MethodsWe included 96 patients diagnosed with AAH between January 2011 and October 2021 who underwent 4-phase liver CT and laboratory blood tests. Two radiologists reviewed the initial CT images with respect to distribution and grade of hepatic steatosis; transient parenchymal arterial enhancement (TPAE); and presence of cirrhosis, ascites, and hepatosplenomegaly. A Maddrey discriminant function score (4.6 × [patient's prothrombin time − control] + total bilirubin [mg/mL]) was used as cutoff indicator for severity, with a score of 32 or higher indicating severe disease. The image findings were compared between the severe (n = 24) and nonsevere (n = 72) groups using the χ2 test or Fisher exact test. After univariate analysis, the most significant factor was identified using a logistic regression analysis.ResultsIn the univariate analysis, there were significant between-group differences in the TPAE, liver cirrhosis, splenomegaly, and ascites (P < 0.0001, P < 0.0001, P = 0.0002, and P = 0.0163, respectively). Among them, TPAE was the only significant factor for severe AAH (P < 0.0001; odds ratio, 48.1; 95% confidence interval, 8.3–280.6). Using this single indicator, the estimated accuracy, positive predictive, and negative predictive values were 86%, 67%, and 97%, respectively.ConclusionsTransient parenchymal arterial enhancement was the only significant CT finding in severe AAH.

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Section: Discussionmentioning

confidence: 99%

Correlation Between Computed Tomography Findings and the Laboratory Test-Derived Severity Score in Patients With Severe Acute Alcoholic Hepatitis

Kim

Lee

et al. 2023

J Comput Assist Tomogr

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“…A high proportion of severe acute hepatitis cases can result in significant liver failure[ 15 , 16 ]. In these cases, extensive hepatocyte necrosis can lead to substantial bridging.…”

Section: Hepatitis-included Hepatic Dysfunctionmentioning

confidence: 99%

“…In addition, ascites can be detected frequently[ 15 ] (Figure 1 ). Grillet et al [ 15 ] reported that heterogeneous liver parenchyma on CT would be particularly beneficial for patients with acute severe autoimmune hepatitis as histological examinations could be technically challenging due to complications. They also reported heterogeneous CT features of severe alcoholic hepatitis, indicating that these imaging features were mainly associated with transient heterogeneous steatosis and liver perfusion disorders[ 15 ].…”

Section: Hepatitis-included Hepatic Dysfunctionmentioning

confidence: 99%

“…Grillet et al [ 15 ] reported that heterogeneous liver parenchyma on CT would be particularly beneficial for patients with acute severe autoimmune hepatitis as histological examinations could be technically challenging due to complications. They also reported heterogeneous CT features of severe alcoholic hepatitis, indicating that these imaging features were mainly associated with transient heterogeneous steatosis and liver perfusion disorders[ 15 ]. Furthermore, Tana et al [ 17 ] used texture analysis to quantify the heterogeneity of the liver parenchyma, and showed that texture features of the liver could provide important quantitative information in predicting the severity and outcomes of patients with acute alcohol-associated hepatitis.…”

Section: Hepatitis-included Hepatic Dysfunctionmentioning

confidence: 99%

“…This sign is called “reverse enhancement”, which is a characteristic manifestation of severe hepatitis. In addition, ascites can be detected frequently[ 15 ] (Figure 1 ). Grillet et al [ 15 ] reported that heterogeneous liver parenchyma on CT would be particularly beneficial for patients with acute severe autoimmune hepatitis as histological examinations could be technically challenging due to complications.…”

Section: Hepatitis-included Hepatic Dysfunctionmentioning

confidence: 99%

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Noninvasive imaging of hepatic dysfunction: A state-of-the-art review

Duan¹,

Jiang²,

Ling³

et al. 2022

WJG

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Hepatic dysfunction represents a wide spectrum of pathological changes, which can be frequently found in hepatitis, cholestasis, metabolic diseases, and focal liver lesions. As hepatic dysfunction is often clinically silent until advanced stages, there remains an unmet need to identify affected patients at early stages to enable individualized intervention which can improve prognosis. Passive liver function tests include biochemical parameters and clinical grading systems ( e.g ., the Child-Pugh score and Model for End-Stage Liver Disease score). Despite widely used and readily available, these approaches provide indirect and limited information regarding hepatic function. Dynamic quantitative tests of liver function are based on clearance capacity tests such as the indocyanine green (ICG) clearance test. However, controversial results have been reported for the ICG clearance test in relation with clinical outcome and the accuracy is easily affected by various factors. Imaging techniques, including ultrasound, computed tomography, and magnetic resonance imaging, allow morphological and functional assessment of the entire hepatobiliary system, hence demonstrating great potential in evaluating hepatic dysfunction noninvasively. In this article, we provide a state-of-the-art summary of noninvasive imaging modalities for hepatic dysfunction assessment along the pathophysiological track, with special emphasis on the imaging modality comparison and selection for each clinical scenario.

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Liver spontaneous hypoattenuation on CT is an imaging biomarker of the severity of acute pancreatitis

Roussey¹,

Calame

Revel³

et al. 2022

Diagnostic and Interventional Imaging

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Non-invasive diagnosis of severe alcoholic hepatitis: Usefulness of cross-sectional imaging

Cited by 6 publications

References 24 publications

Correlation Between Computed Tomography Findings and the Laboratory Test-Derived Severity Score in Patients With Severe Acute Alcoholic Hepatitis

Correlation Between Computed Tomography Findings and the Laboratory Test-Derived Severity Score in Patients With Severe Acute Alcoholic Hepatitis

Noninvasive imaging of hepatic dysfunction: A state-of-the-art review

Liver spontaneous hypoattenuation on CT is an imaging biomarker of the severity of acute pancreatitis

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