Sonography of Diffuse Liver Disease

Tchelepi, Hisham; Ralls, Philip W.; Radin, Randall; Grant, Edward G.

doi:10.7863/jum.2002.21.9.1023

Cited by 244 publications

(198 citation statements)

References 26 publications

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“…Patients with evidence of fatty liver disease was assigned to the NAFLD group, and further divided according to severity of diffuse fatty liver disease (mild-mS, moderate-MS, or severe-SS) on the basis of US beam attenuation [13,14]; otherwise, they were assigned to the group of controls.…”

Section: Study Proceduresmentioning

confidence: 99%

Hepatic artery resistive index (HARI) and non-alcoholic fatty liver disease (NAFLD) fibrosis score in NAFLD patients: cut-off suggestive of non-alcoholic steatohepatitis (NASH) evolution

Tana

Tana²,

Rossi

et al. 2016

J Ultrasound

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Purpose of the study Conventional ultrasound (US) is reliable to reveal the presence of non-alcoholic fatty liver disease (NAFLD), but it is neither sensitive nor specific to reveal fibrosis clues, except in advanced stages where signs of cirrhosis are evident. NALFD fibrosis score is a noninvasive parameter that predicts well the presence of significant fibrosis, but correlations with US parameters are lacking. The aim of this study was, therefore, to compare resistive index of hepatic artery (HARI) of NAFLD patients with different severity degrees of diffuse fatty liver disease vs HARI of controls, and to compare HARI of NAFLD patients with different NAFLD fibrosis scores vs HARI of controls. Methods This was a spontaneous, no-profit observational study conducted in our US department between December 2013 and July 2014. Patients with NAFLD with different severity of disease and healthy controls were included. Echogenicity and size of liver and spleen, maximum portal vein velocity, RI, peak systolic velocity (PSV), and end diastolic velocity (EDV) of splenic artery, PSV, EDV, and RI of hepatic artery, and NAFLD fibrosis score were acquired and compared between groups.Results HARI was significantly lower in NAFLD patients than controls (p \ 0.0001). A significant difference was also found between the groups of NAFLD severity (p \ 0.0001). There was also a difference between HARI of NAFLD patients with different NAFLD fibrosis scores vs HARI of controls (p \ 0.0001) with a positive correlation between HARI and NAFLD fibrosis score. Conclusion and discussion Conventional Doppler US can be helpful to detect NAFLD patients with the risk of fibrous tissue accumulation. HARI tends to exceed the range of controls for patients with NAFLD fibrosis score greater than 0.675. The detection of HARI greater than 0.9 in NAFLD patients, regardless of the US degree of severity of steatosis, might suggest the execution of biopsy to predict the risk of progression to steatohepatitis and fibrous tissue accumulation. Low values of HARI may be expression of lower risk, which does not necessitate any biopsy.Keywords Hepatic artery resistive index Á Non-alcoholic fatty liver disease Á NAFLD fibrosis score Á Non-alcoholic steatohepatitis Á Ultrasound Á Color Doppler Sommario Scopo dello studio L'ecografia convenzionale è risultata affidabile nel rilevare la presenza di steatosi epatica, tra cui la forma non alcolica (NAFLD), ma non è né sensibile né specifica nel rivelare indizi suggestivi di fibrosi, tranne che in fase avanzata dove sono presenti segni conclamati di cirrosi. Il NALFD fibrosis score è un parametro non invasivo che predice bene la presenza di fibrosi significativa, ma non ci sono dati in letteratura riguardanti una possibile correlazione con i parametri ecografici. Lo scopo di questo studio è stato quindi quello di confrontare HARI dei pazienti con NAFLD a differente grado di severità di steatosi epatica vs l'HARI dei controlli, e di confrontare HARI dei pazienti affetti da NAFLD a differente NAFLD fibrosis score...

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Section: Study Proceduresmentioning

confidence: 99%

Hepatic artery resistive index (HARI) and non-alcoholic fatty liver disease (NAFLD) fibrosis score in NAFLD patients: cut-off suggestive of non-alcoholic steatohepatitis (NASH) evolution

Tana

Tana²,

Rossi

et al. 2016

J Ultrasound

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“…Diagnosis of cirrhosis was established according histological criteria when liver biopsy was performed [24], or by the combination of clinical, biochemical and ultrasound imaging data (presence of irregular margins on ultrasound, portal hypertension with laboratory evidence of chronic liver disease) consistent with such a diagnosis [25]. Patients were grouped according to Child-Pugh classification [26] and model for end-stage liver disease (MELD) score [27].…”

Section: Patientsmentioning

confidence: 99%

Chronic antigenic stimuli as a possible explanation for the immunodepression caused by liver cirrhosis

Márquez¹,

Fernández-Gutiérrez²,

Montesdeoca³

et al. 2009

Clinical and Experimental Immunology

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SummaryThe objectives of this work were the analysis of the functional characteristics of circulating monocytes and T lymphocytes in patients with liver cirrhosis, and evaluation of the relationship with an increased exposure to antigens due to bacterial translocation. Forty patients with liver cirrhosis (20 with compensated cirrhosis and 20 with ascitic decompensation) and 20 healthy control subjects were studied. Bacterial translocation was evaluated by serum levels of lipopolysaccharide binding protein (LBP). Macrophage activation was studied by CD40 antigen expression. T lymphocytes were analysed for activation (CD25 + , CD122 + ), effector function (CD8 + CD45RO + CD57 + ), apoptosis (CD95 + ) and regulatory abilities, either by analysis of the membrane expression of co-stimulatory molecules CD80, CD86 and CD28, or by quantification of regulatory T cells CD4 + CD25 high forkhead box P3 (FoxP3). The percentage of activated monocytes and T lymphocytes in patients was increased significantly. The proportions of effector senescent cells and of those near to apoptosis were also significantly higher. With respect to these proportions, there were no significant differences between patients in function of the presence or absence of decompensation or in function of the increased or normal values of LBP. Conversely, those patients with elevated levels of LBP presented a significantly higher frequency of regulatory T cells than those with normal levels. In conclusion, patients with liver cirrhosis showed an intensive activation state with a higher percentage of cells committed to activation-induced death, even in non-advanced stages. It is possible that bacterial permeability and endotoxaemia contribute to the expansion of those lymphocyte populations implicated in the prevention of a more severe antigen-induced immunopathology.

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“…Studies in adults demonstrate the high accuracy of US (over 90%) in confirming the diagnosis of cirrhosis in patients with complications. Early stages and micronodular cirrhosis may be overlooked in up to 30% of cases (9,21). Such data are missing in children.…”

Section: Fibrosis and Cirrhosismentioning

confidence: 99%

“…Further, another limitation of US is that different pathologies may have similar nonspecific findings, and the interpretation depends on the expertise of the operator. To reduce error, it is always important to follow the same routine for examinations, to use different available approaches and optimal transducers, and to be aware of the limitations of US (4,9).…”

Section: The Ultrasound Approach -General Conceptmentioning

confidence: 99%

The role of conventional ultrasound in pediatric chronic liver diseases

Kekez¹

2016

Pedaiatr Today

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The aim of this article is to provide an overview of conventional ultrasound in imaging chronic liver diseases in children. The first part describes the normal ultrasound appearance of a child`s liver and the concepts of examination. The further sections present the usual ultrasound findings, the key sonographic points of the most common chronic paediatric liver conditions, and the role of ultrasound in providing diagnostic and prognostic information, detecting complications and supporting reassuring liver biopsy. The limitations of the method are also discussed. Taking all this into account, the interpretation of ultrasound is better in the context of the clinical picture and, in inconclusive cases, followed up with additional imaging and laboratory work up. Conclusion -In conclusion, regardless of the progress made in diagnostic methodology, ultrasound still remains the first, but mostly not the last imaging modality for presumed chronic liver diseases, in daily clinical practice.

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Sonography of Diffuse Liver Disease

Cited by 244 publications

References 26 publications

Hepatic artery resistive index (HARI) and non-alcoholic fatty liver disease (NAFLD) fibrosis score in NAFLD patients: cut-off suggestive of non-alcoholic steatohepatitis (NASH) evolution

Hepatic artery resistive index (HARI) and non-alcoholic fatty liver disease (NAFLD) fibrosis score in NAFLD patients: cut-off suggestive of non-alcoholic steatohepatitis (NASH) evolution

Chronic antigenic stimuli as a possible explanation for the immunodepression caused by liver cirrhosis

The role of conventional ultrasound in pediatric chronic liver diseases

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