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1
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Mashhadi A, Khalili M, Moghaddam AA, Zadehmir M. Prognostic Value of Porta-Hepatis Lymphadenopathy in Children with Hepatitis A. J Med Ultrasound 2022; 30:272-276. [PMID: 36844764 PMCID: PMC9944826 DOI: 10.4103/jmu.jmu_196_21] [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: 10/30/2021] [Revised: 12/08/2021] [Accepted: 01/27/2022] [Indexed: 12/29/2022] Open
Abstract
Background The present study aimed to investigate the prognostic value of porta-hepatis lymphadenopathy (PHL) in children with hepatitis A virus. Methods The present prospective cohort study included 123 pediatric patients with a definite diagnosis of hepatitis A who were divided into two groups based on the presence or absence of PHL in their abdominal ultrasound: Group A included the patients with a porta-hepatis lymph node of >6 mm in diameter, whereas the patients with a porta-hepatis lymph node of <6 mm in diameter were classified in Group B. The patients were also classified based on the presence or absence of para-aortic lymphadenopathy: Group C had bisecting para-aortic lymph nodes, whereas Group D did not have such findings in their ultrasound. Afterward, the groups were compared in laboratory investigation results and hospital stay. Results According to our results, Group A (n = 57) was significantly higher in aspartate and alanine aminotransferase and alkaline phosphatase levels compared to Group B (P < 0.05), whereas these two groups were not significantly different in the hospital stay. Furthermore, except bilirubin, all laboratory test results were significantly higher in Group C (n = 3) than in Group D. However, there was no significant correlation between the patients' prognosis with the absence or presence of porta-hepatis or para-aortic lymphadenopathy. Conclusion We concluded that there was no significant relationship between porta-hepatis or para-aortic lymphadenopathy and the prognosis of the children with hepatitis A. However, ultrasound findings can help determine the disease severity in pediatric patients with hepatitis A.
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Affiliation(s)
- Amin Mashhadi
- Department of Radiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Manijeh Khalili
- Children and Adolescent Health Research Center, Resistant Tuberculosis Institute, Zahedan University Medical Sciences, Zahedan, Iran
| | - Alireza Ansari Moghaddam
- Health Promotion Research Center, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohadeseh Zadehmir
- Department of Radiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran,Address for correspondence: Dr. Mohadeseh Zadehmir, Department of Radiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran. E-mail:
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2
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Chaubal N, Thomsen T, Kabaalioglu A, Srivastava D, Rösch SS, Dietrich CF. Ultrasound and contrast-enhanced ultrasound (CEUS) in infective liver lesions. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 59:1309-1321. [PMID: 34768289 DOI: 10.1055/a-1645-3138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Infektiöse fokale Leberläsionen (FLL) treten in der klinischen Praxis häufig auf, wobei bakterielle Leberabszesse die Hälfte ausmachen. Eine genaue Diagnose der FLL ist für die Auswahl der am besten geeigneten Therapie und zur Vorbeugung von Komplikationen unerlässlich. Ziel der aktuellen Arbeit ist es, den Nutzen von Ultraschall und kontrastmittelverstärktem Ultraschall (CEUS) zur Erkennung und Charakterisierung infektiöser Leberläsionen zu beschreiben.
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Affiliation(s)
- Nitin Chaubal
- Thane Ultrasound Centre, Thane, India.,Jaslok Hospital and Research Centre, Mumbai, India
| | | | | | - David Srivastava
- Allgemeine Innere Medizin (DAIM) Kliniken Beau Site, Salem und Permanence, Bern, Switzerland
| | - Stephanie Simone Rösch
- Allgemeine Innere Medizin (DAIM) Kliniken Beau Site, Salem und Permanence, Bern, Switzerland
| | - Christoph F Dietrich
- Allgemeine Innere Medizin (DAIM) Kliniken Beau Site, Salem und Permanence, Bern, Switzerland
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3
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Thomsen T, Dietrich CF. [Postmortem sonography helpful in death of unknown origin]. Med Klin Intensivmed Notfmed 2021; 116:254-258. [PMID: 33559701 DOI: 10.1007/s00063-021-00784-6] [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: 01/25/2020] [Revised: 11/19/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
Postmortem imaging has been used primarily in forensic medicine since 1895. Conventional x‑ray, computed tomography (CT), and magnetic resonance imaging (MRI) are used. In studies, sonography is not considered to be of particular value, especially because of postmortem gas formation in adults. We report three cases in which postmortem sonography within three hours of death allowed clarification of a previously unclear cause of death.
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Affiliation(s)
- T Thomsen
- Klinik für Innere Medizin, Westküstenkliniken, Brunsbüttel, Deutschland
| | - C F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Schänzlihalde 11, 3013, Bern, Schweiz.
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4
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Tana C, Schiavone C, Ticinesi A, Ricci F, Giamberardino MA, Cipollone F, Silingardi M, Meschi T, Dietrich CF. Ultrasound imaging of abdominal sarcoidosis: State of the art. World J Clin Cases 2019; 7:809-818. [PMID: 31024952 PMCID: PMC6473121 DOI: 10.12998/wjcc.v7.i7.809] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/08/2019] [Accepted: 03/16/2019] [Indexed: 02/05/2023] Open
Abstract
Since it has been recognized that sarcoidosis (SA) is not an exclusive disorder of the lungs but can also affect other organs such as the liver and spleen, efforts have been made to define specific imaging criteria for the diagnosis of the single organ involvement, and the concept has been reinforced that the exclusion of alternative causes is important to achieve the correct diagnosis. Ultrasound (US) is a useful tool to evaluate patients with suspected abdominal SA, such as of the liver, spleen, kidney, pancreas and other organs, showing findings such as organomegaly, focal lesions and lymphadenopathy. While the diagnosis of abdominal SA is more predictable in the case of involvement of other organs (e.g., lungs), the problem is more complex in the case of isolated abdominal SA. The recent use of contrast-enhanced ultrasound and endoscopic ultrasound elastography has provided additional information about the enhancement patterns and tissue rigidity in abdominal SA. Here we critically review the role of US in abdominal SA, reporting typical findings and limitations of current evidence and by discussing future perspectives of study.
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Affiliation(s)
- Claudio Tana
- Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, and Department of Medicine and Surgery, University-Hospital of Parma, Parma 43126, Italy
| | - Cosima Schiavone
- Department of Internistic Ultrasound, “G. D’Annunzio” University of Chieti, Chieti 66100, Italy
| | - Andrea Ticinesi
- Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, and Department of Medicine and Surgery, University-Hospital of Parma, Parma 43126, Italy
| | - Fabrizio Ricci
- Department of Imaging and Clinical Sciences, Institute for Advanced Biomedical Technologies, “G. D’Annunzio” University of Chieti, Chieti 66100, Italy
| | - Maria Adele Giamberardino
- Geriatrics Clinic, Department of Medicine and Science of Aging, “G. D’Annunzio” University of Chieti, Chieti 66100, Italy
| | - Francesco Cipollone
- Medical Clinic, Department of Medicine and Science of Aging, “G. D’Annunzio” University of Chieti, Chieti 66100, Italy
| | - Mauro Silingardi
- Internal Medicine Unit, Maggiore Hospital of Bologna, Bologna 40133, Italy
| | - Tiziana Meschi
- Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, and Department of Medicine and Surgery, University-Hospital of Parma, Parma 43126, Italy
| | - Christoph F Dietrich
- Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Bad Mergentheim D-97980, Germany
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5
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Yang A, Xiao W, Ju W, Liao Y, Chen M, Zhu X, Wu C, He X. Prevalence and clinical significance of regional lymphadenectomy in patients with hepatocellular carcinoma. ANZ J Surg 2019; 89:393-398. [PMID: 30856685 PMCID: PMC6593848 DOI: 10.1111/ans.15096] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 12/07/2018] [Accepted: 12/28/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND A limited amount of literature involves the clinical significance of regional lymphadenectomy during operations on hepatocellular carcinoma (HCC) patients. Our study aims to explore regional lymphadenectomy rate and node-positive rate, as well as their clinicopathological relevance and prognostic values in patients with HCC receiving liver resection (LR) and liver transplantation (LT). METHODS Patients with HCC who received LR or LT and were diagnosed from 2004 to 2013 were retrieved from the Surveillance Epidemiology and End Results (SEER) database. A total of 6367 patients with staging and regional lymphadenectomy information was included. RESULTS The regional lymphadenectomy rates were 14.3% and 28.6% in patients receiving LR and LT, respectively. Additionally, the rate of LT patients increased from 21.3% to 33.3% in the 2004-2013 time period. In patients with regional lymphadenectomy, node-positive rates were 8.4% and 0.9% in LR and LT patients, respectively. Regional lymphadenectomy was conducted relatively non-specifically in patients receiving LT compared with those receiving LR by analysing its clinicopathological relevance. Furthermore, regional lymphadenectomy did not improve prognosis in the general population or any subgroup. CONCLUSION There was a disparity between high regional lymphadenectomy rate and extremely low node-positive rate in patients with HCC receiving LT, which requires further improvement in future clinical practice.
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Affiliation(s)
- Anli Yang
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Weikai Xiao
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Weiqiang Ju
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuan Liao
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Maogen Chen
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaofeng Zhu
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chenglin Wu
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaoshun He
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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6
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Dong Y, Potthoff A, Klinger C, Barreiros AP, Pietrawski D, Dietrich CF. Ultrasound findings in autoimmune hepatitis. World J Gastroenterol 2018; 24:1583-1590. [PMID: 29686465 PMCID: PMC5910541 DOI: 10.3748/wjg.v24.i15.1583] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/20/2018] [Accepted: 03/30/2018] [Indexed: 02/06/2023] Open
Abstract
Ultrasound findings in autoimmune hepatitis (AIH) have not been reported systematically so far. The use of reliable and accurate noninvasive methods for determining fibrosis stage is important in evaluation of treatment efficacy and fibrosis regression in AIH. Imaging plays an important role in detection of complications and ruling out other possible causes of chronic liver diseases. Ultrasound elastography cut-off values in AIH patients are not the same as those in patients with chronic viral hepatitis or non-alcoholic fatty liver disease. AIH is characterized by wide fluctuations in inflammatory activity. Here we report on current knowledge of ultrasound findings in AIH.
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Affiliation(s)
- Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Andrej Potthoff
- Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule Hannover, Hannover D-30625, Germany
| | - Christoph Klinger
- Department of Internal Medicine 1, Klinikum Ludwigsburg, Ludwigsburg D-71634, Germany
| | - Ana Paula Barreiros
- German Organ Transplantation Foundation, Region Mitte, Mainz D-55131, Germany
| | - Dariusz Pietrawski
- Department of Internal Medicine 2, Caritas-Krankenhaus Bad Mergentheim, Bad Mergentheim D-97980, Germany
| | - Christoph F Dietrich
- Department of Internal Medicine 2, Caritas-Krankenhaus Bad Mergentheim, Bad Mergentheim D-97980, Germany
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7
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Hikita H, Sato M, Endo M, Sato M, Soroida Y, Kobayashi T, Gotoh H, Iwai T, Nakagomi R, Tateishi R, Komuro T, Sone S, Koike K, Yatomi Y, Ikeda H. Disappearance of perihepatic lymph node enlargement after hepatitis C viral eradication with direct-acting antivirals. J Viral Hepat 2018; 25:329-334. [PMID: 29091333 DOI: 10.1111/jvh.12819] [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: 07/11/2017] [Accepted: 09/19/2017] [Indexed: 12/09/2022]
Abstract
Perihepatic lymph node enlargement (PLNE) which has been shown to be negatively associated with hepatocellular carcinoma (HCC) occurrence is frequently observed in chronic liver disease; however, changes in the state of perihepatic lymph nodes after eradication of hepatitis C virus (HCV) have not been investigated yet. We aimed to evaluate this issue. We enrolled 472 patients with chronic HCV infection who achieved viral eradication with direct-acting antivirals (DAA). We investigated whether the status of perihepatic lymph nodes changed before and after HCV eradication (primary endpoint). We also evaluated the association between PLNE and clinical findings such as liver fibrosis or hepatocellular injury before HCV eradication (secondary endpoint). Perihepatic lymph node enlargement was detected in 164 of 472 (34.7%) patients before DAA treatment. Surprisingly, disappearance of PLNE was observed in 23.8% (39 patients) of all PLNE-positive patients after eradication of HCV. Disappearance of PLNE was not associated with baseline clinical parameters or changing rates of clinical findings before and after DAA treatment. At baseline, presence of PLNE was significantly associated with a lower serum HCV-RNA level (P = .03), a higher serum AST level (P = .004) and a higher ALT level (P < .001) after adjustment for sex and age. In conclusion, PLNEs became undetectable after DAA treatment in 23.8% of PLNE-positive patients. Further study with a longer follow-up period is needed to clarify the clinical importance of this phenomenon especially in relationship with the risk of HCC development.
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Affiliation(s)
- H Hikita
- Department of Clinical Laboratory Medicine, Tokyo, Japan
| | - Masaya Sato
- Department of Clinical Laboratory Medicine, Tokyo, Japan.,Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Momoe Endo
- Department of Clinical Laboratory Medicine, Tokyo, Japan
| | - Mamiko Sato
- Department of Clinical Laboratory Medicine, Tokyo, Japan
| | - Y Soroida
- Department of Clinical Laboratory Medicine, Tokyo, Japan
| | - T Kobayashi
- Department of Clinical Laboratory Medicine, Tokyo, Japan
| | - H Gotoh
- Department of Clinical Laboratory Medicine, Tokyo, Japan
| | - T Iwai
- Department of Clinical Laboratory Medicine, Tokyo, Japan
| | - R Nakagomi
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - R Tateishi
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - T Komuro
- Department of Clinical Laboratory Medicine, Tokyo, Japan
| | - S Sone
- Department of Clinical Laboratory Medicine, Tokyo, Japan
| | - K Koike
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Y Yatomi
- Department of Clinical Laboratory Medicine, Tokyo, Japan
| | - H Ikeda
- Department of Clinical Laboratory Medicine, Tokyo, Japan
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8
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Sharma M, Rameshbabu CS, Dietrich CF, Rai P, Bansal R. Endoscopic ultrasound of the hepatoduodenal ligament and liver hilum. Endosc Ultrasound 2018; 7:168-174. [PMID: 27824022 PMCID: PMC6032695 DOI: 10.4103/2303-9027.193584] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The porta hepatis and hepatoduodenal ligament (HDL) are important anatomical pathways of extension of disease to and from the liver. The imaging of this area is difficult. The role of endoscopic ultrasound (EUS) as an imaging modality for hepatoduodenal ligament has not been established so far. All images in the present study have been generated from a detailed review of real time recordings using the curved linear scanning echoendoscope EG -3830 UT (Pentax Corporation, Tokyo, Japan), coupled with a Hitachi avius and Hitach 7500 processor (Hitachi Aloka Medical, Tokyo Japan). Our image orientation is with the cranial aspect of the patient directed toward the right side of the screen. We have illustrated that with a careful technique, a detailed EUS evaluation of the HDL and hepatic hilum is possible. A thorough understanding of the HDL anatomy by curved linear EUS probe may play a crucial role in the accurate diagnosis of a broad spectrum of pathologic conditions of the porta hepatis. EUS examination of the HDL should be a part of the upper abdominal EUS studies. The description and the images described in this article are useful for beginners who want to start imaging of the porta hepatis and hepatoduodenal ligament. This information is useful for staging of malignancies involving common bile duct.
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Affiliation(s)
| | | | - Christoph F Dietrich
- Caritas Krankenhaus Bad Mergentheim Internist, Gastroenterologe und Proktologe Hämatologe-Onkologe, Pneumologe Geriater/Arzt für Palliativmedizin Chefarzt der Med, Bad Mergentheim, Germany
| | - Praveer Rai
- Sanjay Gandhi Post Graduate Institute (SGPGI), Lucknow, Uttar Pradesh, India
| | - Raghav Bansal
- Mount Sinai Elmhurst Hospital Center, Elmhurst, New York, USA
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9
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Hocke M, Braden B, Jenssen C, Dietrich CF. Present status and perspectives of endosonography 2017 in gastroenterology. Korean J Intern Med 2018; 33:36-63. [PMID: 29161800 PMCID: PMC5768548 DOI: 10.3904/kjim.2017.212] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 06/16/2017] [Indexed: 12/13/2022] Open
Abstract
Endoscopic ultrasound has become an essential tool in modern gastroenterology and abdominal surgery. Compared with all other endoscopic methods, it has the most potential for innovation and its future looks bright. Thus, we compiled this summary of established and novel applications of endoscopic ultrasound methods to inform the reader about what is already possible and where future developments will lead in improving patient care further. This review is structured in four parts. The first section reports on developments in diagnostic endoscopic ultrasound, the second looks at semi-invasive endoscopic ultrasound, and the third discusses advances in therapeutic endoscopic ultrasound. An overview on the future prospects of endoscopic ultrasound methods concludes this article.
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Affiliation(s)
- Michael Hocke
- Internal Medicine II, Helios Hospital Meiningen, Germany
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK
| | | | - Christoph F. Dietrich
- Medical Department 2, Caritas Hospital Bad Mergentheim, Bad Mergentheim, Germany
- Correspondence to Christoph F. Dietrich, M.D. Medical Department 2, Caritas Hospital Bad Mergentheim, Uhlandstraße 7, Bad Mergentheim 97980, Germany Tel: +49-7931-582201 Fax: +49-7931-582290 E-mail:
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10
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Yamada Y, Matsumoto S, Mori H, Takaji R, Kiyonaga M, Hijiya N, Tanoue R, Tomonari K, Tanoue S, Hongo N, Ohta M, Seike M, Inomata M, Murakami K, Moriyama M. Periportal lymphatic system on post-hepatobiliary phase Gd-EOB-DTPA-enhanced MR imaging in normal subjects and patients with chronic hepatitis C. Abdom Radiol (NY) 2017; 42:2410-2419. [PMID: 28444420 DOI: 10.1007/s00261-017-1155-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE We sought to evaluate visualization of periportal lymphatics and lymph nodes (lymphatic system) on Gd-EOB-DTPA-enhanced magnetic resonance (MR) images using a fat-suppressed T2-weighted sequence with 3-dimensional (3D) volume isotropic turbo spin echo acquisition (VISTA) at 3.0 T in normal subjects and patients with chronic hepatitis C. METHODS MR imaging was performed in 254 subjects between June 2013 and May 2016. After applying inclusion and exclusion criteria, the final population was 31 normal subjects and 34 patients with chronic hepatitis C. Images were acquired after the hepatobiliary phase following intravenous administration of Gd-EOB-DTPA, which causes signal loss in the bile ducts, to facilitate the visualization of the periportal lymphatic system. Two radiologists assessed the visualization of the periportal lymphatic system in 31 normal subjects. The axial dimensions of the main periportal lymphatic system in normal subjects were measured and compared with those of 34 patients with chronic hepatitis C using the Mann-Whitney U-test, and their correlation with a hepatic fibrosis marker, the Fibrosis-4 (FIB-4), was assessed using Spearman's rank correlation test. RESULTS The periportal lymphatic system was detected as high signal intensity areas surrounding the portal vein up to the third branches by each reader in all normal subjects. The axial dimensions of the main periportal lymphatic system in patients with chronic hepatitis C were significantly larger than those in normal subjects (p < 0.0001), and showed a significantly positive correlation with the FIB-4 score (ρ = 0.73, p < 0.001). CONCLUSIONS Fat-suppressed T2-weighted MR imaging with 3D-VISTA acquired after the hepatobiliary phase on Gd-EOB-DTPA-enhanced imaging may be a useful noninvasive method for evaluating the periportal lymphatic system and the degree of hepatic fibrosis.
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Affiliation(s)
- Yasunari Yamada
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Shunro Matsumoto
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan.
| | - Hiromu Mori
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Ryo Takaji
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Maki Kiyonaga
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Naoki Hijiya
- Department of Molecular Pathology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Rika Tanoue
- Oita Diagnostic Imaging Center, Beppu, Oita, 874-0023, Japan
| | | | - Shuichi Tanoue
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Norio Hongo
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Masayuki Ohta
- Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Masataka Seike
- Gastroenterology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Masafumi Inomata
- Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Kazunari Murakami
- Gastroenterology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Masatsugu Moriyama
- Department of Molecular Pathology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
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11
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Yu J, Chen Y, Wu Y, Ye L, Lian Z, Wei H, Sun R, Tian Z. The differential organogenesis and functionality of two liver-draining lymph nodes in mice. J Autoimmun 2017; 84:109-121. [PMID: 28886898 DOI: 10.1016/j.jaut.2017.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/17/2017] [Accepted: 08/17/2017] [Indexed: 12/13/2022]
Abstract
The liver is an immunological organ. However, fundamental knowledge concerning liver-draining lymph nodes (LNs), which have been newly identified in mice as the portal and celiac LNs, is still lacking. Here, we revealed that the portal LN and celiac LN drain liver lymph through different lymphatic vessels. Although both the portal LN and celiac LN possess typical structures, they have different cell compositions. Interestingly, these two LNs form at different times during fetal development. Moreover, the organogenesis of the celiac LN, but not the portal LN, is controlled by the transcription factor NFIL3. Furthermore, the portal LN and celiac LN also perform different functions. The celiac LN is the predominant site of liver antiviral immune responses, whereas the portal LN functions in the in situ induction of dietary antigen-specific regulatory T cells. In conclusion, the portal LN and celiac LN are two independent liver-draining LNs with different organogenesis histories and separate functions in maintaining immune homeostasis in the liver.
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Affiliation(s)
- Jiali Yu
- Hefei National Laboratory for Physical Sciences at Microscale, The Key Laboratory of Innate Immunity and Chronic Disease (Chinese Academy of Science), Institute of Immunology, School of Life Sciences and Medical Center, University of Science and Technology of China, Hefei, Anhui 230027, China
| | - Yongyan Chen
- Hefei National Laboratory for Physical Sciences at Microscale, The Key Laboratory of Innate Immunity and Chronic Disease (Chinese Academy of Science), Institute of Immunology, School of Life Sciences and Medical Center, University of Science and Technology of China, Hefei, Anhui 230027, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - Yuzhang Wu
- Institute of Immunology, Third Military Medical University, Chongqing, 400038, China.
| | - Lilin Ye
- Institute of Immunology, Third Military Medical University, Chongqing, 400038, China
| | - Zhexiong Lian
- Hefei National Laboratory for Physical Sciences at Microscale, The Key Laboratory of Innate Immunity and Chronic Disease (Chinese Academy of Science), Institute of Immunology, School of Life Sciences and Medical Center, University of Science and Technology of China, Hefei, Anhui 230027, China
| | - Haiming Wei
- Hefei National Laboratory for Physical Sciences at Microscale, The Key Laboratory of Innate Immunity and Chronic Disease (Chinese Academy of Science), Institute of Immunology, School of Life Sciences and Medical Center, University of Science and Technology of China, Hefei, Anhui 230027, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - Rui Sun
- Hefei National Laboratory for Physical Sciences at Microscale, The Key Laboratory of Innate Immunity and Chronic Disease (Chinese Academy of Science), Institute of Immunology, School of Life Sciences and Medical Center, University of Science and Technology of China, Hefei, Anhui 230027, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - Zhigang Tian
- Hefei National Laboratory for Physical Sciences at Microscale, The Key Laboratory of Innate Immunity and Chronic Disease (Chinese Academy of Science), Institute of Immunology, School of Life Sciences and Medical Center, University of Science and Technology of China, Hefei, Anhui 230027, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China.
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Hocke M, Ignee A, Dietrich C. Role of contrast-enhanced endoscopic ultrasound in lymph nodes. Endosc Ultrasound 2017; 6:4-11. [PMID: 28218194 PMCID: PMC5331842 DOI: 10.4103/2303-9027.190929] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 04/25/2016] [Indexed: 12/11/2022] Open
Abstract
Diagnosing unclear lymph node (LN) enlargements in the mediastinum and abdomen is the most important indication of endoscopic ultrasound (EUS)-fine needle aspiration (FNA) after the diagnosis and treatment of pancreatic diseases. Investigating LNs in these areas can happen in different clinical settings. Mostly, it is the first modality in general LN diseases without any peripheral LN enlargements. On the other hand, it can be the question of LN involvement in a known or suspected primary tumor. Due to EUS-FNA cytology, those questions can be answered highly, accurately. However, a primary discrimination of LNs might be helpful to increase the diagnostic value of the FNA cytology, especially in cases with multiple LN enlargements and hard to reach enlarged LNs for example by vessel interposition. Because of the unreliability of B-mode criteria, further diagnostic improvements such as elastography and contrast-enhanced EUS are investigated to increase the accuracy of the initial diagnosis.
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Affiliation(s)
- Michael Hocke
- Medical Department, Helios Klinikum Meiningen, D-98617 Meiningen, Germany
| | - Andre Ignee
- Medical Department, Caritas-Krankenhaus, D-97980 Bad Mergentheim, Germany
| | - Christoph Dietrich
- Medical Department, Caritas-Krankenhaus, D-97980 Bad Mergentheim, Germany
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Jenssen C, Annema JT, Clementsen P, Cui XW, Borst MM, Dietrich CF. Ultrasound techniques in the evaluation of the mediastinum, part 2: mediastinal lymph node anatomy and diagnostic reach of ultrasound techniques, clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography. J Thorac Dis 2015; 7:E439-58. [PMID: 26623120 DOI: 10.3978/j.issn.2072-1439.2015.10.08] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Ultrasound imaging has gained importance in pulmonary medicine over the last decades including conventional transcutaneous ultrasound (TUS), endoscopic ultrasound (EUS), and endobronchial ultrasound (EBUS). Mediastinal lymph node (MLN) staging affects the management of patients with both operable and inoperable lung cancer (e.g., surgery vs. combined chemoradiation therapy). Tissue sampling is often indicated for accurate nodal staging. Recent international lung cancer staging guidelines clearly state that endosonography should be the initial tissue sampling test over surgical staging. Mediastinal nodes can be sampled from the airways [endobronchial ultrasound combined with transbronchial needle aspiration (EBUS-TBNA)] or the esophagus [endoscopic ultrasound fine needle aspiration (EUS-FNA)]. EBUS and EUS have a complementary diagnostic yield and in combination virtually all MLNs can be biopsied. Additionally endosonography has an excellent yield in assessing granulomas in patients suspected of sarcoidosis. The aim of this review in two integrative parts is to discuss the current role and future perspectives of all ultrasound techniques available for the evaluation of mediastinal lymphadenopathy and mediastinal staging of lung cancer. A specific emphasis will be on learning mediastinal endosonography. Part 1 deals with an introduction into ultrasound techniques, MLN anatomy and diagnostic reach of ultrasound techniques and part 2 with the clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography.
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Affiliation(s)
- Christian Jenssen
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Jouke Tabe Annema
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Paul Clementsen
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Xin-Wu Cui
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Mathias Maximilian Borst
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Christoph Frank Dietrich
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
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Feng IC, Wang SJ, Sheu MJ, Koay LB, Lin CY, Ho CH, Sun CS, Kuo HT. Perihepatic nodes detected by point-of-care ultrasound in acute hepatitis and acute-on-chronic liver disease. World J Gastroenterol 2015; 21:12620-12627. [PMID: 26640338 PMCID: PMC4658616 DOI: 10.3748/wjg.v21.i44.12620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 07/07/2015] [Accepted: 09/02/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the manifestations of perihepatic lymph nodes during the episode of acute hepatitis flare by point-of-care ultrasonography.
METHODS: One hundred and seventy-six patients with an episode of acute hepatitis flare (ALT value > 5 × upper normal limit) were enrolled retrospectively. Diagnosis of etiology of the acute hepatitis flare was based on chart records and serological and virological assays. The patients were categorized into two groups (viral origin and non-viral origin) and further defined into ten subgroups according to the etiologies. An ultrasonograpy was performed within 2 h to 72 h (median, 8 h). The maximum size of each noticeable lymph node was measured. Correlation between clinical parameters and nodal manifestations was analyzed
RESULTS: Enlarged lymph nodes (width ≥ 5mm) were noticeable in 110 (62.5%) patients, mostly in acute on chronic hepatitis B (54.5%). The viral group had a higher prevalence rate (89/110 = 80.9%) and larger nodal size (median, 7 mm) than those of the non-viral group (21/66 = 31.8%; median, 0 mm) (P < 0.001 for both). Meanwhile, there were significant differences in the nodal size between acute and chronic viral groups (P < 0.01), and between acute hepatitis A and non-hepatitis A viral groups (P < 0.001). In logistical regression analysis, the nodal width still showed strong significance in multivariate analysis (P < 0.0001) to stratify the two groups. The area under the curve of ROC was 0.805, with a sensitivity of 80.9%, a specificity of 68.2%, positive predictive value of 80.92%, negative predictive value of 68.18%, and an accuracy of 76.14%.
CONCLUSION: Point-of-care ultrasonography to detect perihepatic nodal change is valuable for clarifying the etiologies in an episode of acute hepatitis flare.
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Tian F, Wu JX, Yu WB. Prognostic Factors and Clinical Characteristics for Hepatocellular Carcinoma Patients with Benign Enlarged Perihepatic Lymph Nodes: a Single-Center Experience from China. J Gastrointest Surg 2015; 19:1822-32. [PMID: 26259664 DOI: 10.1007/s11605-015-2900-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 07/27/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND The clinical and prognostic significance of benign perihepatic lymph nodes enlargement (PLNE) from patients with hepatocellular carcinoma (HCC) remains unclear. The objective of this study is to evaluate the relative frequency, incidence and locations of benign PLNE, and the impact on long-term survival of the patients. METHODS A total of 219 consecutive patients who underwent curative resection of HCC between July 2006 and March 2012 in our single institution were divided into two groups according to the presence of PLNE: PLNE group (n = 76), and control group (n = 143). The long-term outcomes were evaluated and compared between the two groups. RESULTS The 1-, 3-, and 5-year recurrence-free survival rates were 77.2, 60.0, and 38.1 % in the PLNE group and 71.3, 42.5, and 25.0 % in the control group (p = 0.080). Corresponding overall survival rates were 96.0, 84.8, 67.1 % and 93.5, 72.4, 46.9 % respectively (p = 0.041). Patients with benign PLNE were associated with a higher rate of centrally located HCCs or tumors adjacent to the major branch of vascular vessels. Multivariate analysis revealed that benign PLNE was an independent positive prognostic factor affecting the overall survival. CONCLUSIONS According to our analysis, patients of HCC with benign PLNE after curative resection can be expected to have better long-term survival. It is also associated with a lower risk of tumor recurrence, but not significant. This finding may provide new insights into daily clinical practice and the pathophysiological characteristics of HCC development.
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Affiliation(s)
- Fei Tian
- Abdominal Surgery Department, Cancer Institute and Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 17 Panjiayuannanli, Chaoyang District, Beijing, 100021, China
| | - Jian-Xiong Wu
- Abdominal Surgery Department, Cancer Institute and Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 17 Panjiayuannanli, Chaoyang District, Beijing, 100021, China.
| | - Wei-Bo Yu
- Abdominal Surgery Department, Cancer Institute and Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 17 Panjiayuannanli, Chaoyang District, Beijing, 100021, China
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Schreiber-Dietrich D, Pohl M, Cui XW, Braden B, Dietrich CF, Chiorean L. Perihepatic lymphadenopathy in children with chronic viral hepatitis. J Ultrason 2015; 15:137-50. [PMID: 26676184 PMCID: PMC4579752 DOI: 10.15557/jou.2015.0012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 04/01/2015] [Accepted: 04/21/2015] [Indexed: 12/26/2022] Open
Abstract
Objective To assess whether lymph node enlargement in the hepatoduodenal ligament occurs in children with chronic viral hepatitis B and C in comparison to healthy controls. Subject and methods In 49 patients with chronic viral hepatitis (38 with chronic hepatitis B, 11 with chronic hepatitis C, 31 male, 18 female; age range 1 to 17 years), and in 51 healthy controls (25 male, 26 female; age range 4 to 16 years), the total perihepatic lymph node volume was assessed using transabdominal ultrasonography as previously described in adult patients. Results Adequate visualization of the liver hilum was achieved in 46/49 (94%) pediatric patients with chronic viral hepatitis and in 46/51 (90%) pediatric healthy controls. In patients with adequate liver hilum visualization, enlarged perihepatic lymph nodes (longitudinal diameter >14 mm) were detected in 32/46 (70%) patients with chronic viral hepatitis and in 5/46 (11%) healthy controls. The total perihepatic lymph nodes volume [mean ± SD] was 1.0 ± 1.2 mL (0.1–5.4 mL) in patients with chronic viral hepatitis and 0.1 ± 0.1 mL (0.0–0.4 mL) in healthy controls (p < 0.05). A maximal lymph node diameter >14 mm identified patients with chronic viral hepatitis with 70% sensitivity and 89% specificity. Conclusion Transabdominal ultrasound can detect lymph nodes within the hepatoduodenal ligament not only in adults but also in children. Paediatric patients with chronic viral hepatitis have significantly enlarged perihepatic lymph nodes compared to controls. Therefore, sonographic assessment of perihepatic lymphadenopathy might be a non-invasive diagnostic tool to screen paediatric patients for chronic viral hepatitis.
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Affiliation(s)
- Dagmar Schreiber-Dietrich
- Innere Medizin 2, Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany ; Medizinische Klinik II, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany
| | - Margret Pohl
- Zentrum der Kinderheilkunde Abteilung für Kindergastroenterologie und Mukoviszidose, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany
| | - Xin-Wu Cui
- Innere Medizin 2, Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals, Headley Way, Oxford, UK
| | - Christoph F Dietrich
- Innere Medizin 2, Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany ; Medizinische Klinik II, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany
| | - Liliana Chiorean
- Innere Medizin 2, Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany ; Département d'imagerie médicale, Clinique des Cévennes, Annonay, France
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Sato M, Hikita H, Hagiwara S, Sato M, Soroida Y, Suzuki A, Gotoh H, Iwai T, Kojima S, Matsuura T, Yotsuyanagi H, Koike K, Yatomi Y, Ikeda H. Potential associations between perihepatic lymph node enlargement and liver fibrosis, hepatocellular injury or hepatocarcinogenesis in chronic hepatitis B virus infection. Hepatol Res 2015; 45:397-404. [PMID: 24849617 DOI: 10.1111/hepr.12361] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 04/03/2014] [Accepted: 05/15/2014] [Indexed: 02/08/2023]
Abstract
AIM Although perihepatic lymph node enlargement (PLNE) is frequently observed in chronic liver disease, little is known about PLNE in chronic hepatitis B virus (HBV) infection. We aimed to evaluate this issue. METHODS We originally enrolled a consecutive 502 patients with chronic HBV infection. Among them, 288 patients without history of interferon-based or nucleoside analog treatment and hepatocellular carcinoma (HCC) were primarily analyzed. RESULTS PLNE was detected in 27 of 288 (9.4%) patients, which was fewer than that in chronic hepatitis C patients but more than that in subjects undertaking a general health examination as previously reported. The presence of PLNE was significantly associated with a higher probability of having an aspartate aminotransferase (AST) platelet ratio index of more than 1.5 (11.1% vs 1.5%, P = 0.01), a higher AST level (38.0 vs 26.8 U/L, P = 0.001), a higher alanine aminotransferase level (50.1 vs 28.0 U/L, P < 0.0001), and a lower platelet count (18.6 vs 20.6 × 10(4) /μL, P = 0.048) after adjustment for sex and age. However, in our original sample (n = 502), PLNE was observed in 1.4% of the patients with HCC and/or its history whereas 9.2% of the patients without HCC, and the proportion was significantly lower in patients with HCC and/or its history (P = 0.03). CONCLUSION PLNE was associated with liver fibrosis and hepatocellular injury, but was negatively associated with HCC in chronic HBV infection.
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Affiliation(s)
- Masaya Sato
- Department of Clinical Laboratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Iyer VR, Hedgire SS, Hoskote SS, Borczuk D, Harisinghani MG. Retrospective cohort study of portacaval lymphadenopathy identified on multidetector CT and implications for follow-up. ACTA ACUST UNITED AC 2014; 40:1481-6. [PMID: 25516214 DOI: 10.1007/s00261-014-0328-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Portacaval lymphadenopathy (PCLA) is common in cirrhosis and chronic viral hepatitis and is frequently an incidental finding on abdominal CT scans. We aimed to detect the incidence of malignancy in organs drained by portacaval nodes in patients with PCLA associated with cirrhosis or chronic viral hepatitis, or incidentally detected PCLA. METHODS We searched CT reports from 2005 to 2007 for the phrases "periportal node" and "portacaval node." MDCTs of patients with portacaval nodes ≥10 mm in maximal short-axis size on contrast-enhanced MDCTs, were included. Records were reviewed for presence of malignancy, liver metastases, chronic viral hepatitis, and cirrhosis. Clinical or imaging follow-up ≥6 months was performed to detect if malignancy developed in organs drained by portacaval nodes in patients with incidental PCLA, cirrhosis, or chronic viral hepatitis. RESULTS 479 patients met inclusion criteria [298 males (62%), mean age 61.4 years]. In 285 (59.5%) patients, PCLA was explained by local pathology or systemic lymphadenopathy. PCLA was incidental in 146 (30.5%) patients. Of these, 112 (76.7%) had ≥6 months of follow-up (median 26 months). No patient with incidental PCLA developed malignancy in organs drained by these nodes. Cirrhosis or chronic viral hepatitis was present in 48 (10.0%) patients. Of these, 42 (87.5%) had ≥6 months follow-up (median 28 months), and only 1 patient developed cholangiocarcinoma (positive predictive value 2.4%). CONCLUSIONS Development of malignancy is rare in patients with PCLA, either incidental or secondary to cirrhosis or chronic viral hepatitis. Our study suggests that no follow-up of PCLA is required in these settings.
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Affiliation(s)
- Veena R Iyer
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA,
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Tucci FA, Broering R, Lutterbeck M, Schlaak JF, Küppers R. Intrahepatic B-cell follicles of chronically hepatitis C virus-infected individuals lack signs of an ectopic germinal center reaction. Eur J Immunol 2014; 44:1842-50. [PMID: 24609763 DOI: 10.1002/eji.201344378] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/05/2014] [Accepted: 03/04/2014] [Indexed: 12/27/2022]
Affiliation(s)
- Felicia A. Tucci
- Institute of Cell Biology (Cancer Research); University of Duisburg-Essen; Essen Germany
| | - Ruth Broering
- Department of Gastroenterology and Hepatology; University of Duisburg-Essen; University Hospital; Essen Germany
| | - Melanie Lutterbeck
- Department of Gastroenterology and Hepatology; University of Duisburg-Essen; University Hospital; Essen Germany
| | - Joerg F. Schlaak
- Department of Gastroenterology and Hepatology; University of Duisburg-Essen; University Hospital; Essen Germany
| | - Ralf Küppers
- Institute of Cell Biology (Cancer Research); University of Duisburg-Essen; Essen Germany
- Centre for Medical Biotechnology (ZMB); University of Duisburg-Essen; Essen Germany
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Cui XW, Friedrich-Rust M, Molo CD, Ignee A, Schreiber-Dietrich D, Dietrich CF. Liver elastography, comments on EFSUMB elastography guidelines 2013. World J Gastroenterol 2013; 19:6329-6347. [PMID: 24151351 PMCID: PMC3801303 DOI: 10.3748/wjg.v19.i38.6329] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 08/11/2013] [Accepted: 09/17/2013] [Indexed: 02/06/2023] Open
Abstract
Recently the European Federation of Societies for Ultrasound in Medicine and Biology Guidelines and Recommendations have been published assessing the clinical use of ultrasound elastography. The document is intended to form a reference and to guide clinical users in a practical way. They give practical advice for the use and interpretation. Liver disease forms the largest section, reflecting published experience to date including evidence from meta-analyses with shear wave and strain elastography. In this review comments and illustrations on the guidelines are given.
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Hikita H, Enooku K, Satoh Y, Yoshida H, Nakagawa H, Masuzaki R, Tateishi R, Soroida Y, Sato M, Suzuki A, Gotoh H, Iwai T, Yokota H, Koike K, Yatomi Y, Ikeda H. Perihepatic lymph node enlargement is a negative predictor for sustained responses to pegylated interferon-α and ribavirin therapy for Japanese patients infected with hepatitis C virus genotype 1. Hepatol Res 2013; 43:1005-12. [PMID: 23356977 DOI: 10.1111/hepr.12061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 12/10/2012] [Accepted: 12/25/2012] [Indexed: 02/01/2023]
Abstract
AIM Although perihepatic lymph node enlargement (PLNE) is reportedly associated with the negative outcome of interferon therapy for chronic hepatitis C, there were limitations in that the results were obtained in patients with various genotypes, viral loads and treatment regimens. We aimed to precisely clarify the significance of PLNE in interferon therapy for chronic hepatitis C. METHODS Between December 2004 and June 2005, 112 patients with hepatitis C virus (HCV) genotype 1 and HCV RNA of more than 100 KIU/mL were enrolled, who underwent pegylated interferon-α plus ribavirin therapy thereafter. PLNE was defined as a perihepatic lymph node of more than 1 cm in the longest axis by ultrasonography. RESULTS The sustained virological response (SVR) rate was lower in patients with PLNE (4/22, 18.2%) than in those without (37/90, 41.1%; P = 0.045) and viral load decline was smaller in patients with PLNE than in those without (P = 0.028). The proportion of PLNE positive patients was the smallest in the SVR group (P = 0.033) among the patient groups divided by the treatment outcome. PLNE was retained as a negative predictor for SVR by multivariate logistic regression analysis (P = 0.012). Furthermore, PLNE was not significantly associated with the mutations at HCV core protein and at interferon sensitivity-determining region, or interleukin-28B polymorphism in 45 patients with HCV genotype 1, enrolled between December 2011 and March 2012. CONCLUSION PLNE is a negative predictor for SVR in patients with HCV genotype 1 and HCV RNA of more than 100 KIU/mL treated with pegylated interferon-α plus ribavirin, independent of other known predictors for SVR.
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Affiliation(s)
- Hiromi Hikita
- Department of Clinical Laboratory Medicine, The University of Tokyo, Tokyo, Japan
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Gotoh H, Enooku K, Soroida Y, Sato M, Hikita H, Suzuki A, Iwai T, Yokota H, Yamazaki T, Koike K, Yatomi Y, Ikeda H. Perihepatic lymph node enlargement observed at a general health examination: A cross-sectional study. Hepatol Res 2013; 43:906-10. [PMID: 23279215 DOI: 10.1111/hepr.12029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 11/16/2012] [Accepted: 11/20/2012] [Indexed: 02/08/2023]
Abstract
AIM Although perihepatic lymph node enlargement (PLNE) is known as a common finding in chronic liver disease, it can be found occasionally at a general health examination. We aimed to clarify the clinical significance of PLNE in general. METHODS Between January 2008 and December 2011, 4234 subjects were enrolled, who underwent a general health examination at the University of Tokyo Hospital. RESULTS PLNE was observed in 69 (1.6%) subjects, among whom 17 (0.4%) had liver disorders and 13 (0.3%) had malignancy, one of whom had both. No disorders were determined in the remaining 40 subjects (0.9%). Among 17 subjects with liver disorder-associated PLNE, anti-hepatitis C virus (HCV) antibody was determined in 11 and serum alanine aminotransferase levels were less than 40 U/L in eight. Among 13 subjects with malignancy-associated PLNE, para-aortic lymph nodes were also enlarged in eight. Among 40 subjects with PLNE of unknown etiology, 27 could be followed up for the mean period of 2.08 years, where no underlying disorders were newly determined with largely unaltered size of PLNE. CONCLUSION The incidence of PLNE in the general population may vary with the prevalence of chronic liver disease, especially HCV infection. When PLNE is observed, liver disorders should be first surveyed including HCV infection even with normal serum alanine aminotransferase levels. PLNE with para-aortic lymph node enlargement may be suggestive of a malignant lesion. The incidence of PLNE of unknown etiology may be approximately 1% in the general population, which may be just followed up without further change.
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Affiliation(s)
- Hiroaki Gotoh
- Department of Clinical Laboratory Medicine, The University of Tokyo, Tokyo, Japan
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Dietrich C, Schreiber-Dietrich D, Nürnberg D. Abdominelle Sonographie. DER GASTROENTEROLOGE 2013; 8:341-356. [DOI: 10.1007/s11377-013-0766-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
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Fujii H, Ohnishi N, Shimura K, Sakamoto M, Ohkawara T, Sawa Y, Nishida K, Ohkawara Y, Kobata T, Yamaguchi K, Itoh Y. Case of autoimmune hepatitis with markedly enlarged hepatoduodenal ligament lymph nodes. World J Gastroenterol 2013; 19:1834-1840. [PMID: 23555173 PMCID: PMC3607761 DOI: 10.3748/wjg.v19.i11.1834] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 01/07/2013] [Accepted: 01/24/2013] [Indexed: 02/06/2023] Open
Abstract
Autoimmune hepatitis (AIH) is a necroinflammatory liver disease of unknown etiology. The disease is characterized histologically by interface hepatitis, biochemically by increased aspartate aminotransferase and alanine aminotransferase levels, and serologically by increased autoantibodies and immunoglobulin G levels. Here we discuss AIH in a previously healthy 37-year-old male with highly elevated serum levels of soluble interleukin-2 receptor and markedly enlarged hepatoduodenal ligament lymph nodes (HLLNs, diameter, 50 mm). Based on these observations, the differential diagnoses were AIH, lymphoma, or Castleman’s disease. Liver biopsy revealed the features of interface hepatitis without bridging fibrosis along with plasma cell infiltration which is the typical characteristics of acute AIH. Lymph node biopsy revealed lymphoid follicles with inflammatory lymphocytic infiltration; immunohistochemical examination excluded the presence of lymphoma cells. Thereafter, he was administered corticosteroid therapy: after 2 mo, the enlarged liver reached an almost normal size and the enlarged HLLNs reduced in size. We could not find AIH cases with such enlarged lymph nodes (diameter, 50 mm) in our literature review. Hence, we speculate that markedly enlarged lymph nodes observed in our patient may be caused by a highly activated, humoral immune response in AIH.
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Abstract
Chronic infections with persistent pathogens such as helminths, mycobacteria, Plasmodium, and hepatitis viruses affect more than a third of the human population and are associated with increased susceptibility to other pathogens as well as reduced vaccine efficacy. Although these observations suggest an impact of chronic infections in modulating immunity to unrelated antigens, little is known regarding the underlying mechanisms. Here, we summarize evidence of the most prevalent infections affecting immunity to unrelated pathogens and vaccines, and discuss potential mechanisms of how different bystander chronic infections might impact immune responses. We suggest that bystander chronic infections affect different stages of host responses and may impact transmission and recognition of other pathogens, innate immune responses, priming and differentiation of adaptive effector responses, as well as the development and maintenance of immunological memory. Further understanding of the immunological effects of coinfection should provide opportunities to enhance vaccine efficacy and control of infectious diseases.
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Hikita H, Nakagawa H, Tateishi R, Masuzaki R, Enooku K, Yoshida H, Omata M, Soroida Y, Sato M, Gotoh H, Suzuki A, Iwai T, Yokota H, Koike K, Yatomi Y, Ikeda H. Perihepatic lymph node enlargement is a negative predictor of liver cancer development in chronic hepatitis C patients. J Gastroenterol 2013; 48:366-73. [PMID: 22790352 DOI: 10.1007/s00535-012-0635-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 06/19/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Perihepatic lymph node enlargement (PLNE) is a common ultrasound finding in chronic hepatitis C patients. Although PLNE is considered to reflect the inflammatory response to hepatitis C virus (HCV), its clinical significance remains unclear. METHODS Between December 2004 and June 2005, we enrolled 846 chronic hepatitis C patients in whom adequate ultrasound examinations had been performed. PLNE was defined as a perihepatic lymph node that was at least 1 cm in the longest axis by ultrasonography. We analyzed the clinical features of patients with PLNE and prospectively investigated the association between PLNE and hepatocellular carcinoma (HCC) development. RESULTS We detected PLNE in 169 (20.0%) patients. Female sex, lower body mass index (BMI), and HCV serotype 1 were independently associated with the presence of PLNE. However, there were no significant differences in liver function tests, liver stiffness, and hepatitis C viral loads between patients with and without PLNE. During the follow-up period (mean 4.8 years), HCC developed in 121 patients. Unexpectedly, patients with PLNE revealed a significantly lower risk of HCC development than those without PLNE (p = 0.019, log rank test). Multivariate analysis revealed that the presence of PLNE was an independent negative predictor of HCC development (hazard ratio 0.551, p = 0.042). In addition, the sustained viral response rate in patients who received interferon (IFN) therapy was significantly lower in patients with PLNE than in patients without PLNE. CONCLUSIONS Patients with PLNE had a lower risk of HCC development than those without PLNE. This study may provide new insights into daily clinical practice and the pathophysiology of HCV-induced hepatitis and hepatocarcinogenesis.
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Affiliation(s)
- Hiromi Hikita
- Department of Clinical Laboratory Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Ying M, Zheng YP, Kot BCW, Cheung JCW, Cheng SCH, Kwong DLW. Three-dimensional elastography for cervical lymph node volume measurements: a study to investigate feasibility, accuracy and reliability. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:396-406. [PMID: 23312962 DOI: 10.1016/j.ultrasmedbio.2012.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 10/01/2012] [Accepted: 10/02/2012] [Indexed: 06/01/2023]
Abstract
This study investigated the feasibility of using three-dimensional (3-D) elastography in measuring cervical lymph node volume and compared the accuracy and reliability of 3-D elastography and 3-D grayscale ultrasound in measurement of ill-defined cervical nodes. Eighteen porcine lymph nodes from the neck were embedded in tissue-mimicking phantoms and scanned with the two ultrasound techniques. Ultrasound measurements were compared with the volume determined by water-displacement method to evaluate measurement accuracy. Inter-observer reproducibility and intra-observer repeatability of measurements were evaluated. Four patients with enlarged neck nodes were included to evaluate intra-observer repeatability of ultrasound measurements. Results demonstrated that lymph nodes that appeared ill-defined on grayscale ultrasound showed well-defined boundaries on elastography. 3-D elastography has higher measurement accuracy (84.2%), reproducibility (intraclass correlation coefficient, ICC = 0.909) and repeatability (ICC = 0.964-0.988) than does 3-D grayscale ultrasound (62.2%, 0.777 and 0.863-0.906 respectively). As a conclusion, 3-D elastography is accurate and reliable in volume measurement of ill-defined lymph nodes and has potential for accurate assessment of lymph node volume.
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Affiliation(s)
- Michael Ying
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
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The value of dynamic imaging for standardization of abdominal ultrasonography. J Med Ultrason (2001) 2012; 39:69-77. [DOI: 10.1007/s10396-011-0341-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Accepted: 11/01/2011] [Indexed: 10/14/2022]
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Clinical significance of perihepatic lymphadenopathy in patients with chronic hepatitis C infection. Dig Dis Sci 2011; 56:2137-44. [PMID: 21259074 DOI: 10.1007/s10620-010-1555-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 12/30/2010] [Indexed: 01/29/2023]
Abstract
BACKGROUND Patients with chronic hepatitis C (HCV) infection commonly have perihepatic lymph node enlargement (PLNE). We investigated the prognostic value of PLNE in the development of complicated cirrhosis and death, as well as the clinical and laboratory factors associated with the presence of PLNE in a cohort of HCV-infected veterans. METHODS Using a retrospective cohort design, we compared the rate of development of decompensated cirrhosis and/or death in a group of HCV-infected patients who did not have evidence of decompensated cirrhosis stratified by the presence or absence of PLNE. We used Kaplan-Meier survival curves. We then evaluated which factors were predictive of detection of PLNE using logistic regression. RESULTS A total of 131 patients were included in the study. Fifty-nine patients had PLNE and 72 patients did not. After a mean follow-up of 42 months, survival in the absence of progression to decompensated cirrhosis and/or death was not significantly different between the two groups (log-rank test, p = 0.27). The only factor predictive of progression to decompensated cirrhosis and/or death was the presence of cirrhosis at baseline (HR 13.13, 95% CI 2.21-79.41). In addition, cirrhosis was the only factor predictive of the detection of PLNE on CT scan (OR 3.09: CI 2.1-25.9). CONCLUSIONS Presence of PLNE in patients with chronic HCV infection is strongly associated with subclinical cirrhosis. However, PLNE does not independently predict the progression of liver disease to decompensated cirrhosis and/or death in HCV-infected patients.
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Scarlata S, Conte ME, Cesari M, Gentilucci UV, Miglioresi L, Pedone C, Picardi A, Ricci GL, Incalzi RA. Gas exchanges and pulmonary vascular abnormalities at different stages of chronic liver disease. Liver Int 2011; 31:525-33. [PMID: 21382163 DOI: 10.1111/j.1478-3231.2011.02467.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND It is unclear whether and to which extent respiratory function abnormalities may complicate the earliest stages of chronic liver disease (CLD). Aim of this study was to compare pulmonary capillary volumes and gas exchange efficiency of CLD patients with and without cirrhosis. METHODS Sixty-seven participants (mean age 56.5 years; women 22.4%) were divided into three groups (matched by age, sex, smoking) according to the baseline CLD stage as follows: (a) healthy controls (Group A, n=20); (b) non-cirrhotic CLD patients (Group B; n=23); (c) cirrhotic CLD patients (Group C; n=24). All participants underwent clinical assessment, respiratory function tests, gas exchange estimation by the alveolar diffusion of carbon monoxide (TLCO) measurement and 6-min walking test. Groups were compared by chi-square and one-way anova tests. RESULTS Chronic liver disease patients had significantly lower levels of TLCO (Group B=17.7 ml/min mmHg, and Group C=14.2 ml/min mmHg) compared with healthy controls (Group A=24.4 ml/min mmHg). Consistent results were obtained when analyses were performed using TLCO expressed as percentage of the predicted value. TLCO adjusted for the alveolar volume was lower in cirrhotic patients compared with both controls and non-cirrhotic CLD patients (P<0.001 and P=0.035 respectively). Group C participants presented blood gas parameters tending to a compensated chronic respiratory alkalosis status compared with the other groups. CONCLUSIONS Pulmonary microvascular and gas exchange modifications are present at early stages of CLD. Future studies should be focused at evaluating the pathophysiological mechanisms underlying this relationship.
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Affiliation(s)
- Simone Scarlata
- Unit of Respiratory Pathophysiology, Università Campus Biomedico, Rome, Italy.
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Perihepatic lymphadenopathy and the response to therapy in chronic hepatitis C patients(). J Ultrasound 2010; 13:164-7. [PMID: 23396905 DOI: 10.1016/j.jus.2010.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION To determine whether ultrasound (US) findings of perihepatic lymphadenopathy in patients with chronic hepatitis C (HCV) are predictive of failure to achieve sustained virological responses (SVR) to treatment with pegylated interferon (PEG-INF) alpha and ribavirin. MATERIALS AND METHODS The study population included 89 patients with HCV treated with PEG-INF and ribavirin in 2003-2007. US scans and liver biopsies were performed at baseline; US was repeated during treatment and 6 months after its completion. Patients with SVRs at the 6-month follow-up were classified as responders; all others (those with no response or shorter responses) were considered nonresponders. RESULTS Baseline US revealed perihepatic lymphadenopathy in 21.3% of the patients, and 31.6% of these patients were responders. In the responder subgroup, 16% of the patients experienced reductions in lymph node volume during treatment, whereas in the nonresponders, lymph node volume increased during treatment. In patients with no lymphadenopathy at baseline US, no lymph nodes were observed at US after the end of treatment, in either the responders or nonresponders. CONCLUSIONS US is becoming increasingly important in the follow-up of chronic HCV patients. In our study, patients with hilar lymphadenopathy were usually nonresponders, and at the end of treatment their lymph node volume was significantly greater than that observed in the responder subgroup.
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Matsumori A, Shimada M, Obata T. Leukocytes are the major target of hepatitis C virus infection: Possible mechanism of multiorgan involvement including the heart. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.cvdpc.2010.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Perihepatic lymph nodes as markers of disease response in patients with hepatitis C-related liver disease: a prospective clinical evaluation. Eur J Gastroenterol Hepatol 2010; 22:257-63. [PMID: 19177027 DOI: 10.1097/meg.0b013e3283232c7e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
AIM To assess the clinical feasibility of utilizing the presence of perihepatic lymphadenopathy, seen on ultrasound, as a marker of response to antiviral treatment in patients with hepatitis C virus (HCV)-related liver disease. METHODS Eighty-five patients with HCV-related liver disease [51 men and 34 women; mean age 47 years (range 26-67)] underwent liver biopsy and baseline ultrasound scans. Twenty-two of these patients were followed up longitudinally with 6-monthly ultrasound scans, whereas they were receiving anti-HCV eradication therapy with interferon and ribavirin. Perihepatic lymph nodes detected in the coeliac axis and peripancreatic region were noted, with the largest node size on maximal diameter recorded. The patients were subsequently assessed in the light of long-term virological response to treatment. RESULTS Perihepatic lymph nodes were detected in 26 of the 85 patients. Of the 22 patients followed up longitudinally, 11 responded to antiviral treatment, nine failed to respond and two did not complete a course of treatment. No significant difference was found between patients with detectable lymphadenopathy and those without according to age, sex, disease severity and genotype. There was a general reduction in size of lymph nodes in both responders and nonresponders to treatment, although this reduction was only significant in the responder group (P=0.003). CONCLUSION The presence of perihepatic lymphadenopathy when detected in patients with viral hepatitis can potentially serve as an indicator of response to treatment. However, as only 30-40% of patients have detectable lymphadenopathy, its clinical utility is limited.
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MACHIDA KEIGO, TSUKIYAMA-KOHARA KYOKO, SEKIGUCH SATOSHI, SEIKE EIJI, TÓNE SHIGENOBU, HAYASHI YUKIKO, TOBITA YOSHIMI, KASAMA YURI, SHIMIZU MASUMI, TAKAHASHI HIDEMI, TAYA CHYOJI, YONEKAWA HIROMICHI, TANAKA NOBUYUKI, KOHARA MICHINORI. Hepatitis C virus and disrupted interferon signaling promote lymphoproliferation via type II CD95 and interleukins. Gastroenterology 2009; 137:285-96, 296.e1-11. [PMID: 19362089 PMCID: PMC4197798 DOI: 10.1053/j.gastro.2009.03.061] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Revised: 03/26/2009] [Accepted: 03/31/2009] [Indexed: 01/25/2023]
Abstract
BACKGROUND & AIMS The molecular mechanisms of lymphoproliferation associated with the disruption of interferon (IFN) signaling and chronic hepatitis C virus (HCV) infection are poorly understood. Lymphomas are extrahepatic manifestations of HCV infection; we sought to clarify the molecular mechanisms of these processes. METHODS We established interferon regulatory factor-1-null (irf-1(-/-)) mice with inducible and persistent expression of HCV structural proteins (irf-1/CN2 mice). All the mice (n = 900) were observed for at least 600 days after Cre/loxP switching. Histologic analyses, as well as analyses of lymphoproliferation, sensitivity to Fas-induced apoptosis, colony formation, and cytokine production, were performed. Proteins associated with these processes were also assessed. RESULTS Irf-1/CN2 mice had extremely high incidences of lymphomas and lymphoproliferative disorders and displayed increased mortality. Disruption of irf-1 reduced the sensitivity to Fas-induced apoptosis and decreased the levels of caspases-3/7 and caspase-9 messenger RNA species and enzymatic activities. Furthermore, the irf-1/CN2 mice showed decreased activation of caspases-3/7 and caspase-9 and increased levels of interleukin (IL)-2, IL-10, and Bcl-2, as well as increased Bcl-2 expression, which promoted oncogenic transformation of lymphocytes. IL-2 and IL-10 were induced by the HCV core protein in splenocytes. CONCLUSIONS Disruption of IFN signaling resulted in development of lymphoma, indicating that differential signaling occurs in lymphocytes compared with liver. This mouse model, in which HCV expression and disruption of IFN signaling synergize to promote lymphoproliferation, will be an important tool for the development of therapeutic agents that target the lymphoproliferative pathway.
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Affiliation(s)
- KEIGO MACHIDA
- Department of Microbiology and Cell Biology, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan,Department of Immunology, Graduate School of Medicine and Faculty of Medicine, University of Tokyo, Tokyo, Japan,Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - KYOKO TSUKIYAMA-KOHARA
- Department of Microbiology and Cell Biology, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan,Department of Experimental Phylaxiology, Faculty of Medical and Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - SATOSHI SEKIGUCH
- Department of Microbiology and Cell Biology, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - EIJI SEIKE
- Department of Internal Medicine, Self-Defense Forces Central Hospital, Tokyo, Japan
| | - SHIGENOBU TÓNE
- Department of Biochemistry, Kawasaki Medical School, Okayama, Japan
| | - YUKIKO HAYASHI
- Department of Pathology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - YOSHIMI TOBITA
- Department of Microbiology and Cell Biology, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - YURI KASAMA
- Department of Experimental Phylaxiology, Faculty of Medical and Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - MASUMI SHIMIZU
- Department of Microbiology and Immunology, Nippon Medical School, Tokyo, Japan
| | - HIDEMI TAKAHASHI
- Department of Microbiology and Immunology, Nippon Medical School, Tokyo, Japan
| | - CHYOJI TAYA
- Laboratory of Animal Science, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - HIROMICHI YONEKAWA
- Laboratory of Animal Science, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - NOBUYUKI TANAKA
- Department of Immunology, Graduate School of Medicine and Faculty of Medicine, University of Tokyo, Tokyo, Japan,Department of Molecular Oncology, Institute of Gerontology, Nippon Medical School, Kanagawa, Japan
| | - MICHINORI KOHARA
- Department of Microbiology and Cell Biology, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
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Kirchner GI, Tischendorf JJW, Bleck J, Wagner S, Caselitz M, Klempnauer J, Manns MP, Gebel M, Gebel M. Perihilar lymph nodes in patients with primary sclerosing cholangitis with and without cholangiocellular carcinoma. Scand J Gastroenterol 2009; 43:1366-70. [PMID: 18609164 DOI: 10.1080/00365520802200002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Enlarged perihilar lymph nodes have been described in patients with primary sclerosing cholangitis (PSC). The aim of the study was to determine the clinical relevance of perihilar lymph nodes in PSC patients with and without cholangiocellular carcinoma (CCC). MATERIAL AND METHODS The status of perihilar lymph nodes was investigated in 117 patients with PSC using "high-end" ultrasound. Thirty-five of the 117 PSC patients had histologically proven CCC. Lymph node status was correlated with the presence of CCC and inflammatory bowel disease (IBD). RESULTS Seventy-three percent of PSC patients without CCC and 86% of patients with CCC had enlarged perihilar lymph nodes (NS). In CCC patients, the width of lymph nodes was significantly larger (12+/-6 mm versus 8+/-4 mm; p=0.0001), and the length:width ratio (2.15+/-0.7:1 versus 2.5+/-0.6:1; p=0.004) of the lymph nodes was significantly lower. Thirty-seven percent of PSC patients without CCC and 57% of patients with PSC and CCC had multiple perihilar lymph nodes (p=0.04). In all patients, the presence versus absence of IBD had no influence on the number (84% versus 74%,) and size of perihilar lymph nodes (length: 21+/-10 mm versus 19+/-7 mm). Lymph node status did not correlate with the number of episodes of cholangitis. CONCLUSIONS Enlarged perihilar lymph nodes are characteristic of patients with PSC. Since perihilar lymph nodes are not predictive of the presence of complicating CCC, such patients should not be excluded from liver transplantation.
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Affiliation(s)
- Gabriele I Kirchner
- Gastroenterology, Hepatology and Endocrinology, Medical School of Hannover, Germany.
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Braden B, Faust D, Ignee A, Schreiber D, Hirche T, Dietrich CF. Clinical relevance of perihepatic lymphadenopathy in acute and chronic liver disease. J Clin Gastroenterol 2008; 42:931-6. [PMID: 18645531 DOI: 10.1097/mcg.0b013e31811edcf7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND GOAL In chronic virus hepatitis C the total perihepatic lymph node volume reflects the underlying liver histology, viral load, and the host's immunologic response. Assessment of the perihepatic lymph node volume may represent an important diagnostic tool, and may help streamline the patient's further management. The purpose of this study was to prospectively assess whether perihepatic lymphadenopathy is associated with the etiology of acute (and chronic) hepatitis. STUDY In 40 consecutive patients with transaminases >500 U/L without known liver disease the total perihepatic lymph node volume was assessed and compared with the ultrasound findings in 263 patients with known chronic liver disease and also 49 healthy controls. RESULTS Thirty-one out of 40 patients were diagnosed with an acute viral hepatitis, whereas 9/40 patients were diagnosed with a toxic cause, resulting in acute liver damage. In all sonographically evaluated patients with acute viral hepatitis (29/31, 94%) perihepatic lymphadenopathy was found, whereas none of the patients with a toxic cause demonstrated lymphadenopathy. In chronic liver disease, perihepatic lymphadenopathy was present in 86% of viral, in 90% of autoimmune hepatitis, in 100% of primary sclerosing cholangitis, in 97% of primary biliary cirrhosis, but only in 6% of hemochromatosis, in 1% of fatty liver disease, and in 4% of cholecystolithiasis. CONCLUSIONS Perihepatic lymphadenopathy is found in infectious and autoimmune liver diseases, but not in metabolic or toxic liver damage. The absence of perihepatic lymph nodes in acute liver failure should lead to intensive search for a toxic or metabolic cause.
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Affiliation(s)
- Barbara Braden
- Medical Department I, University Hospital Frankfurt, Theodor Stern Kai 7, D-60590 Frankfurt am Main, Germany
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Dietrich CF, Braden B, Hocke M, Ott M, Ignee A. Improved characterisation of solitary solid pancreatic tumours using contrast enhanced transabdominal ultrasound. J Cancer Res Clin Oncol 2007; 134:635-43. [PMID: 17952469 DOI: 10.1007/s00432-007-0326-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Accepted: 09/28/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND Contrast enhanced ultrasound (CEUS) is a new imaging method for detection and characterisation of liver tumours. The role of CEUS in pancreatic disease is less obvious. We prospectively evaluated CEUS for characterization of undetermined solid pancreatic lesions (gold standard histology). PATIENTS AND METHODS A total of 112 solitary undetermined pancreatic masses (70 ductal adenocarcinoma and 42 neoplastic nodules of other origin) were prospectively examined in patients without metastatic disease using transabdominal ultrasound. Tumour enhancing features were analyzed in comparison to the surrounding pancreatic parenchyma in patients with adequate visualisation. RESULTS The sign of iso-hypervascularity as a sign of non-ductal adenocarcinoma showed a sensitivity of 100%, specifity of 90% and accuracy of 93.8%. The sign of hypovascularity as a sign of ductal adenocarcinoma showed a sensitivity of 90%, specifity of 100% and an accuracy of 93.8%. CONCLUSION CEUS allows differential diagnosis of ductal adenocarcinoma and non-ductal adenocarcinoma (mainly neuroendocrine tumours and (microcystic) serous pancreatic adenoma) in the most of cases.
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Affiliation(s)
- C F Dietrich
- Medical and Imaging Department, Caritas-Krankenhaus, Innere Medizin 2, Caritaskrankenhaus Bad Mergentheim, Uhlandstr. 7, 97980 Bad Mergentheim, Germany.
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Friedrich-Rust M, Forestier N, Sarrazin C, Reesink HW, Herrmann E, Zeuzem S. Ultrasound evaluation of perihepatic lymph nodes during antiviral therapy with the protease inhibitor telaprevir (VX-950) in patients with chronic hepatitis C infection. ULTRASOUND IN MEDICINE & BIOLOGY 2007; 33:1362-7. [PMID: 17467151 DOI: 10.1016/j.ultrasmedbio.2007.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2006] [Revised: 02/01/2007] [Accepted: 02/25/2007] [Indexed: 05/15/2023]
Abstract
Previous studies have shown that the total perihepatic lymph node (PLN) volume is (1) associated with the extent of inflammatory activity in the liver and (2) changes according to the antiviral response in patients receiving interferon-based therapy for chronic hepatitis C (HCV) infection. The aim of this prospective pilot study was to examine whether the total PLN volume similarly changes in patients receiving antiviral monotherapy with the protease inhibitor telaprevir (VX-950). The present study was conducted in a subgroup of 19 patients with chronic hepatitis C genotype-1 infection treated with the protease inhibitor telaprevir (VX-950) or placebo in a phase Ib clinical trial. The total perihepatic lymph node volume was assessed using sonography before the initiation of antiviral therapy, at the end of 14 d of treatment, and at follow-up. Treatment with telaprevir resulted in a significant reduction of plasma HCV-RNA in all patients at the end of 14 d of treatment. In patients receiving telaprevir, the total PLN volume decreased significantly at the end of 14 d of treatment compared with pretreatment volume (1.26 mL to 0.76 mL, p=0.01). In contrast, no significant difference was seen in patients receiving placebo (1.00 mL to 1.06 mL, p=0.26). These results suggest that the perihepatic lymph node volume can be used as an indicator for viral and histologic response not only as previously reported in patients receiving interferon-based therapy, but also in patients receiving therapy with direct antivirals.
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Affiliation(s)
- Mireen Friedrich-Rust
- Department of Internal Medicine, Saarland University Hospital, Homburg/Saar, Germany
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Mitchell DG, Navarro VJ, Herrine SK, Bergin D, Parker L, Frangos A, McCue P, Rubin R. Compensated hepatitis C: unenhanced MR imaging correlated with pathologic grading and staging. ACTA ACUST UNITED AC 2007; 33:58-64. [PMID: 17387539 DOI: 10.1007/s00261-007-9203-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND We prospectively examined unenhanced MR imaging findings in relation to pathologic fibrosis, inflammation and steatosis in patients with compensated chronic hepatitis C viral infection (HCV). METHODS Unenhanced MRI at 1.5 T was obtained within one month of core liver biopsy in 64 consecutive candidates for antiviral therapy for compensated HCV. Two pathologists independently graded inflammatory activity index (HAI) and steatosis, and staged fibrosis (grades 0-6). Morphologic MRI findings of cirrhosis, periportal lymph nodes, and MR fat signal ratio from dual gradient echo images were assessed independently by two radiologists blinded to clinical data. MRI and laboratory liver function results were correlated with pathologic results, using Spearman correlation coefficient and stepwise multiple regression. RESULTS MR fat signal ratio correlation coefficient with pathologic steatosis was 0.71 (p < 0.0001). Coefficients with fibrosis stage were highest for surface nodularity (r (s) = 47, p < 0.0001) and expanded gallbladder fossa (r (s) = 0.42, p = 0.0006). Coefficients with HAI were highest for lymph node size (r (s) = 0.355, p = 0.0040), surface nodularity (r = 0.47, p < 0.0001), expanded gallbladder fossa (r = 0.332, p = 0.0073), and caudate/right lobe ratio (r = 0.326, p = 0.0110). Combined lab and MRI variables provided the best prediction of fibrosis stage (r (2) = 0.656) and HAI (r (2) = 0.597). CONCLUSIONS A combination of MRI and laboratory findings was most predictive of fibrosis and inflammation.
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Affiliation(s)
- Donald G Mitchell
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA.
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Sotiropoulos GC, Malagó M, Molmenti EP, Lösch C, Lang H, Frilling A, Broelsch CE, Neuhäuser M. Hilar lymph nodes sampling at the time of liver transplantation for hepatocellular carcinoma: to do or not to do? Meta-analysis to determine the impact of hilar lymph nodes metastases on tumor recurrence and survival in patients with hepatocellular carcinoma undergoing liver transplantation. Transpl Int 2007; 20:141-6. [PMID: 17239022 DOI: 10.1111/j.1432-2277.2006.00412.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The purpose of this study was to evaluate the impact of tumor-positive hilar lymph nodes (LN) on tumor recurrence and survival in patients with hepatocellular carcinoma (HCC) undergoing liver transplantation (LT). A computer search of the Medline database was carried out. The outcome of patients with positive hilar LN (study group) was compared with that of patients with negative LN (reference group). Five clinical studies evaluating tumor recurrence after LT for HCC according to hilar LN status were identified. Five further clinical studies evaluated patients' survival in reference to LN metastases. The test of heterogeneity for each comparison revealed no significant differences (exact P=0.4638). A significant correlation between tumor-positive LN and tumor recurrence was shown (exact estimation of common odds ratio by 10.44, 95% confidence interval of 3.431-38.59). Furthermore, data analyses using the Fisher-combination test regarding patient survival in the two groups showed a statistical difference (P<0.0001). The negative prognostic value of hilar LN metastasis for both tumor recurrence and survival was confirmed by this analysis. Given the ever-present diagnostic dilemma associated with enlarged hilar LN, especially in hepatitis C-positive patients, hilar LN sampling during LT for HCC could better define patients at risk.
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Affiliation(s)
- Georgios C Sotiropoulos
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany.
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Pang BSF, Kot BCW, Ying M. Three-dimensional ultrasound volumetric measurements: is the largest number of image planes necessary for outlining the region-of-interest? ULTRASOUND IN MEDICINE & BIOLOGY 2006; 32:1193-202. [PMID: 16875954 DOI: 10.1016/j.ultrasmedbio.2006.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Revised: 03/29/2006] [Accepted: 04/11/2006] [Indexed: 05/11/2023]
Abstract
Volumetric measurement is useful in the clinical practice as it can accurately assess the size of organs and lesions, which aids diagnosis and monitoring of treatment response. This in vitro study was undertaken to evaluate and compare the accuracy of three-dimensional ultrasound (3D-US) volumetric measurements using different numbers of image planes for outlining the region-of-interest. A total of 20 tissue phantoms (10 with regular and 10 with irregular tissue specimens) with known volume (2.2 - 14.7 ml) were constructed. The tissue phantoms were scanned with a commercially-available ultrasound machine in conjunction with a 3D add-on system and the volume of the tissue specimen of the phantoms was measured by manual outlining of the boundaries using different numbers of image plane (16, eight, four and two image planes). Results showed that there was a high accuracy in 3D-US volumetric measurements, when 16 and eight image planes were used (best-fit slope between measured and true volume: 0.9224-0.9761 and 0.9099-0.956, respectively). Results also showed that there was no significant difference in the volume measured with 16 and eight image planes for both phantoms with regular- and irregular-shaped tissue specimens (p > 0.05). The measurement differences between 16 and eight image planes ranged from -0.07 to 0.14 ml for phantoms with regular-shaped tissue and from -0.24 to 0.1 ml for phantoms with irregular-shaped tissue. 3D-US has a high accuracy in volumetric measurements of regular- and irregular-shaped structures. Although highest accuracy in volume measurements was found when 16 image planes were used, similar level of accuracy can be achieved with eight image planes but the measurement time can be reduced by 50%. Therefore, in 3D-US volumetric measurements, the largest number of image planes may not be necessary for outlining the region-of-interest.
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Affiliation(s)
- Beatrice S F Pang
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
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Jacene HA, Stearns V, Wahl RL. Lymphadenopathy Resulting From Acute Hepatitis C Infection Mimicking Metastatic Breast Carcinoma on FDG PET/CT. Clin Nucl Med 2006; 31:379-81. [PMID: 16785802 DOI: 10.1097/01.rlu.0000222675.10765.14] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a case documenting fluorodeoxyglucose (FDG) accumulation in upper abdominal lymph nodes resulting from acute hepatitis C infection. A 42-year-old African-American female with a history of metastatic breast carcinoma was found to have hypermetabolic porta hepatic, peripancreatic, and paraaortic lymphadenopathy and hypermetabolism in the spleen on a surveillance FDG positron emission tomography/computed tomography (PET/CT) scan. Concurrently, she was diagnosed with acute hepatitis C infection. Antiviral therapy was not recommended secondary to the low level of detectable virus at the time of diagnosis. Her breast cancer therapy regimen was continued unaltered. FDG PET/CT scan was repeated 2 months later as a result of concern that the hypermetabolic lymph nodes represented metastatic disease; however, the scan revealed complete resolution of the previously abnormal findings. The resolution of the lymphadenopathy and the patient's clinical course led to the conclusion that the most likely explanation for the FDG PET/CT findings was inflammation secondary to acute hepatitis C infection and not metastatic breast carcinoma. Inflammatory and infectious processes accumulate FDG, occasionally resulting in false-positives for malignancy. Infected macrophages in the lymph nodes draining the liver in this case and stimulation of a cellular immune response by the hepatitis C virus, with resultant cytokine production by cytotoxic and T-helper cells, offer possible explanations for the findings seen on FDG PET/CT in this case. This case highlights the importance of clinical history and laboratory correlation for the proper interpretation of FDG PET scans.
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Affiliation(s)
- Heather A Jacene
- Division of Nuclear Medicine, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Ying M, Pang SF, Sin MH. Reliability of 3-D ultrasound measurements of cervical lymph node volume. ULTRASOUND IN MEDICINE & BIOLOGY 2006; 32:995-1001. [PMID: 16829313 DOI: 10.1016/j.ultrasmedbio.2006.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2005] [Revised: 02/27/2006] [Accepted: 03/09/2006] [Indexed: 05/10/2023]
Abstract
This study was undertaken to evaluate the reliability of three-dimensional (3-D) ultrasound in measuring cervical lymph node volume. Ultrasound examination of the neck was performed on 15 healthy subjects (eight men and seven women). For each subject, the volume of cervical lymph nodes was measured twice with 3-D ultrasound by two operators, to evaluate the reproducibility of measurements (interoperator variability). 3-D ultrasound measurements of cervical node volume were performed with and without using SonoCT and XRES imaging. Each 3-D data set was reviewed and remeasured by the operators to evaluate the repeatability of measurements (intra-operator variability). Results showed that the reproducibility and repeatability of 3-D ultrasound volumetric measurements of cervical nodes was improved when SonoCT and XRES imaging were used. There was a high repeatability of 3-D ultrasound measurements of cervical node volume (> 90%). A high reproducibility of measurements was found in the posterior triangle nodes (90.3% - 90.9%). When SonoCT and XRES imaging were used with the scanning, there was a high reproducibility for parotid node measurements (87.4%) and a satisfactory level of reproducibility for submental (61.8%), submandibular (69.3%) and upper cervical node (79%) measurements. 3-D ultrasound is a useful and reliable method in measuring cervical lymph node volume. However, further studies to improve the reproducibility of 3-D ultrasound measurements of submental, submandibular and upper cervical node volume are suggested.
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Affiliation(s)
- Michael Ying
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China.
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Kuo HT, Lin CY, Chen JJ, Tsai SL. Enlarged lymph nodes in porta hepatis: sonographic sign of chronic hepatitis B and C infections. JOURNAL OF CLINICAL ULTRASOUND : JCU 2006; 34:211-6. [PMID: 16673362 DOI: 10.1002/jcu.20226] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
PURPOSE Enlarged lymph nodes in the hepatoduodenal ligament are prevalent in chronic infection with hepatitis B virus (HBV) or hepatitis C virus (HCV); however, the clinical significance of this sonographic finding in an endemic area is unknown. METHODS Six hundred outpatients were categorized into 4 groups (nonviral, HBV, HCV, and HBV and HCV) using viral markers. The prevalence and size of enlarged lymph nodes were compared. Correlation between clinical parameters and nodal size was evaluated. RESULTS The incidence of detectable nodes in both the HBV group and the HCV group was significantly increased (56.9% and 69.4%, respectively; both p < 0.001) compared with the nonviral group; this rate was independent of aminotransferase levels. Nodal width was the only significant parameter when viral and nonviral groups were compared (p < 0.05). If a width of more than 5 mm was used to predict HBV or HCV infection, the positive predictive rate was 88% and the specificity was 89%. CONCLUSIONS Lymph nodes in the hepatoduodenal ligament, especially those wider than 5 mm, suggest chronic HBV or HCV infection instead of only chronic hepatitis, especially in an endemic area such as Taiwan.
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Affiliation(s)
- Hsing-Tao Kuo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, No. 901, Chung Hwa Road, Yung Kang City, Tainan 710, Taiwan
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Pal S, Sullivan DG, Kim S, Lai KKY, Kae J, Cotler SJ, Carithers RL, Wood BL, Perkins JD, Gretch DR. Productive replication of hepatitis C virus in perihepatic lymph nodes in vivo: implications of HCV lymphotropism. Gastroenterology 2006; 130:1107-16. [PMID: 16618405 DOI: 10.1053/j.gastro.2005.12.039] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2005] [Accepted: 12/14/2005] [Indexed: 12/26/2022]
Abstract
BACKGROUND & AIMS The pathogenesis of chronic hepatitis C is poorly understood. This study examines the ability of hepatitis C virus (HCV) to infect, replicate in, and produce progeny virus from perihepatic lymph nodes in vivo. METHODS Lymph node (LN) biopsy specimens were taken from 20 patients with HCV genotype 1 infection and end-stage liver disease and 20 noninfected negative controls. Sections were probed with HCV RNA strand-specific riboprobes and antibodies specific for HCV core and nonstructural region 3 antigens plus B-cell (CD20) and T-cell (CD2) antigens. In a selected case, HCV quasispecies in serum, peripheral blood mononuclear cells, liver, and perihepatic lymph nodes were analyzed by clonal frequency analysis and sequencing. RESULTS HCV infection was confirmed in 17 of 20 (85%) of lymph node specimens by in situ hybridization, and HCV replication was confirmed in 50% of cases by detection of HCV replicative intermediate RNA. HCV core and nonstructural 3 antigens were detected in lymph nodes by immunocytochemistry. Infected cell phenotypes were primarily CD20 B cells, although other cell types were positive for HCV replication markers. Quasispecies analysis in one case indicated that 68% of variants circulating in serum were also present in lymphoid tissues, and only 40% of serum variants were identified in liver, documenting a major contribution of lymphoid replication to HCV viremia. CONCLUSIONS HCV lymphotropism provides new insights into the complex pathobiology of chronic hepatitis C in humans. We demonstrate for the first time a major contribution of extrahepatic HCV replication to circulating virus in serum (viremia).
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Affiliation(s)
- Sampa Pal
- Department of Laboratory Medicine, University of Washington Medical Center, Seattle, Washington 98104, USA
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Watanabe T, Sassa T, Hiratsuka H, Hattori S, Abe A. Clinical significance of enlarged perihepatic lymph node on ultrasonography. Eur J Gastroenterol Hepatol 2005; 17:185-90. [PMID: 15674096 DOI: 10.1097/00042737-200502000-00009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE To determine the relation between enlarged perihepatic lymph node (PLN) and viraemia, and to find out whether there is a difference in PLN size between the healthy individuals and patients with hepatitis C virus (HCV) infection. METHOD Seventy-four outpatients with HCV infection were primarily enrolled into the study. As controls, 283 individuals who had medical check-ups by ultrasonography without liver disease were also examined. The length and thickness of lymph node were measured. The lymph-node index (LN index) was calculated by multiplying the length and thickness of the lymph node. This index was then compared with serum HCV core antigen (HCV-Ag) levels. According to the level of HCV-Ag, we defined grade I as negative, grade II as minimal, grade III as medium and grade IV as extensive. RESULTS LN index of 100 mm2 or more was found in 83.3% (50 of 60) of patients with hepatitis C, and LN index less than 100 mm2 in 90.9% (101 of 111) of controls. LN index showed a significant correlation with HCV-Ag level (r=0.436, P<0.05). No significant differences were found between LN index and HCV-Ag grade, but LN index increased in patients with grade IV [mean 160.0 mm2 (SD 50.86)] compared to grade I [57.0 mm2 (SD 98.73)], grade II [95.3 mm2 (SD 65.32)] and grade III [149.7 mm2 (SD 41.09)]. CONCLUSION Perihepatic lymphadenopathy indicates viraemia, and LN index seems to be useful in estimating whether patients have hepatitis C infection or are healthy.
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Affiliation(s)
- Tsuneo Watanabe
- Department of Clinical Laboratory, Gifu Social Insurance Hospital, Dota, Kani Gifu, Japan.
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Hirche TO, Russler J, Braden B, Schuessler G, Zeuzem S, Wehrmann T, Seifert H, Dietrich CF. Sonographic detection of perihepatic lymphadenopathy is an indicator for primary sclerosing cholangitis in patients with inflammatory bowel disease. Int J Colorectal Dis 2004; 19:586-94. [PMID: 15088111 DOI: 10.1007/s00384-004-0598-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2004] [Indexed: 02/04/2023]
Abstract
AIM Primary sclerosing cholangitis (PSC) is a frequent complication in patients with inflammatory bowel disease (IBD). While hyperplasia of the perihepatic lymph nodes has been described in patients with PSC, its prevalence and cause in IBD patients remains obscure. In the present study we address the question of whether ultrasound (US) examination is useful to detect perihepatic lymphadenopathy and improve the diagnostic accuracy for PSC in patients with underlying IBD. METHODS A total of 310 consecutive IBD patients were prospectively evaluated by US for enlarged perihepatic lymph nodes, as well as serologic testing for cholestasis-indicating enzymes. In patients with positive test results, viral or autoimmune liver disorders were excluded by serum testing. Next, the presence of PSC was confirmed/excluded by endoscopic retrograde cholangiography (ERC). RESULTS Perihepatic lymphadenopathy was detected by US in 27 of 310 (9%) patients. In 9 (33%) of those, serologic testing identified an underlying autoimmune or viral hepatitis. In the remaining 18 patients, ERC confirmed PSC in 17 (94%) and excluded it in 1. Elevated cholestasis parameters were found in 43 of 310 (14%) patients and 5 (12%) of those were diagnosed with autoimmune or viral hepatitis. In the remaining 38 patients, ERC confirmed PSC in 15 (39%) and excluded it in 23 (61%). Therefore, when autoimmune or viral hepatitis was excluded, enlarged lymph nodes in US predicted PSC more accurately than conventional serum parameters alone (PPV 94 and 39%, respectively [ P<0.001]), and the sensitivity ratio increased by a factor of 1.13 in favor of the US examination. CONCLUSION In patients with IBD, detection of enlarged perihepatic lymph nodes is a highly predictive indicator for the presence of PSC. Alternative causes of perihepatic lymphadenopathy have to be excluded.
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Affiliation(s)
- Tim O Hirche
- Medizinische Klinik II, Klinikum der J. W. Goethe-Universität, Frankfurt am Main, Germany
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Wiegand J, Jäckel E, Cornberg M, Hinrichsen H, Dietrich M, Kroeger J, Fritsch WP, Kubitschke A, Aslan N, Tillmann HL, Manns MP, Wedemeyer H. Long-term follow-up after successful interferon therapy of acute hepatitis C. Hepatology 2004; 40:98-107. [PMID: 15239091 DOI: 10.1002/hep.20291] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Early treatment of acute hepatitis C infection with interferon alfa-2b (IFN-alpha-2b) prevents chronicity in almost all patients. So far, no data are available on the long-term outcome after interferon (IFN) therapy of acute hepatitis C. The aim of this study was to assess the clinical, virological, and immunological long-term outcome of 31 successfully treated patients with acute hepatitis C infection who were followed for a median of 135 weeks (52-224 weeks) after end of therapy. None of the individuals had clinical evidence of liver disease. Alanine aminotransferase (ALT) levels were normal in all but 1 patient. Serum hepatitis C virus (HCV) RNA was negative throughout follow-up, even when investigated with the highly sensitive transcription-mediated amplification (TMA) assay (cutoff 5-10 IU/mL). In addition, no HCV RNA was detected in peripheral blood mononuclear cells (PBMC) of 15 cases tested. The patients' overall quality-of-life scores as determined by the SF-36 questionnaire did not differ from the German reference control cohort. Ex vivo interferon gamma (IFN-gamma) ELISPOT analysis detected HCV-specific CD4(+) T-helper cell reactivity in only 35% of cases, whereas HCV-specific CD8(+) T-cell responses were found in 4 of 5 HLA-A2-positive individuals. Anti-HCV antibody levels decreased significantly during and after therapy in all individuals. In conclusion, early treatment of symptomatic acute hepatitis C with IFN-alpha-2b leads to a long-term virological, biochemical, and clinical response. Waning of anti-HCV humoral immunity and presence of HCV-specific CD8(+) (but not CD4(+)) T cells highlights the complexity of T-cell and B-cell memory to HCV, which might be significantly altered by IFN treatment.
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Affiliation(s)
- Johannes Wiegand
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany
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Soresi M, Bonfissuto G, Sesti R, Riili A, Di Giovanni G, Carroccio A, Tripi S, Montalto G. Perihepatic lymph nodes and antiviral response in chronic HCV-associated hepatitis. ULTRASOUND IN MEDICINE & BIOLOGY 2004; 30:711-717. [PMID: 15219950 DOI: 10.1016/j.ultrasmedbio.2004.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2003] [Revised: 04/02/2004] [Accepted: 04/15/2004] [Indexed: 05/24/2023]
Abstract
To identify predictive factors of response to interferon alpha (IFN-alpha) plus ribavirin therapy in patients with chronic hepatitis C (CHC), the presence of lymphadenopathy (LyA) of the hepatoduodenal ligament and other variables were investigated. A total of 110 patients with histologically proven CHC were enrolled in this study. Ultrasound (US) was performed at the start and end of therapy and 6 months after stopping therapy. At baseline, LyA was present in 35 (43.7%) of 80 patients with alanine aminotransferase (ALT) values and grading was significantly higher than in the LyA-negative group. LyA was more frequent in nonresponders (nonR) than in relapsers (relR) or sustained responders (susR). Lymph node volume (LyV) was significantly lower in susR than in nonR or relR (p < 0.05). Under antiviral treatment, the reduction in LyV was significantly higher in nonR (p < 0.01); in susR and relR, it was not significantly reduced. LyA totally disappeared in two patients of the susR group. Logistic regression analysis confirmed only a positive association of susR with grading and a negative association with staging (p < 0.02 and p < 0.006). In conclusion, this study suggests that US evidence of LyA is useful in evaluating the severity of a given chronic hepatitis C, but it cannot be proposed as a predictive index of response to antiviral treatment.
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