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Takahashi H, Shigefuku R, Yoshida Y, Ikeda H, Matsunaga K, Matsumoto N, Okuse C, Sase S, Itoh F, Suzuki M. Correlation between hepatic blood flow and liver function in alcoholic liver cirrhosis. World J Gastroenterol 2014; 20:17065-17074. [PMID: 25493018 PMCID: PMC4258574 DOI: 10.3748/wjg.v20.i45.17065] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 04/29/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To elucidate the correlation between hepatic blood flow and liver function in alcoholic liver cirrhosis (AL-LC).
METHODS: The subjects included 35 patients with AL-LC (34 men, 1 woman; mean age, 58.9 ± 10.7 years; median age, 61 years; range: 37-76 years). All patients were enrolled in this study after obtaining written informed consent. Liver function was measured with tests measuring albumin (Alb), prothrombin time (PT), brain natriuretic peptide (BNP), branched amino acid and tyrosine ratio (BTR), branched chain amino acid (BCAA), tyrosine, ammonia (NH3), cholinesterase (ChE), immunoreactive insulin (IRI), total bile acid (TBA), and the retention rate of indocyanine green 15 min after administration (ICG R15). Hepatic blood flow, hepatic arterial tissue blood flow (HATBF), portal venous tissue blood flow (PVTBF), and total hepatic tissue blood flow (THTBF) were simultaneously calculated using xenon computed tomography.
RESULTS: PVTBF, HATBF and THTBF were 30.2 ± 10.4, 20.0 ± 10.7, and 50.3 ± 14.9 mL/100 mL/min, respectively. Alb, PT, BNP, BTR, BCAA, tyrosine, NH3, ChE, IRI, TBA, and ICG R15 were 3.50 ± 0.50 g/dL, 72.0% ± 11.5%, 63.2 ± 56.7 pg/mL, 4.06 ± 1.24, 437.5 ± 89.4 μmol/L, 117.7 ± 32.8 μmol/L, 59.4 ± 22.7 μg/dL, 161.0 ± 70.8 IU/L, 12.8 ± 5.0 μg/dL, 68.0 ± 51.8 μmol/L, and 28.6% ± 13.5%, respectively. PVTBF showed a significant negative correlation with ICG R15 (r = -0.468, P <0.01). No significant correlation was seen between ICG 15R, HATBF and THTBF. There was a significant correlation between PVTBF and Alb (r = 0.2499, P < 0.05), and NH3 tended to have an inverse correlation with PVTBF (r = -0.2428, P = 0.0894). There were also many significant correlations between ICG R15 and liver function parameters, including Alb, NH3, PT, BNP, TBA, BCAA, and tyrosine (r = -0.2156, P < 0.05; r = 0.4318, P < 0.01; r = 0.4140, P < 0.01; r = 0.3610, P < 0.05; r = 0.5085, P < 0.001; r = 0.4496, P < 0.01; and r = 0.4740, P < 0.05, respectively).
CONCLUSION: Our investigation showed that there is a close correlation between liver function and hepatic blood flow.
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Takahashi H, Suzuki M, Shigefuku R, Okano M, Hiraishi T, Takagi R, Noguchi Y, Hattori N, Hatsugai M, Nakahara K, Okamoto M, Kobayashi M, Ikeda H, Fukuda Y, Nagase Y, Ishii T, Matsunaga K, Matsumoto N, Okuse C, Sase S, Itoh F. Xenon computed tomography can evaluate the improvement of hepatic hemodynamics before and after endoscopic injection sclerotherapy. J Gastroenterol 2013; 48:1353-61. [PMID: 23397117 DOI: 10.1007/s00535-013-0756-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 01/15/2013] [Indexed: 02/10/2023]
Abstract
BACKGROUND Xenon computed tomography (Xe-CT) provides quantitative information on tissue blood flow (TBF). In the present study, Xe-CT was performed in patients with esophagogastric varices (EGV) before and after endoscopic injection sclerotherapy (EIS) to evaluate hepatic blood flow (HBF), hepatic arterial TBF (HATBF) and portal venous TBF (PVTBF). METHODS Subjects comprised of 88 patients with EGV (49 men, 39 women, average age 65.8 ± 11.5 years, median age 68 years, 30-86 years) and liver cirrhosis related to either hepatitis C virus (C) (n = 33), hepatitis B virus (B) (n = 3), alcohol (AL) (n = 22), AL + C (n = 7), AL + B (n = 1), B + C + AL (n = 1), nonalcoholic steatohepatitis (NASH) (n = 4), autoimmune hepatitis (AIH) (n = 5), primary biliary cirrhosis (PBC) (n = 2), or cryptogenic (n = 10) were enrolled. All patients, who were enrolled in this study, were performed EIS for prophylaxis. Xe-CT and measurement of the retention rate of indocyanine green 15 min after administration (ICG R15) were performed before and after EIS. Total hepatic TBF (THTBF) and PVTBF/HATBF ratio (P/A) were also calculated. RESULTS PVTBF, HATBF, THTBF, P/A and ICG R15 before EIS were 28.3 ± 8.91, 22.5 ± 14.4 and 50.8 ± 17.6 ml/100 ml/min, 1.62 ± 0.71 and 28.8 ± 12.7 %, respectively and those after EIS were 31.9 ± 10.0, 19.3 ± 11.6, and 51.2 ± 17.0 ml/100 ml/min, 1.92 ± 0.84 and 23.6 ± 11.3 %, respectively. PVTBF and P/A after EIS were significantly higher than those before EIS (p = 0.00444, p = 0.0179, respectively), and HATBF and ICG R15 after EIS were significantly lower than those before EIS (p = 0.00129, p < 0.001, respectively). CONCLUSIONS Xenon computed tomography showed that PVTBF increased after EIS for EGV and HATBF decreased in response to an increase in PVTBF.
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Affiliation(s)
- Hideaki Takahashi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan,
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Xenon-inhalation computed tomography for noninvasive quantitative measurement of tissue blood flow in pancreatic tumor. Dig Dis Sci 2012; 57:801-5. [PMID: 21953140 DOI: 10.1007/s10620-011-1915-4] [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: 04/13/2011] [Accepted: 09/04/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS The purpose of this prospective study was to demonstrate the ability to measure pancreatic tumor tissue blood flow (TBF) with a noninvasive method using xenon inhalation computed tomography (xenon-CT) and to correlate TBF with histological features, particularly microvascular density (MVD). METHODS TBFs of pancreatic tumors in 14 consecutive patients were measured by means of xenon-CT at diagnosis and following therapy. Serial abdominal CT scans were obtained before and after inhalation of nonradioactive xenon gas. TBF was calculated using the Fick principle. Furthermore, intratumoral microvessels were stained with anti-CD34 monoclonal antibodies before being quantified by light microscopy (×200). We evaluated MVD based on CD34 expression and correlated it with TBF. RESULTS The quantitative TBF of pancreatic tumors measured by xenon CT ranged from 22.3 to 111.4 ml/min/100 g (mean ± SD, 59.6 ± 43.9 ml/min/100 g). High correlation (r = 0.885, P < 0.001) was observed between TBF and intratumoral MVD. CONCLUSION Xenon-CT is feasible in patients with pancreatic tumors and is able to accurately estimate MVD noninvasively.
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Takahashi H, Suzuki M, Ikeda H, Kobayashi M, Sase S, Yotsuyanagi H, Maeyama S, Iino S, Itoh F. Evaluation of quantitative portal venous, hepatic arterial, and total hepatic tissue blood flow using xenon CT in alcoholic liver cirrhosis-comparison with liver cirrhosis related to hepatitis C virus and nonalcoholic steatohepatitis. Alcohol Clin Exp Res 2009; 34 Suppl 1:S7-S13. [PMID: 18986379 DOI: 10.1111/j.1530-0277.2008.00755.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND/AIMS Xenon computed tomography (Xe-CT) is a noninvasive method of quantifying and visualizing tissue blood flow (TBF). For the liver, Xe-CT allows separate measurement of hepatic arterial and portal venous TBF. The present study evaluated the usefulness of Xe-CT as a noninvasive diagnostic procedure for measuring hepatic TBF in alcoholic liver cirrhosis (AL-LC), compared with liver cirrhosis related to nonalcoholic steatohepatitis (NASH), (NASH-LC), and hepatitis C virus (HCV), (C-LC). METHODS Xe-CT was performed on 22 patients with AL-LC, 7 patients with NASH-LC, and 24 patients with C-LC. Severity of LC was classified according to Child-Pugh classification. Correlations between hepatic TBF, Child-Pugh classification, and indocyanin green retention (ICG) rate after 15 minutes (ICG15R) were examined. Correlations of hepatic TBF in Child-Pugh class A to AL-LC, NASH-LC, and C-LC were also examined. RESULTS Portal venous TBF (PVTBF) displayed a significant negative correlation with Child-Pugh score and ICG15R (r = -0.432, p < 0.01, r = -0.442, p < 0.01, respectively). Moreover, ICG15R displayed a significant positive correlation with Child-Pugh score (r = 0.661, p < 0.001). Meanwhile, mean PVTBF and total hepatic TBF (THTBF) was significantly lower in AL-LC than in C-LC (p < 0.05). Mean PVTBF was significantly lower in Child-Pugh class A to AL-LC and NASH-LC than in that to C-LC (p < 0.05). Similarly, mean THTBF was significantly lower in Child-Pugh class A to NASH-LC than in that to C-LC (p < 0.05). CONCLUSIONS Measurement of hepatic TBF using Xe-CT is useful as a noninvasive, objective method of assessing the state of the liver in chronic liver disease.
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Affiliation(s)
- Hideaki Takahashi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University, School of Medicine, 2-16-1 Sugao Miyamaeku, Kawasaki, 216-8511, Japan.
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Kobayashi M, Suzuki M, Ikeda H, Takahashi H, Matsumoto N, Maeyama S, Sase S, Iino S, Itoh F. Assessment of hepatic steatosis and hepatic tissue blood flow by xenon computed tomography in nonalcoholic steatohepatitis. Hepatol Res 2009; 39:31-9. [PMID: 18761681 DOI: 10.1111/j.1872-034x.2008.00407.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM The diagnosis of non-alcoholic steatohepatitis (NASH) can be difficult using blood tests and imaging studies. Histological diagnosis by liver biopsy remains the gold standard of NASH diagnosis. There is an urgent need to develop and validate simple, reproducible, noninvasive tests to accurately assess NASH stage and grade. We assess the usefulness of xenon computed tomography (Xe-CT), as a non-invasive method of quantitatively and visually determining hepatic tissue blood flows (TBFs), and xenon solubility (lambda value) simultaneously with TBF, in the evaluation of NASH pathophysiology. METHODS Histological severity of fatty changes and severity of fibrosis based on Brunt's classification were determined in 38 NASH patients. We evaluated correlations between the grade of fatty changes and lambda value, and correlations between the stage of fibrosis and TBFs. RESULTS The lambda value showed significant positive correlations with both grade of steatosis (r = 0.813, P < 0.001) and each 10% range of histological fatty infiltration (r = 0.926, P < 0.001). A significant negative correlation was seen between lambda value and the liver : spleen ratio (r = -0.835, P < 0.001). Portal venous tissue blood flow and total hepatic tissue blood flow showed significant negative correlations with the progression of fibrosis (r = -0.465, P < 0.01; r = -0.433, P < 0.01, respectively). Total hepatic tissue blood flow tended to decrease with progressing grade of steatosis. CONCLUSION Xe-CT offers a convenient and objective method for evaluating fatty infiltration and changes in blood flow in the entire liver, and appears useful for detailed evaluation of patients with NASH.
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Affiliation(s)
- Minoru Kobayashi
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki, Japan
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Sase S, Takahashi H, Ikeda H, Kobayashi M, Matsumoto N, Suzuki M. Determination of time-course change rate for arterial xenon using the time course of tissue xenon concentration in xenon-enhanced computed tomography. Med Phys 2008; 35:2331-8. [PMID: 18649466 DOI: 10.1118/1.2912021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In calculating tissue blood flow (TBF) according to the Fick principle, time-course information on arterial tracer concentration is indispensable and has a considerable influence on the accuracy of calculated TBF. In TBF measurement by xenon-enhanced computed tomography (Xe-CT), nonradioactive xenon gas is administered by inhalation as a tracer, and end-tidal xenon is used as a substitute for arterial xenon. There has been the assumption that the time-course change rate for end-tidal xenon concentration (Ke) and that for arterial xenon concentration (Ka) are substantially equal. Respiratory gas sampling is noninvasive to the patient and Ke can be easily measured by exponential curve fitting to end-tidal xenon concentrations. However, it is pointed out that there would be a large difference between Ke and Ka in many cases. The purpose of this work was to develop a method of determining the Ka value using the time course of tissue xenon concentration in Xe-CT. The authors incorporated Ka into the Kety autoradiographic equation as a parameter to be solved, and developed a method of least-squares to obtain the solution for Ka from the time-course changes in xenon concentration in the tissue. The authors applied this method of least-squares to the data from Xe-CT abdominal studies performed on 17 patients; the solution for Ka was found pixel by pixel in the spleen, and its Ka map was created for each patient. On the one hand, the authors obtained the average value of the Ka map of the spleen as the calculated Ka (Ka(calc)) for each patient. On the other hand, the authors measured Ka (Ka(meas)) using the time-course changes in CT enhancement in the abdominal aorta for each patient. There was a good correlation between Ka(calc), and Ka(meas) (r = 0.966, P < 0.0001), and these two Ka values were close to each other (Ka(calc) = 0.935 x Ka(meas) + 0.089). This demonstrates that K(cala) would be close to the true Ka value. Accuracy of TBF by Xe-CT can be improved with use of the average value of the Ka map of an organ like the spleen that has a single blood supply (only arterial inflow).
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Affiliation(s)
- Shigeru Sase
- Anzai Medical Co., Ltd., 3-9-15 Nishi-Shinagawa, Shinagawa-ku, Tokyo 141-0033, Japan.
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Takahashi H, Suzuki M, Ikeda H, Kobayashi M, Sase S, Yotsuyanagi H, Maeyama S, Iino S, Itoh F. Evaluation of quantitative portal venous, hepatic arterial, and total hepatic tissue blood flow using xenon CT in alcoholic liver cirrhosis: comparison with liver cirrhosis C. Alcohol Clin Exp Res 2008; 31:S43-8. [PMID: 17331165 DOI: 10.1111/j.1530-0277.2006.00285.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND/AIMS Xenon computed tomography (Xe-CT) is a noninvasive method of quantifying and visualizing tissue blood flow (TBF). For the liver, Xe-CT allows separate measurement of hepatic arterial and portal venous TBF. The present study evaluated the usefulness of Xe-CT as a noninvasive diagnostic procedure for measuring hepatic TBF in alcoholic liver cirrhosis (AL-LC), compared with liver cirrhosis C (C-LC). METHODS Xenon computed tomography was performed on 12 patients with AL-LC and 17 patients with C-LC. The severity of LC was classified according to Child-Pugh classification. Correlations between hepatic TBF and Child-Pugh classification were examined. Correlations of hepatic TBF in Child-Pugh class A to C-LC and AL-LC were also examined. RESULTS The mean portal venous TBF (PVTBF) was significantly lower in AL-LC than in C-LC (p=0.0316). Similarly, the mean total hepatic TBF (THTBF) was significantly lower in AL-LC than in C-LC (p=0.0390). PVTBF displayed a significant negative correlation with Child-Pugh score (r=-0.396, p=0.0368). CONCLUSIONS Measurement of hepatic TBF using Xe-CT is useful as a noninvasive, objective method of assessing the state of the liver in chronic liver disease.
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Affiliation(s)
- Hideaki Takahashi
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Kawasaki, Japan
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Ikeda H, Suzuki M, Kobayashi M, Takahashi H, Matsumoto N, Maeyama S, Iino S, Sase S, Itoh F. Xenon computed tomography shows hemodynamic change during the progression of chronic hepatitis C. Hepatol Res 2007; 37:104-12. [PMID: 17300705 DOI: 10.1111/j.1872-034x.2007.00020.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIM Xenon computed tomography (Xe-CT) is a non-invasive method of quantifying and visualizing tissue blood flow (TBF). Xe-CT allows separate measurement of hepatic arterial and portal venous flow. The aim of this study was to investigate correlations between the progression of fibrosis and hemodynamic changes in chronic hepatitis C (CHC) patients using Xe-CT. METHODS Separate measurements of portal venous TBF (PVTBF) and hepatic arterial TBF (HATBF) were performed using Xe-CT, and total hepatic TBF (THTBF) was calculated as the sum of PVTBF and HATBF. A total of 50 patients with CHC underwent Xe-CT. Liver biopsy was performed on 42 of the 50 patients, and hepatic fibrosis was classified as mild (F1), moderate (F2), severe (F3) or Child-Pugh class A cirrhosis (F4a). In addition, eight patients with Child-Pugh class B cirrhosis (F4b) were evaluated. RESULTS Significant negative correlations were identified between PVTBF and progression of stage (r(s) = -0.622, P < 0.0001) and between THTBF and progression of stage (r(s) = -0.458, P = 0.0041). CONCLUSION Separate measurement of PVTBF and HATBF using non-invasive Xe-CT provided quantitative and visual information regarding hemodynamics of the entire liver in CHC patients. PVTBF decreases with the progression of fibrosis, even in CHC patients.
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Affiliation(s)
- Hiroki Ikeda
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Kawasaki, Japan
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Murakami T, Hori M, Kim T, Hashimoto K, Dono K, Hayashi S, Sugihara E, Nagano H, Sase S, Sakon M, Monden M, Nakamura H. Xenon-Inhalation Computed Tomography for Noninvasive Quantitative Measurement of Tissue Blood Flow in Hepatocellular Carcinoma. Invest Radiol 2004; 39:210-5. [PMID: 15021324 DOI: 10.1097/01.rli.0000119147.62137.fd] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The purpose of this study was to separately measure the arterial and portal venous tissue blood flow (TBF) of hepatocellular carcinoma (HCC) with a noninvasive method using xenon inhalation CT (xenon-CT) and to differentiate between well-differentiated HCCs and moderately and poorly differentiated HCCs. MATERIALS AND METHODS Total, arterial and portal venous TBFs of 38 surgically proven HCC nodules from 38 patients were measured by means of xenon-CT. Serial abdominal CT scans were obtained before and after inhalation of nonradioactive xenon gas. TBF was computed using the Fick principle, after which the correlation between TBF and pathologic features of the tumors was determined. RESULTS Total, arterial, and portal venous TBFs of HCC were 125.7 +/- 59.9 mL/min/100g, 102.5 +/- 37.3, and 22.2 +/- 11.4, respectively, and the corresponding findings for hepatic parenchyma were 67.3 +/- 13.1, 25.2 +/-9.6, and 42.4 +/- 11.0. Total and arterial TBFs of HCC were significantly higher than those of the hepatic parenchyma (P < 0.01), whereas portal venous TBF of HCC was significantly lower than that of hepatic parenchyma (P < 0.01). Arterial TBF of moderately or poorly differentiated HCC (120.4 +/- 38.2) was significantly higher than that of well-differentiated HCC (60.4 +/- 43.5) (P < 0.01). CONCLUSIONS Arterial and portal venous TBFs of HCC could be measured separately, noninvasively, and safely with xenon-CT. Correlation between TBF and pathologic features of tumors indicate that xenon-CT can be used to differentiate between well-differentiated HCCs and moderately and poorly differentiated HCCs.
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Affiliation(s)
- Takamichi Murakami
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan.
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