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Sambataro D, Bellavia S, Di Mattia P, Centonze D, Emmanuele C, Bonasera A, Caputo G, Quattrocchi AMO, Vinci E, Gebbia V, Valerio MR. Combined Neuroendocrine Carcinoma and Hepatocellular Carcinoma of the Liver: Systematic Literature Review Suggests Implementing Biological Characterization to Optimize Therapeutic Strategy. Cancers (Basel) 2025; 17:1074. [PMID: 40227579 PMCID: PMC11988019 DOI: 10.3390/cancers17071074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2025] [Revised: 03/11/2025] [Accepted: 03/19/2025] [Indexed: 04/15/2025] Open
Abstract
BACKGROUND Mixed neuroendocrine-non-neuroendocrine tumors (MINEN) of the liver are exceptionally rare, with limited data available regarding their clinical behavior, pathogenesis, and optimal management. The coexistence of hepatocellular carcinoma (HCC) and neuroendocrine carcinoma (NEC) within the liver presents diagnostic and therapeutic challenges. METHODS A systematic literature search was conducted on PubMed, identifying cases of primary mixed HCC and NEC in the liver. The search adhered to PRISMA guidelines, and relevant studies were critically analyzed. A total of 45 documented cases were reviewed, focusing on patient demographics, clinical characteristics, treatment strategies, and outcomes. RESULTS Most patients (90%) were male, with a median age of 66.5 years. Hepatitis B or C infection was present in 74% of cases, and liver cirrhosis was reported in 38%. The combined type was the most frequently observed histological pattern (65%). Treatment modalities varied, including transarterial chemoembolization (TACE), radiofrequency ablation (RFA), surgery, and systemic therapies. The median overall survival was 10 months, highlighting the aggressive nature of these tumors. CONCLUSIONS Given the rarity and poor prognosis of hepatic MINEN tumors, multidisciplinary management is essential. Advanced molecular profiling may offer insights into tumor biology and potential therapeutic targets. Future research should explore novel systemic therapies, including immune checkpoint inhibitors, to improve patient outcomes.
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Affiliation(s)
- Daniela Sambataro
- Medical Oncology Unit, Umberto I Hospital, 94100 Enna, Italy; (A.B.); (G.C.); (A.M.O.Q.); (E.V.)
- Department of Medicine and Surgery, Kore University, 94100 Enna, Italy; (P.D.M.); (V.G.)
| | - Sandro Bellavia
- Pathology Unit, Umberto I Hospital, 94100 Enna, Italy; (S.B.); (C.E.)
| | - Paolo Di Mattia
- Department of Medicine and Surgery, Kore University, 94100 Enna, Italy; (P.D.M.); (V.G.)
- Surgery Unit, Umberto I Hospital, 94100 Enna, Italy;
| | | | - Carmela Emmanuele
- Pathology Unit, Umberto I Hospital, 94100 Enna, Italy; (S.B.); (C.E.)
| | - Annalisa Bonasera
- Medical Oncology Unit, Umberto I Hospital, 94100 Enna, Italy; (A.B.); (G.C.); (A.M.O.Q.); (E.V.)
| | - Giuseppe Caputo
- Medical Oncology Unit, Umberto I Hospital, 94100 Enna, Italy; (A.B.); (G.C.); (A.M.O.Q.); (E.V.)
| | | | - Ernesto Vinci
- Medical Oncology Unit, Umberto I Hospital, 94100 Enna, Italy; (A.B.); (G.C.); (A.M.O.Q.); (E.V.)
| | - Vittorio Gebbia
- Department of Medicine and Surgery, Kore University, 94100 Enna, Italy; (P.D.M.); (V.G.)
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Gopal P, Hu X, Robert ME, Zhang X. The evolving role of liver biopsy: Current applications and future prospects. Hepatol Commun 2025; 9:e0628. [PMID: 39774070 PMCID: PMC11717517 DOI: 10.1097/hc9.0000000000000628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2024] [Accepted: 12/04/2024] [Indexed: 01/11/2025] Open
Abstract
Histopathologic evaluation of liver biopsy has played a longstanding role in the diagnosis and management of liver disease. However, the utility of liver biopsy has been questioned by some, given the improved imaging modalities, increased availability of noninvasive serologic tests, and development of artificial intelligence over the past several years. In this review, we discuss the current and future role of liver biopsy in both non-neoplastic and neoplastic liver diseases in the era of improved noninvasive laboratory, radiologic, and digital technologies.
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Affiliation(s)
- Purva Gopal
- Deparment of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Xiaobang Hu
- Department of Pathology and Laboratory Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Marie E. Robert
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Xuchen Zhang
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
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Xiao Y, Gao J, Wang Y, Hao D, Yan W, Wen D, Zeng S, Yang S, Shi Y, Li W. Systemic treatment type is not associated with abnormal post-treatment noninvasive liver stiffness measurement in psoriasis. Front Immunol 2024; 15:1487959. [PMID: 39726606 PMCID: PMC11670192 DOI: 10.3389/fimmu.2024.1487959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Accepted: 11/25/2024] [Indexed: 12/28/2024] Open
Abstract
Background Psoriasis is commonly associated with metabolic dysfunction-associated steatotic liver disease, raising concerns about the hepatic effects of systemic treatments on psoriasis and its comorbid conditions. This study evaluates liver stiffness measurement (LSM) alterations and identifies predictors of abnormal LSM in psoriatic patients following systemic treatments, including biologics and methotrexate. Methods This prospective cohort study is based on the PSOWCH database (Psoriasis Cohort of West China Hospital). We initially included psoriatic patients who had undergone sound touch elastography (STE), then recruited patients who had STE before systemic treatment and reassessed them after at least six months. Three treatment subgroups were formed (interleukin inhibitors, tumor necrosis factor inhibitors, and methotrexate), classifying post-treatment STE outcomes using threshold values of 6.5 kPa and 10.3 kPa. Results Among the 52 recruited patients, overall STE values significantly increased during follow-up. Univariate regression analysis showed that age, gender, psoriasis severity, psoriatic arthritis status, and current treatment type were not significantly correlated with abnormal STE outcomes at cutoff values of 6.5 kPa and 10.3 kPa. In the multivariate model, body mass index (BMI) was identified as a risk factor for post-treatment STE ≥ 6.5 kPa (odds ratio [OR], 1.26; 95% CI, 1.04 to 1.60, P=0.031). Conclusions This exploratory study reveals that systemic treatment type is not associated with abnormal post-treatment LSM. However, a significant association exists between BMI and abnormal LSM outcomes. These findings highlight the critical importance of BMI management in therapeutic interventions for psoriasis.
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Affiliation(s)
- Yue Xiao
- Department of Dermatology and Venereology, West China Hospital, Sichuan University, Chengdu, China
| | - Jingya Gao
- Department of Dermatology and Venereology, West China Hospital, Sichuan University, Chengdu, China
| | - Yiyi Wang
- Department of Dermatology and Venereology, West China Hospital, Sichuan University, Chengdu, China
| | - Dan Hao
- Department of Dermatology and Venereology, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Yan
- Department of Dermatology and Venereology, West China Hospital, Sichuan University, Chengdu, China
| | - Dingke Wen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Siyi Zeng
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Shiqi Yang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yingyu Shi
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Li
- Department of Dermatology and Venereology, West China Hospital, Sichuan University, Chengdu, China
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Fierro-Angulo OM, González-Regueiro JA, Pereira-García A, Ruiz-Margáin A, Solis-Huerta F, Macías-Rodríguez RU. Hematological abnormalities in liver cirrhosis. World J Hepatol 2024; 16:1229-1244. [PMID: 39351511 PMCID: PMC11438588 DOI: 10.4254/wjh.v16.i9.1229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 08/09/2024] [Accepted: 08/22/2024] [Indexed: 09/23/2024] Open
Abstract
Hematological abnormalities are common in cirrhosis and are associated with various pathophysiological mechanisms. Studies have documented a prevalence of thrombocytopenia, leukopenia, and anemia in patients with compensated cirrhosis of 77.9%, 23.5%, and 21.1%, respectively. These abnormalities carry significant clinical implications, including considerations for invasive procedures, infection risk, bleeding risk, and prognosis. Previously, cirrhosis was believed to predispose patients to bleeding due to alterations observed in classical coagulation tests such as prothrombin time, partial thromboplastin time, international normalized ratio, and thrombocytopenia. However, this understanding has evolved, and cirrhosis patients are now also acknowledged as being at a high risk for thrombotic events. Hemostasis in cirrhosis patients presents a complex phenotype, with procoagulant and anticoagulant abnormalities offsetting each other. This multifactorial phenomenon is inadequately reflected by routine laboratory tests. Thrombotic complications are more prevalent in decompensated cirrhosis and may correlate with disease severity. Bleeding is primarily associated with portal hypertension, endothelial dysfunction, mechanical vessel injury, disseminated intravascular coagulation, endotoxemia, and renal injury. This review comprehensively outlines hematologic index abnormalities, mechanisms of hemostasis, coagulation, and fibrinolysis abnormalities, limitations of laboratory testing, and clinical manifestations of bleeding and thrombosis in patients with liver cirrhosis.
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Affiliation(s)
- Oscar Manuel Fierro-Angulo
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico 14080, Mexico
| | - José Alberto González-Regueiro
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico 14080, Mexico
| | - Ariana Pereira-García
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico 14080, Mexico
| | - Astrid Ruiz-Margáin
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico 14080, Mexico
| | - Fernando Solis-Huerta
- Department of Hematology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico 14080, Mexico
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Akbay FG, Toprak Z, Eksi M. Comparison of Percutaneous Core Needle Biopsy Results in Patients Who Previously Underwent Open and Robot-Assisted Kidney Transplantation. J Clin Med 2024; 13:4518. [PMID: 39124784 PMCID: PMC11313316 DOI: 10.3390/jcm13154518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/18/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
Objective: The objective of this study was to investigate the safety and efficacy of percutaneous graft biopsy, specifically in patients who have undergone robotic kidney transplantation, a topic that has received limited attention in the existing literature. While percutaneous graft biopsy is well established in patients who have undergone open transplantation, its application in robotic transplantation remains relatively unexplored. Material and Methods: A retrospective analysis was conducted on patient records spanning from 2013 to 2024, focusing on those who underwent graft biopsy due to acute graft dysfunction. The cohort was bifurcated into two distinct groups: individuals who underwent open kidney transplantation and those who underwent robotic kidney transplantation. Results: The study encompassed a total of 89 patients, with 64 having undergone open kidney transplantation and 25 having undergone robot-assisted kidney transplantation. The mean age of the patients was 40.61 (±12.26) years, with 60 (67.4%) being male and 29 (32.6%) being female. Comparative analysis revealed no significant disparities in age, gender distribution, body mass index, donor type (cadaveric versus living), or rates of graft loss between the two groups. Furthermore, examination of the total complication rates did not uncover any noteworthy differences between the cohorts. Conclusions: Ultrasound-assisted percutaneous needle biopsy is a reliable method in patients who have undergone robot-assisted kidney transplantation in cases of both indication-based and protocol biopsies. This study underscores the reliability of ultrasound-assisted percutaneous needle biopsy as a viable method for patients who have undergone robot-assisted kidney transplantation. By shedding light on the safety and efficacy of percutaneous graft biopsy in the context of robotic transplantation, this research contributes to the expanding body of knowledge in the field, providing valuable insights for clinical practice and future research endeavors.
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Affiliation(s)
- Fatih Gokhan Akbay
- Department of Nephrology, University of Health Sciences, Bakırkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul 34147, Turkey;
| | - Zeki Toprak
- Department of Nephrology, University of Health Sciences, Umraniye Education and Research Hospital, Istanbul 34760, Turkey
| | - Mithat Eksi
- Department of Urology, University of Health Sciences, Bakırkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul 34147, Turkey;
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Shi R, Yang F, Wu H, Liu Y. The Diagnostic Value of Liver Biopsy for Unexplained Liver Dysfunction: A Retrospective Study. J Multidiscip Healthc 2024; 17:2399-2407. [PMID: 38779307 PMCID: PMC11108762 DOI: 10.2147/jmdh.s460338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/15/2024] [Indexed: 05/25/2024] Open
Abstract
Objective To analyse clinical manifestations of unexplained abnormal liver function and perform hepatobiliary histopathology procedures on patients to evaluate the value of liver biopsy in diagnosing the aetiology of unexplained abnormal liver function. Methods A convenience sampling method was used to retrospectively collect the data of patients who were diagnosed with unexplained abnormal liver function and who received liver biopsy in the Pathology Department of Tianjin Second People's Hospital, China, between March 2022 and July 2023 to analyse liver pathology and clinical manifestations. Results A total of 1302 patients were included in this study, which mainly included 11 diseases: autoimmune liver disease (74 cases, 5.68%), drug-induced liver injury (DILI) (204 cases, 15.67%), cancer (237 cases, 18.20%), non-alcoholic fatty liver disease (104 cases, 7.99%), non-alcoholic steatohepatitis (74 cases, 5.68%), viral hepatitis (490 cases, 37.63%), other types of hepatitis (30 cases, 2.30%), cholestatic liver disease (17 cases, 1.31%), alcoholic liver disease (15 cases, 1.15%), hepatic cyst (5 cases, 0.38%) and Gilbert syndrome (4 cases, 0.31%). The success rate of liver biopsy sampling was 100%, and (1.52 ± 0.130) tissue strips were sampled. The average operating time was 11.52 minutes. The percutaneous liver biopsy did not significantly increase short-term liver function index values (serum γ-glutamyl transpeptidase, total bilirubin, alanine transaminase, aspartate aminotransferase, alkaline phosphatase). Ninety-two patients had a small amount of liver subcapsular fluid, but there was no progress after medical treatment. Conclusion Ultrasound-guided percutaneous liver biopsy has value in the diagnosis of unexplained abnormal liver function. Viral hepatitis, cancer and DILI are the most common causes of unexplained abnormal liver function. Liver biopsy does not aggravate the organic and functional impairment of the liver.
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Affiliation(s)
- Ruifang Shi
- Department of Pathology, Tianjin Institute of Hepatology, Tianjin Second People’s Hospital, Tianjin, 300192, People’s Republic of China
| | - Fan Yang
- Department of Pathology, Tianjin Institute of Hepatology, Tianjin Second People’s Hospital, Tianjin, 300192, People’s Republic of China
| | - Hongli Wu
- Department of Clinical Lab, Tianjin Institute of Hepatology, Tianjin Second People’s Hospital, Tianjin, 300192, People’s Republic of China
| | - Yonggang Liu
- Department of Pathology, Tianjin Institute of Hepatology, Tianjin Second People’s Hospital, Tianjin, 300192, People’s Republic of China
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7
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Jones RP. Lesional liver biopsies: better treatments, better studies, better science. Br J Surg 2024; 111:znae063. [PMID: 38752385 DOI: 10.1093/bjs/znae063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 12/05/2024]
Affiliation(s)
- Robert P Jones
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Hepatobiliary Surgery, Liverpool University Teaching Hospitals NHS Foundation Trust, Liverpool, UK
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Lester W, Bent C, Alikhan R, Roberts L, Gordon-Walker T, Trenfield S, White R, Forde C, Arachchillage DJ. A British Society for Haematology guideline on the assessment and management of bleeding risk prior to invasive procedures. Br J Haematol 2024; 204:1697-1713. [PMID: 38517351 DOI: 10.1111/bjh.19360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Will Lester
- Department of Haematology, University Hospitals Birmingham, Birmingham, UK
| | - Clare Bent
- Department of Radiology, University Hospitals Dorset, Dorset, UK
| | - Raza Alikhan
- Department of Haematology, University Hospitals of Cardiff, Cardiff, UK
| | - Lara Roberts
- Department of Haematology, King College London, London, UK
| | - Tim Gordon-Walker
- Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Sarah Trenfield
- Department of Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK
| | - Richard White
- Department of Radiology, Cardiff and Vale UHB, Cardiff, UK
| | - Colm Forde
- Department of Radiology, University Hospitals Birmingham, Birmingham, UK
| | - Deepa J Arachchillage
- Department of Immunology and Inflammation, Centre for Haematology, Imperial College London, London, UK
- Department of Haematology, Imperial College Healthcare NHS Trust, London, UK
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Wang J, Zhou X, Yao M, Tan W, Zhan S, Liu K, Feng Z, Yan H, Dai Y, Yuan J. Comparison and optimization of b value combinations for diffusion-weighted imaging in discriminating hepatic fibrosis. Abdom Radiol (NY) 2024; 49:1113-1121. [PMID: 38285179 DOI: 10.1007/s00261-023-04159-7] [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: 06/29/2023] [Revised: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 01/30/2024]
Abstract
INTRODUCTION AND OBJECTIVES Diffusion-weighted imaging (DWI) has shown potential in characterizing hepatic fibrosis. However, there are no widely accepted apparent diffusion coefficient (ADC) values for the b value combination. This study aims to determine the optimal high and low b values of DWI to assess hepatic fibrosis in patients with chronic liver disease. MATERIALS AND METHODS The prospective study included 81 patients with chronic liver disease and 21 healthy volunteers who underwent DWI, Magnetic resonance elastography (MRE), and liver biopsy. The ADC was calculated by twenty combinations of nine b values (0, 50, 100, 150, 200, 800, 1000, 1200, and 1500 s/mm2). RESULTS All ADC values of the healthy volunteers were significantly higher than those of the hepatic fibrosis group (all P < 0.01). With the progression of hepatic fibrosis, ADC values significantly decreased in b value combinations (100 and 1000 s/mm2, 150 and 1200 s/mm2, 200 and 800 s/mm2, and 200 and 1000 s/mm2). ADC values derived from b values of both 200 and 800 s/mm2 and 200 and 1000 s/mm2 were found to be more discriminative for differentiating the stages of hepatic fibrosis. An excellent correlation was between the ADC200-1000 value and MRE shear stiffness (r = - 0.750, P < 0.001). CONCLUSION DWI offers an alternative to MRE as a useful imaging marker for detecting and staging hepatic fibrosis. Clinically, ADC values for b values ranging from 200-800 s/mm2 to 200-1000 s/mm2 are recommended for the assessment of hepatic fibrosis.
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Affiliation(s)
- Jiaoyan Wang
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No. 528, Zhangheng Road, Pudong District, Shanghai, 201203, China
| | - Xue Zhou
- Department of Radiology, Central Hospital of Jiangjin District and Chongqing University Jiangjin Hospital, Chongqing, 402260, China
| | - Mingrong Yao
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No. 528, Zhangheng Road, Pudong District, Shanghai, 201203, China
| | - Wenli Tan
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No. 528, Zhangheng Road, Pudong District, Shanghai, 201203, China
| | - Songhua Zhan
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No. 528, Zhangheng Road, Pudong District, Shanghai, 201203, China
| | - Kun Liu
- Department of Pathology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Zhen Feng
- Department of Pathology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Huamei Yan
- Clinical Research Center, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Yongming Dai
- MR Collaboration, United Imaging Healthcare, Shanghai, 200030, China
| | - Jie Yuan
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No. 528, Zhangheng Road, Pudong District, Shanghai, 201203, China.
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Grancini V, Cogliati I, Alicandro G, Gaglio A, Gatti S, Donato MF, Orsi E, Resi V. Assessment of hepatic fibrosis with non-invasive indices in subjects with diabetes before and after liver transplantation. Front Endocrinol (Lausanne) 2024; 15:1359960. [PMID: 38505744 PMCID: PMC10948411 DOI: 10.3389/fendo.2024.1359960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/21/2024] [Indexed: 03/21/2024] Open
Abstract
Introduction One of the most common complications of cirrhosis is diabetes, which prevalence is strictly related to severity of hepatopathy. Actually, there are no data on the persistence of post-transplant glucose abnormalities and on a potential impact of diabetes on development of fibrosis in the transplanted liver. To this aim, we evaluated liver fibrosis in cirrhotic subjects before and after being transplanted. Methods The study included 111 individuals who had liver transplantation. The assessment was performed before and two years after surgery to investigate a potential impact of the persistence of diabetes on developing de novo fibrosis in the transplanted liver. The degree of fibrosis was assessed using the Fibrosis Index Based on 4 Factors (FIB-4) and the Aspartate to Platelet Ratio Index (APRI). Results At pre-transplant evaluation, 63 out of 111 (56.8%) subjects were diabetic. Diabetic subjects had higher FIB-4 (Geometric mean, 95% confidence interval: 9.74, 8.32-11.41 vs 5.93, 4.71-7.46, P<0.001) and APRI (2.04, 1.69-2.47 vs 1.18, 0.90-1.55, P<0.001) compared to non-diabetic subjects. Two years after transplantation, 39 out of 111 (35.1%) subjects remained with diabetes and continued to show significantly higher FIB-4 (3.14, 2.57-3.82 vs 1.87, 1.55-2.27, P<0.001) and APRI (0.52, 0.39-0.69 vs 0.26, 0.21-0.32, P<0.001) compared to subjects without diabetes. Discussion Thus, persistence of diabetes after surgery is a possible risk factor for an evolution to fibrosis in the transplanted liver, potentially leading to worsened long-term outcomes in this population.
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Affiliation(s)
- Valeria Grancini
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Irene Cogliati
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianfranco Alicandro
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Department of Pediatrics, Cystic Fibrosis Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessia Gaglio
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Gatti
- Center for Preclinical Research, Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Francesca Donato
- Hepatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuela Orsi
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Veronica Resi
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Reddy KR. Liver biopsy: Archaic but resilient and many roads lead to Rome. Clin Liver Dis (Hoboken) 2024; 23:e0247. [PMID: 38952693 PMCID: PMC11216678 DOI: 10.1097/cld.0000000000000247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 07/03/2024] Open
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Park KY, Park JH, Han K, Yu SH, Lee CB, Kim DS, Park HK, Hwang HS, Hong S. Fatty Liver Change in Older Adults as an Important Risk Factor for Type 2 Diabetes: A Nationwide Cohort Study. Mayo Clin Proc 2023; 98:1809-1819. [PMID: 37804267 DOI: 10.1016/j.mayocp.2023.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 01/16/2023] [Accepted: 02/28/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE To examine the association between changes in fatty liver disease (FLD) over time and the risk of type 2 diabetes in elderly individuals with prediabetes. METHODS A total of 156,984 elderly individuals with prediabetes who underwent national health screening in 2009 and 2011 were followed up through December 31, 2019. The FLD status was defined as a change in the fatty liver index. Prediabetes was defined as impaired fasting glucose levels at baseline. Multivariable Cox proportional hazards regression was used to calculate the hazard ratio and CIs for type 2 diabetes according to the changes in FLD. RESULTS During a median of 8.35 years of follow-up, type 2 diabetes developed in 29,422 (18.7%) elderly individuals with prediabetes. Multivariable adjusted hazard ratio of type 2 diabetes according to FLD change was 2.22 (95% CI, 2.11 to 2.34) in individuals with persistent FLD compared with those who have never had FLD. Although overall weight loss of 5% or more was associated with a 7% lower risk of type 2 diabetes in total participants, fatty liver status was important. Even with weight loss, those with a history of fatty liver-resolved FLD, new FLD, or persistent FLD-had an increased risk of type 2 diabetes. The risk of type 2 diabetes did not increase in individuals with sustained FLD-free status, regardless of weight change. CONCLUSION The presence and change of FLD are important factors for the development of type 2 diabetes in elderly individuals with prediabetes.
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Affiliation(s)
- Kye-Yeung Park
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Jung Hwan Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| | - Sung Hoon Yu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hanyang University Guri Hospital, South Korea
| | - Chang Beom Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hanyang University Guri Hospital, South Korea
| | - Dong Sun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Hoon-Ki Park
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Hwan-Sik Hwang
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Sangmo Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hanyang University Guri Hospital, South Korea.
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13
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Kato H, Kanno S, Ohtaki J, Fukuta M, Nakamura Y, Aoki Y. A lethal case of massive hemorrhage after percutaneous liver biopsy in a patient with thrombasthenia. Leg Med (Tokyo) 2023; 65:102315. [PMID: 37598645 DOI: 10.1016/j.legalmed.2023.102315] [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: 06/29/2023] [Revised: 07/27/2023] [Accepted: 08/14/2023] [Indexed: 08/22/2023]
Abstract
Percutaneous needle liver biopsy is an important procedure in the diagnosis of and assessment of the severity of liver diseases. Although liver biopsy is considered to be a relatively safe procedure, there are occasional cases of death due to massive bleeding after liver biopsy. Thrombasthenia is a disease in which bleeding occurs in the mucosa and skin due to platelet dysfunction. A 60-year-old female was admitted for a liver biopsy for further investigation after an abnormal liver function test. She was diagnosed with thrombasthenia and was being treated with oral tranexamic acid and carbazochrome. Blood tests showed little decrease of platelet count and no abnormalities of blood coagulability. Approximately ten hours after the liver biopsy, the patient complained of nausea and lightheadedness, followed by decreased blood pressure and decreased consciousness. An emergent abdominal CT scan showed a large amount of blood in the abdominal cavity. The patient died despite multidisciplinary treatment, and a forensic autopsy was performed. At internal examination, approximately 2,620 mL of dark red blood was accumulated in the abdominal cavity. A puncture wound led 1.8 cm into the liver from the surface of the liver, and no major vascular damage was observed. The cause of death was considered to be blood loss due to bleeding from the puncture wound. Even if the platelet count is normal, such as in a case of thrombasthenia, the risk of bleeding should not be underestimated. Careful attention should be paid when performing liver biopsy in a patient with risk factors.
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Affiliation(s)
- Hideaki Kato
- Department of Forensic Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
| | - Sanae Kanno
- Department of Forensic Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Jun Ohtaki
- Department of Forensic Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Mamiko Fukuta
- Department of Forensic Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoshimi Nakamura
- Department of Forensic Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yasuhiro Aoki
- Department of Forensic Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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14
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Sun C, Zhao X, Shi L, Fan X, Qi X. Distinct ways to perform a liver biopsy: The core technique setups and updated understanding of these modalities. Endosc Ultrasound 2023; 12:437-444. [PMID: 38948122 PMCID: PMC11213587 DOI: 10.1097/eus.0000000000000035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
There is dramatically increased incidence of several liver diseases worldwide; thus, an unmet need to diagnose and stage these pathological entities heralds the wide application of liver biopsy (LB) techniques. The ways of LB are versatile, including percutaneous LB, transjugular LB, and more recently an approach of minimal invasiveness, that is, EUS-guided LB (EUS-LB). In this review article, we come to the conclusion that EUS-LB may serve as a feasible, reliable, and safe alternative to percutaneous LB and transjugular LB in terms of improved diagnostic yield, excellent sampling performance, and controlled adverse events among patients with focal, infiltrative, and parenchymal liver diseases. Furthermore, extensive efforts have been made to optimize and refine several technical pillars within EUS-LB modality such as the selection of needle size/type, priming manner of biopsy needle, and choice of pass/actuation technique, all of which aim at obtaining better specimen quantity and quality. Another advantageous aspect and unique property pertinent to EUS-guided modality indicate that multiple screening, surveillance, and intervention procedures can be combined into one single endoscopic session. Accordingly, some pilot studies have clarified the clinical usefulness by integrating EUS-LB with simultaneous measurement of portal pressure gradient or examination of liver stiffness. However, more studies, in particular, randomized controlled trials or real-world evidence, are practically warranted to elucidate the validity and safety of EUS-LB as a regular/routine part of managing liver diseases.
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Affiliation(s)
- Chao Sun
- Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu Province, China
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xingliang Zhao
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Lei Shi
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Sichuan Province, China
| | - Xiaofei Fan
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaolong Qi
- Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu Province, China
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15
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Sugiura R, Kuwatani M, Nishida M, Satoh M, Kawakubo K, Kato S, Hirata K, Nakajima M, Hirata H, Takishin Y, Sakamoto N. Significance of Shear Wave Dispersion Slope Values Before Versus After Biliary Drainage in Patients With Obstructive Jaundice: A Single-Center Prospective Observational Cohort Study. Ultrasound Q 2023; 39:152-157. [PMID: 37227117 DOI: 10.1097/ruq.0000000000000644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
ABSTRACT The shear wave dispersion (SWD) slope has become available in the clinical practice and is related to tissue viscosity. However, clinical evaluation using SWD was not yet performed for obstructive jaundice. We aimed to evaluate the change of SWD values between before and after biliary drainage in patients with obstructive jaundice. This prospective observational cohort study evaluated 20 patients with obstructive jaundice who underwent biliary drainage. The SWD and liver elasticity values were measured before versus after biliary drainage, comparing between days -5 and 0 (day 0), days 1 and 3 (day 2), and days 6 and 8 (day 7). The mean ± SD values of SWD measured at day 0, day 2, and day 7 were 15.3 ± 2.7, 14.2 ± 3.3, and 13.3 ± 2.4 m/s/kHz, respectively. Dispersion slope values were decreased significantly from day 0 to day 2, from day 2 to day 7, and from day 0 to day 7 ( P < 0.05). Liver elasticity levels and serum hepatobiliary enzymes were additionally decreased significantly over time after biliary drainage. The correlations between SWD and liver elasticity values were strong ( r = 0.91, P < 0.01). In conclusion, t he SWD values decreased significantly over time after biliary drainage concomitant with liver elasticity.
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Affiliation(s)
- Ryo Sugiura
- Department of Gastroenterology and Hepatology, Hokkaido University, Faculty of Medicine and Graduate School of Medicine
| | | | - Mutsumi Nishida
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Megumi Satoh
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Kazumichi Kawakubo
- Department of Gastroenterology and Hepatology, Hokkaido University, Faculty of Medicine and Graduate School of Medicine
| | - Shin Kato
- Department of Gastroenterology and Hepatology, Hokkaido University, Faculty of Medicine and Graduate School of Medicine
| | - Koji Hirata
- Department of Gastroenterology and Hepatology, Hokkaido University, Faculty of Medicine and Graduate School of Medicine
| | - Masahito Nakajima
- Department of Gastroenterology and Hepatology, Hokkaido University, Faculty of Medicine and Graduate School of Medicine
| | - Hajime Hirata
- Department of Gastroenterology and Hepatology, Hokkaido University, Faculty of Medicine and Graduate School of Medicine
| | - Yunosuke Takishin
- Department of Gastroenterology and Hepatology, Hokkaido University, Faculty of Medicine and Graduate School of Medicine
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Hokkaido University, Faculty of Medicine and Graduate School of Medicine
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16
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Androutsakos T, Dimitriadis K, Revenas K, Vergadis C, Papadakis DD, Sakellariou S, Vallilas C, Hatzis G. Liver Biopsy: To Do or Not to Do - A Single-Center Study. Dig Dis 2023; 41:913-921. [PMID: 37611545 DOI: 10.1159/000533328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/24/2023] [Indexed: 08/25/2023]
Abstract
INTRODUCTION A variety of liver disorders are associated with characteristic histopathological findings that help in their diagnosis and treatment. However, percutaneous liver biopsy (PLB) is prone to limitations and complications. We evaluated all PLBs done in our hospital in a 13-year period, aiming to assess PLB's utility and complications. METHODS All PLBs conducted in an internal medicine department of a tertiary university hospital in Athens, Greece, during a 13-year period were reviewed. Recorded data included demographic characteristics, laboratory results acquired on biopsy day, indication for liver biopsy, and occurrence of side effects. All patients were followed for 1 month post-hospital discharge for possible PLB-related complications. RESULTS A total of 261 patients underwent PLB during the study period. The commonest indication of PLB was investigation of liver mass, followed by transaminasemia. PLB assisted in setting a diagnosis in 218 patients and was unhelpful in only 43, in 14 of them due to inadequate or inappropriate biopsy specimen. Complications attributable to PLB were rare, with 10 patients exhibiting pain, either at biopsy site or in the right shoulder, and 3 having bleeding episodes; no deaths were noted. CONCLUSIONS Our study shows that PLB is still a powerful diagnostic tool in everyday practice, provided it is used when indicated.
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Affiliation(s)
- Theodoros Androutsakos
- Pathophysiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Konstantinos Dimitriadis
- Pathophysiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | | | | | - Stratigoula Sakellariou
- 1st Department of Pathology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Christos Vallilas
- Pathophysiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Gregorios Hatzis
- Pathophysiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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17
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Marcos Carrasco N, López Jerez A, Garrido E, García González M. Estimation of liver fibrosis using elastography in cholestatic diseases: systematic review and meta-analysis. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023. [PMID: 37366032 DOI: 10.17235/reed.2023.9254/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
INTRODUCTION staging fibrosis extent in liver disease is highly relevant for appropriate management. Liver biopsy remains the reference standard for assessment, but noninvasive methods such as elastography are becoming increasingly accurate and relevant. However, evidence regarding elastography in cholestatic diseases is lower than in other etiologies. METHODS we searched MEDLINE, EMBASE and Web of Science for publications on the diagnostic accuracy of transient elastography and sonoelastography in cholestatic diseases (PBC and PSC) using biopsy as the reference standard. A systematic review and meta-analysis of the results was then carried out. RESULTS a total of 13 studies were included. Using transient elastography in PBC sensitivity and specificity were estimated to be 0.76 and 0.93; 0.88 and 0.9; and 0.91 and 0.95 for ≥ F2, ≥ F3 and = F4, respectively. For sonoelastography in PBC sensitivity and specificity estimates were 0.79 and 0.82; 0.95 and 0.86; and 0.94 and 0.85 for ≥ F2, ≥ F3 y = F4, respectively. In PSC, transient elastography had a sensivity and specificity of 0.76 and 0.88; 0.91 and 0.86; and 0.71 and 0.93 for ≥ F2, ≥ F3 and = F4, respectively. CONCLUSION elastography has adequate diagnostic accuracy in the assessment of fibrosis stages in cholestatic liver diseases.
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Affiliation(s)
| | | | - Elena Garrido
- Gastroenterología, Hospital Universitario Ramón y Cajal, España
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18
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Gingold-Belfer R, Shinhar N, Bachar GN, Issa N, Boltin D, Sharon E, Shohat T, Sapoznikov B, Swartz A, Peleg N, Konikoff T, Schmilovitz-Weiss H. Predictors of poor outcome following liver biopsy for the investigation of new hepatic space occupying lesion/s. Clin Imaging 2023; 99:19-24. [PMID: 37043869 DOI: 10.1016/j.clinimag.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/14/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Ultrasound-guided percutaneous liver biopsy (UPLB) is currently performed mainly to determine if new hepatic space occupying lesions (SOL) represent benign, primary malignant, or metastatic disease. This study sought to investigate the outcome of UPLB in this setting. METHODS In a retrospective study, patients with a new hepatic SOL who underwent UPLB during 1/2006-12/2016 were included and followed to 12/2018. Clinical data and pathology reports were reviewed. Mortality within 60 days and no change in patients' management following UPLB were defined as medically futile. RESULTS Included 140 patients, 50% male, mean age 68.8 ± 11.5 years; 112 patients died, all of malignant disease. 32 patients (23%) died within 60 days of UPLB. Median post-UPLB survival was 151 days. Survival was significantly shorter in patients with >1 hepatic lesion (n = 108) or an extrahepatic malignant lesion (n = 77) (p = 0.0082, p = 0.0301, respectively). On Cox Proportional Hazards analysis, significant predictors of mortality within 60 days of UPLB were: age as a continuous variable, (HR 1.070, 95% CI 1.011-1.131, p = 0.018), serum albumin <2.9 g/dL, (HR 4.822 95% CI 1.335-17.425, p = 0.016) and serum LDH >1500 U/L (HR 9.443, 95% CI 3.404-26.197, p < 0.0001). CONCLUSIONS In patients with these features or with disseminated disease, liver biopsy should be carefully reconsidered.
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Affiliation(s)
- Rachel Gingold-Belfer
- Gastroenterology Division, Rabin Medical Center - Beilinson Hospital, Petach Tikva 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Nadav Shinhar
- Gastroenterology Unit, Meir Hospital, Kfar Saba 4428164, Israel
| | - Gil N Bachar
- Radiology Department, Rabin Medical Center - Hasharon Hospital, Petach Tikva 4937211, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Nidal Issa
- Department of Surgery B, Rabin Medical Center - Hasharon Hospital, Petach Tikva 4937211, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Doron Boltin
- Gastroenterology Division, Rabin Medical Center - Beilinson Hospital, Petach Tikva 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Eran Sharon
- Department of Surgery B, Rabin Medical Center - Beilinson Hospital, Petach Tikva 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Tzippy Shohat
- Statistics Department, Rabin Medical Center - Beilinson Hospital, Petach Tikva 4941492, Israel
| | - Boris Sapoznikov
- Gastroenterology Division, Rabin Medical Center - Hasharon Hospital, Petach Tikva 4937211, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ariel Swartz
- Pathology Department, Rabin Medical Center - Hasharon Hospital, Petach Tikva 4937211, Israel
| | - Noam Peleg
- Gastroenterology Division, Rabin Medical Center - Beilinson Hospital, Petach Tikva 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Tom Konikoff
- Gastroenterology Division, Rabin Medical Center - Beilinson Hospital, Petach Tikva 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Hemda Schmilovitz-Weiss
- Gastroenterology Division, Rabin Medical Center - Hasharon Hospital, Petach Tikva 4937211, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
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19
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Chandan S, Deliwala S, Khan SR, Mohan BP, Dhindsa BS, Bapaye J, Goyal H, Kassab LL, Kamal F, Sayles HR, Kochhar GS, Adler DG. EUS-guided versus percutaneous liver biopsy: A comprehensive review and meta-analysis of outcomes. Endosc Ultrasound 2023; 12:171-180. [PMID: 36204798 PMCID: PMC10237604 DOI: 10.4103/eus-d-21-00268] [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: 12/12/2021] [Accepted: 04/28/2022] [Indexed: 05/07/2023] Open
Abstract
EUS-guided liver biopsy (EUS-LB) has gained momentum in recent years, especially with availability of newer needle designs. Given the emerging comparative data on EUS-LB with second-generation needles and percutaneous LB (PC-LB), we conducted a systematic review and meta-analysis to compare the safety and efficacy of the two techniques. We searched multiple databases from inception through November 2021 to identify studies comparing outcomes of EUS-LB and PC-LB. Pooled estimates were calculated using a random-effects model, and the results were expressed in terms of pooled proportions and odds ratio (OR) along with relevant 95% confidence intervals (CIs). Five studies with 748 patients were included in the final analysis. EUS-LB was performed in 276 patients and PC-LB in 472 patients. Across all studies, PC-LB had an overall higher diagnostic accuracy than EUS-LB, 98.6% confidence interval (CI: 94.7-99.7) versus 88.3% (49.6-98.3), OR: 1.65, P = 0.04. On assessing data from randomized controlled trials, there was no difference between the two. While pooled diagnostic adequacy and overall adverse events were not significantly different between PC-LB and EUS-LB, the former was superior in terms of the mean number of complete portal tracts (CPT) and total specimen length. PC-LB and EUS-LB produce similar results. PC-LB allows obtaining longer samples and more CPT. Further studies are needed to see if these trends hold up as more providers begin to perform EUS-LB.
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Affiliation(s)
- Saurabh Chandan
- Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, USA
| | - Smit Deliwala
- Department of Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
| | - Shahab R. Khan
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Babu P. Mohan
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Banreet S. Dhindsa
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jay Bapaye
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Hemant Goyal
- Department of Gastroenterology, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA
| | - Lena L. Kassab
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Faisal Kamal
- Division of Gastroenterology, University of California-San Francisco, California, USA
| | - Harlan R. Sayles
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Gursimran S. Kochhar
- Division of Gastroenterology, Hepatology and Nutrition, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Douglas G. Adler
- Center for Advanced Therapeutic Endoscopy, Centura Health, Porter Adventist Hospital, Denver, Colorado, USA
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20
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Banini BA, Patel S, Yu JW, Kang L, Bailey C, Strife BJ, Siddiqui MS, Patel V, Matherly SC, Lee H, Lewis S, Cherian R, Stravitz RT, Luketic V, Sanyal AJ, Sterling RK. Derivation and Validation of a Model to Predict Clinically Significant Portal Hypertension Using Transient Elastography and FIB-4. J Clin Gastroenterol 2023; 57:189-197. [PMID: 34999644 PMCID: PMC9271129 DOI: 10.1097/mcg.0000000000001664] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 12/04/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Liver biopsy and hepatic venous pressure gradient (HVPG), the gold standard for assessing advanced fibrosis (AF) and clinically significant portal hypertension (CSPH), are invasive, costly, and time-consuming. GOAL We investigated if the combination of fibrosis index based on 4 factors (FIB-4) and liver stiffness measure (LSM) can identify AF and more importantly, CSPH. PATIENTS AND METHODS Patients with chronic liver disease referred for transjugular liver biopsy were analyzed retrospectively. FIB-4 and LSM were compared with liver histology for diagnosing AF. FIB-4, LSM, and platelet count were compared with HVPG for diagnosing CSPH. Optimal cutoffs for predicting CSPH were determined by grid search. A composite log-odds to predict CSPH was derived from logistic regression using LSM, FIB-4, and gender. Internal bootstrap validation and external validation were performed. RESULTS A total of 142 patients were included in the derivation; 42.3% had AF, and 11.3% had CSPH using the current gold standards. The area under the receiver operating characteristic curve (AUROC) for LSM, FIB-4, and their combination to predict AF were 0.7550, 0.7049, and 0.7768, respectively. LSM, FIB-4, and platelet count predicted CSPH with AUROC 0.6818, 0.7532, and 0.7240, respectively. LSM plus FIB-4 showed the best performance in predicting CSPH with AUROC 0.8155. Based on LSM, FIB-4, and gender, a novel model-the Portal Hypertension Assessment Tool (PHAT)-was developed to predict CSPH. PHAT score ≥-2.76 predicted CSPH with sensitivity 94%, specificity 67%, positive predictive value 27%, negative predictive value 99%, and accuracy 70%. In internal and external validation, AUROCs for the model were 0.8293 and 0.7899, respectively. CONCLUSION A model consisting of FIB-4, LSM, and gender can identify CSPH among patients with chronic liver disease.
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Affiliation(s)
- Bubu A Banini
- Division of Gastroenterology, Hepatology, and Nutrition
- Section of Digestive Diseases, Yale University, New Haven, CT
| | - Samarth Patel
- Division of Gastroenterology, Hepatology, and Nutrition
- Division of Gastroenterology and Hepatology, Hunter-Holmes McGuire Veterans Affairs Medical Center, Richmond, VA
| | | | | | | | - Brian J Strife
- Division of Interventional Radiology, Virginia Commonwealth University
| | | | | | | | - Hannah Lee
- Division of Gastroenterology, Hepatology, and Nutrition
| | - Shawn Lewis
- Division of Gastroenterology, Hepatology, and Nutrition
| | - Reena Cherian
- Division of Gastroenterology, Hepatology, and Nutrition
| | | | | | - Arun J Sanyal
- Division of Gastroenterology, Hepatology, and Nutrition
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21
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Giri S, Agrawal D, Gopan A, Varghese J, Tripathy T. Diagnostic outcome and safety of plugged liver biopsy in high-risk patients: a systematic review and meta-analysis. Acta Radiol 2023; 64:1775-1782. [PMID: 36694955 DOI: 10.1177/02841851231151513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Percutaneous liver biopsy is the gold standard test for the assessment of liver disease. In patients with coagulopathy, ascites, post-transplantation, and hypervascular tumors, biopsy is associated with increased risk of adverse events (AEs). Transjugular liver biopsy (TJLB) is recommended in these conditions but is expensive and unavailable at many centers. Plugged liver biopsy (PLB) provides an alternate diagnostic modality in these high-risk cases. PURPOSE To analyze the pooled diagnostic outcome and safety of PLB in high-risk cases. MATERIAL AND METHODS A literature search of various databases from January 1990 to July 2022 was conducted for studies evaluating the outcome of PLB in high-risk cases. The primary outcomes were pooled sample adequacy and AEs. Pooled event rates across studies were expressed with summative statistics. RESULTS A total of 17 studies (2329 patients) were included in the meta-analysis. The pooled proportion of sample adequacy was 98.9% (95% confidence interval [CI]=98.2-99.6). Severe AEs, major bleeding, and minor AEs were seen in 0.7% (95% CI=0.1-1.3), 0.4% (95% CI=0.1-0.8), and 11.5% (95% CI=2.4-20.6) of the patients. There was only one reported mortality, giving a pooled incidence of 0.0002% (95% CI=0.0-0.0038). Compared to TJLB (5 studies, n = 336), there was no difference in either sample adequacy (odds ratio [OR]=2.34, 95% CI=0.83-6.58) or risk of serious AEs (OR=0.47, 95% CI=0.173-1.31). CONCLUSION PLB can be safely performed on patients with coagulopathy and/or ascites with high sample adequacy rates and low incidence of AEs and mortality.
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Affiliation(s)
- Suprabhat Giri
- Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Dhiraj Agrawal
- Department of Gastroenterology, PACE Hospital, Hyderabad, India
| | - Amrit Gopan
- Department of Gastroenterology, 29549Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Jijo Varghese
- Department of Gastroenterology, KM Cherian Institute of Medical Sciences, Kallissery, India
| | - Taraprasad Tripathy
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, India
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22
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Lisman T. Bleeding and thrombosis in cirrhosis. CARDIO-HEPATOLOGY 2023:165-202. [DOI: 10.1016/b978-0-12-817394-7.00010-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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23
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Tago K, Tsukada J, Sudo N, Shibutani K, Okada M, Abe H, Ibukuro K, Higaki T, Takayama T. Comparison between CT volumetry and extracellular volume fraction using liver dynamic CT for the predictive ability of liver fibrosis in patients with hepatocellular carcinoma. Eur Radiol 2022; 32:7555-7565. [PMID: 35593960 DOI: 10.1007/s00330-022-08852-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/13/2022] [Accepted: 04/28/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To compare the predictive ability of liver fibrosis (LF) by CT-volumetry (CTV) for liver and spleen and extracellular volume fraction (ECV) for liver in patients undergoing liver resection. METHODS We retrospectively analysed 90 consecutive patients who underwent CTV and ECV. Manually placed region-of-interest ECV (manual-ECV), rigid-registration ECV (rigid-ECV), and nonrigid-registration ECV (nonrigid-ECV) were calculated as ECV(%) = (1-haematocrit) × (ΔHUliver/ΔHUaorta), where ΔHU = subtraction of unenhanced phase from equilibrium phase (240 s). Manual-ECV was compared with CTV for the estimation of LF. The total liver volume to body surface area (TLV/BSA), splenic volume to BSA (SV/BSA), ratio of TLV to SV (TLV/SV), ratio of right liver volume to SV (RV/SV), and liver segmental volume ratio (LSVR) were measured. ROC analyses were performed for ECV and CTV. RESULTS After excluding 10 patients, seventy-eight (97.5%) out of 80 patients had a Child-Pugh score of 5 points, and two (2.5%) patients had a Child-Pugh score of 6 points. AUC of ECV showed no significant difference among manual-ECV, rigid-ECV, and nonrigid-ECV. TLV/BSA, SV/BSA, TLV/SV, and RV/SV had a higher correlation with LF grades than manual-ECV. AUC of SV/BSA was significantly higher than that of manual-ECV in F0-1 vs F2-4 and F0-2 vs F3-4. AUC of SV/BSA (0.76-0.83) was higher than that of manual-ECV (0.61-0.75) for all LF grades, although manual-ECV could differentiate between F0-3 and F4 at high AUC (0.75). CONCLUSIONS In patients undergoing liver resection, SV/BSA is a better method for estimating severe LF grades, although manual-ECV has the ability to estimate cirrhosis (≥ F4). KEY POINTS The splenic volume is a better method for estimating liver fibrosis grades. The extracellular volume fraction is also a candidate for the estimation of severe liver fibrosis.
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Affiliation(s)
- Kenichiro Tago
- Departments of Radiology of Nihon University School of Medicine, 30-1, Oyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Jitsuro Tsukada
- Departments of Radiology of Nihon University School of Medicine, 30-1, Oyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Naohiro Sudo
- Departments of Radiology of Nihon University School of Medicine, 30-1, Oyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Kazu Shibutani
- Departments of Radiology of Nihon University School of Medicine, 30-1, Oyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Masahiro Okada
- Departments of Radiology of Nihon University School of Medicine, 30-1, Oyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Hayato Abe
- Departments of Digestive Surgery Nihon University School of Medicine, Tokyo, Japan
| | - Kenji Ibukuro
- Departments of Radiology of Nihon University School of Medicine, 30-1, Oyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Tokio Higaki
- Departments of Digestive Surgery Nihon University School of Medicine, Tokyo, Japan
| | - Tadatoshi Takayama
- Departments of Digestive Surgery Nihon University School of Medicine, Tokyo, Japan
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Lee JM, Lee D, Christiansen S, Hagedorn JM, Chen Z, Deer T. Spinal Cord Stimulation in Special Populations: Best Practices from the American Society of Pain and Neuroscience to Improve Safety and Efficacy. J Pain Res 2022; 15:3263-3273. [PMID: 36304486 PMCID: PMC9594348 DOI: 10.2147/jpr.s372921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/11/2022] [Indexed: 11/10/2022] Open
Abstract
Chronic bleeding disorders, allergy to implants, and chronic infections are all complicating factors when considering neuromodulation therapies. The American Society of Pain and Neuroscience (ASPN) determined a need for clinical guidance in these special patient populations that have increased risk of complications, in order to ensure patient safety and optimal outcomes with device implantation. The purpose of this publication was to review the published literature and explore the unique clinical challenges encountered among several special patient populations with relation to spinal cord stimulation. The executive board of the ASPN appointed a diverse group of well-established physicians to develop best practice guidelines regarding spinal cord stimulation implantation in these special populations. The physicians used the United States Preventive Services Task Force (USPSTF) structured guidelines for grading and level of certainty to make evidence-based recommendations about clinical practice. Where sufficient evidence was lacking to justify a USPSTF ranking, the physicians queried experts in neuromodulation and achieved consensus. These best practices and interventional guideline found the evidence for the use of neuromodulation in specialized patient populations to be relatively modest.
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Affiliation(s)
- Jennifer M Lee
- Department of Sports & Spine, EvergreenHealth Medical Group, Kirkland, WA, USA
| | - David Lee
- Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, USA
| | - Sandy Christiansen
- Department of Anesthesiology & Perioperative Medicine, Oregon Health Sciences University, Portland, OR, USA
| | | | - Zheyan Chen
- Department of Anesthesiology & Perioperative Medicine, Oregon Health Sciences University, Portland, OR, USA
| | - Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
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Malik P, Pillai S, Agarwal K, Abdelwahed S, Bhandari R, Singh A, Chidharla A, Patel K, Singh P, Manaktala P, Rabbani R, Koritala T, Gupta S. Diagnostic Accuracy of Elastography and Liver Disease: A Meta-Analysis. Gastroenterology Res 2022; 15:232-239. [PMID: 36407808 PMCID: PMC9635782 DOI: 10.14740/gr1557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/19/2022] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Ultrasound-based transient elastography (TE) is a non-invasive alternative to liver biopsy for the staging of hepatic fibrosis due to various chronic liver diseases. This meta-analysis aims to assess the diagnostic accuracy of TE for detecting liver cirrhosis (F4) and severe fibrosis (F3) in patients with chronic liver diseases, in comparison to the gold standard liver biopsy. METHODS A systematic search was performed using PubMed search engine following Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines from inception to May 2021. The meta-analysis studies evaluating the diagnostic accuracy of TE for severe fibrosis and cirrhosis were identified. We conducted a meta-meta-analysis to generate pooled estimates of the sensitivity, specificity, and diagnostic odds ratios (ORs) for F3 and F4 fibrosis stage. RESULTS We included five studies with a total of 124 sub-studies and 20,341 patients in our analysis. Three studies have reported the diagnostic accuracy of TE in detecting F3/severe fibrosis stage and found 81.9% pooled sensitivity (95% confidence interval (CI): 79.9-83.7%; P < 0.001) (I2 = 0%), 84.7% pooled specificity (95% CI: 81.3-87.6%) (I2 = 81%; P = 0.02). All five studies reported the diagnostic accuracy of TE in detecting F4/liver cirrhosis stage. We found 84.8% pooled sensitivity (95% CI: 81.4-87.7%) (I2 = 86.4%; P < 0.001), 87.5% pooled specificity (95% CI: 85.4-89.3%) (I2 = 90%; P < 0.001) and pooled diagnostic OR (41.8; 95% CI: 3.9 - 56.5) (I2 = 87%; P < 0.001). CONCLUSIONS Ultrasound-based TE has excellent diagnostic accuracy for identifying cirrhosis and liver fibrosis stages 3. Future studies should focus on estimating the diagnostic accuracy of other fibrosis stages in chronic liver disease patients. This will eventually decrease the risk associated with invasive liver biopsy.
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Affiliation(s)
- Preeti Malik
- Department of Pathology, Montefiore Medical Center, Bronx, NY, USA
- Preeti Malik and Shreejith Pillai contributed equally to this article as first authors
| | - Shreejith Pillai
- Department of Internal Medicine, Henry Ford Health System, Detroit, MI, USA
- Preeti Malik and Shreejith Pillai contributed equally to this article as first authors
| | - Kriti Agarwal
- Department of Internal Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Salwa Abdelwahed
- Department of Family and Community Medicine, University of Missouri, Kansas City, MO, USA
| | - Renu Bhandari
- Department of Internal Medicine, Manipal College of Medical Sciences, Pokhara, Nepal
| | - Abhishek Singh
- Department of Internal Medicine, Mount Sinai Morningside, New York, NY, USA
| | - Anusha Chidharla
- Department of Hematology Oncology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kajal Patel
- Department of Internal Medicine, Smt Kashibai Navale Medical College, Nahre, Maharashtra, India
| | | | - Pritika Manaktala
- Department of Internal Medicine, Canton Medical Education Foundation/NEOMED, Canton, OH, USA
| | - Rizwan Rabbani
- Department of Internal Medicine, Temple University Hospital, Philadelphia, PA, USA
| | - Thoyaja Koritala
- Department of Internal Medicine, Mayo Clinic Health System, Mankato, MN, USA
| | - Sachin Gupta
- Department of Internal Medicine, Reading Hospital, West Reading, PA, USA
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Troelstra MA, Van Dijk AM, Witjes JJ, Mak AL, Zwirs D, Runge JH, Verheij J, Beuers UH, Nieuwdorp M, Holleboom AG, Nederveen AJ, Gurney-Champion OJ. Self-supervised neural network improves tri-exponential intravoxel incoherent motion model fitting compared to least-squares fitting in non-alcoholic fatty liver disease. Front Physiol 2022; 13:942495. [PMID: 36148303 PMCID: PMC9485997 DOI: 10.3389/fphys.2022.942495] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
Recent literature suggests that tri-exponential models may provide additional information and fit liver intravoxel incoherent motion (IVIM) data more accurately than conventional bi-exponential models. However, voxel-wise fitting of IVIM results in noisy and unreliable parameter maps. For bi-exponential IVIM, neural networks (NN) were able to produce superior parameter maps than conventional least-squares (LSQ) generated images. Hence, to improve parameter map quality of tri-exponential IVIM, we developed an unsupervised physics-informed deep neural network (IVIM3-NET). We assessed its performance in simulations and in patients with non-alcoholic fatty liver disease (NAFLD) and compared outcomes with bi-exponential LSQ and NN fits and tri-exponential LSQ fits. Scanning was performed using a 3.0T free-breathing multi-slice diffusion-weighted single-shot echo-planar imaging sequence with 18 b-values. Images were analysed for visual quality, comparing the bi- and tri-exponential IVIM models for LSQ fits and NN fits using parameter-map signal-to-noise ratios (SNR) and adjusted R2. IVIM parameters were compared to histological fibrosis, disease activity and steatosis grades. Parameter map quality improved with bi- and tri-exponential NN approaches, with a significant increase in average parameter-map SNR from 3.38 to 5.59 and 2.45 to 4.01 for bi- and tri-exponential LSQ and NN models respectively. In 33 out of 36 patients, the tri-exponential model exhibited higher adjusted R2 values than the bi-exponential model. Correlating IVIM data to liver histology showed that the bi- and tri-exponential NN outperformed both LSQ models for the majority of IVIM parameters (10 out of 15 significant correlations). Overall, our results support the use of a tri-exponential IVIM model in NAFLD. We show that the IVIM3-NET can be used to improve image quality compared to a tri-exponential LSQ fit and provides promising correlations with histopathology similar to the bi-exponential neural network fit, while generating potentially complementary additional parameters.
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Affiliation(s)
- Marian A. Troelstra
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands
- *Correspondence: Marian A. Troelstra,
| | | | - Julia J. Witjes
- Department of Vascular Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Anne Linde Mak
- Department of Vascular Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Diona Zwirs
- Department of Vascular Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Jurgen H. Runge
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Joanne Verheij
- Department of Pathology, Amsterdam UMC, Amsterdam, Netherlands
| | - Ulrich H. Beuers
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, Netherlands
| | - Max Nieuwdorp
- Department of Vascular Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | | | - Aart J. Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands
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Rangwani S, Ardeshna DR, Mumtaz K, Kelly SG, Han SY, Krishna SG. Update on endoscopic ultrasound-guided liver biopsy. World J Gastroenterol 2022; 28:3586-3594. [PMID: 36161047 PMCID: PMC9372801 DOI: 10.3748/wjg.v28.i28.3586] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/21/2022] [Accepted: 06/26/2022] [Indexed: 02/06/2023] Open
Abstract
Endoscopic ultrasound guided liver biopsy (EUS-LB) has emerged as a minimally-invasive alternative to the traditional (percutaneous or transjugular) liver biopsy techniques for the diagnosis of liver parenchymal diseases. Po-tentially, EUS-LB combines the advantages of percutaneous and transjugular liver biopsy in addressing focused sampling in addition to measuring portal pressure. Additionally, EUS-LB facilitates access to both the lobes of the liver which is not considered with the traditional percutaneous liver biopsy. Multiple studies have compared EUS-LB with conventional liver biopsy and reported comparable diagnostic yield, increased acquisition of complete portal tracts, and longer specimen length as compared to the traditional approaches. EUS-LB is associated with lesser post-procedural pain and shorter recovery time, while providing lower risk of complications when compared to traditional liver biopsy. Innovations in needle types, needle sizes and suction techniques have aimed at further optimizing the EUS-LB technique. This review article updates current literature with focus on the variations in the technique and equipment used for EUS-LB, and compares EUS-LB with traditional methods of liver biopsy.
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Affiliation(s)
- Shiva Rangwani
- Division of Gastroenterology, Hepatology, and Nutrition,Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Devarshi R Ardeshna
- Division of Gastroenterology, Hepatology, and Nutrition,Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Khalid Mumtaz
- Division of Gastroenterology, Hepatology, and Nutrition,Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Sean G Kelly
- Division of Gastroenterology, Hepatology, and Nutrition,Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Samuel Y Han
- Division of Gastroenterology, Hepatology, and Nutrition,Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Somashekar G Krishna
- Division of Gastroenterology, Hepatology, and Nutrition,Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
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Lisman T, Caldwell SH, Intagliata NM. Haemostatic alterations and management of haemostasis in patients with cirrhosis. J Hepatol 2022; 76:1291-1305. [PMID: 35589251 DOI: 10.1016/j.jhep.2021.11.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/31/2021] [Accepted: 11/02/2021] [Indexed: 12/12/2022]
Abstract
Patients with cirrhosis frequently acquire complex changes in their haemostatic system including a decreased platelet count and decreased levels of various haemostatic proteins. Although historically patients with cirrhosis were thought to have a haemostasis-related bleeding tendency, it is now widely accepted that the haemostatic system of patients with cirrhosis remains in balance as a result of simultaneous changes in pro- and anti-haemostatic systems. The concept of rebalanced haemostasis has led to changes in clinical management, although firm evidence from well-designed clinical studies is largely lacking. For example, many invasive procedures in patients with cirrhosis and a prolonged prothrombin time are now performed without prophylaxis with fresh frozen plasma. Conversely, clinicians have become more aware of the need for anti-thrombotic therapy, even in those patients with abnormal routine coagulation tests. This paper will outline recent advances in pathogenesis, prevention and treatment of both bleeding and thrombotic complications in patients with cirrhosis. Among other topics, we will discuss the haemostatic status of acutely ill patients with cirrhosis, the various causes of bleeding in patients with cirrhosis, and how best to prevent or treat bleeding. In addition, we will discuss the hypercoagulable features of patients with cirrhosis, new insights into the pathogenesis of portal vein thrombosis, and how best to prevent or treat thromboses.
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Affiliation(s)
- Ton Lisman
- Surgical Research Laboratory and Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Stephen H Caldwell
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Coagulation in Liver Disease, University of Virginia Medical Center, Charlottesville VA, United States
| | - Nicolas M Intagliata
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Coagulation in Liver Disease, University of Virginia Medical Center, Charlottesville VA, United States
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Villa E, Bianchini M, Blasi A, Denys A, Giannini EG, de Gottardi A, Lisman T, de Raucourt E, Ripoll C, Rautou PE. EASL Clinical Practice Guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis. J Hepatol 2022; 76:1151-1184. [PMID: 35300861 DOI: 10.1016/j.jhep.2021.09.003] [Citation(s) in RCA: 172] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 12/11/2022]
Abstract
The prevention and management of bleeding and thrombosis in patients with cirrhosis poses several difficult clinical questions. These Clinical Practice Guidelines have been developed to provide practical guidance on debated topics, including current views on haemostasis in liver disease, controversy regarding the need to correct thrombocytopenia and abnormalities in the coagulation system in patients undergoing invasive procedures, and the need for thromboprophylaxis in hospitalised patients with haemostatic abnormalities. Multiple recommendations in this document are based on interventions that the panel feels are not useful, even though widely applied in clinical practice.
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YILMAZ H. Perkütanöz Karaciğer Biyopsisi Hasta Deneyimlerini Anlamak Hekimleri Yasal Yaptırımlardan Koruyabilir. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2022. [DOI: 10.30934/kusbed.1061033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Krag A, Roskams T, Pinzani M, Mueller S. Diagnostic challenges in patients with alcohol-related liver disease. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022; 60:45-57. [PMID: 35042253 DOI: 10.1055/a-1713-4372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Alcohol is globally the leading risk factor for cirrhosis and is subsumed under the term alcohol-related liver disease (ALD). However, only ca. 10% of people with harmful alcohol consumption (>40 gram alcohol per day) develop cirrhosis, while 15% have normal liver histology. Unfortunately, laboratory parameters and ultrasound hold little value to neither rule-in nor rule out alcohol related liver fibrosis. While several indices with combinations of liver associated markers such as FIB4 seem to be promising, non-invasive test strategies are urgently needed with cut-off's that can be applied to guide clinical decision making. The aims of this review article are to highlight novel developments for the diagnosis of ALD and to identify topics of controversy and potential future directions. In the last 15 years, elastography to measure liver stiffness (LS) has significantly improved our screening strategies for cirrhosis. LS values below 6 kPa are considered as normal and exclude ALD. LS of 8 and 12.5 kPa represent generally accepted cut-off values for F3 and F4 fibrosis. Especially, transient elastography (TE) has been assessed in numerous studies, but similar performance can be obtained with point shear wave elastography, 2 SD shear wave elastography or MR elastography. Important confounders of elevated LS such as inflammation should also be considered and alcohol withdrawal not only improves liver inflammation but also LS. Liver stiffness measurement has signficiantly improved early diagnosis and follow-up of fibrosis in patients with ALD and patients with diagnosed manifest but clinically compensated cirrhosis should undergo further clinical examinations to rule out complications of portal hypertension. In addition, surveillance for the occurrence of hepatocellular carcinoma is recommended in all cirrhotic patients.
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Affiliation(s)
- Aleksander Krag
- Centre for Liver Research/Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Tania Roskams
- Department of Imaging and Pathology, University of Leuven, Leuven, Netherlands
| | - Massimo Pinzani
- University College London Institute for Liver and Digestive Health, Royal Free Hospital, London, United Kingdom of Great Britain and Northern Ireland
| | - Sebastian Mueller
- Centre of Alcohol Research, University of Heidelberg, Heidelberg, Germany.,Department of Medicine, Salem KH, Heidelberg, Germany
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Mulazzani L, Terzi E, Casadei G, Pasquali V, Felicani C, Stefanini F, Granito A, Serra C, Piscaglia F. Retrospective analysis of safety of ultrasound-guided percutaneous liver biopsy in the 21st century. Eur J Gastroenterol Hepatol 2021; 33:e355-e362. [PMID: 35048647 DOI: 10.1097/meg.0000000000002080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ultrasound-guided percutaneous liver biopsy is a standard procedure, but it might be burdened with serious adverse events, mainly hemorrhagic. Literature lacks recent studies taking into account new ultrasound machines, more sensitive to tiny vessels and the evolution of the bioptic technique, including ultrasound guidance in all instances. Hence, the primary aim of this study was to evaluate complication rates of ultrasound-guided percutaneous liver biopsy in a recent population. Secondary aims were to evaluate if the experience of operator is a determinant of risk of complication and to identify other potential risk factors. METHODS We evaluated 800 procedures carried out in one hospital in the period 2010-2018. RESULTS Complication rate resulted in 4%, with the occurrence of moderate hemorrhagic complications in 0.75%. No cases of severe events or death were registered. A higher risk of bleeding was found to be associated with less experienced operators, while the need to perform multiple needle insertions increased the probability of adverse events. CONCLUSION The present findings confirmed ultrasound-guided percutaneous liver biopsy to be a substantially safe procedure with a low risk of overall adverse events and bleeding in particular, especially when performed by expert operators.
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Affiliation(s)
- Lorenzo Mulazzani
- Unit of Internal Medicine, Policlinico di S. Orsola, University of Bologna
| | - Eleonora Terzi
- Unit of Internal Medicine, Policlinico di S. Orsola, University of Bologna
| | - Giacomo Casadei
- Unit of Internal Medicine, Policlinico di S. Orsola, University of Bologna
| | - Valentina Pasquali
- Unit of Internal Medicine, Policlinico di S. Orsola, University of Bologna
| | - Cristina Felicani
- Department of organ insufficiency and transplantation, Departmental Program of Diagnostic and Therapeutic Interventional Ultrasound, Policlinico di S. Orsola, Bologna, Italy
| | - Federico Stefanini
- Unit of Internal Medicine, Policlinico di S. Orsola, University of Bologna
| | - Alessandro Granito
- Unit of Internal Medicine, Policlinico di S. Orsola, University of Bologna
| | - Carla Serra
- Department of organ insufficiency and transplantation, Departmental Program of Diagnostic and Therapeutic Interventional Ultrasound, Policlinico di S. Orsola, Bologna, Italy
| | - Fabio Piscaglia
- Unit of Internal Medicine, Policlinico di S. Orsola, University of Bologna
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Marsh RL, Kelly S, Mumtaz K, Kaffenberger J. Utility and Limitations of Transient Elastography to Monitor Hepatic Steatosis, Hepatic Fibrosis, and Methotrexate-Associated Hepatic Disease in Psoriasis: A Systematic Review. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2021; 14:24-28. [PMID: 35096251 PMCID: PMC8794495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Psoriasis is associated with hepatic steatosis, fibrosis, and methotrexate-associated liver injury. There is a need for reliable methods to monitor liver disease in psoriasis. Transient elastography (TE) is a validated non-invasive method for assessing hepatic steatosis and fibrosis. Psoriasis-specific TE studies have been limited until recently. Here, we review the utility and limitations of TE to detect and monitor liver disease in the context of psoriasis. METHODS A comprehensive search using OVID, PubMed, and gray literature was conducted (2005-November 2019) to identify studies of TE use in psoriasis for assessment of hepatic steatosis and fibrosis. RESULTS Fifteen studies met inclusion criteria. A total of 1,536 patients with psoriasis or psoriatic arthritis were represented. TE-detected liver fibrosis is associated with age, diabetes, obesity, and severity of psoriasis. TE successfully evaluates hepatic steatosis and fibrosis. Elastography has a high negative predictive value and specificity in the context of methotrexate-associated liver fibrosis in psoriasis; however, reported associations between abnormal elastography results and cumulative methotrexate dose varied significantly despite methotrexate's association with hepatotoxicity and fibrosis. The presence of central adiposity is associated with increased TE failure rate. LIMITATION The TE studies included in this review date from 2007 to 2019, which could contribute to publication bias, as the technique of TE has improved over this time period. CONCLUSION TE is a useful and non-invasive modality to detect hepatic steatosis and fibrosis in psoriasis. Dermatologists might consider TE in psoriatic patients and concomitant risk factors for fibrosis with the understanding that failure rates may be higher in patients with central adiposity.
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Affiliation(s)
- Rachel L Marsh
- Drs. Marsh and Kaffenberger are with the Dpartment of Internal Medicine, Division of Dermatology at The Ohio State University Wexner Medical Center in Columbus, Ohio
- Drs. Kelly and Mumtaz are with the Department of Internal Medicine, Division of Gastroenterology, Hepatology, and Nutrition at The Ohio State University Wexner Medical Center in Columbus, Ohio
| | - Sean Kelly
- Drs. Marsh and Kaffenberger are with the Dpartment of Internal Medicine, Division of Dermatology at The Ohio State University Wexner Medical Center in Columbus, Ohio
- Drs. Kelly and Mumtaz are with the Department of Internal Medicine, Division of Gastroenterology, Hepatology, and Nutrition at The Ohio State University Wexner Medical Center in Columbus, Ohio
| | - Khalid Mumtaz
- Drs. Marsh and Kaffenberger are with the Dpartment of Internal Medicine, Division of Dermatology at The Ohio State University Wexner Medical Center in Columbus, Ohio
- Drs. Kelly and Mumtaz are with the Department of Internal Medicine, Division of Gastroenterology, Hepatology, and Nutrition at The Ohio State University Wexner Medical Center in Columbus, Ohio
| | - Jessica Kaffenberger
- Drs. Marsh and Kaffenberger are with the Dpartment of Internal Medicine, Division of Dermatology at The Ohio State University Wexner Medical Center in Columbus, Ohio
- Drs. Kelly and Mumtaz are with the Department of Internal Medicine, Division of Gastroenterology, Hepatology, and Nutrition at The Ohio State University Wexner Medical Center in Columbus, Ohio
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Alqahtani SA, Schattenberg JM. NAFLD in the Elderly. Clin Interv Aging 2021; 16:1633-1649. [PMID: 34548787 PMCID: PMC8448161 DOI: 10.2147/cia.s295524] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/12/2021] [Indexed: 12/25/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is an increasingly prevalent disease globally. Current estimates are that 24% of the adult population, thus, one billion individuals worldwide, are affected. Interestingly, the prevalence of fatty liver seems to peak between 40─50 years of age in males and 60─69 years in females, often slightly decreasing in older (>70 years) cohorts. Furthermore, several risk factors for NAFLD development, such as hypertension, diabetes, hyperlipidemia, and obesity are higher in older adults. The diagnosis and management strategies in older adults are sometimes challenging, and certain age-specific factors have to be taken into account by healthcare professionals. In this review, we provide an overview of considerations relevant to the management and diagnosis of NAFLD in older adults (age >65 years) and discuss the types of pharmacological interventions available for the management of non-alcoholic steatohepatitis (NASH) in the aging population.
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Affiliation(s)
- Saleh A Alqahtani
- Liver Transplantation Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.,Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD, USA
| | - Jörn M Schattenberg
- Metabolic Liver Research Program, I. Department of Medicine, University Medical Center, Mainz, Germany
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35
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Oka A, Ishimura N, Ishihara S. A New Dawn for the Use of Artificial Intelligence in Gastroenterology, Hepatology and Pancreatology. Diagnostics (Basel) 2021; 11:1719. [PMID: 34574060 PMCID: PMC8468082 DOI: 10.3390/diagnostics11091719] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 12/15/2022] Open
Abstract
Artificial intelligence (AI) is rapidly becoming an essential tool in the medical field as well as in daily life. Recent developments in deep learning, a subfield of AI, have brought remarkable advances in image recognition, which facilitates improvement in the early detection of cancer by endoscopy, ultrasonography, and computed tomography. In addition, AI-assisted big data analysis represents a great step forward for precision medicine. This review provides an overview of AI technology, particularly for gastroenterology, hepatology, and pancreatology, to help clinicians utilize AI in the near future.
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Affiliation(s)
- Akihiko Oka
- Department of Internal Medicine II, Faculty of Medicine, Shimane University, Izumo 693-8501, Shimane, Japan; (N.I.); (S.I.)
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Sripongpun P, Pongpaibul A, Charatcharoenwitthaya P. Value and risk of percutaneous liver biopsy in patients with cirrhosis and clinical suspicion of autoimmune hepatitis. BMJ Open Gastroenterol 2021; 8:bmjgast-2021-000701. [PMID: 34362759 PMCID: PMC8351491 DOI: 10.1136/bmjgast-2021-000701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/20/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The decision regarding whether to perform a liver biopsy in patients with cirrhosis and clinically suspected autoimmune hepatitis (AIH) remains a challenge. This study aimed to assess the utility and complications of percutaneous liver biopsy in cirrhosis for differentiating AIH from other liver conditions. METHODS A clinicopathological database of patients undergoing percutaneous liver biopsies for suspected AIH (unexplained hepatitis with elevated γ-globulin and autoantibody seropositivity) was reviewed to identify patients presenting with cirrhosis. Biopsy slides were reviewed by an experienced hepatopathologist who was blinded to clinical data. RESULTS In 207 patients who underwent liver biopsy for suspected AIH, 59 patients (mean age: 59.0±12.0 years, 83.1% female) had clinically diagnosis of cirrhosis. Mean Child-Turcotte-Pugh score was 6.6±1.6, and 44% of patients had a Child-Turcotte-Pugh score≥7. According to the revised International AIH Group (IAIHG) criteria, histology assessment combined with clinical information facilitated a diagnosis of AIH or overlap syndrome of AIH and primary biliary cholangitis (PBC) in 81.4% of cases. Liver biopsy identified other aetiologies, including PBC (n=2), non-alcoholic steatohepatitis (n=6) and cryptogenic cirrhosis (n=3). A reliable diagnosis of AIH could be made using histological category of the simplified criteria in 69.2% and 81.8% of cases using IAIHG scores before biopsy of <10 and 10-15, respectively. Three patients with cirrhosis (5.1%) experienced bleeding following biopsy, but none of 148 patients with non-cirrhosis had bleeding complication (p=0.022). CONCLUSION Liver biopsy provides important diagnostic information for the management of patients with cirrhosis and suspected AIH, but the procedure is associated with significant risk.
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Affiliation(s)
- Pimsiri Sripongpun
- Medicine, Mahidol University Faculty of Medicine Siriraj Hospital, Bangkok, Thailand.,Medicine, Faculty of Medicine Prince of Songkla University, Hat Yai, Songkla, Thailand
| | - Ananya Pongpaibul
- Pathology, Mahidol University Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
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Fang W, Noda M, Gotoh K, Morooka Y, Noda T, Kobayashi S, Doki Y, Eguchi H, Umeshita K. Fatty liver disease in Living Liver Donors: A Single-Institute Experience of 220 Donors. Transpl Int 2021; 34:2238-2246. [PMID: 34355425 DOI: 10.1111/tri.14005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/05/2021] [Accepted: 07/28/2021] [Indexed: 11/27/2022]
Abstract
We retrospectively reviewed 220 living liver donors, with a focus on the development of postoperative fatty liver. Data regarding demographics, comorbidities, imaging tests, operations, and biopsies were obtained from medical records. We used unenhanced CT and USG to diagnose fatty liver. Donor candidates with fatty liver underwent weight loss intervention until imaging tests no longer demonstrated any features of fatty liver. Among 220 donors, 61 were diagnosed with preoperative fatty liver. The mean BMI of these 61 donors significantly decreased from 24.9 at the first visit to 23.6 kg/m2 immediately before surgery (p=0.0386). A multivariate analysis revealed the following significant risk factors for postoperative fatty liver: male sex (p=0.0033), BMI immediately before surgery (p=0.0028), and a history of treatment for preoperative fatty liver (p=0.0231). Postoperative fatty liver was often refractory to weight loss intervention. No improvement was observed in 14 of the 32 donors who had been diagnosed with fatty liver postoperatively, and 1 of the 14 donors even developed NASH. In conclusion, special attention should be paid to prevent fatty liver after surgery in male donors who show a high BMI immediately before surgery and with a history of treatment for preoperative fatty liver, and lifelong follow-up is recommended.
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Affiliation(s)
- Wen Fang
- Division of Health Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Momoko Noda
- Department of Nursing, Osaka University Hospital, Osaka, Japan
| | - Kunihito Gotoh
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuki Morooka
- School of Nursing, Mukogawa Women's University, Hyogo, Japan
| | - Takehiro Noda
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Shogo Kobayashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Koji Umeshita
- Division of Health Science, Graduate School of Medicine, Osaka University, Osaka, Japan.,Osaka International Cancer Institute, Osaka, Japan
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Aksakal M, Oktar SO, Sendur HN, Esendaglı G, Ozenirler S, Cindoruk M, Hızel K. Diagnostic performance of 2D shear wave elastography in predicting liver fibrosis in patients with chronic hepatitis B and C: a histopathological correlation study. Abdom Radiol (NY) 2021; 46:3238-3244. [PMID: 33723676 DOI: 10.1007/s00261-021-03019-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/21/2021] [Accepted: 02/25/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE In this study, we investigated the diagnostic efficacy of 2D-Shear Wave Elastography (2D-SWE) in detecting stages of liver fibrosis and determining the disease-specific cut-off values in patients with chronic hepatitis B and C infection, using histopathological analysis as the reference method. METHOD Our study included 103 consecutive adult patients with chronic hepatitis B and C infection (CHB and CHC) who had liver biopsy within three months of elastography examination. A real-time 2D-SWE was performed using the LOGIQ E9 system (GE Medical Systems, Wisconsin, USA). The correlation between the liver stiffness measurements and the METAVIR scores was evaluated. The diagnostic performance of 2D-SWE was assessed, and cut-off values were set. RESULTS We found a statistically significant positive correlation between elastography values and the degree of liver fibrosis (Spearman's correlation coefficient = 0.76 and 0.83 for CHB and CHC; respectively) (p = 0.0001). The stiffness cut-off values were F ≥ 1: 5.92 kPa, F ≥ 2: 7.69 kPa, F ≥ 3: 8.97 kPa, F ≥ 4: 12.15 kPa in CHB; and F ≥ 1: 6.09 kPa, F ≥ 2: 7.81 kPa, F ≥ 3: 9.0 kPa, F ≥ 4: 12.47 kPa in CHC patients. CONCLUSION 2D-SWE is reliable and accurate for the diagnosis of liver fibrosis. In selected patients, 2D-SWE may be useful in reducing the need for liver biopsy when staging fibrosis. Further studies in larger prospective series are needed to confirm these results and determine the most appropriate cut-off values for each stage of liver fibrosis.
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Affiliation(s)
- Mehmet Aksakal
- Department of Radiology, Gazi University, 06500, Beşevler, Ankara, Turkey.
| | - Suna Ozhan Oktar
- Department of Radiology, Gazi University, 06500, Beşevler, Ankara, Turkey
| | - Halit Nahit Sendur
- Department of Radiology, Gazi University, 06500, Beşevler, Ankara, Turkey
| | - Güldal Esendaglı
- Department of Pathology, Gazi University, 06500, Beşevler, Ankara, Turkey
| | - Seren Ozenirler
- Department of Gastroenterology, Gazi University, 06500, Beşevler, Ankara, Turkey
| | - Mehmet Cindoruk
- Department of Gastroenterology, Gazi University, 06500, Beşevler, Ankara, Turkey
| | - Kenan Hızel
- Department of Infectious Diseases, Gazi University, 06500, Beşevler, Ankara, Turkey
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Effect of breath holding at the end of the inspiration and expiration phases on liver stiffness measured by 2D-MR elastography. Abdom Radiol (NY) 2021; 46:2516-2526. [PMID: 33386913 DOI: 10.1007/s00261-020-02893-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/27/2020] [Accepted: 12/04/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Evaluate the effect of breath holding at the end of the inspiration and expiration phases on the measurement of liver stiffness by 2D-MR elastography (MRE). METHODS The study included 61 subjects, of which 31 subjects were pathologically confirmed liver fibrosis patients [liver fibrosis group (LFG)] and 30 healthy subjects [healthy group (HG)]. MRE was used to measure the liver stiffness of subjects in inspiration breath-hold (IBH) and expiration breath-hold (EBH) states. RESULTS In IBH and EBH states, the liver stiffness measured by MRE was not significantly different in the HG (P = 0.125, > 0.05), while the LFG showed a significant difference (P <0.001). Also, a significant difference was observed between the change values in the mild/moderate fibrosis group (MFG) and advanced fibrosis group (AFG) (P = 0.005, < 0.05). CONCLUSIONS The liver stiffness values in patients with liver fibrosis were affected by breath-holding states. The higher the stage of liver fibrosis, the greater the change in liver stiffness values, but no significant difference was observed between liver stiffness values in healthy subjects under the two breath-holding conditions. Different breath-holding states are factors influencing liver fibrosis stiffness measured by MRE, which should be given due attention in both clinical and research contexts.
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Franzè MS, Bottari A, Caloggero S, Pitrone A, Barbera A, Lembo T, Caccamo G, Cacciola I, Maimone S, Alibrandi A, Pitrone C, Squadrito G, Raimondo G, Saitta C. Rate of hepatocellular carcinoma diagnosis in cirrhotic patients with ultrasound-detected liver nodules. Intern Emerg Med 2021; 16:949-955. [PMID: 33111165 DOI: 10.1007/s11739-020-02541-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
Ultrasound (US) detection of liver nodules in cirrhotic patients requires further radiological examinations and often a follow-up with repeated short-term evaluations to verify the presence of hepatocellular carcinoma (HCC). Aims of the study were to assess the rate of HCC diagnosis and to identify HCC predictors in a cohort of cirrhotics followed-up after US detection of the liver nodule(s). One-hundred-eighty-eight consecutive cirrhotic patients (124 males, mean age 64.2 years) with liver nodule(s) detected by US were enrolled. All patients underwent second-level imaging [computed tomography (TC) or magnetic resonance (MR)], and those without a definite diagnosis of HCC were followed-up with TC and/or RM repeated every 3-6 months up to 18 months if HCC was not diagnosed. After 18 months, non-HCC patients came back to routine US surveillance. HCC was diagnosed in 73/188 cases (38.8%). In 66/73 patients (90.4%) HCC was identified at first radiological evaluation after US, while in the remaining seven subjects it was diagnosed at the subsequent imaging examination. Age (p = 0.001) and nodule dimension (p = 0.0001) were independent predictors of HCC at multivariate analysis. Fourty-nine/188 patients were lost at follow up after 18 months. Twenty/139 remaining patients developed HCC and 3/139 cholangiocarcinoma; 77 died between 3 and 110 months from the beginning of the study (61 for end-stage liver disease, 8 for extrahepatic causes, eight for unknown causes). Patients who developed liver cancer earlier during the follow up had the shortest overall survival. US-detected liver nodules are not neoplastic in more than half of cirrhotic patients. A definite diagnosis may be obtained at the time of the first radiologic evaluation after US in the vast majority of the cases. Patients in whom nodules are found not to be tumoral may return to the US surveillance program routinely applied to all cirrhotics.
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Affiliation(s)
- Maria Stella Franzè
- Division of Medicine and Hepatology, Department of Medical Sciences, University Hospital of Messina, Via Consolare Valeria, 1 - 98124, Messina, Italy
| | - Antonio Bottari
- Division of Radiology, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Simona Caloggero
- Division of Radiology, Department of Radiology and Radiotherapy, University Hospital of Messina, Messina, Italy
| | - Alessia Pitrone
- Division of Radiology, Department of Radiology and Radiotherapy, University Hospital of Messina, Messina, Italy
| | - Adalberto Barbera
- Division of Oncologic Surgery, Department of Human Pathology, University of Messina, Messina, Italy
| | - Tindaro Lembo
- Division of Medicine and Hepatology, Department of Medical Sciences, University Hospital of Messina, Via Consolare Valeria, 1 - 98124, Messina, Italy
- Present address: Unit of Internal Medicine, Institute of Social Security, San Marino, Republic of San Marino
| | - Gaia Caccamo
- Division of Medicine and Hepatology, Department of Medical Sciences, University Hospital of Messina, Via Consolare Valeria, 1 - 98124, Messina, Italy
| | - Irene Cacciola
- Division of Medicine and Hepatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Sergio Maimone
- Division of Medicine and Hepatology, Department of Medical Sciences, University Hospital of Messina, Via Consolare Valeria, 1 - 98124, Messina, Italy
| | - Angela Alibrandi
- Division of Statistical and Mathematical Sciences, Department of Economics, University of Messina, Messina, Italy
| | - Concetta Pitrone
- Division of Medicine and Hepatology, Department of Medical Sciences, University Hospital of Messina, Via Consolare Valeria, 1 - 98124, Messina, Italy
| | - Giovanni Squadrito
- Division of Internal Medicine, Department of Medical Sciences, University Hospital of Messina, Messina, Italy
| | - Giovanni Raimondo
- Division of Medicine and Hepatology, Department of Medical Sciences, University Hospital of Messina, Via Consolare Valeria, 1 - 98124, Messina, Italy
- Division of Medicine and Hepatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Carlo Saitta
- Division of Medicine and Hepatology, Department of Medical Sciences, University Hospital of Messina, Via Consolare Valeria, 1 - 98124, Messina, Italy.
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Troelstra MA, Witjes JJ, van Dijk AM, Mak AL, Gurney-Champion O, Runge JH, Zwirs D, Stols-Gonçalves D, Zwinderman AH, Ten Wolde M, Monajemi H, Ramsoekh S, Sinkus R, van Delden OM, Beuers UH, Verheij J, Nieuwdorp M, Nederveen AJ, Holleboom AG. Assessment of Imaging Modalities Against Liver Biopsy in Nonalcoholic Fatty Liver Disease: The Amsterdam NAFLD-NASH Cohort. J Magn Reson Imaging 2021; 54:1937-1949. [PMID: 33991378 PMCID: PMC9290703 DOI: 10.1002/jmri.27703] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 12/17/2022] Open
Abstract
Background Noninvasive diagnostic methods are urgently required in disease stratification and monitoring in nonalcoholic fatty liver disease (NAFLD). Multiparametric magnetic resonance imaging (MRI) is a promising technique to assess hepatic steatosis, inflammation, and fibrosis, potentially enabling noninvasive identification of individuals with active and advanced stages of NAFLD. Purpose To examine the diagnostic performance of multiparametric MRI for the assessment of disease severity along the NAFLD disease spectrum with comparison to histological scores. Study Type Prospective, cohort. Population Thirty‐seven patients with NAFLD. Field Strength/Sequence Multiparametric MRI at 3.0 T consisted of magnetic resonance (MR) spectroscopy (MRS) with multi‐echo stimulated‐echo acquisition mode, magnitude‐based and three‐point Dixon using a two‐dimensional multi‐echo gradient echo, MR elastography (MRE) using a generalized multishot gradient‐recalled echo sequence and intravoxel incoherent motion (IVIM) using a multislice diffusion weighted single‐shot echo‐planar sequence. Assessment Histological steatosis grades were compared to proton density fat fraction measured by MRS (PDFFMRS), magnitude‐based MRI (PDFFMRI‐M), and three‐point Dixon (PDFFDixon), as well as FibroScan® controlled attenuation parameter (CAP). Fibrosis and disease activity were compared to IVIM and MRE. FibroScan® liver stiffness measurements were compared to fibrosis levels. Diagnostic performance of all imaging parameters was determined for distinction between simple steatosis and nonalcoholic steatohepatitis (NASH). Statistical Tests Spearman's rank test, Kruskal–Wallis test, Dunn's post‐hoc test with Holm‐Bonferroni P‐value adjustment, receiver operating characteristic curve analysis. A P‐value <0.05 was considered statistically significant. Results Histological steatosis grade correlated significantly with PDFFMRS (rs = 0.66, P < 0.001), PDFFMRI‐M (rs = 0.68, P < 0.001), and PDFFDixon (rs = 0.67, P < 0.001), whereas no correlation was found with CAP. MRE and IVIM diffusion and perfusion significantly correlated with disease activity (rs = 0.55, P < 0.001, rs = −0.40, P = 0.016, rs = −0.37, P = 0.027, respectively) and fibrosis (rs = 0.55, P < 0.001, rs = −0.46, P = 0.0051; rs = −0.53, P < 0.001, respectively). MRE and IVIM diffusion had the highest area‐under‐the‐curve for distinction between simple steatosis and NASH (0.79 and 0.73, respectively). Data Conclusion Multiparametric MRI is a promising method for noninvasive, accurate, and sensitive distinction between simple hepatic steatosis and NASH, as well as for the assessment of steatosis and fibrosis severity. Level of Evidence 2 Technical Efficacy 2
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Affiliation(s)
- Marian A Troelstra
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Julia J Witjes
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Anne-Marieke van Dijk
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Anne L Mak
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Oliver Gurney-Champion
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Jurgen H Runge
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Diona Zwirs
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Daniela Stols-Gonçalves
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Aelko H Zwinderman
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Marije Ten Wolde
- Department of Internal Medicine, Flevoziekenhuis, Almere, The Netherlands
| | - Houshang Monajemi
- Department of Internal Medicine, Rijnstate Ziekenhuis, Arnhem, The Netherlands
| | - Sandjai Ramsoekh
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Ralph Sinkus
- Inserm U1148, LVTS, University Paris Diderot, University Paris 13, Paris, France.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Otto M van Delden
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Ulrich H Beuers
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Joanne Verheij
- Department of Pathology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Max Nieuwdorp
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Aart J Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Adriaan G Holleboom
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
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Sækmose SG, Holst R, Lottenburger T, Ytting H, Nielsen HJ, Junker P, Schlosser A, Sorensen GL. Circadian, Week-to-Week, and Physical Exercise-Induced Variation of Serum Microfibrillar-Associated Protein 4. Biomark Insights 2021; 16:11772719211016359. [PMID: 34035648 PMCID: PMC8127734 DOI: 10.1177/11772719211016359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 04/19/2021] [Indexed: 01/06/2023] Open
Abstract
Serum microfibrillar-associated protein 4 (sMFAP4) has been investigated as a biomarker for various diseases and is demonstrated to show significant gradual increase with severity of liver fibrosis. Ideal biomarkers used for disease diagnosis or prognosis should display deviating levels in affected individuals only and be robust to factors unrelated to the disease. Here we show the impact of normal physiological variation of sMFAP4 by characterizing the circadian variation, week-to-week variation, and physical exercise-induced levels. Serum samples from 3 groups of healthy volunteers were drawn: 7 times during a 24-hour period, 5 times during a 3-week period, and before and after a standardized physical exercise challenge. sMFAP4 was determined by AlphaLISA. Statistical analysis was performed using mixed effects modeling of repeated measurements. Circadian variation of sMFAP4 was demonstrated, with time of peak and nadir values depending on age and gender. For males, the peak values were observed during nighttime whereas for females, peak values were observed in the morning. Individual sMFAP4 levels remained stable over a period of 3 weeks and physical exercise inferred a mild negative influence. In conclusion, the circadian sMFAP4 variation was significant, and the levels could be influenced by physical activity. However, these variations were of limited magnitude relative to previously observed disease-induced levels in support of the biomarker potential of sMFAP4.
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Affiliation(s)
- Susanne Gjørup Sækmose
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.,Department of Clinical Immunology, Naestved Hospital, Naestved, Denmark
| | - René Holst
- Oslo Centre of Biostatistics and Epidemiology, University in Oslo and Oslo University Hospital, Norway
| | | | - Henriette Ytting
- Department of Hepatology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hans Jørgen Nielsen
- Department of Surgical Gastroenterology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Peter Junker
- Department of Rheumatology, Odense University Hospital, University of Southern Denmark, Denmark
| | - Anders Schlosser
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Grith Lykke Sorensen
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
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Verma K, Rungta S, Kumari S, Deep A, Swaroop S. APRI and FIB-4 performance to assess liver fibrosis against predefined Fibroscan values in chronic hepatitis C virus infection. J Family Med Prim Care 2021; 10:4082-4088. [PMID: 35136771 PMCID: PMC8797084 DOI: 10.4103/jfmpc.jfmpc_666_21] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/08/2021] [Accepted: 07/10/2021] [Indexed: 11/26/2022] Open
Abstract
Backgrounds and Aims: Chronic hepatitis C (CHC) infection can leads to chronic liver disease, fibrosis, then cirrhosis, and, finally, hepatocellular carcinoma (HCC); moreover, it is the most common indication for liver transplantation. Liver biopsy is still the gold standard method for the staging of liver fibrosis as it is an invasive procedure with complications. There are some noninvasive methods such as fibroscan that are now the investigation of choice; FIB-4 and aminotransferase to platelet ratio index (APRI) are other noninvasive tools to assess liver fibrosis by using aspartate aminotransferase (AST), alanine aminotransferase (ALT), platelet count, and age. This study aims to evaluate the efficacy and performance of FIB-4 and APRI against fibroscan in patients infected with the hepatitis C virus. Method: It is a cross-sectional study that was conducted in a tertiary health care center in Uttar Pradesh, India, from January 2017 to January 2020. Fibroscan was done for all patients. A blood sample was used to determine AST, ALT, and platelet count. FIB-4 and APRI were calculated from laboratory data. Result: 187 of the 487 patients in the study have F0-F1 fibrosis, 69 have F2, 53 have F3 fibrosis, and 178 have cirrhosis. Based on receiver operating characteristic (ROC) analysis, single optimum cut-offs for diagnosing significant fibrosis and cirrhosis were 1.2 for APRI and 2.25 for FIB-4. Conclusions: Compared with Fibroscan, APRI and FIB-4 showed good performance in detecting the patients without liver fibrosis as well as satisfactory performance in detecting significant fibrosis. These scores should be used in combination with other noninvasive scores for an accurate assessment of liver fibrosis.
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Agarwal R. Aging Liver and Interpretation of Liver Tests. GERIATRIC GASTROENTEROLOGY 2021:1329-1352. [DOI: 10.1007/978-3-030-30192-7_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Kagadis GC, Drazinos P, Gatos I, Tsantis S, Papadimitroulas P, Spiliopoulos S, Karnabatidis D, Theotokas I, Zoumpoulis P, Hazle JD. Deep learning networks on chronic liver disease assessment with fine-tuning of shear wave elastography image sequences. Phys Med Biol 2020; 65:215027. [PMID: 32998480 DOI: 10.1088/1361-6560/abae06] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Chronic liver disease (CLD) is currently one of the major causes of death worldwide. If not treated, it may lead to cirrhosis, hepatic carcinoma and death. Ultrasound (US) shear wave elastography (SWE) is a relatively new, popular, non-invasive technique among radiologists. Although many studies have been published validating the SWE technique either in a clinical setting, or by applying machine learning on SWE elastograms, minimal work has been done on comparing the performance of popular pre-trained deep learning networks on CLD assessment. Currently available literature reports suggest technical advancements on specific deep learning structures, with specific inputs and usually on a limited CLD fibrosis stage class group, with limited comparison on competitive deep learning schemes fed with different input types. The aim of the present study is to compare some popular deep learning pre-trained networks using temporally stable and full elastograms, with or without augmentation as well as propose suitable deep learning schemes for CLD diagnosis and progress assessment. 200 liver biopsy validated patients with CLD, underwent US SWE examination. Four images from the same liver area were saved to extract elastograms and processed to exclude areas that were temporally unstable. Then, full and temporally stable masked elastograms for each patient were separately fed into GoogLeNet, AlexNet, VGG16, ResNet50 and DenseNet201 with and without augmentation. The networks were tested for differentiation of CLD stages in seven classification schemes over 30 repetitions using liver biopsy as the reference. All networks achieved maximum mean accuracies ranging from 87.2%-97.4% and area under the receiver operating characteristic curves (AUCs) ranging from 0.979-0.990 while the radiologists had AUCs ranging from 0.800-0.870. ResNet50 and DenseNet201 had better average performance than the other networks. The use of the temporal stability mask led to improved performance on about 50% of inputs and network combinations while augmentation led to lower performance for all networks. These findings can provide potential networks with higher accuracy and better setting in the CLD diagnosis and progress assessment. A larger data set would help identify the best network and settings for CLD assessment in clinical practice.
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Affiliation(s)
- George C Kagadis
- 3DMI Research Group, Department of Medical Physics, School of Medicine, University of Patras, Rion GR 26504, Greece. Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States of America
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Jiménez Sánchez J, Serrano Díaz L, Gallego Pérez B, Marín Bernabé CM, García Belmonte D, Gómez Lozano M, Gajownik Ú, Martínez Crespo JJ. Percutaneous hepatic biopsy under propofol sedation. A safe and effective procedure. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 112:903-908. [PMID: 33118358 DOI: 10.17235/reed.2020.6942/2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION the percutaneous hepatic biopsy is a necessary procedure for the diagnosis of liver diseases which can cause complications and psychological discomfort for the patient. AIMS to determine the safety profile of propofol in percutaneous hepatic biopsy, the complications of the technique per se and patients satisfaction once completed. METHODS a retrospective observational study was performed via the acquisition of data of tolerance and perceived quality by the patients using a transversal survey. RESULTS ninety-seven patients were included with an average propofol dose of 170.46 mg. Of the complications resulting from the sedation, there were six slight desaturations (6.2 %) resolved with a forehead maneuver (50 %) or cessation of the propofol infusion pump (50 %) and eleven hypotension episodes (11.3 %) resolved without intervention (82.82 %) or with fluid replacement (18.18 %). Of the complications resulting from the technique, there were three cases of early-onset pain (3.1 %) and one delayed (1.03 %); all were resolved with 1 g of intravenous paracetamol. All patients were discharged with oral tolerance and without the need for analgesia 24 hours after the procedure. General satisfaction, as well as psychological discomfort, were evaluated as "very good/excellent" in 100 % of the patients. DISCUSSION propofol demonstrated a favorable safety profile in hepatic biopsy, aiding in the ultimate success of the procedure and tolerance for the patient. We propose the expansion of the use of sedation with propofol to this procedure.
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Affiliation(s)
| | | | | | | | | | | | - Úrszula Gajownik
- Aparato Digestivo , Hospital Clínico Universitario Virgen de la Arrixaca, España
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Mojtahed A, Gee MS, Yokoo T. Pearls and Pitfalls of Metabolic Liver Magnetic Resonance Imaging in the Pediatric Population. Semin Ultrasound CT MR 2020; 41:451-461. [DOI: 10.1053/j.sult.2020.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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McCarty TR, Bazarbashi AN, Njei B, Ryou M, Aslanian HR, Muniraj T. Endoscopic Ultrasound-Guided, Percutaneous, and Transjugular Liver Biopsy: A Comparative Systematic Review and Meta-Analysis. Clin Endosc 2020; 53:583-593. [PMID: 33027584 PMCID: PMC7548145 DOI: 10.5946/ce.2019.211] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 04/03/2020] [Indexed: 12/15/2022] Open
Abstract
Background/Aims Percutaneous liver biopsy (PCLB) or transjugular liver biopsy (TJLB) have traditionally been performed to obtain a sample of hepatic tissue; however, endoscopic ultrasound-guided liver biopsy (EUSLB) has become an attractive alternative. The aim of this study was to compare the efficacy and safety of EUSLB, PCLB, and TJLB.
Methods Search strategies were developed in accordance with PRISMA and MOOSE guidelines. Major outcomes included the following: adequacy of biopsy specimens (i.e., complete portal triads [CPT], total specimen length [TSL] in mm, and length of longest piece [LLP]) in mm), and rate of adverse events. Only studies comparing all biopsy approaches (i.e., EUSLB, PCLB, and TJLB) were included.
Results Five studies (EUSLB [n=301]; PCLB [n=176]; and TJLB [n=179]) were included. Biopsy cumulative adequacy rates for EUSLB, PCLB, and TJLB were 93.51%, 98.27%, and 97.61%, respectively. Based on the subgroup analysis limited to EUS biopsy needles in current clinical practice, there was no difference in biopsy adequacy or adverse events for EUSLB compared to PCLB and TJLB (all p>0.050). A comparison of EUSLB and PCLB revealed no difference between specimens regarding both CPT (p=0.079) and LLP (p=0.085); however, a longer TSL (p<0.001) was observed. Compared to TJLB, EUSLB showed no difference in LLP (p=0.351), fewer CPT (p=0.042), and longer TSL (p=0.005).
Conclusions EUSLB appears to be a safe, minimally invasive procedure that is comparable to PCLB and TJLB regarding biopsy specimens obtained and rate of adverse events associated with each method.
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Affiliation(s)
- Thomas R McCarty
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Ahmad Najdat Bazarbashi
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Basile Njei
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Marvin Ryou
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Harry R Aslanian
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Thiruvengadam Muniraj
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
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Yilmaz N. Hemobilia Causing Acute Cholecystitis and Pancreatitis after Percutaneous Liver Biopsy: A Case Report and Review of the Literature. Visc Med 2020; 36:246-249. [PMID: 32775357 DOI: 10.1159/000503365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 09/12/2019] [Indexed: 11/19/2022] Open
Abstract
We report a case of a 75-year-old woman who developed acute cholecystitis and acute pancreatitis due to hemobilia after a percutaneous liver biopsy. She was admitted to our hospital 13 days after the procedure. The patient presented with cholangitis and acute biliary pancreatitis and underwent endoscopic retrograde cholangiopancreatography (ERCP). Active hemobilia was observed during the ERCP, and sphincterotomy and stent placement were carried out. Angiography was performed because of ongoing bleeding and demonstrated multiple arterioportal fistulas. The bleeding vessel was successfully embolized through an angiographic catheter with microcoils and Histoacryl glue.
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Affiliation(s)
- Nimet Yilmaz
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Sanko, Gaziantep, Turkey
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Neuberger J, Patel J, Caldwell H, Davies S, Hebditch V, Hollywood C, Hubscher S, Karkhanis S, Lester W, Roslund N, West R, Wyatt JI, Heydtmann M. Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology. Gut 2020; 69:1382-1403. [PMID: 32467090 PMCID: PMC7398479 DOI: 10.1136/gutjnl-2020-321299] [Citation(s) in RCA: 189] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 12/11/2022]
Abstract
Liver biopsy is required when clinically important information about the diagnosis, prognosis or management of a patient cannot be obtained by safer means, or for research purposes. There are several approaches to liver biopsy but predominantly percutaneous or transvenous approaches are used. A wide choice of needles is available and the approach and type of needle used will depend on the clinical state of the patient and local expertise but, for non-lesional biopsies, a 16-gauge needle is recommended. Many patients with liver disease will have abnormal laboratory coagulation tests or receive anticoagulation or antiplatelet medication. A greater understanding of the changes in haemostasis in liver disease allows for a more rational, evidence-based approach to peri-biopsy management. Overall, liver biopsy is safe but there is a small morbidity and a very small mortality so patients must be fully counselled. The specimen must be of sufficient size for histopathological interpretation. Communication with the histopathologist, with access to relevant clinical information and the results of other investigations, is essential for the generation of a clinically useful report.
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Affiliation(s)
- James Neuberger
- Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jai Patel
- Department of Vascular Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Helen Caldwell
- Liver Unit, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
| | - Susan Davies
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Coral Hollywood
- Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK
| | - Stefan Hubscher
- Department of Pathology, University of Birmingham, Birmingham, UK
| | - Salil Karkhanis
- Department of Radiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Will Lester
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | | | | | - Judith I Wyatt
- Department of Pathology, St James University Hospital, Leeds, UK
| | - Mathis Heydtmann
- Department of Gastroenterology, Royal Alexandra Hospital, Glasgow, UK
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