BACKGROUND AND AIMS: FibroScan(R) is a new medical device that noninvasively measures liver stiffness. The aim of this study was to assess the accuracy of the liver stiffness measurement by FibroScan(R) for making the diagnosis of liver fibrosis in patients with chronic viral hepatitis. METHODS: We studied 103 patients with chronic viral hepatitis B or C and they underwent FibroScan(R) and liver biopsy between October 2005 and August 2006. Liver fibrosis was staged on a 0-4 scale according to the Korean Society of Pathologists Scoring System. The diagnostic accuracy was assessed by analysis of the receiver operator characteristics (ROC). RESULTS: The liver stiffness was 3.5-57.1 kPa (mean: 11.8, SD: 8.9). The mean value of liver stiffness in each fibrosis stage group (F1, F2, F3 and F4) was 5.8+/-1.8 kPa, 11.3+/-6.8 kPa, 11.8+/-6.0 kPa and 23.4+/-16.5 kPa, respectively. Liver stiffness measured by FibroScan(R) showed reliable correlation with the liver fibrosis stage as confirmed by liver biopsy (r=0.56, p<0.001). The AUROC (95% CI) of > or = F2, > or = F3 and F4 was 0.93 (0.86-0.99), 0.72 (0.62-0.82) and 0.80 (0.67-0.92), respectively. The sensitivity and specificity of 7.5 kPa, which was the cutoff value for > or = F2, was 84% and 90%, respectively. CONCLUSIONS: FibroScan(R) is a reliable method for the diagnosis of significant fibrosis (> or =F2) and cirrhosis in patients with chronic liver disease. The liver stiffness measurement by FibroScan(R) showed good diagnostic performance for significant fibrosis.
Adult ; Aged ; Disease Progression ; Female ; Hepatitis B, Chronic/complications/*ultrasonography ; Hepatitis C, Chronic/complications/*ultrasonography ; Humans ; Liver/*ultrasonography ; Liver Cirrhosis/etiology/*ultrasonography ; Male ; Middle Aged ; Predictive Value of Tests ; ROC Curve ; Sensitivity and Specificity

Portal flow steal occasionally persists even after the liver transplantation, which may reduce the portal flow and thus threaten the patients' outcome. Therefore, pre- and peri-operative detection of portal steal phenomenon requiring radiological or surgical interruption is essential for the liver transplantation candidates as well as for the recipients.
Adult ; Hepatitis B, Chronic/complications ; Humans ; Liver Cirrhosis/etiology/*therapy ; *Liver Transplantation ; Male ; Mesenteric Veins/*ultrasonography

Hepatitis B, Chronic ; complications ; Humans ; Liver ; diagnostic imaging ; pathology ; Liver Cirrhosis ; diagnostic imaging ; etiology ; pathology ; Ultrasonography

Adult ; Female ; Hepatitis ; complications ; diagnostic imaging ; mortality ; Humans ; Infant, Newborn ; Pregnancy ; Pregnancy Complications ; diagnostic imaging ; mortality ; Prognosis ; Ultrasonography

Radiological imaging plays a crucial role in the diagnosis of hepatocellular carcinoma (HCC) as the noninvasive diagnosis of HCC in high-risk patients by typical imaging findings alone is widely adopted in major practice guidelines for HCC. While imaging techniques have markedly improved in detecting small liver lesions, they often detect incidental benign liver lesions and non-hepatocellular malignancy that can be misdiagnosed as HCC. The most common mimicker of HCC in cirrhotic liver is nontumorous arterioportal shunts that are seen as focal hypervascular liver lesions on dynamic contrast-enhanced cross-sectional imaging. Rapidly enhancing hemangiomas can be easily misdiagnosed as HCC especially on MR imaging with liver-specific contrast agent. Focal inflammatory liver lesions mimic HCC by demonstrating arterial-phase hypervascularity and subsequent washout on dynamic contrast-enhanced imaging. It is important to recognize the suggestive imaging findings for intrahepatic cholangiocarcinoma (CC) as the management of CC is largely different from that of HCC. There are other benign mimickers of HCC such as angiomyolipomas and focal nodular hyperplasia-like nodules. Recognition of their typical imaging findings can reduce false-positive HCC diagnosis.
Carcinoma, Hepatocellular/*diagnosis/radiography ; Diagnosis, Differential ; Hemangioma/complications/radiography/ultrasonography ; Hepatitis B/complications ; Humans ; Inflammation/radiography/ultrasonography ; Liver/radiography/ultrasonography ; Liver Cirrhosis/complications/radiography ; Liver Neoplasms/*diagnosis/radiography ; Magnetic Resonance Imaging ; Non-alcoholic Fatty Liver Disease/radiography/ultrasonography

OBJECTIVEIt is important to use noninvasive methods to differentiate liver fibrosis and liver cirrhosis. A prospective study was conducted to evaluate the validity of ultrasonography (US) in evaluating the severity of liver fibrosis in patients with chronic viral hepatitis in reference to the pathologic diagnosis of their liver biopsy specimens.

METHODSThe liver fibrosis status of 324 chronic viral hepatitis patients was evaluated by both needle biopsy and US. Histologically their liver fibrosis was graded as S0-S4, and the inflammatory reaction in the liver was graded as G1-G4. The US examination included qualitative description of the liver surface and liver parenchyma, and the quantitative parameters were vascular diameters, blood flow volume and spleen size.

RESULTSUS qualitative description of the liver surface and liver parenchyma was correlated to the severity of fibrosis and the degree of the inflammation seen in the liver biopsies. An analysis of US quantitative parameters showed that a cut-off value of 12.1 cm for the length of spleen had a sensitivity of 60.0%, and specificity of 75.3% in detecting early liver fibrosis. For other quantitative parameters, the cut-off values were 8mm for the diameter of the splenic vein, 30.5 cm/sec for maximal blood flow velocity in the portal vein and 12 mm in diameter of the main portal vein. The diagnostic sensitivities for these parameters were 60.0%, 78.6% and 76.7%; the diagnostic specificities were 78.1%, 66.9% and 44.6% respectively.

CONCLUSIONEarly cirrhosis can be detected by US, and the sonographic results were well paralleled with their pathologic diagnoses made by liver biopsies. Individual US parameter has limited sensitivity and specificity in diagnosing early cirrhosis. In clinical practice a combination of 2-3 parameters could be used to detect or exclude severe liver fibrosis.

Adult ; Female ; Hepatitis B, Chronic ; complications ; diagnostic imaging ; Hepatitis C, Chronic ; complications ; diagnostic imaging ; Humans ; Liver Cirrhosis ; diagnostic imaging ; virology ; Male ; Prospective Studies ; Ultrasonography

No abstract available.
Biopsy ; Elasticity ; *Elasticity Imaging Techniques ; Fatty Liver/complications ; Hepatitis B, Chronic/complications ; Hepatitis C, Chronic/complications ; Humans ; Inflammation/complications ; Liver Cirrhosis/etiology/pathology/*ultrasonography ; Risk Factors ; Severity of Illness Index

BACKGROUNDS/AIMS: In some patients with chronic hepatitis, liver stiffness (LS) findings do not reflect fibrosis stage. This study was performed to evaluate whether acute liver inflammation could influence LS findings. METHODS: Patients with acute hepatitis A admitted to our hospital were included. Hepatitis was classified on admission using serum ALT and bilirubin levels as inflammation phase, jaundice phase, or recovery phase. Patients who admitted during the recovery phase (whose ALT and bilirubin levels fell continuously during hospitalization) and therefore, their peak-ALT and peak bilirubin levels could not be determined were exduded. Enrolled patients underwent FibroScan during hospitalization and after discharge. RESULTS: Seventy-six patients with acute hepatitis A were enrolled (median age, 29 years; 46 men and 30 women). Among them, 33 (43.4%) and 43 (56.6%) patients were admitted during the inflammation phase and jaundice phase, respectively. For patients admitted during the inflammation phase, mean (+/-SD) time from symptom-onset day to maximum ALT level was 7 (+/-3) days. For all patients, mean time from symptom-onset to maximum bilirubin level was 11 (+/-4) days. Mean LS during admission was 8.9 (+/-Pa (median, 8.4 kPa). LS was significantly correlated with serum bilirubin level, which was the only factor found to be significantly associated with the increased LS (>7.08 kPa). In all patients, LS increased gradually from the symptom-onset and peaked at 8-9 days later. CONCLUSIONS: Severe hepatic inflammation can affect the LS findings and thus, care is required when assessing fibrosis stage using LS measurement in patients with severe inflammation.
Acute Disease ; Adult ; Alanine Transaminase/blood ; Bilirubin/blood ; *Elasticity Imaging Techniques ; Female ; Hepatitis A/complications/*ultrasonography ; Humans ; Liver/pathology/*ultrasonography ; Male ; Retrospective Studies

BACKGROUNDS/AIMS: It is not easy to differentiate between patients with cirrhosis and those with alcoholic liver disease. Liver biopsy is generally considered the gold standard for assessing hepatic fibrosis; however, this protocol frequently carries a risk of severe complications and false-negative results. Transient elastography (Fibroscan, Echosens, Paris, France), which is a noninvasive method of measuring liver stiffness, has become available for assessing liver fibrosis. Liver stiffness reportedly differs markedly with the cirrhosis etiology. The aim of this study was thus to determine the diagnostic accuracy of the Fibroscan in the detection of cirrhosis in patients with alcoholic liver disease. METHODS: We enrolled 45 patients with alcoholic liver disease. Fibroscan, abdominal ultrasonography, aspartate aminotransferase/platelet ratio index (APRI), and liver biopsy were performed on all patients. Fibrosis stage was assessed using the Batts-Ludwig scoring system. RESULTS: The stage of fibrosis (F1-F4) was distributed among the cohort as follows: 5 patients at F1, 4 patients at F2, 7 patients at F3, and 29 patients at F4. Liver stiffness differed significantly between each fibrosis stage (P<0.001). For the diagnosis of cirrhosis, the area under the receiver operating characteristic curve was 0.97 for transient elastography (95% confidence interval, CI, 0.93-1.01), 0.81 for ultrasonography (95% CI, 0.68-0.94), and 0.83 for APRI score (95% CI, 0.70-0.95). The optimal cut-off value of liver stiffness for detecting cirrhosis was 25.8 kPa, with a sensitivity of 90% and a specificity of 87%. CONCLUSIONS: Transient elastography is a useful method for diagnosing cirrhosis in patients with alcoholic liver disease.
Adult ; Aspartate Aminotransferases/blood ; Elasticity Imaging Techniques/*methods ; Female ; Fibrosis ; Hepatitis, Alcoholic/complications/*ultrasonography ; Humans ; Liver/pathology/ultrasonography ; Liver Cirrhosis/complications/*ultrasonography ; Male ; Middle Aged ; Platelet Count ; ROC Curve

BACKGROUND/AIMS: Serum bilirubin exerts antioxidant and cytoprotective effects. In addition, elevated serum bilirubin levels are associated with a decreased risk of metabolic and cardiovascular diseases. However, few studies have evaluated whether serum bilirubin is associated with non-alcoholic fatty liver disease (NAFLD), which is closely associated with other metabolic diseases. The aim of this study was thus to elucidate the association between serum total bilirubin levels and NAFLD. METHODS: A cross-sectional study of 17,348 subjects undergoing a routine health check-up was conducted. Subjects positive for hepatitis B or hepatitis C virus, or with other hepatitis history were excluded. NAFLD was diagnosed on the basis of typical ultrasonographic findings and an alcohol consumption of less than 20 g/day. RESULTS: The mean age of the subjects was 49 years and 9,076 (52.3%) were men. The prevalence of NAFLD decreased steadily as the serum bilirubin level increased in both men and women (P<0.001 for both). Multivariate regression analysis adjusted for other metabolic risk factors showed that serum bilirubin level was inversely associated with the prevalence of NAFLD [odds ratio (OR)=0.88, 95% confidence interval (CI)=0.80-0.97]. Furthermore, there was an inverse, dose-dependent association between NAFLD and serum total bilirubin levels (OR=0.83, 95% CI=0.75-0.93 in the third quartile; OR=0.80, 95% CI=0.71-0.90 in the fourth quartile vs. lowest quartile, P for trend <0.001). CONCLUSIONS: Serum bilirubin levels were found to be inversely associated with the prevalence of NAFLD independent of known metabolic risk factors. Serum bilirubin might be a protective marker for NAFLD.
Adult ; Alcohol Drinking ; Bilirubin/*blood ; Cross-Sectional Studies ; DNA, Viral/blood ; Fatty Liver/complications/epidemiology/*ultrasonography ; Female ; Hepatitis B/complications ; Hepatitis C/complications ; Humans ; Male ; Middle Aged ; Odds Ratio ; Prevalence ; RNA, Viral/blood ; Regression Analysis ; Risk Factors ; Young Adult