Humans ; Liver Cirrhosis ; diagnosis ; mortality ; physiopathology ; Logistic Models ; Prognosis

Acetamides ; Aminopyrine ; Animals ; Breath Tests ; methods ; Carbon Isotopes ; Chemical and Drug Induced Liver Injury ; diagnosis ; pathology ; physiopathology ; Humans ; Liver ; injuries ; pathology ; physiopathology ; Liver Cirrhosis ; diagnosis ; pathology ; physiopathology ; Liver Diseases ; diagnosis ; pathology ; physiopathology ; Liver Function Tests ; Phenylalanine ; Prognosis

OBJECTIVETo analyze the value of time-signal intensity curve (TIC) in dynamic contrast-enhanced magnetic resonance imaging (DEC-MRI) in the evaluation of liver fibrosis.

METHODSThirty-six consecutive patients and healthy volunteers were divided into 4 groups according to the stages of fibrosis, namely the normal group (n=9), mild fibrosis group (n=5), moderate to severe fibrosis group (n=7), and liver cirrhosis group (n=15). All the subjects underwent conventional and DEC-MRI, and the TIC was generated automatically to evaluate the peak height, TTP, MSI and MSD. The correlations between the TIC parameters and the stage of fibrosis were assessed. Receiver operating characteristic (ROC) curve analyses were conducted to evaluate the value of the TIC parameters in the evaluation of fibrosis stage.

RESULTSModerate but significant inverse correlations of the peak height, MSI, and to fibrosis stage were noted in these patients (P<0.05); the peak time was positively correlated to the fibrosis stage (P<0.05). In patients with a fibrosis stage ≥1, the AUC of the measured TIC parameters ranged from 0.747 to 0.783, with the MSD of the spleen had the highest AUC (0.783). For a fibrosis stage ≥3, the AUC of the indices ranged between 0.728 and 0.877, highest for liver MSI of the arterial phase, followed by the portal vein MSI, liver MSI of portal venous phase, liver MSD, splenic MSI of arterial phase and splenic MSD. In the diagnosis of liver cirrhosis, the AUC (range 0.742-0.821) decreased in the order of liver MSI of the portal venous phase, liver MSD, liver MSI of the arterial phase, the portal vein MSI, splenic MSI of the arterial phase and splenic MSD.

CONCLUSIONTIC of DEC-MRI can be used to evaluate hemodynamic changes in the liver, and may serve as a practical non-invasive functional imaging modality for assessing the severity of liver fibrosis.

Adolescent ; Adult ; Aged ; Contrast Media ; Female ; Gadolinium DTPA ; Hemodynamics ; physiology ; Humans ; Liver ; blood supply ; physiopathology ; Liver Cirrhosis ; diagnosis ; physiopathology ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Young Adult

OBJECTIVETo analyse the factors which influence the four serum fibrosis markers hyaluronic acid (HA), type III procollagen (PCIII), laminin (LN) and type IV collagen (CIV).

METHODSThe levels of serum HA, PCIII, LN and CIV were measured by RIA in 141 patients with chronic hepatitis B (CHB), then the patients were divided into two groups according to the serum fibrosis markers, namely consistent group and inconsistent group. the liver biopsy materials were examined pathomorphologically and liver function was detected by automatic biochemistry analyzer, The interior diameters of the portal vein, the spleen vein and the thickness of the spleen were also measured with ultrasonography.

RESULTS16 patients (14.16%) whose serum fibrosis markers were inconsistent with histological stage of liver fibrosis were found. Their serum fibrosis markers were not correlated with staging of liver fibrosis (P>0.05), but were positively correlated with inflammation grade (x(2)=12.07, P<0.05), at same time, the serum levels of alanine aminotransferase (ALT), aspartate aminotransferase(AST), gamma-glutamyltransferase (GGT) and globulin (GLB) decreased obviously, from 89.28 U/L +/- 64.25 U/L to 49.31 U/L +/- 26.75 U/L (t=2.45, P<0.05), 66.10 U/L +/- 42.30 U/L to 40.83 U/L +/- 22.40 U/L (t=2.33, P<0.05), 86.26 U/L +/- 70.36 U/L to 48.99 U/L +/- 29.96 U/L (t=2.08, P<0.05) and 32.13 g/L +/- 5.18 g/L to 28.05 g/L +/- 3.47 g/L (t=3.03, P<0.01) respectively. And the level of albumin (ALB) and the ratio of albumin and globulin (A/G) increased evidently, from 42.34 g/L +/- 4.81 g/L to 46.19 g/L +/- 3.61 g/L (t=3.06, P<0.01) and 1.35 +/- 0.28 to 1.63 +/- 0.26 (t=3.70, P<0.01). But the serum level of alkaline phosphatase (ALP), total bilirubin (TBil), total protein (TP), the width of main portal vein, the width of splenic vein and the thickness of the spleen did not change clearly (P>0.05).

CONCLUSIONAs diagnostic markers, serum fibrosis markers as well as inflammation grade and liver function should be taken into account.

Adult ; Alanine Transaminase ; blood ; Aspartate Aminotransferases ; blood ; Biomarkers ; Female ; Globulins ; analysis ; Humans ; Liver ; physiopathology ; Liver Cirrhosis ; blood ; diagnosis ; physiopathology ; Male ; Middle Aged ; Serum Albumin ; analysis ; gamma-Glutamyltransferase ; blood

No abstract available.
Hepatic Veins/*physiopathology ; Humans ; Liver Cirrhosis/complications/*diagnosis ; Predictive Value of Tests ; Prognosis ; Severity of Illness Index ; Venous Pressure

OBJECTIVETo investigate the role of perfusion-weighted magnetic resonance imaging (MRI) in evaluation of cirrhotic liver.

METHODSWith a 4F catheter, 1% diluted carbon tetrachloride (1 ml/kg) was selectively injected into right or left hepatic artery of 12 dogs fortnightly. The half liver into which carbon tetrachloride was injected was called as study side (SS), while the other half liver without carbon tetrachloride injection was called as study control side (SCS). Conventional and perfusion-weighted MRI were performed in every 4 weeks. Via a 4F catheter, 5ml gadolinium diethylentriamine pentaaceti acid (Gd-DTPA) dilution was injected into superior mesenteric artery at the 5th scan. The signal intensity-time curves of SS, SCS, and portal vein were completed in MR workstation. The maximal relative signal increase (MRSI), peak time (tp), and slope of the curves were measured.

RESULTSOn conventional MR images, no abnormalities of externality and signal intensity were observed in both SS and SCS of liver at each stage. The mean tp, MRSI, and slope of intensity-time curves in normal liver were 10.56 seconds, 1.01, and 10.23 arbitrary unit (au)/s, respectively. Three parameters of curves didn't show obvious change in SCS of liver at every stage. Abnormal perfusion curves occurred in SS of liver at the 12th week after the 1st injection. The abnormality of perfusion curve in SS was more and more serious as the times of injection increased. The mean tp, MRSI, and slope intensity-time curves in SS of liver were 19.45 seconds, 0.43, and 3.60 au/s respectively at the 24th week.

CONCLUSIONPerfusion-weighted imaging can potentially provide information about portal perfusion of hepatic parenchyma, and to some degree, reflect the severity of cirrhosis.

Animals ; Carbon Tetrachloride Poisoning ; Dogs ; Gadolinium DTPA ; Image Enhancement ; instrumentation ; Liver ; pathology ; ultrastructure ; Liver Circulation ; physiology ; Liver Cirrhosis, Experimental ; diagnosis ; physiopathology ; Magnetic Resonance Imaging ; instrumentation ; methods

Chronic liver disease represents a major public health problem, accounting for significant morbidity and mortality worldwide. As prognosis and management depend mainly on the amount and progression of liver fibrosis, accurate quantification of liver fibrosis is essential for therapeutic decision-making and follow-up of chronic liver diseases. Even though liver biopsy is the gold standard for evaluation of liver fibrosis, non-invasive methods that could substitute for invasive procedures have been investigated during past decades. Transient elastography (TE, FibroScan(R)) is a novel non-invasive method for assessment of liver fibrosis with chronic liver disease. TE can be performed in the outpatient clinic with immediate results and excellent reproducibility. Its diagnostic accuracy for assessment of liver fibrosis has been demonstrated in patients with chronic viral hepatitis; as a result, unnecessary liver biopsy could be avoided in some patients. Moreover, due to its excellent patient acceptance, TE could be used for monitoring disease progression or predicting development of liver-related complications. This review aims at discussing the usefulness of TE in clinical practice.
Antiviral Agents/therapeutic use ; Carcinoma, Hepatocellular/epidemiology/physiopathology ; Chronic Disease ; *Elasticity Imaging Techniques ; Hepatitis B/drug therapy/physiopathology ; Hepatitis C/drug therapy/physiopathology ; Humans ; Liver Cirrhosis/*diagnosis/ultrasonography ; Liver Neoplasms/epidemiology/physiopathology ; Recurrence

Portal hypertension as a consequence of liver cirrhosis is responsible for serious complications such as variceal bleeding, ascites and hepatic encephalopathy. Successful pharmacological treatment of portal hypertension can prevent the risk of the variceal bleeding, and contribute to reduce the morbidity and mortality in patients with liver cirrhosis. To identify the effect of drugs on portal hypertension, portal pressure was evaluated accurately before and after the drug administration. The hepatic venous pressure gradient has been accepted as the gold-standard method for assessing the severity of portal hypertension and the response to drug treatment. The mean hepatic venous pressure gradient was 15.1+/-5.4 mmHg in Korean cirrhotic patients who had experienced variceal bleeding. Non-selective beta blockers are the treatment of choice for primary and secondary prevention of variceal bleeding. The dose of propranolol should be subsequently adjusted until the resting heart rate had been reduced by 25% or less than 55 beats per minute. It has been reported that the optimal dose of propranolol is variable due to racial differences in cardiovascular receptor sensitivity. In Korean patients with portal hypertension and liver cirrhosis, the mean required dose of propranolol to reach target heart rate was 165 mg (range; 80-280 mg). This review covers mainly the results of the pharmacological therapy of portal hypertension in Korean cirrhotic patients.
Adrenergic beta-Antagonists/administration & dosage ; Hepatic Veins ; Humans ; Hypertension, Portal/diagnosis/*drug therapy/physiopathology ; Korea ; Liver Cirrhosis/complications/physiopathology ; Propranolol/administration & dosage ; Venous Pressure/drug effects

Portal hypertension is a severe consequence of chronic liver diseases and is responsible for the main clinical complications of liver cirrhosis. Hepatic venous pressure gradient (HVPG) measurement is the best available method to evaluate the presence and severity of portal hypertension. Clinically significant portal hypertension is defined as an increase in HVPG to >10 mmHg. In this condition, the complications of portal hypertension might begin to appear. HVPG measurement is increasingly used in the clinical fields, and the HVPG is a robust surrogate marker in many clinical applications such as diagnosis, risk stratification, identification of patients with hepatocellular carcinoma who are candidates for liver resection, monitoring of the efficacy of medical treatment, and assessment of progression of portal hypertension. Patients who had a reduction in HVPG of > or =20% or to < or =12 mmHg in response to drug therapy are defined as responders. Responders have a markedly decreased risk of bleeding/rebleeding, ascites, and spontaneous bacterial peritonitis, which results in improved survival. This review provides clinical use of HVPG measurement in the field of liver disease.
Chronic Disease ; Hemodynamics ; Hemorrhage/etiology ; Hepatic Veins/physiology ; Humans ; Hypertension, Portal/complications ; Liver Cirrhosis/diagnosis ; Liver Diseases/complications/*physiopathology ; Portal Pressure

OBJECTIVETo investigate the positive rate of auto antibodies and autoimmune liver diseases in patients with abnormal liver function and it's clinical significance.

METHODS511 sera with abnormal ALT (>40 U/L) were continuously collected, all the sera were examined for antibodies and clinical information of 469 cases were studied.

RESULTSAmong the 511 sera, 14.09% of them showed of ANA positive, 0.59% of SMA positive, 2.94% of AMA positive, 0.98% of AMA-M2 positive, 0.59% of SS-A positive, 0.19% of SS-B positive, 0.19% of JO-1 and 0.78% of dsDNA positive and all SLA/LP, LC-1 and LKM-1 and ANA profile were negative. Clinical information was analyzed on 469 cases which have complete data from the 511 patients. Of these 469 cases, 5 cases (1.06%) were found to be PBC, 2 case (0.43%) were AIH, no PSC was found, 77.78% patients among those with positive auto antibodies were diagnosed as viral hepatitis and there were 18.29% patients with viral hepatitis showed different auto antibodies.

CONCLUSIONThe high titer auto antibodies were important criterion for diagnosis of autoimmune liver diseases. The positive rate of autoantibodies of autoimmune liver diseases was similar to hepatitis C and E

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Autoantibodies ; blood ; Child ; Child, Preschool ; Cholangitis, Sclerosing ; diagnosis ; immunology ; Diagnosis, Differential ; Female ; Hepatitis, Autoimmune ; diagnosis ; immunology ; Humans ; Liver ; physiopathology ; Liver Cirrhosis, Biliary ; diagnosis ; immunology ; Liver Function Tests ; Male ; Middle Aged