1.Evolving B-mode ultrasound-based techniques for assessing metabolic dysfunction-associated steatotic liver disease: Now and beyond
Walaa Abdelhamed ; Mohamed Elbadry ; Mohamed El-Kassas
Liver Research 2026;10(2):109-120
Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as the leading cause of chronic liver disease worldwide, coinciding with the growing burden of obesity and type 2 diabetes mellitus. While liver biopsy remains the gold standard for assessing hepatic steatosis and fibrosis, its invasiveness, sampling variability, and limited feasibility have necessitated the establishment of non-invasive diagnostic alternatives. Among non-invasive alternatives, conventional B-mode ultrasound (US) has retained a central role as the first-line imaging modality owing to its wide availability, low cost, and reasonable sensitivity and specificity, particularly in moderate-to-severe steatosis. However, traditional B-mode US has several limitations, including operator dependence, poor sensitivity in mild steatosis, and reduced accuracy in obese individuals. Semi-quantitative scoring systems and emerging technologies such as attenuation imaging, shear wave elastography, and vibration-controlled transient elastography, have been recently introduced to improve diagnostic accuracy. Additionally, artificial intelligence (AI) is increasingly being integrated into US platforms to enhance image interpretation, standardize assessments, and reduce interobserver variability. This review provides a comprehensive appraisal of the diagnostic performance, strengths, and limitations of conventional B-mode US and its advanced products in the context of MASLD. US-based techniques are also compared with magnetic resonance spectroscopy and histological assessment, highlighting the evolving role of AI in US diagnostics. Given the global rise of MASLD, optimizing and standardizing US-based approaches are essential to improve early detection, risk stratification, and monitoring strategies. With continued technological refinement and integration of AI, US remains a cornerstone of MASLD diagnosis in clinical practice.
2.Revolutionizing medicine:Exploring the breakthroughs in liver xenotransplantation
El-Kassas MOHAMED ; Abdelhamed WALAA ; Al-Naamani KHALID
Liver Research 2025;9(3):199-208
The critical shortage of liver transplant donors necessitates innovative solutions,with xeno-transplantation emerging as a promising alternative.Despite significant ethical,scientific,and practical challenges,recent advancements in liver xenotransplantation,particularly using pigs as donors for non-human primates(NHPs),have extended graft survival duration.However,life-threatening issues such as thrombocytopenia and coagulation disorders persist,limiting survival to under a month.Advances in genetic engineering have enabled the modification of pig genomes to match the human immune system better,targeting genes responsible for immune rejection and increasing compatibility.While these breakthroughs enhance the potential for human transplantation,the challenges of immune rejection and long-term functionality remain substantial.This review highlights recent progress in liver xeno-transplantation from pigs to NHPs and explores the implications for potential human clinical application.
3.Hepatitis B virus as a risk factor for hepatocellular carcinoma:There is still much work to do
Abdelhamed WALAA ; El-Kassas MOHAMED
Liver Research 2024;8(2):83-90
Hepatitis B virus(HBV)infection is a significant health problem that can result in progression to liver cirrhosis,decompensation,and the development of hepatocellular carcinoma(HCC).On a country level,the prevalence of chronic HBV infection varies between 0.1%and 35.0%,depending on the locality and the population being investigated.One-third of all liver cancer fatalities worldwide are attributable to HBV.The adoption of standard birth-dose immunization exerted the most significant impact on the decline of HBV prevalence.HCC incidence ranges from 0.01%to 1.40%in noncirrhotic patients and from 0.9%to 5.4%annually,in the settings of liver cirrhosis.Although antiviral therapy significantly reduces the risk of developing HBV-related HCC,studies have demonstrated that the risk persists,and that HCC screening is still essential.This review discusses the complex relationship between HBV infection and HCC,recent epidemiological data,different aspects of clinical disease characteristics,and the impact of antiviral therapy in this context.
4.Portal vein tumor thrombosis in hepatocellular carcinoma patients:Is it the end?
Abdelhamed WALAA ; Shousha HEND ; El-Kassas MOHAMED
Liver Research 2024;8(3):141-151
Hepatocellular carcinoma(HCC)is the sixth most prevalent form of cancer globally and the third leading cause of cancer-related mortality.The incidence of portal vein tumor thrombosis(PVTT)in HCC patients is 21%at one year and 46%at three years.The presence of PVTT has consistently been associated with a poor prognosis for HCC patients over the past decades.Notably,HCC prognosis is influenced not only by the presence of PVTT but also by the degree or extent of PVTT.Currently,there is a lack of global consensus or established protocols regarding the optimal management of HCC with associated PVTT.The Barcelona Clinic for Liver Cancer classifies HCC patients with PVTT as stage C,indicating an advanced stage,and limiting treatment recommendations for these patients to systemic therapy.In recent years,there has been an increase in the availability of therapeutic options for HCC patients with PVTT.Treat-ment modalities include systemic therapy,transarterial chemoembolization,surgical resection,stereo-tactic body radiotherapy,transarterial radioembolization,and liver transplantation.An ideal therapy for each patient necessitates a multidisciplinary approach.This review article presents the latest updates in managing HCC patients with PVTT.


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