Isolated hepatic non-obstructive sinusoidal dilatation, 20-year single center experience

AIM To characterize isolated non-obstructive sinusoidal dilatation(SD) by identifying associated conditions, laboratory findings, and histological patterns. METHODS Retrospectively reviewed 491 patients with SD between 1995 and 2015. Patients with obstruction at the level of the small/large hepatic veins, portal veins, or right-sided heart failure were excluded along with history of cirrhosis, hepatic malignancy, liver transplant, or absence of electrocardiogram/cardiac echocardiogram. Liver histology was reviewed for extent of SD, fibrosis, red blood cell extravasation, nodular regenerative hyperplasia, hepaticpeliosis, and hepatocellular plate atrophy(HPA). RESULTS We identified 88 patients with non-obstructive SD. Inflammatory conditions(32%) were the most common cause. The most common pattern of liver abnormalities was cholestatic(76%). Majority(78%) had localized SD to Zone Ⅲ. Medication-related SD had higher proportion of portal hypertension(53%), ascites(58%), and median AST(113 U/L) and ALT(90 U/L) levels. Nineteen patients in our study died within one-year after diagnosis of SD, majority from complications related to underlying diseases.CONCLUSION Significant proportion of SD and HPA exist without impaired hepatic venous outflow. Isolated SD on liver biopsy, in the absence of congestive hepatopathy, requires further evaluation and portal hypertension should be rule out.

CT of hepatocellular carcinoma in non-alcoholic fatty liver disease: imaging characteristics and inter-rater agreement

Aim:To determine the computed tomography(CT)features of non-alcoholic fatty liver disease(NAFLD)associated hepatocellular carcinoma(HCC).Methods:In this institutional review board approved study,we reviewed 38 patients with NAFLD(68.4%male;mean age 63 years)with histology confirmed HCC and triphasic liver CT.CT images were independently reviewed by four readers blinded to clinical and pathology data.The reviewers assessed HCC for arterial phase hyper enhancement(APHE),portal venous phase washout(PVWO),delayed phase washout(DPWO),and enhancing capsule.Features of cirrhotic morphology and portal hypertension(PH)were also evaluated.The final CT features were determined by majority and a fifth reader reviewed cases lacking majority.Inter-rater agreement was determined by prevalence-adjusted kappa.Results:Mean HCC size was 3.6±2.8 cm(range,1.1-16.0 cm).The HCCs showed APHE in 92.1%,PVWO in 55.3%,DPWO in 81.6%,and enhancing capsule in 44.7%.Cirrhotic morphology was present in 65.8%and PH in 63.2%.Inter-rater agreement was moderate to almost perfect for APHE(0.74-1.0),cirrhosis(0.79-0.89),and PH(0.79-0.95),weak to perfect for DPWO(0.47-0.95)and poor for PVWO(0-0.42). ;Conclusion:NAFLD associated HCC demonstrate less frequent portal venous washout on CT which may affect their imaging diagnosis.