AIM： To study the presence of sustained low diffusing capacity （DLco） after liver transplantation （LT） in patients with hepatopulmonary syndrome （HPS）. METHODS： Six patients with mild-to-severe HPS and 24 with...AIM： To study the presence of sustained low diffusing capacity （DLco） after liver transplantation （LT） in patients with hepatopulmonary syndrome （HPS）. METHODS： Six patients with mild-to-severe HPS and 24 without HPS who underwent LT were prospectively followed before and after LT at mid-term （median, 15 mo）. HPS patients were also assessed at Iong-tem （median, 86 mo）. RESULTS： Before LT, HPS patients showed lower PaO2 （71 ± 8 mmHg）, higher AaPO2 （43 ± 10 mmHg） and lower DLco （54% ± 9% predicted）, due to a combination of moderate-to-severe ventilation-perfusion （VA/Q） imbalance, mild shunt and diffusion limitation, than non- HPS patients （94 ± 4 mmHg and 19 ± 3 mmHg, and 85% ± 3% predicted, respectively） （P 〈 0.05 each）. Seven non-HPS patients had also reduced DLco （70% ± 4% predicted）. At mid- and long-term after LT, compared to pre- LT, HPS patients normalized PaO2 （91 ± 3 mmHg and 87 ± 5 mmHg）, AaPO2 （14 ± 3 mmHg and 23 ± 5 mmHg） and all VA/Q descriptors （P 〈 0.05 each） without changes in DLco （53% ± 8% and 56% ± 7% predicted, respectively）. Post-LT DLco in non-HPS patients with pre- LT low DLco was unchanged （75% ± 6% predicted）. CONCLUSION： While complete VA/Q resolution in HPS indicates a reversible functional disturbance, sustained low DLco after LT also present in some non-HPS patients, points to persistence of sub-clinical liver-induced pulmonary vascular changes.展开更多
AIM To evaluate the diagnostic performance of computed tomography(CT) volumetry for discriminating the fibrosis stage in patients with nonalcoholic fatty liver disease(NAFLD).METHODS A total of 38 NAFLD patients were ...AIM To evaluate the diagnostic performance of computed tomography(CT) volumetry for discriminating the fibrosis stage in patients with nonalcoholic fatty liver disease(NAFLD).METHODS A total of 38 NAFLD patients were enrolled. On the basis of CT imaging, the volumes of total, left lateral segment(LLS), left medial segment, caudate lobe, and right lobe(RL) of the liver were calculated with a dedicated liver application. The relationship between the volume percentage of each area and fibrosis stage was analyzed using Spearman's rank correlation coefficient. A receiver operating characteristic(ROC) curve analysis was performed to determine the accuracy of CT volumetry for discriminating fibrosis stage.RESULTS The volume percentages of the caudate lobe and the LLS significantly increased with the fibrosis stage(r = 0.815, P < 0.001; and r = 0.465, P = 0.003, respectively). Contrarily, the volume percentage of the RL significantly decreased with fibrosis stage(r =-0.563, P < 0.001). The volume percentage of the caudate lobe had the best diagnostic accuracy for staging fibrosis, and the area under the ROC curve values for discriminating fibrosis stage were as follows: ≥ F1, 0.896; ≥ F2, 0.929; ≥ F3, 0.955; and ≥ F4, 0.923. The best cut-off for advanced fibrosis(F3-F4) was 4.789%, 85.7% sensitivity and 94.1% specificity.CONCLUSION The volume percentage of the caudate lobe calculated by CT volumetry is a useful diagnostic parameter for staging fibrosis in NAFLD patients.展开更多
基金Supported by Red Respira-ISCIII-RTIC-03/11 and Generalitat de Catalunya, No. 2005SGR-00822
文摘AIM： To study the presence of sustained low diffusing capacity （DLco） after liver transplantation （LT） in patients with hepatopulmonary syndrome （HPS）. METHODS： Six patients with mild-to-severe HPS and 24 without HPS who underwent LT were prospectively followed before and after LT at mid-term （median, 15 mo）. HPS patients were also assessed at Iong-tem （median, 86 mo）. RESULTS： Before LT, HPS patients showed lower PaO2 （71 ± 8 mmHg）, higher AaPO2 （43 ± 10 mmHg） and lower DLco （54% ± 9% predicted）, due to a combination of moderate-to-severe ventilation-perfusion （VA/Q） imbalance, mild shunt and diffusion limitation, than non- HPS patients （94 ± 4 mmHg and 19 ± 3 mmHg, and 85% ± 3% predicted, respectively） （P 〈 0.05 each）. Seven non-HPS patients had also reduced DLco （70% ± 4% predicted）. At mid- and long-term after LT, compared to pre- LT, HPS patients normalized PaO2 （91 ± 3 mmHg and 87 ± 5 mmHg）, AaPO2 （14 ± 3 mmHg and 23 ± 5 mmHg） and all VA/Q descriptors （P 〈 0.05 each） without changes in DLco （53% ± 8% and 56% ± 7% predicted, respectively）. Post-LT DLco in non-HPS patients with pre- LT low DLco was unchanged （75% ± 6% predicted）. CONCLUSION： While complete VA/Q resolution in HPS indicates a reversible functional disturbance, sustained low DLco after LT also present in some non-HPS patients, points to persistence of sub-clinical liver-induced pulmonary vascular changes.
基金Supported by a Grant-in-in-Aid for Scientific Research(C)(No26461796) from the Japanese Ministry of Education,Culture,Sports,Science,and Technology
文摘AIM To evaluate the diagnostic performance of computed tomography(CT) volumetry for discriminating the fibrosis stage in patients with nonalcoholic fatty liver disease(NAFLD).METHODS A total of 38 NAFLD patients were enrolled. On the basis of CT imaging, the volumes of total, left lateral segment(LLS), left medial segment, caudate lobe, and right lobe(RL) of the liver were calculated with a dedicated liver application. The relationship between the volume percentage of each area and fibrosis stage was analyzed using Spearman's rank correlation coefficient. A receiver operating characteristic(ROC) curve analysis was performed to determine the accuracy of CT volumetry for discriminating fibrosis stage.RESULTS The volume percentages of the caudate lobe and the LLS significantly increased with the fibrosis stage(r = 0.815, P < 0.001; and r = 0.465, P = 0.003, respectively). Contrarily, the volume percentage of the RL significantly decreased with fibrosis stage(r =-0.563, P < 0.001). The volume percentage of the caudate lobe had the best diagnostic accuracy for staging fibrosis, and the area under the ROC curve values for discriminating fibrosis stage were as follows: ≥ F1, 0.896; ≥ F2, 0.929; ≥ F3, 0.955; and ≥ F4, 0.923. The best cut-off for advanced fibrosis(F3-F4) was 4.789%, 85.7% sensitivity and 94.1% specificity.CONCLUSION The volume percentage of the caudate lobe calculated by CT volumetry is a useful diagnostic parameter for staging fibrosis in NAFLD patients.
