Fibrosis in nonalcoholic fatty liver disease: Noninvasive assessment using computed tomography volumetry

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.

Prevalence of nonalcoholic fatty liver disease and its association with age in patients with type 2 diabetes mellitus

BACKGROUND Type 2 diabetes mellitus(T2DM)is a risk factor for nonalcoholic fatty liver disease(NAFLD).AIM To determine the prevalence and clinical correlates of NAFLD in a large cohort of patients with T2DM.METHODS Four hundred thirty-seven participants with T2DM who consulted at Meijo Hospital from April 2019 to September 2020 and underwent computed tomography(CT)were assessed.The mean age was 74±13 years,and 269 were men.Hepatic attenuation minus splenic attenuation(CTL−S)less than 1 Hounsfield unit was considered fatty liver.NAFLD was defined as fatty liver in the absence of significant alcohol consumption and hepatitis virus infection.A multiple logistic regression was used to assess the independent factors associated with NAFLD.RESULTS NAFLD was identified in 25.2%of the participants.Young age(odds ratio[OR]=−0.945;95%confidence interval[CI]:0.922–0.969),higher hemoglobin levels(OR=1.501,95%CI:1.278–1.764),lower high-density lipoprotein(HDL)cholesterol levels(OR=0.971,95%CI:0.953–0.989),and the absence of dialysis(OR=0.109,95%CI:0.014–0.856)were independent predictors of NAFLD.CONCLUSION NAFLD was detected with CT in 25.2%of the participants.NAFLD was associated with younger age,higher hemoglobin levels,lower HDL cholesterol levels,and an absence of dialysis.

Current status of imaging in nonalcoholic fatty liver disease

Non-alcoholic fatty liver disease(NAFLD) is the most common diffuse liver disease, with a worldwide prevalence of 20% to 46%. NAFLD can be subdivided into simple steatosis and nonalcoholic steatohepatitis. Most cases of simple steatosis are non-progressive, whereas nonalcoholic steatohepatitis may result in chronic liver injury and progressive fibrosis in a significant minority. Effective risk stratification and management of NAFLD requires evaluation of hepatic parenchymal fat, fibrosis, and inflammation. Liver biopsy remains the current gold standard; however, non-invasive imaging methods are rapidly evolving and may replace biopsy in some circumstances. These methods include well-established techniques, such as conventional ultrasonography, computed tomography, and magnetic resonance imaging and newer imaging technologies, such as ultrasound elastography, quantitative ultrasound techniques, magnetic resonance elastography, and magnetic resonancebased fat quantitation techniques. The aim of this article is to review the current status of imaging methods for NAFLD risk stratification and management, including their diagnostic accuracy, limitations, and practical applicability.

Radiologic evaluation of nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease(NAFLD)is a frequent cause of chronic liver diseases,ranging from simple steatosis to nonalcoholic steatohepatitis(NASH)-related liver cirrhosis.Although liver biopsy is still the gold standard for the diagnosis of NAFLD,especially for the diagnosis of NASH,imaging methods have been increasingly accepted as noninvasive alternatives to liver biopsy.Ultrasonography is a well-established and costeffective imaging technique for the diagnosis of hepatic steatosis,especially for screening a large population at risk of NAFLD.Ultrasonography has a reasonable accuracy in detecting moderate-to-severe hepatic steatosis although it is less accurate for detecting mild hepatic steatosis,operator-dependent,and rather qualitative.Computed tomography is not appropriate for general population assessment of hepatic steatosis given its inaccuracy in detecting mild hepatic steatosis and potential radiation hazard.However,computed tomography may be effective in specific clinical situations,such as evaluation of donor candidates for hepatic transplantation.Magnetic resonance spectroscopy and magnetic resonance imaging are now regarded as the most accurate practical methods of measuring liver fat in clinical practice,especially for longitudinal followup of patients with NAFLD.Ultrasound elastography and magnetic resonance elastography are increasingly used to evaluate the degree of liver fibrosis in patients with NAFLD and to differentiate NASH from simple steatosis.This article will review current imaging methods used to evaluate hepatic steatosis,including the diagnostic accuracy,limitations,and practical applicability of each method.It will also briefly describe the potential role of elastography techniques in the evaluation of patients with NAFLD.

Chest CT quantitative parameters in patients with acute exacerbation of chronic obstructive pulmonary disease:Correlations with blood eosinophil level

Objective To observe the correlations of chest CT quantitative parameters in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with blood eosinophil(EOS)level.Methods Chest CT data of 162 AECOPD patients with elevated eosinophils were retrospectively analyzed.The patients were divided into low EOS group(n=105)and high EOS group(n=57)according to the absolute counting of blood EOS.The quantitative CT parameters,including the number of whole lung bronchi and the volume of blood vessels,low-attenuation area percentage(LAA%)of whole lung,of left/right lung and each lobe of lung,as well as the luminal diameter(LD),wall thickness(WT),wall area(WA)and WA percentage of total bronchial cross-section(WA%)of grade 3 to 8 bronchi were compared between groups.Spearman correlations were performed to analyze the correlations of quantitative CT parameters with blood EOS level.Results LAA%of the whole lung,of the left/right lung and each lobe of lung,as well as of the upper lobe of right lung LD grade 4,middle lobe of right lung WT grade 5,upper lobe of right lung WA grade 4,middle lobe of right lung WA grade 5 and lower lobe of left lung WA grade 3 in low EOS group were all higher than those in high EOS group(all P<0.05).Except for the upper lobe of right lung LD grade 4,the above quantitative CT indexes being significant different between groups were all weakly and negatively correlated with blood EOS level(r=-0.335 to-0.164,all P<0.05).Conclusion Chest CT quantitative parameters of AECOPD patients were correlated with blood EOS level,among which LAA%,a part of WT and WA were all weakly negatively correlated with blood EOS level.

Association between non-alcoholic fatty liver disease and coronary artery disease severity

Background Both non-alcoholic fatty liver disease （NAFLD） and coronary artery disease （CAD） are closely associated with many metabolic disorders. Invasive coronary angiography （CAG） is a common approach as an intervention for CAD.However, the association between angiographic severity of coronary artery and NAFLD remains controversial. This study aimed to evaluate the relationship between NAFLD and CAD.Methods Totally 542 consecutive patients who planned to undergo CAG due to a suspected CAD were enrolled.Abdominal computed tomography （CT） was performed before angiography to detect NAFLD. CAD was defined as stenosis of at least 50% in at least one major coronary artery. The severity of CAD was assessed by the number of vessels affected and the vessel score multiplied by the severity score （Gensini score）. Significant stenosis was defined as 70% or greater reduction in lumen diameter. A probability value of P 〈0.05 was considered statistically significant.Results Of 542 patients studied, 248 （45.8%） were found to have NAFLD by abdominal CT, and 382 patients （88%）were found to have significant CAD by CAG. Age, diabetes mellitus, waist circumference, body mass index, and obesity were associated with NAFLD. According to the results of Logistic regression analysis, the presence of NAFLD independently increased the risk for CAD, as seen in CAG （odds ratio （OR）, 95% confidence interval （CI）： 7.585（4.617-12.461）; P 〈0.001）. NAFLD was significantly more common in patients as CAD severity increased （P〈0.001）.Conclusions The presence of NAFLD is associated with high severity of CAD, requiring that patients with abdominal obesity be also investigated for NAFLD. Patients with NAFLD should be closely followed up for the presence and severity of CAD.

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.

Impact of X-radiation in the management of COVID-19 disease

Coronaviruses are a diverse group of viruses that infect both animals and humans.Even though the existence of coronavirus and its infection to humans is not new,the 2019-novel coronavirus(nCoV)caused a major burden to individuals and society i.e.,anxiety,fear of infection,extreme competition for hospitalization,and more importantly financial liability.The nCoV infection/disease diagnosis was based on non-specific signs and symptoms,biochemical parameters,detection of the virus using reverse-transcription polymerase chain reaction(RTPCR),and X-ray-based imaging.This review focuses on the consolidation of potentials of X-ray-based imaging modality[chest-X radiography(CXR)and chest computed tomography(CT)]and low-dose radiation therapy(LDRT)for screening,severity,and management of COVID-19 disease.Reported studies suggest that CXR contributed significantly toward initial rapid screening/diagnosis and CT-imaging to monitor the disease severity.The chest CT has high sensitivity up to 98%and low specificity for diagnosis and severity of COVID-19 disease compared to RT-PCR.Similarly,LDRT compliments drug therapy in the early recovery/Less hospital stays by maintaining the physiological parameters better than the drug therapy alone.All the results undoubtedly demonstrated the evidence that X-ray-based technology continues to evolve and play a significant role in human health care even during the pandemic.

Bone diseases in rabbits with hyperparathyroidism: computed tomography, magnetic resonance imaging and histopathology

Background Hyperparathyroidism （HPT） occurs at an early age and has a high disability rate. Unfortunately, confirmed diagnosis in most patients is done at a very late stage, when the patients have shown typical symptoms and signs, and when treatment does not produce any desirable effect. It has become urgent to find a method that would detect early bone diseases in HPT to obtain time for the ideal treatment. This study evaluated the accuracy of high field magnetic resonance imaging （MRI） combined with spiral computed tomography （SCT） scan in detecting early bone diseases in HPT, through imaging techniques and histopathological examinations on an animal model of HPT. Methods Eighty adult rabbits were randomly divided into two groups with forty in each. The control group was fed normal diet （Ca：P = 1：0.7）; the experimental group was fed high phosphate diet （Ca：P = 1：7） for 3, 4, 5, or 6-month intervals to establish the animal model of HPT. The staging and imaging findings of the early bone diseases in HPT were determined by high field MRI and SCT scan at the 3rd, 4th, 5th and 6th month. Each rabbit was sacrificed after high field MRI and SCT scan, and the parathyroid and bones were removed for pathological examination to evaluate the accuracy of imaging diagnosis. Results Parathyroid histopathological studies revealed hyperplasia, osteoporosis and early cortical bone resorption. The bone diseases in HPT displayed different levels of low signal intensity on T1WI and low to intermediate signal intensity on T2WI in bone of stage 0, Ⅰ, Ⅱ or Ⅲ, but showed correspondingly absent, probable, osteoporotic and subperiosteal cortical resorption on SCT scan. Conclusion High field MRI combined with SCT scan not only detects early bone diseases in HPT, but also indicates staging, and might be a reliable method of studying early bone diseases in HPT.

Utility of Spiral Computed Tomography in the Study of Dislocation of Cricoarytenoid Joint

The cricoarytenoid relationship presented with spiral computed tomography was demonstrated and the reconstruction of arytenoid dislocation was presented by using multiplanar reconstruction algorithms. Fifteen patients with arytenoid dislocation documented by fiberoptic laryngoscopy and strobovideolaryngoscopy and 10 normal persons were displayed by spiral computed tomography (CT). A making design of our own had been used to diagnose arytenoid dislocation on axial CT image. Results showed that dislocation of cricoarytenoid joint was consistently demonstrated on several of the overlapping thin axial reconstructions in each of the 15 patients, in whom asymmetry of the bilateral cricoarytenoid joints was noted on axial images. It was found that on the glottic-fissure level the basal angle on abnormal side was larger in 8 patients than that on the normal side and smaller in 7 patients in patient group, whereas right basal angle was equal to the left in 8 subjects, except 2 in control group. There was statistically significant difference in the number of the equal to two basal angles of glottic fissure between control group and patient group (P<0.025). High-quality sagittal and coronal reconstructive images often were helpful in confirming or clarifying the complex arytenoid orientations. The findings that two-side basal angle was not equal in triangle of glottic fissure can be used as an objective parameter to diagnose arytenoid dislocation. Spiral CT is a useful adjunct in the diagnosis and treatment of dislocation of cricoarytenoid joint.

Differential diagnosis of coronavirus disease 2019 from community-acquired-pneumonia by computed tomography scan and follow-up

Objective Coronavirus disease 2019(COVID-19)is currently the most serious infectious disease in the world.An accurate diagnosis of this disease in the clinic is very important.This study aims to improve the differential ability of computed tomography(CT)to diagnose COVID-19 and other community-acquired pneumonias(CAPs)and evaluate the short-term prognosis of these patients.Methods The clinical and imaging data of 165 COVID-19 and 118 CAP patients diagnosed in seven hospitals in Anhui Province,China from January 21 to February 28,2020 were retrospectively analysed.The CT manifestations of the two groups were recorded and compared.A correlation analysis was used to examine the relationship between COVID-19 and age,size of lung lesions,number of involved lobes,and CT findings of patients.The factors that were helpful in diagnosing the two groups of patients were identified based on specificity and sensitivity.Results The typical CT findings of COVID-19 are simple ground-glass opacities(GGO),GGO with consolidation or grid-like changes.The sensitivity and specificity of the combination of age,white blood cell count,and ground-glass opacity in the diagnosis of COVID-19 were 92.7 and 66.1%,respectively.Pulmonary consolidation,fibrous cords,and bronchial wall thickening were used as indicators to exclude COVID-19.The sensitivity and specificity of the combination of these findings were 78.0 and 63.6%,respectively.The follow-up results showed that 67.8%(112/165)of COVID-19 patients had abnormal changes in their lung parameters,and the severity of the pulmonary sequelae of patients over 60 years of age worsened with age.Conclusions Age,white blood cell count and ground-glass opacity have high accuracy in the early diagnosis of COVID-19 and the differential diagnosis from CAP.Patients aged over 60 years with COVID-19 have a poor prognosis.This result provides certain significant guidance for the diagnosis and treatment of new coronavirus pneumonia.

Liver involvement in patients with COVID-19 infection:A comprehensive overview of diagnostic imaging features

During the first wave of the pandemic,coronavirus disease 2019(COVID-19)infection has been considered mainly as a pulmonary infection.However,different clinical and radiological manifestations were observed over time,including involvement of abdominal organs.Nowadays,the liver is considered one of the main affected abdominal organs.Hepatic involvement may be caused by either a direct damage by the virus or an indirect damage related to COVID-19 induced thrombosis or to the use of different drugs.After clinical assessment,radiology plays a key role in the evaluation of liver involvement.Ultrasonography(US),computed tomography(CT)and magnetic resonance imaging(MRI)may be used to evaluate liver involvement.US is widely available and it is considered the first-line technique to assess liver involvement in COVID-19 infection,in particular liver steatosis and portal-vein thrombosis.CT and MRI are used as second-and third-line techniques,respectively,considering their higher sensitivity and specificity compared to US for assessment of both parenchyma and vascularization.This review aims to the spectrum of COVID-19 liver involvement and the most common imaging features of COVID-19 liver damage.

Revolution CT剂量匹配技术对肝脏脂肪含量测量值的影响

目的:探讨基于剂量匹配的个体化低管电流扫描对定量CT(QCT)肝脏脂肪含量测量及图像质量的影响。方法:前瞻性将2022年2月-12月在本院接受胸部及上腹部CT扫描的253例患者纳入研究。对两次扫描重叠部分的肝脏进行对照研究。胸部扫描采用个体化低剂量扫描(A组),管电压120 kVp,管电流采用Smart mA技术,通过手动调整噪声指数(NI)降低管电流,使其辐射剂量等同于基于Auto-prescription技术推荐的80 kVp或100 kVp的辐射剂量,分别记为A1组和A2组。上腹部为常规120 kVp扫描(B组),与A组对应分为B1、B2组。扫描完成后对A组图像分别采用40%、60%和80%权重后置ASIR-V进行图像重建。分别测量每组图像上胸部及上腹部扫描时肝脏重叠部位的CT值及其SD值和肝脏脂肪含量体积百分比(Fat%QCT),以同层面两侧竖脊肌作为背景组织,计算肝实质的SNR和CNR。由两位观察者分别采用5分法评估各组胸部图像的图像质量。采用配对样本t检验比较A、B组之间肝脏的Fat%QCT、CT值及其SD值、SNR和CNR及辐射剂量的差异。采用Bland-Altman分析评估胸腹部图像上测量的Fat%QCT值的一致性。两位放射科医师对图像质量主观评分的一致性及差异分别采用Kappa检验和Wilcoxon秩和检验。结果:A组内不同权重ASIR-V图像上测量的Fat%QCT值的差异无统计学意义(P>0.05);A、B组之间肝脏的CT值和Fat%QCT值的差异均无统计学意义(P>0.05);A组后置60%ASIR-V图像上肝脏的SNR和CNR高于B组,但图像质量主观评分的差异无统计学意义(P>0.05)。结论:以Auto-prescription技术推荐的辐射剂量为参考,通过剂量匹配,在常规120 kVp时通过改变管电流的方法来降低辐射剂量,对QCT肝脏脂肪含量的测量无显著影响,且不同权重后置ASIR-V对QCT肝脏脂肪含量的测量无影响。

肝脏占位病变能谱CT成像中不同期相虚拟平扫替代真实平扫的效能及方案选择

目的基于肝脏病变,探讨Revolution CT不同期相虚拟平扫(VNC)与真实平扫(TNC)的等效性及影响因素。资料与方法回顾性收集东南大学附属中大医院2021年12月—2022年4月行肝脏平扫及动脉(A)、静脉(V)及延迟(D)三期能谱增强的62例患者,测量直径≥5 mm的肝脏病灶,按TNC的CT值分为1组(≤20 Hu)及2组(>20 Hu),按强化程度分为a组(三期增强强化程度均≤20 Hu)和b组(三期增强中至少有一期强化程度>20 Hu),分别比较TNC和三期VNC组病灶的CT值、最大径及病灶检出率,使用多因素回归分析观察VNC与TNC CT值差值的影响因素。结果各组病灶CT值差异有统计学意义(χ^(2)/F=14.712、18.603、7.334,P均<0.01),仅1a组病灶VNCV和VNCD与TNC差异无统计学意义(P均>0.05),其余病灶与TNC相比,a类病灶VNC偏低,b类病灶VNC偏高(P均<0.05)。各组病灶VNCA和VNCV与TNC的最大径差异无统计学意义且呈极强相关(P均>0.05;r均>0.8,P均<0.001)。4组检出率差异有统计学意义(χ^(2)=47.660,P<0.001),VNCV高于VNCA及VNCD(P均<0.05)。VNC与TNC的CT值差值与增强CT值呈正相关(r2修正=0.209、0.142、0.062,P均<0.001)。结论对于肝脏病变,Revolution CT静脉期VNC是替代TNC的最佳期相,并能通过静脉期CT值行一定矫正。

明胶海绵-凝血酶原-碘海醇用于封堵CT引导下经皮肝穿刺活检针道

目的 观察明胶海绵-凝血酶原-碘海醇用于封堵CT引导下经皮肝穿刺活检针道的安全性及可行性。方法回顾性分析101例因不明原因肝病、肝硬化、肝占位性病变并发凝血功能异常而接受CT引导下肝穿刺活检患者,穿刺取材后均以明胶海绵颗粒-人凝血酶原复合物-碘海醇混合物封堵针道;观察穿刺活检效果、并发症及穿刺前后凝血及肝功能指标。结果 101例均穿刺取材成功,技术成功率及组织学标本充分度均为100%,并均获得明确病理诊断。18例(18/101,17.82%)出现并发症,包括穿刺部位轻微疼痛、封堵剂渗透至肝包膜下或皮下;未见出血、气胸及胆管损伤等严重并发症。穿刺活检前、后凝血及肝功能差异均无统计学意义(P均>0.05)。结论 明胶海绵颗粒-凝血酶原-碘海醇用于封堵经皮肝穿刺活检针道安全、可靠,可减少出血等并发症。

CT影像组学识别非酒精性脂肪性肝炎的应用研究

目的构建并验证基于CT的全肝影像组学模型用于识别非酒精性脂肪性肝炎(non-alcoholic steatohepatitis,NASH)。方法回顾性选取2018年6月至2022年12月浙江省人民医院收治的122例非酒精性脂肪性肝病患者,其中NASH患者52例。将纳入患者按7:3比例随机分为训练组(n=85)和测试组(n=37),选取每例患者的肝脏平扫图像提取影像组学特征,对训练组提取的特征进行降维并建立影像组学标签,之后联合相关临床特征构建联合预测模型用于识别NASH患者,使用受试者操作特征曲线及测试组数据评估模型的诊断效能。结果联合预测模型基于年龄和影像组学标签构建,该模型在训练组和测试组中识别NASH患者的诊断效能分别为0.899和0.880,特异性分别为91.2%和88.1%,敏感度分别为86.7%和88.2%。校准曲线在训练组和测试组中也显示出良好的校准性能。结论基于肝脏CT的影像组学模型可定量评估NASH,有望为临床提供一种无创性评价工具。

肝移植受者术前心脏疾病风险评估的现状及展望

随着肝移植疾病谱和器官分配体系等因素的改变,越来越多伴有心血管合并症的患者进入移植等待名单。手术应激、严重感染、免疫抑制药物不良反应等亦会导致术后心脏并发症发生风险显著增加,影响受者短期及长期生存。因此,术前对受者心脏结构及功能进行全面评估,对改善肝移植预后尤其重要。本文就肝移植围手术期心脏疾病风险增加的主要原因、肝移植受者心脏疾病风险评估的时机和方法进行综述,介绍当前肝移植术前常见心脏疾病的评估手段,以期为进一步降低肝移植术后心脏并发症发生率、提高移植物和受者存活率、改善临床预后结果提供参考。

影像学检查方法在非酒精性脂肪性肝病定量分析中的应用

目的:就超声、电子计算机断层扫描与磁共振成像在非酒精性脂肪性肝病定量分析中的应用进行概述。方法:检索中国知网、中华医学期刊全文数据库和PubMed数据库中,超声、电子计算机断层扫描与磁共振成像及其相关新技术在非酒精性脂肪性肝病定量分析中的应用和最新进展。结果:超声被较多应用于非酒精性脂肪性肝病的分级、病变范围初步评估和随诊观察;电子计算机断层扫描被广泛应用于非酒精性脂肪性肝病的定性、分级及半定量分析;磁共振成像是临床上最具价值的无创性影像学非酒精性脂肪性肝病定量分析方法。结论:超声、电子计算机断层扫描与磁共振成像均能对非酒精性脂肪性肝病的诊断、定级及定量分析起到积极作用,而以三种无创性影像学技术为基础发展的新技术将对未来非酒精性脂肪性肝病的定量分析起到至关重要的作用,并具有极大的应用价值和良好的医学前景。

自身免疫性肝病患者腹部淋巴结肿大的临床及影像学特征分析

目的探讨CT评估自身免疫性肝病(AILD)患者腹部淋巴结肿大的临床价值。方法选取2015年1月-2019年12月在天津医科大学总医院就诊的136例AILD患者(设为AILD组),并以65例其他慢性肝病患者作为对照组。回顾性分析两组患者的腹部CT资料,统计腹部不同区域淋巴结的体积及数目分布,应用受试者工作特征曲线下面积(AUROC)评估腹部淋巴结肿大对AILD的诊断价值,并采用logistic回归分析肝周淋巴结肿大的危险因素。结果AILD组腹部淋巴结的平均体积[(0.47±0.61)cm^(3)vs.(0.25±0.20)cm^(3)]及数目[(8.10±4.97)个vs.(4.26±3.25)个]均较对照组增大或增加(P<0.001)。肝周淋巴结数目联合肠系膜淋巴结体积诊断AILD的AUROC为0.816(P<0.001)。77例行肝组织活检的AILD患者中,肝周淋巴结阳性组肝组织中界面性肝炎的发生率高于肝周淋巴结阴性组(52.31%vs.16.67%,χ^(2)=5.169,P<0.05)。多因素logistic回归分析显示,血清IgG抗体水平增高是肝周淋巴结肿大的独立危险因素(OR=1.012,95%CI 1.000~1.024,P<0.05)。结论肝周及肠系膜淋巴结肿大有助于AILD的鉴别诊断,肝周淋巴结肿大与AILD肝炎性活跃度相关。

肝移植术后可逆性肝窦阻塞综合征1例

患者男,41岁,腹胀10余天、双下肢水肿3天;2个月前因原发性肝癌接受肝移植术,术后口服他克莫司;近2个月体质量增加约10kg。查体:腹部膨隆并见术后瘢痕,肋下未触及肝脏,无明显压痛及反跳痛,移动性浊音(+),肠鸣音弱;双下肢水肿,病理征(-)。实验室检查:谷丙转氨酶16.9 U/L,谷草转氨酶16.8U/L,碱性磷酸酶66.8U/L,总胆红素7.3μmol/L,直接胆红素4.6μmol/L。