Metabolic dysfunction-associated fatty liver disease has become the most common chronic liver disease as well as the most common cause for liver transplantation. With its different methods types, ...elastography of the liver can be used for non-invasive evaluation of the liver fibrosis and steatosis degree. The article focuses on the description, use, advantages, and limitations of the currently known elastographic techniques. It proposes a simple risk assessment algorithm for the liver fibrosis progress evaluation. The following is an overview of the use of liver and spleen elastography in the detection of clinically relevant portal hypertension. It concludes with research and technological possibilities that could be important to the field in the upcoming years.
Liver steatosis is a chronic liver disease that is becoming one of the most important global health problems, due to its direct connection with metabolic syndrome, its significant impact on patients' ...socioeconomic status and frailty, and the occurrence of advanced chronic liver disease. In recent years, there has been rapid technological progress in the ultrasound-based diagnostics field that can help us to quantitatively assess liver steatosis, including continuous attenuation parameters in A and B ultrasound modes, backscatter coefficients (e.g., speed of sound) and ultrasound envelope statistic parametric imaging. The methods used in this field are widely available, have favorable time and financial profiles, and are well accepted by patients. Less is known about their reliability in defining the presence and degree of liver steatosis. Numerous study reports have shown the methods' favorable negative and positive predictive values in comparison with reference investigations (liver biopsy and MRI). Important research has also evaluated the role of these methods in diagnosing and monitoring non-alcoholic fatty liver disease (NAFLD). Since NAFLD is becoming the dominant global cause of liver cirrhosis, and due to the close but complex interplay of liver steatosis with the coexistence of liver fibrosis, knowledge regarding NAFLD's influence on the progression of liver fibrosis is of crucial importance. Study findings, therefore, indicate the possibility of using these same diagnostic methods to evaluate the impact of NAFLD on the patient's liver fibrosis progression risk, metabolic risk factors, cardiovascular complications, and the occurrence of hepatocellular carcinoma. The mentioned areas are particularly important in light of the fact that most of the known chronic liver disease etiologies are increasingly intertwined with the simultaneous presence of NAFLD.
No data on the use of 2D shear wave elastography exists regarding the evaluation of the new-onset ascites causality.
To determine whether 2D shear wave elastography can help in the non-invasive ...assessment of the new-onset ascites cause. To assess the applicability of liver stiffness measured by 2D shear wave elastography using Esaote MyLab Nine apparatus in patients with ascites.
In 52 consecutive patients with new-onset ascites (January 2020 to October 2021), liver stiffness using 2D shear wave elastography was prospectively measured. The reliable measurements were used for further analysis. Relevant clinical and laboratory data was collected.
The calculated liver stiffness measurement cut-off value of 14.4 kPa held 94% accuracy, 100% sensitivity, and 83% specificity when determining ascites with serum ascites albumin gradient ≥11 g/L. Reliable 2D shear wave elastography success rate was 84%.
2D shear wave elastography may potentially be used to differentiate transudative from exudative ascites, especially in patients with portal hypertension and peritoneal carcinomatosis.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Sarcopenia is becoming a well-established player in evaluating patients with chronic liver disease. Data regarding its clinical significance and consequences in the course of liver disease have been ...growing; many of the data support the idea that it impacts decompensation event frequency, prolonged hospitalization, and mortality, as well as providing the possibility to better prioritize patients on lists awaiting liver transplantation. When assessing the whole clinical scope of the field, which includes malnutrition and frailty, as well as the complete spectrum of muscle mass, strength, and function, it becomes clear that a well-founded approach in everyday clinical practice is essential. In this respect, this article attempts to unveil the most recently published data regarding possible methods and modalities that could be used to diagnose sarcopenia as early as possible, along with the required accuracy and reliability. From the most important field discoveries to data that need further clarification, the merits and weaknesses of the very diverse existing evaluation methods are presented. Finally, a critical overview is given, in an attempt to discern study lines of importance from those that could pose further ambiguity for the theme. The author also poses relevant questions that remain unanswered but are of clinical importance in the field.
Portalna hipertenzija je posledica različnih bolezenskih stanj organov in žilja, ki sodelujejo v portalnem krvnem obtoku. Različnim bolezenskim stanjem so skupni zapleti, ki se pojavijo. V dobi novih ...preiskovalnih metod za zgodnje odkrivanje obstoja portalne hipertenzije se postavlja vprašanje mesta, ki naj bi ga imela ultrazvočna preiskava na tem diagnostičnem področju. Članek poizkuša izluščiti prednosti in uporabnost ultrazvočne preiskave na področju diagnosticiranja portalne hipertenzije, kakor tudi opozoriti na področja, kjer preiskava kot diagnostična metoda ni več uporabna.
The role of ultrasound in portal hypertension Hari, Andrej; Tepeš, Katja; Borut Štabuc
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
03/2019, Letnik:
88, Številka:
3-4
Journal Article
Recenzirano
Odprti dostop
Portal hypertension is the result of various organ and vascular conditions that are involved in portal circulation. Different diseases have similar complications. In the era of new investigative ...methods for early detection of the presence of portal hypertension, the question arises of the position that ultrasound examination should have in this diagnostic area. The article tries to elucidate the advantages and usability of the ultrasound investigation in the field of portal hypertension, as well as to draw attention to areas where this diagnostic investigation is no longer useful.
Background & Aims
Hepatic venous pressure gradient (HVPG) and transjugular liver biopsy (TJLB) are increasingly used in the management of patients with liver disease. We aimed to describe the safety ...profile of these procedures, providing data on the intra‐ and periprocedure complications, radiation exposure and amount of iodinated contrast material used.
Methods
In 106 consecutive patients undergoing HVPG and TJLB data on fluoroscopy time (FT), absorbed radiation dose, equivalent effective dose (mSv) and volume of iodinated contrast material (ICM) were prospectively collected and reviewed, together with clinical and laboratory data. Incidence and severity of procedure‐related complications were assessed. In 28 hospitalised patients, creatinine values after 72 hours of the procedure were reviewed to identify contrast‐induced nephropathy (CIN).
Results
Median effective radiation dose was 5.4 mSv (IQR 10 mSv). A total 28.3% of patients exceeded an effective exposure of 10 mSv and 9.4% exceeded 20 mSv. Only age and BMI correlated with radiation dose (R = .327, P=.001 and R = .410, P<.0001 respectively), and only BMI remained independently associated with an exposure over 20 mSv. Procedure‐related complications occurred in eight patients (7.5%), and were minor in six cases. Median ICM volume was 12.5 mL. 6/28 patients met the diagnostic criteria for CIN.
Conclusions
Hepatic venous pressure gradient and Transjugular liver biopsy show a good safety profile and radiation exposure associated with these procedures is in most of the cases low. In hepatic haemodynamic procedures, efforts should be made to reduce the radiation dose in patients with overweight/obesity and to use the minimal possible ICM volume in patients with acute‐on‐chronic liver failure.
New properties and exotic quantum phenomena can form due to periodic nanotextures, including Moire patterns, ferroic domains, and topologically protected magnetization and polarization textures. ...Despite the availability of powerful tools to characterize the atomic crystal structure, the visualization of nanoscale strain-modulated structural motifs remains challenging. Here, we develop nondestructive real-space imaging of periodic lattice distortions in thin epitaxial films and report an emergent periodic nanotexture in a Mott insulator. Specifically, we combine iterative phase retrieval with unsupervised machine learning to invert the diffuse scattering pattern from conventional X-ray reciprocal-space maps into real-space images of crystalline displacements. Our imaging in PbTiO3/SrTiO3superlattices exhibiting checkerboard strain modulation substantiates published phase-field model calculations. Furthermore, the imaging of biaxially strained Mott insulator Ca2RuO4reveals a strain-induced nanotexture comprised of nanometer-thin metallic-structure wires separated by nanometer-thin Mott-insulating-structure walls, as confirmed by cryogenic scanning transmission electron microscopy (cryo-STEM). The nanotexture in Ca2RuO4film is induced by the metal-to-insulator transition and has not been reported in bulk crystals. We expect the phasing of diffuse X-ray scattering from thin crystalline films in combination with cryo-STEM to open a powerful avenue for discovering, visualizing, and quantifying the periodic strain-modulated structures in quantum materials.
Mott metal–insulator transitions possess electronic, magnetic, and structural degrees of freedom promising next‐generation energy‐efficient electronics. A previously unknown, hierarchically ordered, ...and anisotropic supercrystal state is reported and its intrinsic formation characterized in‐situ during a Mott transition in a Ca2RuO4 thin film. Machine learning‐assisted X‐ray nanodiffraction together with cryogenic electron microscopy reveal multi‐scale periodic domain formation at and below the film transition temperature (TFilm ≈ 200–250 K) and a separate anisotropic spatial structure at and above TFilm. Local resistivity measurements imply an intrinsic coupling of the supercrystal orientation to the material's anisotropic conductivity. These findings add a new degree of complexity to the physical understanding of Mott transitions, opening opportunities for designing materials with tunable electronic properties.
In a thin epitaxially strained film of a Mott insulator, a hierarchical anisotropic supercrystal is found below metal–insulator transition temperature (top). A different anisotropic structure is observed at temperatures above (bottom). An electronic anisotropy correlated with the supercrystal is discovered, switching preferential conductivity direction by 90°.
Spontaneous Supercrystal Formation
In article number 2403873, Oleg Yu. Gorobtsov and co‐workers discover a new anisotropic structural hierarchy over multiple length scales forming spontaneously in ...thin films of a Mott insulator Ca2RuO4. The anisotropy of structure correlates to a switchable anisotropy of electrical properties, providing new device design opportunities.
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