To investigate the usefulness of shear-wave speed and dispersion slope measurements obtained, using an ultrasound elastography system in rat livers with various degrees of necroinflammation and ...fibrosis. A total of 25 male Sprague Dawley rats were randomly divided into 5 groups of 5 rats each: G0 (control), G1 (CCl
injected twice a week for 1 wk), G2 (CCl
injected four times a wk for 1 wk), G3 (CCl
injected twice a wk for 6 wk) and G4 (CCl
injected twice a wk for 10 wk). The shear-wave speed (m/s) and the dispersion slope (m/s/kHz) were measured. Histologic features (inflammation, necrosis and fibrosis) were used as reference standards. In multivariable analysis with histologic features as independent variables, the fibrosis grade was significantly related to shear-wave speed (p < 0.05) and the necrosis grade was significantly related to dispersion slope (p < 0.05). Dispersion slope is more useful than shear-wave speed for predicting the degree of necroinflammation.
Background
Acoustic radiation force impulse (ARFI) elastography is an ultrasound technique that is capable of measuring tissue stiffness noninvasively. It is difficult to differentiate idiopathic ...portal hypertension (IPH) from liver cirrhosis (LC) or chronic hepatitis (CH), and liver biopsy is essential. We investigated whether it would be possible to noninvasively diagnose IPH by measuring the stiffness of the liver and spleen by ARFI.
Methods
The subjects were 17 IPH patients, 25 LC patients, 20 CH patients, and 20 normal controls (NC). We measured liver stiffness, spleen stiffness, and the spleen/liver stiffness ratio, and plotted ROC curves.
Results
The median value of liver stiffness in the IPH group was lower than that in the LC group (
p
= 0.00077) and about the same as in the CH group (
p
= 0.79). The median value of spleen stiffness was highest in the IPH group (IPH vs. LC group,
p
= 0.003; IPH vs. CH group,
p
< 0.00001). The spleen/liver stiffness ratio was lower in the LC group and in the CH group, and higher in the IPH group (
p
< 0.001, respectively). When an ROC curve of spleen/liver stiffness ratios was plotted to differentiate between the IPH group and the combined group of patients with other liver diseases (LC + CH group), when a cutoff value of 1.71 was used, the AUROC was 0.933 sensitivity 0.941, specificity 0.800, and accuracy 0.839.
Conclusion
Measuring the spleen/liver stiffness ratio by ARFI made it possible to noninvasively, specifically, and accurately diagnose IPH.
Shear wave (SW) dispersion imaging is a newly developed imaging technology for assessing the dispersion slope of SWs, which is related to tissue viscosity in diffuse liver disease. Our preclinical ...and preliminary clinical studies have shown that SW speed is more useful than dispersion slope for predicting the degree of fibrosis and that dispersion slope is more useful than SW speed for predicting the degree of necroinflammation. Thus, dispersion slope, which reflects viscosity, may provide additional pathophysiological insight into diffuse liver disease.
Aim
Interferon‐free direct‐acting antiviral (DAA) therapy is an effective treatment for chronic hepatitis C (CH(C)) patients. Activity of natural killer (NK) cells was reported to be impaired in ...patients with hepatitis C virus infection. The aim of this study was to examine whether DAA therapy could restore NK activity in patients with CH(C).
Methods
Direct‐acting antiviral therapy was given to 31 CH(C) patients as asunaprevir/daclatasvir (ASV/DCV) (n = 15), ledipasvir/sofosbuvir (n = 7), ombitasvir/paritaprevir/ritonavir (n = 6), or elbasvir/grazoprevir (n = 3). Prior to therapy (0M), at the completion of the therapy (EOT), and at 24 weeks after completion (AFTER), NK activity and the frequency of CD56dimNK and CD56brightNK cells in peripheral blood were estimated by Cr release assay and flow cytometry. Statistical analysis was carried out by anova and the Mann–Whitney U‐test.
Results
In one of the ASV/DCV‐treated patients, treatment was stopped 12 weeks after initiation of therapy because of viral breakthrough. The anova showed that NK activity significantly improved at EOT (vs. 0M, P < 0.01) and at AFTER (vs. 0M, P < 0.001) in 30 patients with sustained virologic response. It also showed that the frequency of CD56dimNK cells was significantly increased at EOT and at AFTER (vs. 0M, P < 0.05). In addition, the NK activity ratio (AFTER/0M) had no significant difference between patient groups with higher and lower Fibrosis‐4 scores.
Conclusion
Direct‐acting antiviral therapy in CH(C) patients could improve NK activity by increasing the frequency of CD56dimNK cells. Additionally, our results might imply that DAAs therapy could reduce the risk of hepatocarcinogenesis by restoring innate immune responses.
Aim
To evaluate the usefulness and safety of a newly developed full‐core biopsy needle.
Methods
We selected 149 patients who underwent percutaneous liver biopsy at our institution from February 2019 ...to April 2021. We excluded 35 patients with hepatic fibrosis stage F3 or higher, which made it histopathologically difficult to measure the number of complete portal triads. The patients were divided into two groups as follows: 62 cases with the 18‐G conventional automated needle (TruCore needle: T needle), and 52 cases with the 18‐G full‐core needle (CorVocet needle: C needle). We measured the number of complete portal triads in the liver tissue specimens, and the sum of the length and width of the collected tissues. Moreover, we compared the number of session counts, fragmentations, and complications.
Results
The sum of the length and the width was 12.8 mm (11.2–14.3) and 15.9 mm (13.1–17.3; p < 0.001), and 0.68 mm (0.63–0.74) and 0.82 mm (0.78–0.90; p < 0.001) for the T needle and C needle, respectively. The number of complete portal triads and fragmentation was six (3–8) and 10 (6–13; p < 0.001), and one (1–10) and one (1–3; p < 0.001), for the T needle and C needle, respectively. There was one session count (1–2) in both groups; however, there were significantly higher cases of two sessions with the T needle than that with the C needle (p = 0.018). There were no serious adverse events.
Conclusions
Compared with the conventional needles, the newly developed full‐core needles enabled the acquisition of a larger amount of tissue sample in liver biopsy.
Yamamoto et al. report a case of intraductal residual lesions after endoscopic papillectomy successfully treated with endoscopic radiofrequency ablation therapy. This report provides readers with ...images and videos of precise intraductal radiofrequency ablation therapy methods for safe and effective eradication of intraductal residual lesions.
Objective To evaluate irreversible electroporation (IRE) for locally advanced pancreatic cancer (LAPC). Methods This study was approved by our local review board. Eight patients with histologically ...proven LAPC ≤5 cm were prospectively enrolled to undergo ultrasound-guided IRE. The primary endpoint was complications within 90 days. Secondary outcomes were the overall survival (OS) and time to local progression. Safety was assessed using Common Terminology Criteria for Adverse Events Version 4.0. Results All patients were treated successfully. The median procedure time was 150 min. The median largest tumor diameter was 29.5 mm (20.0-48.0 mm) in the pancreatic head (n=5) and body (n=3). Open (n=4) and percutaneous (n=4) approaches were used. No patients died within 90 days after IRE. There were 5 minor complications in 3 patients and 4 major complications in 3 patients. The incidence rates of major complications did not differ significantly between the approaches. The median time to local progression after IRE was 12.0 months, and the median OS was 17.5 months from IRE and 24.0 months from the diagnosis, with no significant differences between the approaches. Conclusions Percutaneous and open IRE may be acceptable for patients with LAPC (despite some major adverse events) and may represent a useful new therapeutic option.
Chronic liver disease (CLD) leads to the development of hepatocellular carcinoma, which is one of the leading causes of cancer-related deaths globally.
Liver fibrosis is the most important prognostic ...factor for hepatocellular carcinoma development and prognosis in CLD, and accurate staging of liver fibrosis is pivotal in clinical practice.
Although liver biopsy is the gold standard for evaluating liver fibrosis, liver biopsy has several limitations including invasiveness, sampling error, and intraobserver and interobserver reproducibility.
To resolve these problems, several noninvasive methods for evaluating liver fibrosis have been developed using serum fibrosis markers, ultrasound-based modalities, and magnetic resonance imaging-based modalities.
.
Background/Purpose
Shear wave elastography (SWE) is a clinical method used to evaluate liver hardness. In this study, we assessed its applicability in assessing the pancreas and its potential for ...diagnosing chronic pancreatitis.
Methods
We performed SWE on 59 patients who underwent abdominal ultrasound, and measured the computed tomography (CT) values of the pancreas. Patients were classified as having a normal pancreas (NP), early chronic pancreatitis (ECP), or chronic pancreatitis (CP). SW elasticity (SWe), SW dispersion (SWd), and CT values between groups were analyzed.
Results
SWe significantly differed between the CP and NP/ECP groups (NP vs CP; P = 0.001, ECP vs CP; P = 0.026,), while SWd showed a significant difference only between the NP and CP group (NP vs CP; P = 0.001). The CT values were significantly different between the CP and NP/ECP groups (NP vs CP; P = 0.0006, ECP vs CP; P = 0.0027).
Conclusion
Pancreatic SWE and CT values were helpful in the diagnosis of chronic pancreatitis. SWd may reveal status changes in ECP.
Kojima et al. investigated the efficacy of shear wave elastography by extracorporeal abdominal ultrasound to evaluate stiffness of the pancreas. This method facilitated the diagnosis of chronic pancreatitis and showed a significant correlation between the values of shear wave elastography and chronic pancreatitis, suggesting the usefulness of elastography in chronic pancreatitis.
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