Diffuse Liver Disease Research Articles

Computer-aided Characterization and Diagnosis of Diffuse Liver Diseases Based on Ultrasound Imaging: A Review.

Diffuse liver diseases, such as hepatitis, fatty liver, and cirrhosis, are becoming a leading cause of fatality and disability all over the world. Early detection and diagnosis of these diseases is extremely important to save lives and improve effectiveness of treatment. Ultrasound imaging, a noninvasive diagnostic technique, is the most commonly used modality for examining liver abnormalities. However, the accuracy of ultrasound-based diagnosis depends highly on expertise of radiologists. Computer-aided diagnosis systems based on ultrasound imaging assist in fast diagnosis, provide a reliable "second opinion" for experts, and act as an effective tool to measure response of treatment on patients undergoing clinical trials. In this review, we first describe appearance of liver abnormalities in ultrasound images and state the practical issues encountered in characterization of diffuse liver diseases that can be addressed by software algorithms. We then discuss computer-aided diagnosis in general with features and classifiers relevant to diffuse liver diseases. In later sections of this paper, we review the published studies and describe the key findings of those studies. A concise tabular summary comparing image database, features extraction, feature selection, and classification algorithms presented in the published studies is also exhibited. Finally, we conclude with a summary of key findings and directions for further improvements in the areas of accuracy and objectiveness of computer-aided diagnosis.

MULTIPARAMETER ULTRASOUND FOR LIVER AND PANCREAS IN MODERN CONDITIONS

The Aim. To determine the value of multiparametric ultrasonic methods of research in the frame-work of comprehensive elastography.Materials and methods. The study included 256 people: men - 145 (56,7%), women - 111 (43,3%), aged 47,4 ± 5,7, suffering from diffuse liver diseases and pancreas diseases. To determine the diagnostic and prognostic value of a comprehensive elastography use there were performed: transient edastography, compression elastography, endosonography in elastography compression, shear wave elastography.Results. According to the study it was found: the body mass index (more than 25 kg/cm2) is the restriction to conduct transient elastography, compression elastography; heart disorder - compression elastography and compression elastography at endosonography (AUROC = 0,893, [0,878 - 0,979]). Compression elastography of pancreas at endosonography is the method of choice in the differential diagnosis of benign and malignant processes, to clarify the “zone of interest” for puncture-aspiration biopsy (AUROC = 0,981, [0,891-0,982]).Conclusions. Multiparameter ultrasound elastography study complex increases the diagnostic and prognostic value of the algorithm of patients examination with liver and pancreas diseases: specificity- 97,5%, sensitivity - 95,6%, accuracy - 96,5%.

Magnetic Resonanance Imaging of the Liver (Including Biliary Contrast Agents)—Part 2: Protocols for Liver Magnetic Resonanance Imaging and Characterization of Common Focal Liver Lesions

Magnetic resonance imaging (MRI) is a fundamental tool for the noninvasive evaluation of liver pathologies. The anatomical position, the mobility with respiration, and the peculiar hemodynamics of the liver present several issues that have taken advantage from technological advances in MRI technology in the last decade, in particular regarding hardware, software, and contrast media (CM). We provided an overview of these topics in the first part of the review. MRI pulse sequences of clinical use in liver imaging can be divided into (1) T2-weighted sequences, for detection and characterization of focal and diffuse lesions without contrast, (2) T1-weighted sequences, with or without contrast injection, for further lesion characterization, and (3) additional techniques, such as diffusion-weighted imaging (DWI) and magnetic resonance cholangiopancreatography (MRCP). Most sequences have different names and abbreviations, and the reader is invited to find the respective commercial name specific for each vendor in appropriate references.1 The use of CM adds information on function and vascularity of liver parenchyma and focal lesions. The optimization of the technique for postcontrast studies and the basic concepts for characterization of focal liver lesions are briefly discussed in the following sections. MRI provides several advanced techniques for quantitative evaluation of diffuse liver disease. The complexity of these techniques is beyond the scope of this review, and only a brief description on magnetic resonance elastography (MRE), fat and iron quantification would be provided. At the end of our overview, we would discuss strategies to build basic liver protocols.

Hepatic artery resistive index (HARI) and non-alcoholic fatty liver disease (NAFLD) fibrosis score in NAFLD patients: cut-off suggestive of non-alcoholic steatohepatitis (NASH) evolution.

Conventional ultrasound (US) is reliable to reveal the presence of non-alcoholic fatty liver disease (NAFLD), but it is neither sensitive nor specific to reveal fibrosis clues, except in advanced stages where signs of cirrhosis are evident. NALFD fibrosis score is a non-invasive parameter that predicts well the presence of significant fibrosis, but correlations with US parameters are lacking. The aim of this study was, therefore, to compare resistive index of hepatic artery (HARI) of NAFLD patients with different severity degrees of diffuse fatty liver disease vs HARI of controls, and to compare HARI of NAFLD patients with different NAFLD fibrosis scores vs HARI of controls. This was a spontaneous, no-profit observational study conducted in our US department between December 2013 and July 2014. Patients with NAFLD with different severity of disease and healthy controls were included. Echogenicity and size of liver and spleen, maximum portal vein velocity, RI, peak systolic velocity (PSV), and end diastolic velocity (EDV) of splenic artery, PSV, EDV, and RI of hepatic artery, and NAFLD fibrosis score were acquired and compared between groups. HARI was significantly lower in NAFLD patients than controls (p<0.0001). A significant difference was also found between the groups of NAFLD severity (p<0.0001). There was also a difference between HARI of NAFLD patients with different NAFLD fibrosis scores vs HARI of controls (p<0.0001) with a positive correlation between HARI and NAFLD fibrosis score. Conventional Doppler US can be helpful to detect NAFLD patients with the risk of fibrous tissue accumulation. HARI tends to exceed the range of controls for patients with NAFLD fibrosis score greater than 0.675. The detection of HARI greater than 0.9 in NAFLD patients, regardless of the US degree of severity of steatosis, might suggest the execution of biopsy to predict the risk of progression to steatohepatitis and fibrous tissue accumulation. Low values of HARI may be expression of lower risk, which does not necessitate any biopsy.

Quantitative BOLD imaging at 3T: Temporal changes in hepatocellular carcinoma and fibrosis following oxygen challenge.

PurposeTo evaluate the utility of oxygen challenge and report on temporal changes in blood oxygenation level‐dependent (BOLD) contrast in normal liver, hepatocellular carcinoma (HCC) and background fibrosis.Materials and MethodsEleven volunteers (nine male and two female, mean age 33.5, range 27–41 years) and 10 patients (nine male and one female, mean age 68.9, range 56–87 years) with hepatocellular carcinoma on a background of diffuse liver disease were recruited. Imaging was performed on a 3T system using a multiphase, multiecho, fast gradient echo sequence. Oxygen was administered via a Hudson mask after 2 minutes of free‐breathing. Paired t‐tests were performed to determine if the mean pre‐ and post‐O2 differences were statistically significant.ResultsIn patients with liver fibrosis (n = 8) the change in T2* following O2 administration was elevated (0.88 ± 0.582 msec, range 0.03–1.69 msec) and the difference was significant (P = 0.004). The magnitude of the BOLD response in patients with HCC (n = 10) was larger, however the response was more variable (1.07 ± 1.458 msec, range –0.93–3.26 msec), and the difference was borderline significant (P = 0.046). The BOLD response in the volunteer cohort was not significant (P = 0.121, 0.59 ± 1.162 msec, range –0.81–2.44 msec).ConclusionThis work demonstrates that the BOLD response following oxygen challenge within cirrhotic liver is consistent with a breakdown in vascular autoregulatory mechanisms. Similarly, the elevated BOLD response within HCC is consistent with the abnormal capillary vasculature within tumors and the arterialization of the blood supply. Our results suggest that oxygen challenge may prove a viable BOLD contrast mechanism in the liver. J. Magn. Reson. Imaging 2016;44:739–744.

Risk factors for bleeding after liver biopsy.

Determine factors that increase the risk of bleeding after liver biopsy. Retrospective review of radiology and clinical databases from Jan 2008 to Jun 2014 revealed 847 patients with liver biopsy. Of these, 154 (group I) had targeted biopsy of focal lesion and 142 (group 2) had random core biopsy for diffuse liver disease. The rest of the patients were excluded due to insufficient post-biopsy data. Data including pre-biopsy laboratory results, history of transfusion, and biopsy complications were recorded in the study cohort. After review of initial results, a "Risk Score" for bleeding was created using platelet count, INR, estimated glomerular filtration rate (eGFR), and suspicion of malignancy. Zero point was given for normal laboratory results or absence of malignancy. One point was given for mildly abnormal laboratory values or presence of malignancy. Severe biochemical abnormalities, e.g., INR>2.0, eGFR<30mL/min, or platelet count≤50×10(9)/L were given two points each. The "Risk Score" was made of adding individual points. Of 847 patients queried by retrospective database search, 296 had adequate records for the period of 2weeks prior to biopsy to 4weeks after biopsy. The remaining patients had liver biopsy as outpatients and probably did not have bleeding complications but no electronic records were found to confirm this. 25 (8.4%) of 296 patients had post-biopsy bleeding, with incidences of 11.7% and 4.9% in groups 1 and 2 (p=0.04). On logistic regression analysis, the only significant predictor of bleeding was the "Risk Score" (p=0.01, odds ratio 4.6). There was substantial overlap in INR, and platelet count in bleeders vs. non-bleeders. Pre-biopsy fresh frozen plasma or platelet concentrate infusions did not reduce the risk of bleeding. INR and platelet count are not an independent risk factors for post-biopsy bleeding. A "Risk Score" made up of individual risk factors was a better predictor of bleeding.

Liver biopsy: past, present and future

Liver biopsy is an integral part of evaluation of liver disease. Indications and techniques have developed to allow functional and prognostic liver assessment, along with biochemistry and dynamic imaging, in both diffuse and focal liver disease. However, non-invasive techniques are changing the way clinicians use liver biopsy.

«LARGE-FOR-SIZE» LIVER LEFT LATERAL SECTION GRAFTS IN INFANTS

Transplantation of liver left lateral section (LLS) firmly established itself as a radical and effective method of treatment of advanced diffuse and unresectable focal liver diseases in pediatric patients. At the same time surgical community faced the challenge of matching the size of the adult donor’s graft to the volume of the child’s abdomen. Review of the literature presents historical aspects of transplantology, some approaches to measurement of the required liver parenchyma functional mass and methods to prevent complications associated with the usage of large LLS grafts in infants. In addition, the latest data on estimation of intra-abdominal pressure and development of intra-abdominal hypertension syndrome are also presented.

Liver Imaging Reporting and Data System:: Substantial Discordance Between CT and MR for Imaging Classification of Hepatic Nodules

The Liver Imaging Reporting and Data System (LI-RADS) is a newly developed nomogram for standardizing the performance and interpretation of liver imaging. However, it is unclear which imaging technique is optimal to exactly define LI-RADS scale. This study aims to determine the concordance of computed tomography (CT) and magnetic resonance imaging (MRI) for the classification of hepatic nodules (HNs) using a LI-RADS scoring system. Major imaging features (arterial hyper-enhancement, washout, pseudo-capsule, diameter, and tumor embolus) on CT versus MRI for 118 HNs in 84 patients with diffuse liver disease were rated independently using LI-RADS by two groups of readers. Inter-reader agreement (IRA) and intraclass agreement was determined by Fleiss and Cohen's kappa (κ). Logistic regression for correlated data was used to compare diagnostic ability. IRA was perfect for determination of nodule size and tumor embolus (κ = 0.94-0.98). IRA was moderate to substantial for determination of arterial hyper-enhancement, washout, and pseudo-capsule (κ = 0.54-0.72). Intraclass agreement between CT and MRI was substantial for determination of washout (0.632 [95% CI: 0.494, 0.771]) and pseudo-capsule (0.670 [95% CI: 0.494, 0.847]), and fair for arterial hyper-enhancement (0.203 [95% CI: 0.051, 0.354]). CT against MR produced false-negative findings of arterial hyper-enhancement by 57.1%, washout by 21.2%, and pseudo-capsule by 42.9%; and underestimated LI-RADS score by 16.9% for LR 3, 37.3% for LR 4, and 8.5% for LR 5. CT produced significantly lower accuracy (54.3% vs 67.8%, P < 0.001) and sensitivity (31.6% vs 71.1%, P < 0.001) than MRI in the prediction of malignancy. There are substantial discordance between CT and MR for stratification of HNs using LI-RADS. MRI could be better than CT in optimizing the performance of LI-RADS.

Clinical Features and Prognostic Significance of Liver Involvement in Sarcoidosis

Background:Sarcoidosis is a systemic disease, characterised by non-caseating granulomas in various organs. Liver involvement is not an uncommon feature of sarcoidosis. However, firm data establishing the clinical features and prognosis in these patients are lacking, although the incidence of liver sarcoidosis is high. In this study, we aimed to investigate the features of liver involvement in patients with sarcoidosis. Another aim was to evaluate the prognostic significance of liver disease by comparing the differences between patients with no liver involvement, limited and diffuse liver involvement.Methods:We conducted a retrospective study to evaluate the clinical and laboratory findings of 271 sarcoidosis patients seen at our institution. Patients with liver sarcoidosis identified by liver biopsy were compared to patients without liver involvement for clinical features and prognosis. The biopsy sample was considered positive if it demonstrated non-caseaiting granulomas with negative fungal and mycobacterial cultures. The patients were classified into three groups according to the radiological and histopathological biopsyresults:no liver involvement; limited liverinvolvement:two sites positive; and diffuse liverinvolvement:three or more sites positive for granulomas.Results:Hepatic involvement was identified by biopsy in 81 (81/271, 29.8%) while 43 (43/271, 15.8%) patients had elevated liver function tests. Most of the patients (94.6%) had lung involvement. Other organs involved, in the order of frequency,were:lymph nodes, skin, eye, spleen and parotid gland. There was no significant difference between the three groups for forced expiratory volume in one second, forced vital capacity, total lung capacity, diffusing capacity of the lungs for carbon monoxide/alveolar volume, serum and 24-hour urinary calcium levels. Serum angiotensin-converting enzyme levels were significantly higher (p&lt;0.01) in patients with diffuse liver involvement than patients with no or limited liver disease. Progressive disease was more frequent (p&lt;0.01) in patients with diffuse liver disease. Extra-pulmonary organ involvement was significantly different between the three groups (p&lt;0.01).Conclusions:Diffuse liver involvement in sarcoidosis is a significant risk factor for progressive disease. Patients with diffuse liver disease have a worse prognosis than patients without or with limited liver involvement. Diffuse hepatic involvement in sarcoidosis is also associated with an increased incidence of extra-pulmonary organ involvement. Presence of diffuse liver disease may reveal a severe prognosis for sarcoidosis patients.

Quality Improvement of Liver Ultrasound Images Using Fuzzy Techniques.

Background:Liver ultrasound images are so common and are applied so often to diagnose diffuse liver diseases like fatty liver. However, the low quality of such images makes it difficult to analyze them and diagnose diseases. The purpose of this study, therefore, is to improve the contrast and quality of liver ultrasound images.Methods:In this study, a number of image contrast enhancement algorithms which are based on fuzzy logic were applied to liver ultrasound images - in which the view of kidney is observable - using Matlab2013b to improve the image contrast and quality which has a fuzzy definition; just like image contrast improvement algorithms using a fuzzy intensification operator, contrast improvement algorithms applying fuzzy image histogram hyperbolization, and contrast improvement algorithms by fuzzy IF-THEN rules.Results:With the measurement of Mean Squared Error and Peak Signal to Noise Ratio obtained from different images, fuzzy methods provided better results, and their implementation - compared with histogram equalization method - led both to the improvement of contrast and visual quality of images and to the improvement of liver segmentation algorithms results in images.Conclusion:Comparison of the four algorithms revealed the power of fuzzy logic in improving image contrast compared with traditional image processing algorithms. Moreover, contrast improvement algorithm based on a fuzzy intensification operator was selected as the strongest algorithm considering the measured indicators. This method can also be used in future studies on other ultrasound images for quality improvement and other image processing and analysis applications.

ACTUAL PRINCIPLES OF THERAPY CHRONIC HEPATITIS OF VARIOUS ETIOLOGIES

The review analyzes the current understanding of the mechanisms of formation of liver fibrosis in chronic diffuse liver diseases. The urgency and importance of the clinical evaluation of the degree of fibrosis, are shown methods of early diagnosis of liver fibrosis and its progression are offered. The modern principles of treatment of chronic hepatitis of various etiologies based on numerous clinical and experimental studies described in domestic and foreign literature are presented. Detailed description of the main directions of comprehensive treatment program with the main characteristic of causal agents and pathogenetic therapy, the aim of which is to correct the universal units of liver fibrogenesis is shown. Reversibility of liver fibrosis at an effective antiviral therapy for patients with chronic viral hepatitis is convincinglu presented. At present time Further study of clinical and immunological aspects of fibrogenesis in chronic diffuse liver diseases for the improvement of anti-fibrotic therapy remains relevant.

Functional MR imaging of the liver

The diagnostics of diffuse liver disease traditionally rely on liver biopsies and histopathological analysis of tissue specimens. However, a liver biopsy is invasive and carries some non-negligible risks, especially for patients with decreased liver function and those requiring repeated follow-up examinations. Over the last decades, magnetic resonance imaging (MRI) has developed into a valuable tool for the non-invasive characterization of focal liver lesions and diseases of the bile ducts. Recently, several MRI methods have been developed and clinically evaluated that also allow the diagnostics and staging of diffuse liver diseases, e.g. non-alcoholic fatty liver disease, hepatitis, hepatic fibrosis, liver cirrhosis, hemochromatosis and hemosiderosis. The sequelae of diffuse liver diseases, such as a decreased liver functional reserve or portal hypertension, can also be detected and quantified by modern MRI methods. This article provides the reader with the basic principles of functional MRI of the liver and discusses the importance in a clinical context.

Transcranial Electrostimulation in Treatment of Chronic Diffuse Liver Diseases

Transcranial electrostimulation of hemodynamics of the liver, systemic microcirculation, severity of cytolytic syndrome, lipid peroxidation processes, and condition of enzyme antioxidant defense in patients with chronic diffuse liver diseases (CDLD) as a method of drug-free treatment of such patients is discussed.

Feasibility study for assessing liver fibrosis in paediatric and adolescent patients using real-time shear wave elastography.

The objective of this study was to evaluate the feasibility of shear wave elastography (SWE), as a non-invasive means of assessing liver fibrosis stage in paediatric and adolescent patients. Consecutive paediatric and adolescent subjects scheduled for liver biopsy (LB) evaluation of known or suspected diffuse liver disease were included after informed guardian consent and subject assent in this IRB-approved single institution study. Elastograms were acquired prior to liver biopsy, from the liver under a breath-hold after normal inspiration when possible. Biopsy specimens underwent blinded pathologist review using the METAVIR scoring system. Twenty-four patients (M : F = 13:11) with a mean age of 17 years (range: 1-21 years) underwent liver biopsy. The distribution of fibrosis on pathological examination was: F0 = 10, F1 = 9, F2 = 1, F3 = 3, and F4 = 1. Subjects with stages F0 and F1 fibrosis had a mean SWE value of 6.93 kPa (95% CI: 6.33-7.44 kPa) and 8.33 kPa (95% CI: 6.83-10.80 kPa) respectively. The SWE value for the one subject with stage F2 fibrosis was 6.36 kPa, whereas for F3 and F4 were 8.86 (95% CI: 5.70-11.40) and 17.85 kPa respectively. The correlation between SWE values and fibrosis grade was strong (r = 0.58, P = 0.003), and the area under the ROC curve differentiatiang ≥F2 fibrosis was 0.62 (95% CI: 0.26-0.98). Estimation of liver stiffness using real-time SWE is feasible using the SC6-1 ultrasound probe in paediatric and adolescent patients and strongly correlates with the stage of fibrosis.

Liver transplantation in children and adults

The article presents an analysis of modern domestic and foreign literature on the problems of liver transplantation in children and adults. Liver transplantation is performed for more than 50 years and it has become a reliable, rational way, and sometimes the only life-saving treatment for children and adults suffering from diffuse liver disease or unresectable tumors. Currently, the Russian Federation opened 14 centers for liver transplantation (in Moscow, St. Petersburg, Belgorod, Krasnodar, Irkutsk, Novosibirsk, Yekaterinburg and Nizhniy Novgorod), which is performed annually 200-240 operations. Estimated demand for the provision of this service is much higher: 52-64 center, and 2000-2500 operations per year. However, liver transplantation in children performs only in two centers in Moscow. Possibility of timely planning of liver transplantation in children of any age has now become a reality, but with a very limited capacity. Recently there has been improvement in diagnostic capabilities to identify various congenital and acquired diseases of the liver in children requiring liver transplantation. We can already predict the increase in demand for this type of surgery. In the North-Western Federal District is a center in which possible liver transplantation in adults, while the children’s opportunities for transplantation in the region do not have. The reasons leading to liver transplantation in children and adults are different. In adult practice dominated by cirrhosis in the outcome of chronic viral hepatitis B and C, whereas in children biliary atresia and congenital metabolic disorders.

Age dependence of spleen- and muscle-corrected hepatic signal enhancement on hepatobiliary phase gadoxetate MRI.

To identify correlations of signal enhancements (SE) and SE normalized to reference tissues of the spleen, kidney, liver, musculus erector spinae (MES) and ductus hepatocholedochus (DHC) on hepatobiliary phase gadoxetate-enhanced MRIwith patient age in non-cirrhotic patients. A heterogeneous cohort of 131 patients with different clinical backgrounds underwent a standardized 3.0-T gadoxetate-enhanced liver MRI between November 2008 and June 2013. After exclusion of cirrhotic patients, a cohort of 75 patients with no diagnosed diffuse liver disease was selected. The ratio of signal intensity 20min post- to pre-contrast administration (SE) in the spleen, kidney, liver, MES and DHC, and the SE of the kidney, liver and DHC normalized to the reference tissues spleen or MES were compared to patient age. Patient age was inversely correlated with the liver SE normalized to the spleen and MES SE (both p < 0.001) and proportionally with the SE of the spleen (p = 0.043), the MES (p = 0.030) and the kidney (p = 0.022). No significant correlations were observed for the DHC (p = 0.347) and liver SE (p = 0.606). The age dependence of hepatic SE normalized to the enhancement in the spleen and MES calls for a cautious interpretation of these quantification methods. • Patient age was inversely correlated with spleen- and MES-corrected liver rSE (p < 0.001). • Patient age was correlated with spleen (p = 0.043) and MES SE (p = 0.030). • Patient age may confound quantitative liver function assessment using gadoxetate-enhanced liver MRI.

Imaging-Based Liver Function Tests--Past, Present and Future.

Preoperative assessment of liver function and prediction of postoperative functional reserve are important in patients scheduled for liver resection. While determination of absolute liver function currently mostly relies on laboratory tests and clinical scores, postoperative remnant liver function is estimated volumetrically using imaging data obtained with computed tomography (CT) or magnetic resonance imaging (MRI). Accurate estimation of hepatic function is also relevant for intensive care patients, oncologic patients, and patients with diffuse liver disease. The indocyanine green (ICG) test is still the only established test for estimating true global liver function. However, more recent tools such as the LiMAx test also allow global assessment of hepatic function. These tests are limited when liver function is inhomogeneously distributed, which is the case in such conditions as unilateral cholestasis or after portal vein embolization. Imaging-based liver function tests were first developed in nuclear medicine and, compared with laboratory tests, have the advantage of displaying the spatial distribution of liver function. Nuclear medicine scans are obtained using tracers such as 99mTc galactosyl and 99mTc mebrofenin. Liver function is typically assessed using planar scintigraphy. However, three-dimensional volumetry is possible with single-photon emission computed tomography (SPECT-CT). Another technique for image-based liver function estimation is Gd-EOB-enhanced MRI. While metabolization of Gd-EOB in the body is similar to that of ICG and mebrofenin, its distribution in the liver can be displayed by MRI with higher temporal and spatial resolution. Moreover, MRI-based determination of liver function can be integrated into routine preoperative imaging. This makes MRI an ideal candidate for preoperative determination of liver function, though the best pulse sequence and the parameter to be derived from the image information remain to be identified. Another question to be answered is how the results may be affected by renal function and the presence of hyperbilirubinemia. As more results from clinical evaluation including comparison with postoperative liver function data become available, image-based liver function tests, especially with use of Gd-EOB as the contrast medium, have the potential to add another dimension to preoperative imaging. Liver function consists of a multitude of subfunctions such as biotransformation, excretion and storage. Global liver function tests are score-based tests such as Child-Pugh or MELD as well as the ICG- and LiMAx-test. Imaging-based liver function tests add spatial information. Current clinical standard is the 99mTc-Mebrofenin-scintigraphy. MRI-based function tests with Gd-EOB-DTPA have the potential to integrate seamlessly into clinical workup, feature a higher temporal and spatial resolution and do not rely on ionizing radiation.

State-of-the-art cross-sectional liver imaging: beyond lesion detection and characterization.

Cross-sectional imaging with computed tomography or magnetic resonance imaging is routinely used to detect and diagnose liver lesions; however, these examinations can provide additional important information. The improvement of equipment and techniques has allowed outstanding evaluation of the vascular and biliary anatomy, which is practicable in most routine examinations. Anatomical variants may exclude patients from certain therapeutic options and may be the cause of morbidity or mortality after surgery or interventional procedures. Diffuse liver disease, such as steatosis, hemochromatosis, or fibrosis, must be diagnosed and quantified. Usually these conditions are silent until the late stages, and imaging plays an important role in detecting them early. Additionally, a background of diffuse disease may interfere in a focal lesion systematic reasoning. The diagnostic probability of a particular nodule varies according to the background liver disease. Nowadays, most diffuse liver diseases can be easily and accurately quantified by imaging, which has allowed better understanding of these diseases and improved patient management. Finally, cross-sectional imaging can calculate total and partial liver volumes and estimate the future liver remnant after hepatectomy. This information helps to select patients for portal vein embolization and reduces postoperative complications. Use of a specific hepatic contrast agent on magnetic resonance imaging, in addition to improving detection and characterization of focal lesions, provides functional global and segmental information about the liver parenchyma.

PWE-090 Does my patient–s normal liver biopsy mean they won't develop liver disease?

Introduction Liver biopsy remains a commonly used investigation amongst patients with abnormal liver biochemistry and normal serology, both in the diagnosis and staging of liver disease. Although commonly considered the “gold standard” it typically samples approximately 1/50,000thof the total liver mass and as such diffuse liver disease could plausibly be missed.1It is associated with complications of pain and bleeding and has a small but appreciable mortality (0.01–0.17%).2We report follow up data from a Nottinghamshire cohort of patients with abnormal liver biochemistry and normally reported liver biopsy between 1992–2001. We aim to assess whether a normal liver biopsy in the context of abnormal liver biochemistry is protective against development of and death from chronic liver disease. Method Patients with a normally reported liver biopsy and abnormal liver chemistry from Nottingham University Hospitals between 1992–2001 were identified from retrospective scrutiny of local Histopathology databases. Patient notes and computer records as of 1stJanuary 2015 were analysed to assess mortality, cause of death (where applicable), and development of cirrhosis. Office of National Statistics (ONS) UK population data was used to provide a comparable “control” group. Results 171 patients were identified. 32 (18.7%) were known to have died by 1stJan 2015. Of those who had died, 2 (6.5%) had hepatocellular carcinoma secondary to cirrhosis recorded as cause of death. This figure is significantly higher than the 1.53% of deaths attributed to liver disease in the UK population in 2010.3We intend to report on the incidence of cirrhosis in the remainder of the cohort as compared to a matched control population. Conclusion Our data suggest that a normal liver biopsy in the presence of abnormal liver biochemistry does not protect against future death from complications of chronic liver disease. We question whether alternative non-invasive markers of fibrosis could potentially have comparable or superior value in predicting development of cirrhosis and death from liver disease in this patient group. Disclosure of interest None Declared. References Guido M, Rugge M. Liver biopsy sampling in chronic viral hepatitis. Semin Liver Dis. 2004;24(1):89–97 Grant A, Neuberger J. Guidelines on the use of liver biopsy in clinical practice. BSG. See comment in PubMed Commons below Gut. 1999;45(Suppl 4):IV1–IV11 Office of National Statistics – Mortality statistics – England and Wales, 2010