Liver Spleen Index Research Articles

СОВРЕМЕННЫЕ ВОЗМОЖНОСТИ МЕТОДОВ ЛУЧЕВОЙ ДИАГНОСТИКИ В ОЦЕНКЕ ТЯЖЕСТИ ЖИРОВОГО ГЕПАТОЗА ПРИ НЕАЛКОГОЛЬНОЙ ЖИРОВОЙ БОЛЕЗНИ ПЕЧЕНИ (КЛИНИЧЕСКИЙ СЛУЧАЙ)

Purpose: To estimate the potential of imaging methods in the diagnosis of non-alcoholic fatty liver disease (NAFLD) based on the example of a clinical case. Material and methods: A 42 years-old man with suspected of NAFLD, by the clinical and laboratory tests results, underwent a quantitative assessment of fatty hepatosis using radiodiagnosis imaging methods. We used US “liver protocol” with attenuation imaging technique (ATI), shear wave elastography (SWE), shear wave dispersion imaging (SWD), computed tomography (CT) with quantitative and qualitative assessment using the liver-spleen index (CTL-S); MRI with application that provides volumetric whole-liver fat fraction (FF) measurements by proton density (PDFF), on the basis of IDEAL IQ program. The morphological verification of liver biopsy was also performed. Results: All imaging method used in this clinical case showed severe degree of fatty hepathosis, that correlated with biopsy of liver. In repeated studies, on the background of treatment, the quantitative indicators of all imaging methods had a similar dynamics of reduction of the degree of fatty hepatosis. Conclusion: The clinical case of verified acute steatohepatitis shows the possibilities of its diagnostics by means of the radiation modalities. We used US with ATI, SWE и SWD, CT with CTL-S, MRI with FF that demonstrated high diagnostic efficiency for determination fatty hepatosis and the possibility of its quantification. These technologies are suitable for widespread implementation into clinical practice providing good diagnostic accuracy. CT associated with higher doses of radiation is not considered to be the basic method of choice for diagnosing NAFLD, but still may provide a physician with necessary information to determine further treatment strategy.

Improved parenchymal liver enhancement with extended delay on Gd-EOB-DTPA-enhanced MRI in patients with parenchymal liver disease: associated clinical and imaging factors

To establish the effect of prolonged hepatobiliary phase (HBP) delay time on hepatic enhancement in patients with parenchymal liver disease (PLD). Gadoxetate disodium (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) examinations with HBP were obtained after 20- (HBP-20) and 30-minute (HBP-30) delays in patients with PLD. For each patient, the Model for End-Stage Liver Disease (MELD) score, total and direct bilirubin, aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), prothrombin time (PT), and partial thromboplastin time (PTT) were recorded. Signal intensities of the liver, main portal vein, and spleen on pre-contrast, HBP-20, and HBP-30 were documented. Signal intensities were used to calculate liver relative enhancement (LRE), liver-spleen index (LSI), and liver-portal vein index (LPI) for HBP-20 and HBP-30. Improved hepatic enhancement was considered if two or more indices were higher on HBP-30 than HBP-20. A logistic regression model was constructed with improved hepatic enhancement as the outcome. One hundred and twenty-nine patients underwent 142 MRIs. Mean LRE, LSI, and LPI each increased from HBP-20 to HBP-30 (p = 0.004, p < 0.001, and p < 0.001, respectively). Seventy-two point five percent of cases demonstrated improved hepatic enhancement. The odds ratios for improved hepatic enhancement were 0.85 for MELD score (p = 0.02) and 3.2 for the 3 T scanner (p = 0.02), adjusted for age and sex. Increasing HBP delay to 30 minutes improves hepatic enhancement in patients with PLD, particularly if using a 3 T scanner. This effect is attenuated with higher MELD scores.

Factors Affecting the Quantitative Liver?Spleen Scan in Normal Individuals

The quantitative liver-spleen scan (QLSS) can estimate the functional hepatic mass and the organ volumes by precise measurement of sulfur colloid (SC) distribution. The normal range determined in prior studies was estimated from patients with absence of chronic liver disease in which intense fasting appeared to produce slightly abnormal values. This study was to determine the effect of fasting or fed status and colloid particle size on quantitative measurements from the QLSS in a small cohort of normal individuals. Twelve persons without any medical problems had QLSS taken twice, 2 weeks apart, one fasting and one postprandial. Patients were scanned after injection of 5-6 mCi of SC; six patients were given solution A (5- to 12-microm particle size) and six patients solution B (2- to 12-microm particle size). SPECT and planar analysis were performed. SC distribution of total counts between the liver and the spleen {[L/(L + S)]t ratio}, liver-spleen index (LSI), and liver-bone marrow index (LBI) were calculated. The perfused hepatic mass (PHM) is the average of the LSI and LBI. Spleen and liver volumes are expressed as milliliters per pound ideal body weight (IBW). Results showed that the liver and spleen volumes (solution B postprandial, 9.27 +/- 2.48 and 1.47 +/- 0.57 ml/lb IBW, respectively) and LBI were not affected by the type of SC solution or by ingestion status. L/(L + S) total and pixel count ratios were significantly higher for solution B and postprandial studies. [L/(L + S)]t, LSI, and PHM increased significantly (P < 0.05) from fasting to postprandial for solution A (0.71 +/- 0.13 vs 0.79 +/- 0.08, 80 +/- 14 vs 91 +/- 8, and 102 +/- 10 vs 106 +/- 8, respectively) and for solution B (0.81 +/- 0.05 vs 0.90 +/- 0.02, 86 +/- 4 vs 95 +/- 3, and 101 +/- 5 vs 110 +/- 3). Neither fasting nor postprandial LSI and PHM were significantly different between solution A and solution B. We conclude the following. (1) The QLSS functional indices in "true" normal patients fall within the previously reported normal range. (2) Calculated liver and spleen volumes are not altered by fasting or sulfur colloid particle size. (3) Fasting significantly decreased the [L/(L + S)]t, LSI, and PHM. (4) A postprandial scan may be preferable since the normal values for [L/(L + S)]t, LSI, and PHM are greater, with a narrower range, than fasting values.

Perfused Kupffer cell mass

The perfused Kupffer cell mass determines sulfur colloid distribution by liver spleen scan (LSS) and is proportional to the perfused hepatocyte mass. This accounts for the correlation of sulfur colloid distribution with tests of hepatic function and raises the question of whether the LSS can be used as a quantitative test of hepatic function. The recent ability to precisely measure sulfur colloid distribution by single-photon-emission computerized tomography (SPECT) prompted us to evaluate the clinical value in 329 consecutive patients with adequate LSS and clinical information, of which 27 apparent normals and 220 patients with chronic liver disease (CLD) were included in this study. The liver-bone marrow index (LBI) indicated the distribution of counts between the liver and bone marrow. The liver-spleen index (LSI) indicated the distribution between liver and spleen adjusted for spleen size. The LBI and LSI correlated with each other (r = 0.753; P < 0.001). The arithmetic mean of LBI and LSI was defined as the severity score. Detailed clinical evaluation was available in these patients and included 109 who had liver biopsy. A severity score in 27 normals was 102 +/- 5 (mean +/- SD) with all values > 85. The severity score correlated with hepatic fibrosis (r = -0.694; P < 0.001) in 109 patients with benign liver disease who had recent biopsies and with the Child-Pugh classification (r = 0.78; P < 0.001) in 220 patients with CLD.(ABSTRACT TRUNCATED AT 250 WORDS)