Liver-spleen Ratio Research Articles

Morphological Changes of Liver Among Post-Fontan Surgery Patients

Abstract Purpose Liver screening and longitudinal study of Fontan Associated Liver Diseases (FALD) is essential to identifying hepatomegaly and how hepatomegaly relates to various stages of liver fibrosis. In this study, we investigated longitudinal liver shape changes and liver stiffness in a cohort of patients with Fontan Associated Liver Disease. Methods We used 170 image volumes of 40 Fontan stage 3 completion patients. We also used 65 computed tomography images of healthy individuals from three datasets for comparison. Thirteen radiomic shape features of Fontan patients and individuals with a healthy liver were extracted and analyzed longitudinally. We studied correlations among features, liver spleen ratio, and liver stiffness with shape features. Results The enlargement of the liver, along with all shape features, was observed in all post-surgery intervals related to hepatomegaly and fibrosis. The shape features of healthy individuals and Fontan cases differ significantly in the longitudinal analysis and in the liver-spleen ratio. There is a positive correlation among body mass index, body surface area, age, Fontan surgery years, and liver stiffness. Conclusion The changes in shape features between Fontan patients and healthy subjects are statistically significant, which shows the relation for hepatomegaly and liver fibrosis. Accurate delineation of these features with artificial intelligence-based segmentation could serve as a valuable adjunct for the clinical follow-up of Fontan patients.

Tirzepatide, a dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide 1 receptor agonist, exhibits favourable effects on pancreatic β-cells and hepatic steatosis in obese type 2 diabetic db/db mice.

Tirzepatide, a dual agonist of glucagon-like peptide receptor and glucose-dependent insulinotropic polypeptide receptor, is expected to exhibit high clinical efficacy in obese type 2 diabetic patients. We evaluated the effects of tirzepatide on pancreatic β-cells and the liver, an insulin-target organ, in a mouse model of obese type 2 diabetes mellitus. Obese type 2 diabetic db/db mice (BKS.Cg-/+ Leprdb/+ Leprdb/Jcl*) were used in this study. Starting at 7 weeks of age, mice were treated with tirzepatide (30 nmol/kg, subcutaneous injection twice a week) or semaglutide (200 nmol/kg, subcutaneous injection twice a week). The control group received phosphate-buffered saline (40-50 μL/subcutaneous injection twice a week). After 4 weeks of drug administration, pancreatic β-cells and the liver were removed and examined. Compared to the control group, blood glucose and body weight were significantly reduced in the group that received either tirzepatide or semaglutide (p < 0.001 and p < 0.05, respectively). Fasting insulin was significantly higher in the semaglutide and tirzepatide groups compared to the control group (p < 0.001). β-Cell mass and quality of insulin granules in β-cells similarly increased in the semaglutide and tirzepatide groups compared to the control group (p < 0.05 and p < 0.001, respectively). The fat staining area in the liver in oil red O staining and the liver-spleen ratio in computed tomography showed improvement only in the tirzepatide group (p < 0.001 and p < 0.005, respectively). Liver macrophage M1/M2 ratio similarly improved with semaglutide and tirzepatide (p < 0.05). Tirzepatide and semaglutide exhibited similar potent glucose-lowering effects. At concentrations used in the present experiments, tirzepatide exhibited more beneficial effects on β-cell-related gene expression, insulin granule count and glucose-stimulated insulin secretion compared to semaglutide. In addition, tirzepatide exhibited a stronger favourable effect on hepatic fat deposition and improved inflammation in the liver. This is the first report showing that tirzepatide, a novel diabetes drug, exhibits a superior effect on pancreatic β-cells and the liver of obese type 2 diabetic mice.

Faster rehabilitation weight gain is associated with liver fat in adult survivors of childhood severe acute malnutrition

BackgroundNutritional rehabilitation during severe acute malnutrition (SAM) aims to quickly restore a healthy body weight, but rapid weight gain has been associated with later cardiovascular risk. We hypothesized that faster weight gain during SAM rehabilitation and post-hospitalization is associated with liver fat in adult survivors.MethodJamaican adult survivors of childhood SAM underwent abdominal CT scan to estimate liver fat as mean liver attenuation (MLA) and liver spleen ratio (L/S). Birth weight (BW) and anthropometry measured during, and post-hospitalization were abstracted from admission records.ResultsWe studied 42 marasmus survivors (MRs) and 40 kwashiorkor survivors (KWs). MRs had a lower mean BW (SD) 2.5 (0.8) vs 3.0 (0.7) kg; p=0.01) and were more wasted (p&lt;0.001) and stunted (p=0.03) than KWs on admission to hospital. MRs and KWs had similar rates of rehabilitation weight gain, which was inversely associated with MLA among all survivors of SM (r=-0.246, p=0.029), but only in MRs when assessed by diagnosis (r= -0.449, p=0.004). The association between rehabilitation weight gain and adult liver fat in MRs was not altered by BW, admission wasting or stunting. In KWs, post-hospitalization height gain was inversely associated with MLA (difference = -0.64, 95%CI: -0.64 to -0.13; p=0.006).ConclusionsFaster rehabilitation weight gain is associated with liver fat in adult survivors of childhood severe acute malnutrition. The finding that BW did not influence these outcomes may reflect the timing of the nutritional insult in utero. Target weight gain during nutritional rehabilitation may need to be lowered to optimize long-term outcomes in these children.

Liver–Spleen Ratio: Can It Be Used for the Prediction of Coronary Artery Disease?

Considering that ectopic fat accumulation in various organs, especially the heart and liver, is a cardiometabolic risk factor, the need for easily accessible markers of ectopic fat accumulation is inevitable. The main starting point of the study is based on the hypothesis of predicting cardiovascular disease risk through the link that can be established between the liver-spleen ratio, which is one of the strong indicators of hepa- tosteatosis, and epicardial adipose tissue volume. This was a retrospective study. The records of 283 consecutive patients who underwent coronary computed tomography angiography in our Radiology Department were reviewed retrospectively from our hospital's system. All patients' epicardial adipose tissue volume and liver-spleen ratio were calculated using appropriate criteria on non- contrast computed tomography images. Additionally, the Coronary Artery Disease- Reporting and Data System was calculated on contrast computed tomography images. The participating patients were divided into groups according to the liver-spleen ratio and Coronary Artery Disease-Reporting and Data System score. We found that while there was a negative correlation between the liver-spleen ratio and epicardial adipose tissue volume in the hepatosteatosis group, this relationship was not observed in the non-steatosis group. In addition, we observed that the family his- tory of cardiovascular disease and the frequency of cardiovascular disease were higher in the hepatosteatosis group than in the other group, and there was a correlation between cardiovascular disease and the liver-spleen ratio. Also, we found that age and liver- spleen ratio values were found to be independent predictors of coronary artery disease. In our study, we found that the frequency of cardiovascular disease was lower in patients with a high liver-spleen ratio. We also demonstrated in the study that the liver-spleen ratio, which indicates a low level of epicardial adipose tissue volume accumulation, is an independent predictor of cardiovascular disease. In addition, the use of liver-spleen ratio, which is more valuable than liver attenuation in predicting hepatic steatosis, may be more useful in evaluating the risk of hepatosteatosis-related cardio- vascular disease.

Prognostic significance of liver CT-attenuation and 18F-FDG uptake for predicting hepatic recurrence following curative resection of colorectal cancer.

This study investigated the predictive values of computed tomography (CT)-attenuation and fluorine-18-fluorodeoxyglucose (18F-FDG) uptake in the liver for the hepatic recurrence of colorectal cancer. This study retrospectively included 257 colorectal cancer patients who underwent staging 18F-FDG positron emission tomography (PET)/CT and were subsequently treated with curative surgical resection. Using non contrast-enhanced CT images in PET/CT, the liver-spleen ratio and liver-spleen difference of CT-attenuation and CT-attenuation of the liver were calculated. The maximum and mean 18F-FDG uptake in the liver was measured using the PET images. The relationship of these five liver parameters to recurrence-free survival (RFS), hepatic RFS, and extrahepatic RFS was assessed. In univariate survival analysis, the liver-spleen ratio, liver-spleen difference, and maximum 18F-FDG uptake of the liver were significant predictors of both RFS and hepatic RFS (P<0.05), whereas none of the five liver parameters were significantly associated with extrahepatic RFS (P>0.05). Patients with a low liver-spleen ratio and liver-spleen difference and a high maximum 18F-FDG uptake showed better hepatic RFS than those with a high liver-spleen ratio and liver-spleen difference and a low maximum 18F-FDG uptake. In multivariate analysis, the liver-spleen ratio, liver-spleen difference, and maximum 18F-FDG uptake of liver remained significant predictors for hepatic RFS after adjusting for age, sex, obesity, andstage (P<0.05). Computed tomography-attenuation and maximum 18F-FDG uptake in the liver on 18F-FDG PET/CT were significant predictive factors for hepatic RFS in patients with colorectal cancer after curative resection.

Fat signal fraction assessed with MRI predicts hepatic recurrence following hepatic resection for colorectal liver metastases.

The effect of hepatic steatosis on the development of colorectal liver metastases (CRLM) remains unknown. This study evaluated the usefulness of fat signal fraction assessed with magnetic resonance imaging (MRI) and the effect of hepatic steatosis on hepatic recurrences following initial hepatectomy for CRLM. Between January 2013 and December 2019, 64 patients underwent initial hepatectomy for CRLM. The medical records of these patients were reviewed to evaluate the recurrence and survival outcomes. The fat signal fraction was positively correlated with the nonalcoholic fatty liver disease activity score and liver-spleen ratio. Recurrence following the initial hepatectomy was observed in 48/64 patients, and hepatic recurrence was observed in 30/64 patients. The fat signal fraction was significantly higher in patients with hepatic recurrence after initial hepatectomy. The hepatic recurrence rate was 69.2% in patients with fat signal fraction ≥ 0.0258, which was significantly higher than that in patients with fat signal fraction < 0.0258. Hepatic recurrence-free survival rate was significantly higher in patients with fat signal fraction < 0.0258 than in those with fat signal fraction ≥ 0.0258. Multivariate analyses revealed that fat signal fraction ≥ 0.0258 was an independent risk factor for hepatic recurrence. The fat signal fraction assessed with MRI was significantly associated with hepatic recurrence following initial hepatectomy for CRLM.

Quantitative evaluation of liver function with gadoxetic acid enhanced MRI: Comparison among signal intensity-, T1-relaxometry-, and dynamic-hepatocyte-specific-contrast-enhanced MRI- derived parameters

Aims Three types of gadoxetic acid enhanced MRI parameters have been proposed to quantify liver function. However, until now there is no consensus on which one that has the greatest potential for use in clinical practice. This study was conducted to compare the efficacy of three types of gadoxetic acid enhanced MR parameters for quantitative assessment of liver function. Methods Imaging data of 10 patients with chronic liver disease and 20 healthy volunteers were analyzed. Parameters based on signal intensity(SI), T1 changes or dynamic-hepatocyte-specific-contrast-enhancement MR were calculated. Their mutual correlations, discriminatory capacity between cirrhotic and healthy liver and correlations with Child-Pugh score and Model for end-stage liver-disease (MELD) were estimated. Results The strongest correlations were observed between relative enhancement of the liver and T1 time at 20 min after contrast agent injection, and between liver-spleen contrast ratio at 20 min after contrast agent injection and hepatic uptake rate (|r|> 0.90, p < .05, both). All parameters but input-relative blood flow (p = 0.17) were significantly different between patient and control group (p < .05), with AUROCs of liver-to-muscle ratio (LMR), increase of LMR and hepatic extraction fraction greater than 0.90 (p < .05). Liver-to-spleen ratio, LMR and hepatic uptake index presented a strong correlation with Child-Pugh score and MELD (|r|> 0.8, p < .05). Conclusion Simple SI-based parameters were as good as more complex parameters in evaluating liver function at gadoxetic acid enhanced MR. In clinical routine LMR seems to be the easiest-to-use parameter for quantitative evaluation of liver function.

Prognostic value of baseline imaging and clinical features in patients with advanced hepatocellular carcinoma

SummaryAimsTo investigate the prognostic value of baseline imaging features for overall survival (OS) and liver decompensation (LD) in patients with hepatocellular carcinoma (HCC).DesignPatients with advanced HCC from the SORAMIC trial were evaluated in this post hoc analysis. Several radiological imaging features were collected from baseline computed tomography (CT) and magnetic resonance imaging (MRI) imaging, besides clinical values. The prognostic value of these features for OS and LD (grade 2 bilirubin increase) was quantified with univariate Cox proportional hazard models and multivariate Least Absolute Shrinkage and Selection Operator (LASSO) regression.ResultsThree hundred and seventy-six patients were included in this study. The treatment arm was not correlated with OS. LASSO showed satellite lesions, atypical HCC, peritumoral arterial enhancement, larger tumour size, higher albumin–bilirubin (ALBI) score, liver–spleen ratio <1.5, ascites, pleural effusion and higher bilirubin values were predictors of worse OS, and higher relative liver enhancement, smooth margin and capsule were associated with better OS. LASSO analysis for LD showed satellite lesions, peritumoral hypointensity in hepatobiliary phase, high ALBI score, higher bilirubin values and ascites were predictors of LD, while randomisation to sorafenib arm was associated with lower LD.ConclusionsImaging features showing aggressive tumour biology and poor liver function, in addition to clinical parameters, can serve as imaging biomarkers for OS and LD in patients receiving sorafenib and selective internal radiation therapy for HCC.

Prediction of post-hepatectomy liver failure using gadoxetic acid-enhanced magnetic resonance imaging for hepatocellular carcinoma with portal vein invasion

PurposeAccurate prediction of post-hepatectomy liver failure (PHLF) is important in advanced hepatocellular carcinoma (HCC). We aimed to retrospectively evaluate the utility of gadoxetic acid-enhanced MRI for predicting PHLF in patients who underwent anatomic hepatectomy for HCC with portal vein invasion. MethodsForty-one patients (32 men, 9 women) were included. Hepatobiliary-phase MR images were acquired 20 min after injection of gadoxetic acid using a 3D fat-suppressed T1-weighted spoiled gradient-echo sequence. Liver-spleen ratio (LSR), remnant hepatocellular uptake index (rHUI), and HUI were calculated. The severity of PHLF was defined according to the International Study Group of Liver Surgery. Differences in LSR between the resected liver and the remnant liver, and HUI and rHUI/HUI between no/mild and severe PHLF were compared using the Wilcoxon signed-rank test and Wilcoxon rank-sum test, respectively. Univariate and multivariate logistic regression analyses were performed to identify predictors of severe PHLF. Areas under the receiver operating characteristic curves (AUCs) of rHUI and rHUI/HUI were calculated for predicting severe PHLF. ResultsNine patients developed severe PHLF. LSR of the remnant liver was significantly higher than that of the resected liver (P < 0.001). Severe PHLF demonstrated significantly lower rHUI (P < 0.001) and rHUI/HUI (P < 0.001) compared with no/mild PHLF. Multivariate logistic regression analysis showed that decreased rHUI (P = 0.012, AUC=0.885) and rHUI/HUI (P = 0.002, AUC=0.852) were independent predictors of severe PHLF. ConclusionGadoxetic acid-enhanced MRI can be a promising noninvasive examination for assessing global and regional liver function, allowing estimation of the functional liver remnant and accurate prediction of severe PHLF before hepatic resection.

Nonalcoholic Fatty Liver Disease in Nonobese Subjects of African Origin Has Atypical Metabolic Characteristics.

BackgroundNonobese nonalcoholic fatty liver disease is reported in several populations. However, because persons of African origin display unique fat accumulation, insulin resistance, and lipid profiles, we investigated fatty liver in nonobese persons of African origin.MethodWe recruited 78 urban Jamaican volunteers. CT was used to estimate liver and abdominal fat and dual-energy X-ray absorptiometry to measure body composition. Fasting blood was collected for lipids, alanine aminotransferase (ALT), adiponectin, and fetuin-A. Homeostatic model assessment of insulin resistance (HOMA-IR), whole-body insulin sensitivity index (WBISI), insulinogenic index (IGI), and oral disposition index (oDI) were calculated after a 75-g oral glucose tolerance test.ResultsFifty-two percent of participants were male; mean (±SD) age was 28.5 ± 7.8 years, and body mass index was 22.4 ± 3.0 kg/m2. Mean liver attenuation (MLA) and liver/spleen (LS) ratio, both inversely correlated to liver fat, were 62.8 ± 4.3 HU and 1.2 ± 0.1, respectively; 3.8% of participants had liver fat >30% (LS ratio < 1). In age, sex, and BMI-adjusted correlations, MLA was negatively associated with weight (r = −0.30; P = 0.009) and height (r = −0.28; P = 0.017) and was associated with fasting glucose (r = 0.23; P = 0.05), fasting insulin (r = 0.42; P ≤ 0.001) and HOMA-IR (r = 0.35; P = 0.004). Serum lipids, ALT, adiponectin, fetuin-A, WBISI, IGI, and oDI were not associated with liver fat.ConclusionsIn nonobese Afro-Caribbean participants, greater liver fat was associated with weight and height and lower fasting insulin and hyperinsulinemia appears to be influential in the reduction of NAFLD. These findings may be influenced by ethnicity, body size, and method of estimating liver fat.

Independent markers of nonalcoholic fatty liver disease in a gentrifying population-based Chinese cohort.

Prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing in developing countries, but its causes are not known. We aimed to ascertain the prevalence and determinants of NAFLD in a new largely unmedicated population-based cohort from the rapidly gentrifying region of Pinggu, China. We randomized cluster sampled 4002 Pinggu residents aged 26 to 76years. Data from 1238 men and 1928 women without significant alcohol drinking or hepatitis virus B or C infection were analysed. NAFLD was defined using a liver-spleen ratio (L/S ratio) ≤1.1 on unenhanced abdominal computed tomography (CT) scanning. Of men and women, 26.5% and 20.1%, respectively, had NAFLD. NAFLD prevalence was highest in younger men and older women. In multivariate logistic regression models, higher body mass index, waist circumference, serum triglyceride, alanine transaminase, and haemoglobin A1c independently increased the odds of NAFLD in both men and women separately. Higher annual household income and systolic blood pressure for men and higher serum uric acid and red meat intake and lower physical activity levels for women also independently associated with higher odds of NAFLD. Individuals with L/S ratio ≤1.1 had linearly increasing rates of obesity, diabetes, and metabolic syndrome that paralleled fatty liver increase. NAFLD is common in a gentrifying Chinese population particularly in younger men of high socioeconomic status and older women with sedentary behaviour who eat red meat. Demographic factors add independent risk of NAFLD above traditional metabolic risk factors. A CT L/S ratio of ≤1.1 identifies individuals at high risk of metabolic disease.

Cognitive function observation and clinical features of 100 cases of elderly patients with non-alcoholic fatty liver disease

Objective To observe the changes of cognitive function, clinical characteristics and hippocampal structure in elderly patients with non-alcoholic fatty liver disease (NAFLD). Methods From December 2014 to June 2016, at Department of Geriatrics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 169 elderly hospitalized patients who underwent health checkups were enrolled and divided into NAFLD group and non-NAFLD group. The clinical data of two groups were collected, and the Montreal cognitive assessment scale (MoCA) was used for cognitive function assessment. The serum level of soluble transferrin receptor (sTfR) was detected, the liver-spleen ratio was measured and hippocampal proton magnetic resonance spectroscopy (1H-MRS) was performed. T test and linear regression analysis were used for statistical analysis. Results Among the 169 elderly patients, 100 were NAFLD and 69 were non-NAFLD. The body mass index(BMI) and waist-to-hip ratio(WHR)of patients in NAFLD group were (25.9±3.4) kg/m2 and 1.03±0.13, respectively, which were higher than those in non-NAFLD group ((24.2±3.7) kg/m2 and 0.95±0.06), and the differences were statistically significant (t=-2.714 and -3.605, both P<0.01). MoCA score of the patients in NAFLD group was 20.1±5.8, which was lower than that in non-NAFLD group (22.1±4.4), and the difference was statistically significant(t=2.154, P=0.033). The serum sTfR level and liver-spleen computed tomography(CT) ratio of NAFLD group were (8.78±4.31) mg/L and 0.97±0.12, respectively, which were lower than those of non-NAFLD group ((12.66±3.93) mg/L and 1.19±0.15), and the differences were statistically significant(t=3.765 and 6.142, both P<0.01). The CT ratio of liver to spleen (β=7.597, 95% confidence interval(CI): 2.938 to 12.935) and sTfR (β= 0.552, 95%CI: 0.304 to 0.787) were positively correlated with cognitive function in elderly patients (both P<0.01). The height of right hippocampus of NAFLD group was (0.410±0.074) mm, which was lower than that of non-NAFLD group ((0.453±0.086) mm), and the difference was statistically significant (t=2.078, P=0.042). Conclusion Cognitive impairment in elderly NAFLD patients is closely related to iron load and liver fat. Key words: Cognition; Non-alcoholic fatty liver disease; Soluble transferrin receptor; Proton magnetic resonance spectroscopy

Usefulness of functional remnant liver volume assessment using EOB-MRI to predict posthepatectomy liver failure in hepatectomy of more than one segment

Introduction: Several reports described Gd-EOB-DTPA-enhanced MRI (EOB-MRI) can be potentially used for evaluation of liver function. This modality has better versatility and spatial resolution compared with 99mTc-GSA scintigraphy. We assessed whether functional remnant liver volumetry (FRLV) using EOB-MRI predicted post hepatectomy liver failure (PHLF). Method: We retrospectively analyzed 114 cases performed hepatectomy of more than one segment (MOS). Signal intensity (SI) of remnant liver were measured by putting region of interest in T1WI image. SI of spinal erector muscle and spleen were calculated for standardization of SI value. Functional remnant liver score was derived in division of average SI of liver by average SI of muscle (or spleen) as liver-muscle ratio(LMR) and liver-spleen ratio(LSR), respectively. Future remnant volume was calculated by volume analyzer, then FRLV was calculated by multiplying LMR(or LSR) and remnant volume. Standardized FRLV(sFRLV) was calculated by dividing FRLV by body surface area. Definition of PHLF is used ISGLS classification. Results: LMR correlated with ICG-R15(p=0.004), but not LSR, FRLV or sFRLV. PHLF(≥GradeB) occurred in 5 patients (4.4%). In univariate analysis, predictive factors of PHLF were operative time(p=0.010), blood loss(p=0.013), FRLV(LMR) (p=0.021), sFRLV(LMR)(p=0.015), FRLV(LSR)(p=0.040), and sFRLV(LSR)(p=0.044). In multivariate analysis, only sFRLV(LMR) was independent predictive factor of PHLF(p=0.042). ROC analysis revealed that cut-off value of sFRLV(LMR) predicting PHLF was 599ml/m2(AUC: 0.913). In analysis of PTPE cases (n=17), 10 cases over cut-off of sFRLV did not occur PHLF, but 7 cases lower than cut-off occurred PHLF in 4 patients (57%) (p=0.019). Conclusion: sFRLV using EOB-MRI predicts PHLF in hepatectomy of MOS.

Evaluation of liver function using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid enhanced magnetic resonance imaging based on a three-dimensional volumetric analysis system

BackgroundMagnetic resonance imaging with gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (EOB-MRI) is a diagnostic modality for liver tumors. Three-dimensional (3D) volumetric analysis systems using EOB-MRI data are used to simulate liver anatomy for surgery. This study was conducted to investigate clinical utility of a 3D volumetric analysis system on EOB-MRI to evaluate liver function.MethodsBetween August 2014 and December 2015, 181 patients underwent laboratory and radiological exams as standardized preoperative evaluation for liver surgery. The liver-spleen contrast-enhanced ratio (LSR) was measured by a semi-automated 3D volumetric analysis system on EOB-MRI. First, the inter-evaluator variability of the calculated LSR was evaluated. Additionally, a subset of liver surgical specimens was evaluated histologically by using immunohistochemical staining. Finally, the correlations between the LSR and grading systems of liver function, laboratory data, or histological findings were analyzed.ResultsThe inter-evaluator correlation coefficient of the measured LSR was 0.986. The mean LSR was significantly correlated with the Child–Pugh score (p = 0.014) and the ALBI score (p < 0.001). Significant correlations were also observed between the LSR and indocyanine green retention rate at 15 min (r = − 0.601, p < 0.001), between the LSR and liver fibrosis stage (r = − 0.556, p < 0.001), and between the LSR and liver steatosis grade (r = − 0.396, p < 0.001).ConclusionThe LSR calculated by a 3D volumetric analysis system on EOB-MRI was highly reproducible and was shown to be correlated with liver function parameters and liver histology. These data suggest that this imaging modality can be a reliable tool to evaluate liver function.

Computed Tomography Liver Spleen Ratio as Predictive Marker of Liver Injury among Adult Filipina Early Breast Cancer Receiving Neoadjuvant Therapy from 2010-2016: A Six-Year Retrospective Study

There is no way to predict development of liver injury in early breast cancer patients during neoadjuvant treatment. It is our aim to determine such by determining Computed tomography liver spleen ratio (LS ratio) and comparing it to liver function test. Methods: Retrospective review for Stage I-III invasive breast cancer. Computed tomography LS ratio was reviewed by one radiologist. LS ratio cut off values were tested of their accuracy wherein computed AUC of &gt; 0.70 is considered valid predictive markers. Results: Thirty-five patients were seen with median age of 54, 57% had stage IIIB cancer. Patients’ average LS ratio 1.10±0.30 at the start, thenit slightly increased towards the end of the treatment (1.13±0.32). SGPT (37.43 to 35.09, p=0.479) changed from start to end. Liver spleen ratio significantly correlated with SGPT (r= -0.541, p=0.001). At end of treatment, LS ratio is correlated with SGPT (r = -0.464, p=0.005). It has higher sensitivity at start of treatment 100%, cut off 0.52, while end of treatment cut off was 0.87 has higher sensitivity (100%) in predicting liver injury. Liver Spleen ratio at end of treatment showed higher accuracy (AUC =0.597) indicating the LS ratio can be utilized as marker for predicting liver injury. Conclusion: End of treatment, liver injury was seen in those receiving anthracycline- based regimen. Liver spleen ratio is significantly correlated with SGPT. Liver spleen ratio at end of treatment showed higher accuracy indicating the LS ratio be utilized as marker for predicting liver injury

76P - Computed tomography liver spleen ratio as predictive marker of liver injury in early breast cancer receiving neoadjuvant therapy from 2010-2016

76P - Computed tomography liver spleen ratio as predictive marker of liver injury in early breast cancer receiving neoadjuvant therapy from 2010-2016

Differential relationships of hepatic and epicardial fat to body composition in HIV.

HIV‐infected patients commonly experience changes in central and peripheral fat content as well as ectopic fat accumulation. However, whether hepatic and epicardial fat stores relate differentially to body composition or how these associations are modified by HIV status has not been well explored. A previously recruited sample of 124 HIV‐infected patients and 58 healthy controls had undergone dual energy X‐ray absorptiometry (DEXA) and computed tomography (CT) from which body composition measures, liver–spleen ratio, and epicardial fat volume were obtained. Unique to the HIV‐infected group, there was a parabolic association between abdominal subcutaneous adipose tissue (SAT) area and liver–spleen ratio (P = 0.03, inflection point 324 cm2) such that hepatic fat content was greatest at the extremes of low and high SAT. A quadratic model also closely described the relationship between mean leg fat and liver–spleen ratio among patients with HIV (P = 0.02, inflection point 4.7 kg), again suggesting greater liver fat content with both low and high leg fat. Notably, an analogous relationship of epicardial fat with SAT was not evident among HIV‐infected individuals or healthy controls. In contrast, visceral adipose tissue (VAT) linearly related to both liver–spleen ratio in HIV and epicardial fat volume irrespective of HIV status in multivariable models. In conclusion, our analyses implicate both low and high SAT as risk factors for hepatic fat accumulation in HIV. These findings add to growing evidence of SAT dysfunction in the setting of HIV infection, and highlight key physiologic differences between hepatic and epicardial fat depots.

Abstract MP044: Fatty Liver Disease, Visceral Fat and Pectoral Muscle Area Are Independently Associated with Subclinical Atherosclerosis in Heavy Smokers

Introduction: Cardiovascular disease is a leading cause of death in those with chronic obstructive pulmonary disease. Coronary artery calcium (CAC) is a subclinical measure of cardiovascular disease. Fatty liver disease and visceral fat (VAT) are associated with CAC, and pectoral muscle area (PMA) has been shown to be associated with CAC in our population. However, it is unclear if fatty liver disease, VAT and PMA are all independently associated with CAC or if confounding exists. Hypothesis: We hypothesized that fatty liver disease will be associated with CAC independent of VAT and PMA. Methods: We utilized cross-sectional data from COPDGene, a cohort of former and current smokers with at least 10 pack-years of smoking history with CT measures of CAC, VAT, PMA, and liver and spleen attenuation. CAC positivity was defined as greater than 2.5 units of square root transformed total CAC volume to account for measurement variability. The liver/spleen ratio (LSR) was calculated, and fatty liver disease was defined as LSR &lt; 1. Multiple logistic regression was used to assess the association between the presence of CAC and fatty liver disease. Models were adjusted for age, sex, race, and current smoking, pack-years of smoking, high cholesterol, hypertension, diabetes, pectoral muscle area and visceral fat. Interactions between fatty liver disease and sex and fatty liver disease and race were tested. Results: Of the 5873 individuals with complete data, 3210 (54.7%) had CAC and 1153 (19.6%) had fatty liver disease. Both PMA (p&lt;0.0001) and VAT (p=0.0002) were associated with having CAC, and with having fatty liver disease (p&lt;0.0001 for both). There was a significant interaction between race and fatty liver disease (p=0.03). In non-Hispanic whites (NHW), fatty liver disease was associated with having CAC (OR=1.10, 95% CI 0.92-1.32), while in AA, fatty liver disease was not associated with CAC (OR=0.79, 95% CI 0.58-1.07). Removing VAT and PMA did not attenuate these results. There was no significant interaction between fatty liver disease and sex. Conclusion: In a large cohort of heavy smokers, fatty liver disease, VAT and PMA were associated with subclinical atherosclerosis independent of traditional cardiovascular risk factors in NHW but not AA. The racial differences in this association could indicate different biologic pathways in cardiovascular disease.

Computed tomography liver spleen ratio as predictive marker of liver injury among adult Filipina early breast cancer receiving neoadjuvant therapy from 2010-2016: A six-year retrospective study

Computed tomography liver spleen ratio as predictive marker of liver injury among adult Filipina early breast cancer receiving neoadjuvant therapy from 2010-2016: A six-year retrospective study

G.P.134: Liver functional impairment and glycolipid metabolic abnormality in myotonic dystrophy type 1

Recently, non-alcoholic steatohepatitis complicated in myotonic dystrophy type 1 (DM1) has been reported. Glucose intolerance is one of well-known complications in DM1. Lipid metabolic abnormality such as increase of visceral fat or abnormal response to oral lipid absorption test is also described in DM1. The aim of this study was to elucidate the relation between liver functional impairment and glycolipid metabolic abnormality in DM1. Forty-two patients in DM1 without cholelithiasis (19 females and 23 males; the mean age, 46.7years; the mean number of CTG repeat, 1125) were participated. Subjects had computed tomography (CT) examination to measure area of visceral fat (Vfat) and liver spleen ratio of CT density (LSR). Routine blood test was performed. Linear regression analysis was used to assess the association among Vfat, LSR, the number of CTG repeat, age, and results of blood test. According to the oral glucose tolerance test, patients were classified into diabetes (12 cases), impaired glucose tolerance (IGT, 18), and normal (NGT, 12). Similar parameters in each group were compared using non-parametric test. Forty-five percent of patients showed V-fad above 100cm 2 . Nineteen percent had LSR less 0.9. High value of gamma GTP was observed in 81%, abnormal ALT was in 57%, and AST in 33%. The number of CTG repeat was significantly correlated to Vfat or gamma GTP. There was significant positive correlation between Vfat and gamma GTP, ALT or AST. Gamma GTP was significantly correlated to serum triglyceride or fasting plasma glucose. Vfat in diabetes group was significantly higher than that in IGT or NGT, although there was no significant difference for Vfat between IGT and NGT. Gamma GTP in IGT was significantly higher than that in NGT, and was lower than that in diabetes group. Liver functional impairment was relevant to glucose intolerance, visceral fat accumulation, and the number of CTG repeat in DM1.