Percentage Of Steatosis Research Articles

The effects of black seed supplementation on cardiovascular risk factors in patients with nonalcoholic fatty liver disease: A randomized, double-blind, placebo-controlled clinical trial.

Nonalcoholic fatty liver disease (NAFLD) is highly related to cardiovascular disorders risk factors. This study aimed to evaluate the effects of black seed (Nigella sativa) supplementation on cardiovascular disorders risk factors in patients with NAFLD. This randomized, double-blind, placebo-controlled clinical trial was conducted on 50 patients with NAFLD. Participants were assigned to receive a lifestyle modification plus 2g/day of either N.sativa or placebo for 12weeks. Compared with the placebo, N.sativa supplementation led to significant reductions in serum glucose (-7.95 vs. -1.22; p=.041), serum insulin (-3.87 vs. -1.07; p=.027), homeostatic model of assessment for insulin resistance (-1.02 vs. -0.28; p=.021), and a significant increase in quantitative insulin sensitivity check index (0.03 vs. 0.006; p=.002). All of these changes were remained significant after adjusting for known confounding variables; however, there was no significant difference in lipid profile changes between the two groups (p=.05). N.sativa supplementation significantly decreased hepatic steatosis percentage compared with the placebo after adjustment for confounding variables (p=.005). In conclusion, our results indicate that daily intake of 2-g N.sativa plus lifestyle modification is superior to lifestyle modification alone in amelioration of insulin resistance and hepatic steatosis in patients with NAFLD.

Nigella sativa and inflammatory biomarkers in patients with non-alcoholic fatty liver disease: Results from a randomized, double-blind, placebo-controlled, clinical trial

ObjectiveThe aim of this study was to assess the effects of Nigella sativa consumption on inflammatory biomarkers in patients with Non-alcoholic fatty liver disease (NAFLD). MethodsThis is a randomized, double-blind, placebo-controlled clinical trial. Fifty NAFLD patients were assigned to receive either two gram/day Nigella sativa seed as Nigella sativa group (NSG), or two gram/day starch as placebo group (PG) for 12 weeks. ResultsAt the end of the study, the serum levels of tumor necrosis factor-α (TNF-α) decreased significantly compared with the beginning of the study in both groups, while the levels of high sensitive C reactive protein (hs-CRP) and nuclear factor kappa-B (NF-κB) only decreased significantly in the NSG (P 0 < 0.05). Only reduction in the serum levels of TNF-α was significantly more in NSG compared to the PG (P = 0.001). After adjusting the effects of confounding factors, the results remained unchanged. According to Fibroscan exam, hepatic steatosis and its percentage decreased significantly only in the NSG (P 0 < 0.005); however, the changes were not significantly different between two groups. After adjusting for confounding factors, only steatosis percentage reduction was significantly more in the NSG compared to PG (P = 0.005). ConclusionOur results have shown that two gram/day consumption of Nigella sativa can reduce inflammatory biomarkers in patients with NAFLD. Further studies with different doses are highly recommended to find the optimal dosage.

Livers from brain dead donors with chronic active alcohol abuse for liver transplantation

Background: Liver grafts from donors with chronic and active history of alcohol abuse are usually discarded for liver transplantation (LT). Our aim is to report our results with those grafts. Methods: We performed a case control study on 113 LT from 2015 to 2016. Inclusion criteria for the study group were adult patients transplanted with livers from donors with chronic active alcohol abuse. The control group consisted in randomly matched LTs with similar recipient (R) and donor (D) age, sex and ischemia time, performed in those two years with standard livers. The ratio of case-to-control was 1:2. Short term results, biochemical data from day 0 to 30 after LT, complications and survival are reported. Data were compared. P≤0.5 was considered statistically significant. Results: The study group consisted of 4 LT whereas 8 patients transplanted with standard grafts served as control group. Mean micro-macro steatosis percentage in livers from donors with alcohol abuse was 36±16%. Laboratory exams showed statistically significant worse values for Aspartate Aminotransferase and International Normalized Ratio at Day 0, and Total Bilirubin at day 8, for livers from donors with alcohol abuse. No statistical difference was found in the occurrence of rejection episodes. All patients of both groups are alive after 347±264 days (range 24-725) from LT. Conclusion: May be it’s time to reconsider the use for LT of livers from donors with chronic and active alcohol abuse.

Will the machine perfusion of the liver increase the number of donor organs suitable for transplantation?

Worldwide, there is a trend towards an increase in the number of patients waiting for liver transplantation, despite an increase in the total number of liver transplantation operations. Solving the problem of donor organ shortage is possible through the use of organs from marginal donors: organs removed after cardiac arrest, organs with a high percentage of steatosis, organs from donors over the age of 60 years. The main reason for refusing to use them is the risk of severe complications and an unfavorable outcome of the operation. Static cold preservation today is the main method of protecting donor organs from thermal damage, which possesses rather effective protective properties. At the same time, the duration of cold preservation has a limited time interval. There is always uncertainty about the viability of the organ. Modern methods for assessing donor organs such as donor history, laboratory data, visual examination and morphology, do not reliably predict liver function after transplantation. In this regard, the development of methods for preserving the organ after removing, which do not degrade the quality of the organ or even are capable of restoring the lost functions, is relevant. The machine perfusion of the liver is one of the new concepts aimed at solving this problem. The article highlights the international experience of using the machine perfusion of the donor liver over the past 15 years. Machine perfusion is a promising trend of transplantation development, which allows reducing the shortage of donor organs and improving their quality.

Ultrasonographic fatty liver indicator detects mild steatosis and correlates with metabolic/histological parameters in various liver diseases

Background and aimsFatty liver is a common feature of different types of liver diseases. The sensitivity and specificity of ultrasonography for diagnosing fatty liver are variable. A semi-quantitative ultrasound score, i.e., the ultrasonographic fatty liver indicator (US-FLI), is closely associated with metabolic/histological variables in patients with nonalcoholic fatty liver disease (NAFLD). The main aims of this study were to assess the diagnostic performance of US-FLI in detecting varying degrees of histological steatosis, and to examine the association of US-FLI with metabolic/histological parameters in 352 biopsied patients with various chronic liver diseases (173 with hepatitis C [HCV], 23 with hepatitis B [HBV], 123 with NAFLD and 33 with other etiologies). ResultsUS-FLI accurately detected mild steatosis (minimum amount 10% on histology) with a cut-off value ≥2 (sensitivity 90.1%, specificity 90%), moderate steatosis (≥30%) with a cut-off value ≥3 (sensitivity 86.4%, specificity 92.5%) and severe steatosis (>66%) with a cut-off value ≥5 (sensitivity 88.5%, specificity 87%). US-FLI was correlated with steatosis percentage in each liver disease group as well as with lobular inflammation, ballooning, portal fibrosis, grading and staging in patients with NAFLD or HCV. US-FLI was also correlated with waist circumference, body mass index and insulin resistance both in the whole sample and in each liver disease group. ConclusionsUS-FLI accurately identifies histological severity and is correlated with metabolic parameters in patients with various steatogenic liver diseases. US-FLI is an easy and versatile tool for the screening of steatosis and the metabolic health of these patients.

Metabolic effects of Crocus sativus and protective action against non-alcoholic fatty liver disease in diabetic rats.

Non-alcoholic fatty liver disease (NAFLD) is the result of the accumulation of adipose tissue deposits in the liver and it is associated with type 2 diabetes. Crocus sativus (saffron) is known for its antioxidant and its potential hypoglycemic effects. We investigated the role of saffron on NAFLD in diabetic rats. Thirty adult male rats were allocated into three groups; control (n=10), which received normal diet; streptozotocin (STZ) group (n=10), which received normal chow diet, 10% fructose in their drinking water and STZ (40 mg/kg body weight; STZ-saffron group (n=10), which followed the same dietary and pharmacological pattern as STZ group and were additionally supplemented with saffron (100 mg/kg/day). Metabolic profile was measured and histopathological examination of the liver was evaluated. STZ group exhibited the highest glucose levels at the end of the experiment (P<0.05), while there was no difference between control and STZ-saffron group (584 vs. 213 mg/dl vs. 209 mg/dl, respectively). STZ group revealed higher percentage of steatosis (5–33%) when compared to the other two groups (P<0.005). Saffron exhibits both hypoglycemic and hepatoprotective actions. Yet, further studies enlightening the exact mechanisms of saffron's mode of actions are required.

Risk Factors and Predictors of Discordance Between Transient Elastography (FibroScan®) and Liver Biopsy

Introduction: Management of patients with liver diseases is frequently driven by the degree of liver fibrosis. Noninvasive methods for staging fibrosis via transient elastography (TE), such as Echosens FibroScan® device, have begun to replace the use of liver biopsy. However, discordance between FibroScan® and liver biopsy has been reported. The aim of this study is to evaluate the frequency and risk factors of discordance between liver biopsy and FibroScan® scores. Methods: This is a retrospective cohort study of all patients at Weill Cornell Medical Center who underwent TE evaluation via FibroScan® within one year of liver biopsy. Discordance was defined as ≥2-stage difference between fibrosis stage on biopsy compared to FibroScan®. Risk factors for patients with discordance versus concordance were compared. Univariate analysis was conducted using T-test testing and Fisher's Exact testing, while logistic regression was utilized to conduct multivariate model testing. All statistical analysis was performed using R. Results: 1036 patients underwent TE evaluation. 49 patients, with a mean age of 52.8 years (±12.6 years), had a liver biopsy within one year. 20.4% of patients were found to have discordant studies. 70% had a lower FibroScan® fibrosis staging compared to biopsy fibrosis staging. Patients had a mean 91.89% Fibroscan® success rate. On univariate analysis, younger age at the time of the FibroScan® was significantly associated with discordance (p=0.038). There was no statistical significance when comparing discordance with other pre-specified factors, including gender, BMI, ALT, percentage of steatosis or iron, FibroScan® operator, or FibroScan® probe. In a multivariate analysis, age, ALT, and biopsy diagnosis - particularly HBV, were statistically significant in being predictive of discordance (p=0.0495, p=0.0447 and p=0.023, respectively). Conclusion: We demonstrate that discordance between liver biopsy and FibroScan® fibrosis score occurs in a large proportion of patients. Younger age was associated with discordance. Multivariate analysis demonstrates the combination of age, ALT and the diagnosis of HBV are also predictive of discordance. Hepatologists should be wary of replacing liver biopsy with TE given a high rate of discordance. Future studies to validate these findings, and create prediction tools to direct clinicians to pursue biopsies over TE are needed, to improve clinical care and patient outcomes.

Diagnostic accuracy and clinical utility of a new noninvasive index for hepatic steatosis in patients with hepatitis B virus infection.

The aim of the present study was to construct a cost-effective noninvasive diagnostic index for prediction of hepatic steatosis in patients with hepatitis B virus(HBV) infection. From January 2011 to January 2015, a total of 364 consecutive subjects who underwent liver biopsies were enrolled. The Receiver-operating characteristic(ROC) curves and Obuchowski measure were constructed to evaluate the diagnostic accuracy of the new index. The AUROCs of steatosis index of patients with HBV infection (SIHBV) in predicting of steatosis were 0.929 (95% confidence interval:0.889–0.970, P < 0.05) in the model group and 0.855 (0.794–0.917, P < 0.05) in the validation group respectively. Comparisons of AUROCs demonstrated that SIHBV was significantly superior to Korean Score, fatty liver index (FLI), hepatic steatosis index (HSI), lipid accumulation product(LAP), and fatty liver disease (FLD) index for prediction of hepatic steatosis in model group and validation group(all P < 0.01). Especially for patients with hepatic steatosis percentage of 5.0–9.9% and 10.0–19.9%, SIHBV had a sensitivity of 63.6% and 79.2%, whereas it were 29.1% and 45.8% for Ultrasonography (all P < 0.05). In conclusion, as a cost-effective, simple, noninvasive, and readily available method, SIHBV may act as a massive screening tool before further examinations such as MRI, CT, transient elastography, or liver biopsy, especially for developing countries.

Adaptation of liver stiffness measurement depth in bariatric surgery candidates with suspected nonalcoholic fatty liver disease.

A thick layer of subcutaneous adipose tissue may lead to an overestimation of liver stiffness by transient elastography. The aim of this study was to assess whether liver stiffness measurement (LSM) was overestimated using an XL probe in patients with severe obesity and, if so, to reprocess the data to the adapted depth to obtain the appropriate LSM (LSMa). A total of 152 obese patients prospectively underwent bariatric surgery and needle liver biopsy. Liver stiffness was measured by transient elastography 15 days before. To determine whether the LSM was overestimated, an expert operator retrospectively determined whether the skin-to-capsula distance was greater than 35 mm by analyzing the hyperechogenicity of ultrasound signals and the measured slope between 35 and 75 mm. In the case of an overestimation, a deeper measurement depth was selected to calculate the LSMa. There was an overestimation of the LSM obtained between 35 and 75 mm in 76 patients (50%). Among these patients, the LSMa was obtained between 40 and 75 mm in 49 patients and between 45 and 80 mm in 27 patients. Only the percentage of steatosis was independently and positively correlated with LSM overestimation. The areas under receiver operating characteristic of LSMa was 0.82±0.04 for predicting fibrosis stage F3. The Obuchowski measure was 0.85±0.02. The LSM was overestimated in severely obese patients obtained between 35 and 75 mm using an XL probe in 76 patients (50%), but LSM can be performed correctly in these patients after adapting the measurement depth to deeper beneath the patients' skin.

Estimating Liver Steatosis: Can Artificial Neural Network And Image Analysis Improve The Accuracy

Introduction/ Background Liver steatosis is very important in transplantation pathology as it directly influences the graft dysfunction. Pretransplant donor biopsy materials are evaluated by the pathologists, and degree of steatosis, especially large droplet steatosis (LDS) which is described as lipid droplets with a diameter of at least 15 micron, is estimated under light microscope. But when doing so, there can be great intra- and inter-observer variability. In order to overcome this problem several automated systems and image analysis methods are used. Aims The most challenging issue for automated steatosis image analysis is to distinguish real oil droplets from sinusoidal regions. Although some morphometric features are employed to make this discrimination, whole feature space could not be represented for a fatty liver cell. In this study we have contributed a new approach, which tries to solve this discrimination issue with an artificial learning system. Methods Ten consecutive hematoxylin and eosin (HE) stained, formalin fixed paraffin embedded donor liver biopsies, reported by 2 pathologist, were evaluated by a third pathologist and steatosis percentage was given as total and LDS by using the percentage of area occupied by lipid droplets to total biopsy area. Automated image analysis was performed on about 200 photographs taken to represent the whole biopsy at X20 magnification by Zeiss Axio Scope.A1 microscope using Kameram™ software and established as percentage of LDS to total biopsy area. Segmented positive (oil) and negative (non- oil) components are labeled by an expert pathologist and after some preprocesses they are fed to an Artificial Neural Network for training. We have used about 1000 droplets for training and 1500 droplets for performance evaluation. The proposed scheme is utilized to calculate liver fat ratio on digital images and the results are compared with expert’s opinions. Results There was great variation among pathologists and when compared to the automated analysis and pathologists were prone to overestimate the steatosis (Table 1). As this overestimation can lead to nonuse of the donor liver, the accurate assessment of the steatosis is critical. Since the biopsy is the gold standard for the assessment of steatosis, methodology of this examination should be as objective as possible. Our results show that automated assessment of liver steatosis is very useful in order not to loose donor livers, by overestimation. Automated image analysis used before were based on morphometric features of liver droplet regions, and use Patient ID System TDS System LDS Expert 1-2 TDS Expert 1-2 LDS Expert 3 TDS Expert 3 LDS 1 8.8 5.5 30 25 25 15 2 6.5 2.6 15 10 35 5 3 8 6 25 20 35 30 4 6.1 3.7 13 8 15 5 5 4.3 1.9 10 8 25 5 6 5.1 2 8 3 25 7 8.2 4.3 20 15 35 20 8 11.8 9.6 30 20 45 25 9 11 7.4 25 15 35 25 T able 1: The total droplet steatosis (TDS) and large droplet steatosis (LDS) percentages estimated by the pathologists and calculated by the software of this Artificial Neural Network for training to discriminate sinusoidal areas from lipid areas reached a high accuracy. In this study, we proposed a new approach to discriminate lipid areas from sinusoids without using morphometric features, which needs be confirmed in a large cohort. The performance can be improved by employing some different pattern classification techniques such as Support Vector Machines as a future study.

Quantitative Assessment of Liver Steatosis on Tissue Section Using Infrared Spectroscopy

Quantitative Assessment of Liver Steatosis on Tissue Section Using Infrared Spectroscopy

Non‐invasive assessment of liver steatosis in non‐alcoholic fatty liver disease

The diagnosis of non-alcoholic fatty liver disease (NAFLD) is based on the histological findings. Further, there may be interobserver differences. Liver to spleen (L/S) ratio on computed tomography (CT) is employed to detect or even quantify the fat content of the liver. The objective of this study was to accurately diagnose fatty liver by evaluating the relationship between L/S ratio and histological findings. Sixty-seven biopsy-proven NAFLD patients were enrolled. L/S ratio on CT was calculated. The area of steatosis in liver specimens was measured by BIOREVO BZ-9000 microscope, and the percentage of steatosis was calculated using Dynamic cell count BZ-H1C software. Steatotic grade assessed by pathologist was significantly correlated with the percentage of steatosis and L/S ratio. Factors associated with steatosis were L/S ratio, aspartate aminotransferase and Homeostasis Model of Assessment - Insulin Resistance as determined by multivariate analysis. L/S ratios were: S0, 1.16 ± 0.20 (mean ± standard deviation); S1, 0.88 ± 0.28; S2, 0.76 ± 0.20; and S3, 0.40 ± 0.18, respectively. The optimal cut-off value of L/S ratio to exclude steatosis was 1.1, and the area under the receiver-operator curve for the diagnosis of steatosis was 0.886. Our study suggests that while 0% of steatosis showed 1.296 L/S ratio, the cut-off value of L/S ratio would be 1.1 at least to exclude clinically important liver steatosis.

Quantification of hepatic steatosis: A comparison of the accuracy among multiple magnetic resonance techniques

Magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) are important diagnostic tools for the non-invasive assessment of hepatic steatosis (HS). This study was conducted to compare different magnetic resonance (MR) techniques and correlate the MR findings with histological and intracellular lipid density findings. In this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant prospective study, 60 patients scheduled for liver resection were included in this study. Fat fraction in the non-tumorous liver parenchyma was estimated using double-echo MRI, triple-echo MRI (TE-MRI), and MRS. HS was defined by the histologic steatosis percentage (HSP), and intrahepatocellular triglyceride density (IHTGD) of the surgical specimen used as the reference standard. Imaging quantification results were evaluated using Pearson's correlation. Lin's concordance coefficient and Bland-Altman 95% limits of agreement were used to evaluate the concordance of IHTGDs estimated by the three MR techniques. The diagnostic performance was compared using receiver operating characteristic curve analysis. HS assessed by TE-MRI and MRS had a stronger relationship with HS assessed by HSP and IHTGD. The TE-MRI method had the highest concordance correlation coefficients (ρ = 0.881) and percentage (95%, 57/60) within the Bland-Altman 95% limits of agreement. Receiver operating characteristic curve analysis for diagnosing > 5% HSP showed significantly larger area under the curve (0.9783) for TE-MRI than for double-echo MRI (0.8773, P = 0.0121). Among the three MR techniques, TE-MRI and MRS may be the preferred techniques for non-invasive assessment of HS.

Assessment of hepatic steatosis by transplant surgeon and expert pathologist: A prospective, double-blind evaluation of 201 donor livers

An accurate clinical assessment of hepatic steatosis before transplantation is critical for successful outcomes after liver transplantation, especially if a pathologist is not available at the time of procurement. This prospective study investigated the surgeon's accuracy in predicting hepatic steatosis and organ quality in 201 adult donor livers. A steatosis assessment by a blinded expert pathologist served as the reference gold standard. The surgeon's steatosis estimate correlated more strongly with large-droplet macrovesicular steatosis [ld-MaS; nonparametric Spearman correlation coefficient (rS ) = 0.504] versus small-droplet macrovesicular steatosis (sd-MaS; rS = 0.398). True microvesicular steatosis was present in only 2 donors (1%). Liver texture criteria (yellowness, absence of scratch marks, and round edges) were mainly associated with ld-MaS (variance = 0.619) and were less associated with sd-MaS (variance = 0.264). The prediction of ≥30% ld-MaS versus <30% ld-MaS was excellent when liver texture criteria were used (accuracy = 86.2%), but it was less accurate when the surgeon's direct estimation of the steatosis percentage was used (accuracy = 75.5%). The surgeon's quality grading correlated with the degree of ld-MaS and the surgeon's steatosis estimate as well as the incidence of poor initial function and primary nonfunction. In conclusion, the precise estimation of steatosis remains challenging even in experienced hands. Liver texture characteristics are more helpful in identifying macrosteatotic organs than the surgeon's actual perception of steatosis. These findings are especially important when histological assessment is not available at the donor's hospital.

Magnetic Resonance for Quantitative Assessment of Liver Steatosis: A New Potential Tool to Monitor Antiretroviral-Drug-Related Toxicities

There is an increasing need for new diagnostic tools to monitor antiretroviral drug-related toxicities. Magnetic resonance (MR) imaging and MR spectroscopy are non-invasive diagnostic methods used in the detection and quantification of liver fat. The aim of this study was to compare sensitivity and specificity of different MR techniques in the quantitative assessment of liver steatosis, using liver biopsy as the reference standard, in patients with and without HIV infection. Sequentially evaluated patients with suspected steatosis who were referred for liver biopsy at our tertiary care site were eligible. MR liver fat content (LFC) was estimated by T2-weighted and fat-suppressed T2-weighted spin-echo, dual-phase T1-weighted gradient-echo, multiecho gradient-echo and (1)H spectroscopy. Association between LFC and histological steatosis percentage was calculated by using univariate linear regressions and Pearson's coefficient. Respective receiver operating characteristic (ROC) curves were used to compare specificity and sensitivity of MR methods in diagnosis (cutoff 5%) and in quantitative evaluation (cutoff 33%) of steatosis. A total of 28 patients were identified: 12 refused or had contraindications for liver biopsy and 16 had biopsies plus MR. LFC and histological steatosis percentage were strongly associated (fat-suppressed r=0.86 [P<0.001], dual-phase r=0.88 [P<0.001], multiecho r=0.95 [P<0,001] and spectroscopy r=0.84 [P=0.01]). MR techniques had high sensitivity and specificity in diagnosis and quantitative assessment of steatosis (areas under ROC curves ranging from 0.88 to 0.98). This pilot study confirms that MR may be a sensitive non-invasive alternative to biopsy for the quantitative assessment of liver fat and a potential end point to monitor antiretroviral-drug-related toxicities.

Analysis of Tissue Bioimpedance as a Measurement of Liver Steatosis: Experimental Model in Large Animals

BackgroundElectrical bioimpedance (BI) has been used to indirectly measure steatosis. This method has not yet been established in the clinics thus experimental studies are needed in big animals. We assessed BI to measure liver steatosis in porcine animals. MethodsTwelve large-white × Landrace pigs weighing 35 kg were allocated to a study (n = 9) and a control group (n = 3). A special diet was used to promote steatosis among the study group: methionine deficient and choline-restricted diet that contains supplements of cholesterol, collate and excess of saturated fat. Control group animals were fed a normal diet. A new tetrapolar electrode model was used for BI measurement, which were performed during open laparotomy by inserting a probe into one of the lobes. Measurements were done in the third and fourth segments of the pig liver, placing the probe either on the surface or inserted into the parenchyma of the liver. Open biopsies were obtained at the end of the measurements. Histological samples were processed and stained with hematoxylin-eosin to estimate macrosteatosis. Pearson correlation coefficient between BI and percentage steatosis were calculated at different frequencies. ResultsAfter 4 months of the special diet all the animals in the study group developed steatosis (90% to 20%), whereas none of the control group was affected. Pearson correlation coefficients between BI and percentage of steatosis were significant (0.877–0.878) with the best correlations obtained with a probe placed on the fourth segment of the liver surface and the best frequency to perform the measurements being 50 and 75 kHz. ConclusionsBI is an accurate, fast method for steatosis measurements, that is easier and cheaper than either open or needle biopsy.

Non‐invasive diagnosis of liver steatosis using controlled attenuation parameter (CAP) and transient elastography

Recently, a study showed that Controlled Attenuation Parameter (CAP), evaluated with transient elastography, could efficiently separate steatosis grades. The aim of this study was to prospectively evaluate the performance of CAP for the diagnosis of steatosis in patients with chronic liver disease. Consecutive patients with chronic liver disease had steatosis diagnosis using CAP, blood sample and liver biopsy. Steatosis was graded as the percentage of hepatocytes with fat: S0 ≤ 10%, S1: 11 ~ 33%, S2: 34 ~ 66%, S3 ≥ 67%. Characteristics of the 112 patients included were as follows: age 54 years, BMI 26 kg m(-) ², HCV 36%, NAFLD 25%. Steatosis repartition was: S0 52%, S1 19%, S2 14%, S3 15%. CAP was significantly correlated with SteatoTest, Fatty Liver Index (FLI), percentage of steatosis on liver biopsy, steatosis grade and slightly with liver stiffness, but not with fibrosis and activity grade on liver biopsy. Using CAP vs SteatoTest vs FLI score, Area Under the Receiver-Operating Characteristics (ROC) curves (AUROC)s were 0.84 vs 0.72 vs 0.72 for the diagnosis of steatosis ≥ S1, 0.86 vs 0.73 vs 0.71 for the diagnosis of steatosis ≥ S2, and 0.93 vs 0.73 vs 0.75 for the diagnosis of steatosis S3 respectively. For a sensitivity ≥ 90%, cut-offs of CAP were 215 dB m(-1) for S ≥ 1, 252 dB m(-1) for S ≥ 2, and 296 dB m(-1) for S3. CAP is very efficient to detect even low grade steatosis. CAP being implemented on FibroScan(®) (Echosens, Paris, France), both steatosis and fibrosis can be evaluated simultaneously, enlarging the spectrum of non-invasive techniques for the management of chronic liver diseases.

Impact of Graft Steatosis on the Post-transplantation Biliary Complications for Living Donor Liver Transplant Recipients in China

After living donor liver transplantation (LDLT), the prevalence of complications related to the biliary system is 6-35%. In spite of great improvements in both surgical techniques and postoperative and long-term medical treatment, the biliary complications are still considered a relatively high risk for LDLT. The aim of this retrospective study was to analyze the incidence of biliary complications and identify predisposing risk factors. The clinical and follow-up data of 175 adult patients receiving LDLT (right lobe or left lobe) between 2002 and December 2008 were collected and retrospectively analyzed. Patients were divided into 2 groups: with biliary complications (n=30) and without biliary complications (n=145). Thirty patients (17.1%) had post-transplantation biliary complications. Eight patients (4.6%) were diagnosed with bile leakage, while 24 patients (13.7%) developed biliary stricture. Percentage of steatosis of the graft and hepatic artery thrombosis after LDLT were two factors upon univariate analysis (p=0.034, p=0.01, respectively). In multivariate logistic analysis, 20-50% macrovesicular steatosis emerged as a new defined risk factor by us (p=0.001). There was no difference in patient survival rate in different groups and sorts of graft steatosis (p>0.05). We consider that using a graft with macro-vesicular steatosis in 20-50% should be put on the table carefully, balancing both sides of positive and negative.

Controlled Attenuation Parameter (CAP): a noninvasive method for the detection of hepatic steatosis based on transient elastography

Accurate tools for the noninvasive detection of hepatic steatosis are needed. The Controlled Attenuation Parameter (CAP) specifically targets liver steatosis using a process based on transient elastography. Patients with chronic liver disease and body mass index (BMI) ≥28 kg/m(2) underwent biopsy and liver stiffness measurement (LSM) with simultaneous CAP determination using the FibroScan(®) M probe. The performance of the CAP for diagnosing steatosis compared with biopsy was assessed using areas under receiver operating characteristic curves (AUROC). A total of 153 patients were included: 69% were male, median BMI was 32 kg/m(2); 47% had nonalcoholic fatty liver disease (NAFLD); and 65% had significant (≥10%) steatosis. The CAP was significantly correlated with the percentage of steatosis (ρ = 0.47) and steatosis grade (ρ = 0.51; both P < 0.00005). The median CAP was higher among patients with significant steatosis (317 [IQR 284-339] vs. 250 [227-279] dB/m with <10% steatosis; P < 0.0005) and the AUROC for this outcome was 0.81 (95% CI 0.74-0.88). At a cut-off of 283 dB/m, the CAP was 76% sensitive, 79% specific, and had positive and negative predictive values of 87% and 64%, respectively. CAP performance was not influenced by measurement variability, but was higher in patients with mild (F0-F1) fibrosis (AUROC 0.89 vs. 0.72 with F2-F4; P = 0.03). The AUROCs of the CAP for ≥5%, >33% and >66% steatosis were 0.79, 0.76 and 0.70, respectively. The CAP is a promising tool for the noninvasive detection of hepatic steatosis. Advantages of CAP include its ease of measurement, operator-independence and simultaneous availability with LSM for fibrosis assessment.

Hepatic Steatosis in Morbidly Obese Patients Undergoing Gastric Bypass Surgery: Assessment With Open-System 1H-MR Spectroscopy

The purpose of this study was to assess, with histopathologic control, the use of open-system 1-T (1)H MR spectroscopy for the evaluation of hepatic steatosis in morbidly obese patients undergoing gastric bypass surgery. Patients underwent (1)H MR spectroscopy (MRS) for the assessment of steatosis before and 3 months after surgery. Liver biopsy was performed during surgery. Hepatic steatosis was expressed as the ratio of fat peak area to cumulative water and fat peak areas. Histopathologic percentage of steatosis was graded as none (0-5%), mild (5-33%), moderate (33-66%), or severe (> 66%). The accuracy of (1)H-MRS and Spearman correlation coefficient were calculated. Differences between groups were assessed with the Wilcoxon signed rank and Mann-Whitney tests. The study included 38 patients (median age, 45.5 years; median body mass index, 47.7). Before surgery, median steatosis measured with (1)H-MRS was 5.8%. The accuracy of (1)H-MRS was 89% (32/36), and the (1)H-MRS findings correlated with the histopathologic assessment of steatosis (r = 0.85, p < 0.001). With (1)H-MRS, no steatosis was discriminated from mild steatosis (p = 0.011), mild was discriminated from moderate steatosis (p < 0.001), and moderate was discriminated from severe steatosis (p = 0.021). Three months after surgery, steatosis had decreased to 3.1% (p < 0.001). The prevalence of hepatic steatosis measured with (1)H-MRS decreased from 53% to 32%. In the care of morbidly obese patients undergoing assessment of hepatic steatosis and changes in steatosis after gastric bypass surgery, (1)H-MRS with an open 1-T MRI system is feasible. Measurements of hepatic fat with (1)H-MRS are accurate and correlate with clinical and histopathologic results.