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Wu L, Wu Y, Jin J, Li X, Zhang N, Jie Y, Zheng R, Chong Y, Ren J. An Optimal Prognostic Model Based on Multiparameter Ultrasound for Acute-on-Chronic Liver Failure. ULTRASOUND IN MEDICINE & BIOLOGY 2023:S0301-5629(23)00208-9. [PMID: 37451951 DOI: 10.1016/j.ultrasmedbio.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/05/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Acute-on-chronic liver failure (ACLF) is associated with a considerably high mortality, and accurate prognosis prediction is critical to navigate intervention decisions and improve clinical outcomes. The objective of this study was to establish a better prognostic model for ACLF based on multiparameter ultrasound in combination with clinical features. METHODS A total of 149 patients with ACLF were prospectively enrolled and underwent conventional ultrasound, 2-D shear wave elastography (SWE), attenuation imaging, color Doppler sonography, superb microvascular imaging and contrast-enhanced ultrasound (CEUS). Univariate and multivariate analyses were performed to identify independent ultrasound signatures for the prognosis of ACLF, which, when integrated with clinical characteristics, were used to establish a prognostic model. RESULTS Hepatic perfusion features of CEUS differed significantly between the poor and good prognosis groups, among which the time interval (TI) between peak portal vein (PV) velocity and liver parenchyma (LP) enhancement, TI(PV, LP), was independently associated with the prognosis of ACLF. A prediction model comprising TI(PV, LP) and the international normalized ratio was established, and the area under the curve (AUC) was 0.851, which is greater than those of the Model for End-stage Liver Disease (0.785), fall time of LP model (0.754), 2-D SWE nomogram (0.708) and TI(PV, LP) (0.352). Furthermore, the performance of the model was verified in an independent validation cohort (AUC = 0.920). CONCLUSION The newly developed model performs better than existing tested models; thus, it has potential as a better non-invasive model for predicting the prognosis of patients with ACLF. A future multicenter, large-sample study is required to validate the performance of this model.
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Affiliation(s)
- Lili Wu
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, China
| | - Yuankai Wu
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jieyang Jin
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, China
| | - Xinhua Li
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Nanxiang Zhang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yusheng Jie
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Rongqin Zheng
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, China
| | - Yutian Chong
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jie Ren
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, China.
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Marenga G, Traficante S, Ragonici S, Vincenzi C, Rocchetti M, De Rito G, Fonsi GB, Messineo D. Successful Diagnosis of a Longstanding Giant Amoebic Liver Abscess Using Contrast-Enhanced Ultrasonography (CEUS): A Case Report in a Western Country. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:493-498. [PMID: 30969949 PMCID: PMC6474154 DOI: 10.12659/ajcr.914378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND E. histolytica liver abscess results from extra-intestinal diffusion of amebiasis, which is responsible for up 100 000 deaths per annum, placing it second only to malaria in mortality. Currently, the criterion standard for the diagnosis of liver abscesses is ultrasound, but CEUS (contrast-enhanced ultrasound) is emerging as a more accurate method for liver study, and it could be more accurate than ultrasound and non-invasive compared to CT. CASE REPORT A white man (59 years old) with a 2-day history of dyspnea, acute abdominal pain in right upper quadrant, and raised inflammatory markers was admitted to a second-level Emergency Department in Rome (Italy). He reported several trips to tropical areas many years before, during which he ingested non-potable water and became infected with Entamoeba histolytica. This was treated medically with success. After administration of antibiotics (meropenem and metronidazole), a liver CEUS (contrast-enhanced ultrasonography) with administration of SonoVue (sulphur hexafluoride microbubbles) confirmed a giant liver abscess (15×16 cm). One day later, CT-guided drainage was performed without complications and the patient was discharged on the 25th post-procedure day, with improved blood results. CONCLUSIONS Acute abdominal pain can be caused by a variety of diseases, but a diagnosis of parasitic abscess should not be overlooked in non-endemic Western countries. CEUS is a new, promising, and more accurate technique that can be utilized to recognize liver abnormalities, including abscesses; however, retrospective population-wide studies are necessary to define the differential diagnoses.
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Affiliation(s)
- Giuseppe Marenga
- Department of Emergency, Sapienza University of Rome, Rome, Italy
| | | | - Serena Ragonici
- Department of Emergency, Sapienza University of Rome, Rome, Italy
| | - Claudia Vincenzi
- Department of Emergency, Sapienza University of Rome, Rome, Italy
| | - Maura Rocchetti
- Department of Emergency, Sapienza University of Rome, Rome, Italy
| | - Giuseppe De Rito
- Department of Emergency, Sapienza University of Rome, Rome, Italy
| | | | - Daniela Messineo
- Department of Radiological Sciences, Oncology and Anatomo-Pathological Science, Sapienza University of Rome, Rome, Italy
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Morishita K, Hiramoto A, Michishita A, Takagi S, Osuga T, Lim SY, Nakamura K, Sasaki N, Ohta H, Takiguchi M. Washout Ratio in the Hepatic Vein Measured by Contrast-Enhanced Ultrasonography to Distinguish Between Inflammatory and Noninflammatory Hepatic Disorders in Dogs. J Vet Intern Med 2017; 31:770-777. [PMID: 28382699 PMCID: PMC5435075 DOI: 10.1111/jvim.14685] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/24/2017] [Accepted: 02/02/2017] [Indexed: 02/07/2023] Open
Abstract
Background Perflubutane microbubbles, a second‐generation ultrasound contrast agent, are phagocytized by Kupffer cells. This characteristic may be useful to differentiate diffuse hepatic diseases in dogs. Hypothesis/objectives To determine whether the washout ratio in the hepatic vein (HV) measured by contrast‐enhanced ultrasonography (CEUS) can distinguish between inflammatory and noninflammatory hepatic disorders in dogs. Animals Forty‐one client‐owned dogs with hepatic disorders including 14 with hepatitis, 7 with primary hypoplasia of the portal vein (PHPV), 9 with congenital portosystemic shunt (cPSS), and 11 with other hepatopathy were enrolled. Six dogs without hepatic disease also were evaluated as healthy controls. Methods Dogs with hepatic disorders were prospectively included. Contrast‐enhanced ultrasonography of the HV was performed for 2 minutes. Washout ratio was defined as the attenuation rate from peak intensity to the intensity at the end of the CEUS study. Results Washout ratio in the hepatitis group (median, 18.0%; range, 2.0–37.0%) was significantly lower than that of the PHPV (median, 52.2%; range, 11.5–86.3%), cPSS (median, 60.0%; range, 28.6–77.4%), other hepatopathy (median, 70.5%; range, 26.6–88.4%), and normal (median, 78.0%; range, 60.7–91.7%) groups. The area under the receiver operating characteristic curve for hepatitis was 0.960, with a 95% confidence interval (CI) of 0.853–0.990. Washout ratio ≤37.1% resulted in a sensitivity of 100% (95% CI, 78.5–100%) and specificity of 85.2% (95% CI, 67.5–94.1%) for the prediction of hepatitis. Conclusions and Clinical Importance Washout ratio can distinguish hepatitis from the other noninflammatory disorders with high accuracy. This result might reflect impaired Kupffer cell phagocytosis in dogs with hepatitis.
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Affiliation(s)
- K Morishita
- Department of Veterinary Clinical Sciences, Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - A Hiramoto
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - A Michishita
- Department of Veterinary Clinical Sciences, Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - S Takagi
- Department of Veterinary Clinical Sciences, Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - T Osuga
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - S Y Lim
- Department of Veterinary Clinical Studies, Faculty of Veterinary Medicine, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - K Nakamura
- Department of Veterinary Clinical Sciences, Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - N Sasaki
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - H Ohta
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - M Takiguchi
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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Morishita K, Hiramoto A, Osuga T, Lim SY, Khoirun N, Sasaki N, Nakamura K, Ohta H, Yamasaki M, Takiguchi M. Contrast-enhanced ultrasonography of the hepatic vein in normal dogs. J Vet Med Sci 2016; 78:1753-1758. [PMID: 27534912 PMCID: PMC5240750 DOI: 10.1292/jvms.16-0062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Contrast-enhanced ultrasonography (CEUS) of the hepatic vein can assess intrahepatic
hemodynamic changes and has been studied as a noninvasive method to assess the severity of
portal hypertension and hepatic fibrosis in humans. However, few reports have described
its usefulness in veterinary medicine. The purpose of this study was to characterize CEUS
findings of the hepatic vein in normal dogs and assess the repeatability of this method
both in a conscious group (n=6) and a sedated group (n=6). Sonazoid® (0.01
ml/kg) was used as a contrast agent, and scanning of the hepatic vein
was performed for 2 min. Time-intensity curves were generated from regions of interest in
the hepatic vein. Four perfusion parameters were measured for quantitative analysis:
hepatic vein arrival time (HVAT), time to peak (TTP), time to peak phase (TTPP) and
wash-out ratio (WR). CEUS examinations were performed three times in each dog. The median
(range) values of HVAT, TTP, TTPP and WR in the conscious group were 13.5 sec (9–22 sec),
12.5 sec (6–24 sec), 8 sec (6–13 sec) and 78.0% (60.7–91.7%), respectively. Median (range)
values of HVAT, TTP, TTPP and WR in the sedated group were 12 sec (8–17 sec), 12.5 sec
(9–17 sec), 9 sec (7–13 sec) and 84.1% (63.0–94.4%), respectively. The coefficients of
variation of these parameters in the conscious and sedated groups were 7.6–29.7% and
11.8–14.8%, respectively.
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Affiliation(s)
- Keitaro Morishita
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Hokkaido 060-0818, Japan
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