Ascitic Fluid Cytokines in Chronic Liver Disease: A Possible Prognostic Tool

2021 ◽  
Author(s):  
Shimaa atta ◽  
Manal Kamel ◽  
Wafaa Mansour ◽  
Taghreed Hussein ◽  
Kesmat Maher ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Ascitic Fluid ◽  
Serum Levels ◽  
Malignant Ascites ◽  
Focal Lesions ◽  
Prognostic Tool ◽  
Significant Difference ◽  
Focal Hepatic Lesions ◽  
Hepatic Lesions ◽  
Fluid Levels

Introduction: Malignant ascites results from imbalance between protein in the peritoneal cavity and absorption of fluids via the lymphatic system. More than twenty interleukins are known to play an important role in the protection against tumors. Materials and methods: Ascitic fluid IL1B, IL2, IL4, IL6, IL10, TNFα, and IFNγ levels were assessed in forty-five patients with liver cirrhosis and ascites as judged by histopathological and ultra-sonographic findings. They were divided into two groups according to presence of hepatic focal lesions. Ten patients with focal hepatic lesions were randomly selected and subjected to analysis of serum levels of IL2 and IL10. Results: Ascitic fluid IL-4, IL-6 and IL-10 levels were found to be significantly higher in patients with hepatocellular carcinoma than patients with cirrhosis. TNFα, and IFNγ were also found to be higher in hepatocellular carcinoma than patients with cirrhosis but with no significance. On the other hand, there was no significant difference in levels of IL1B and IL2 between the two groups. Ascitic fluid IL2 and IL10 levels were found to be higher in ascitic fluid than in serum of the same patients. Conclusion: Ascitic fluid levels of IL-4, IL-6 and IL-10 are higher in hepatocellular carcinoma patients than patients with cirrhosis alone. Levels of ascitic fluid IL2 and IL10 were proved to be a better prognostic tool than their levels in sera of the same patients. To conclude; patients with cirrhosis may be subjected to schedualed examination of ascitic fluid cytokine to predect transformation into hepatocellular carcinoma.

scholarly journals Significance of posterior acoustic enhancement ultrasonographic findings in the diagnosis of hepatocellular carcinoma

2019 ◽  
Vol 72 (5-6) ◽  
pp. 160-164
Author(s):  
Jelena Stosic ◽  
Srdjan Stosic ◽  
Biljana Kukic ◽  
Mladjan Protic
Keyword(s):  
Hepatocellular Carcinoma ◽  
Retrospective Study ◽  
Liver Disease ◽  
Ultrasound Examination ◽  
Significant Finding ◽  
Focal Lesions ◽  
Hepatocellular Carcinomas ◽  
Focal Hepatic Lesions ◽  
Patients At Risk ◽  
Hepatic Lesions

Introduction. On ultrasound, hepatocellular carcinoma presents with nodular or multinodular lesions of different size and echostructure, sometimes with a surrounding halo, and lateral acoustic shadows or posterior acoustic enhancement. The aim of this study was to determine the incidence of posterior acoustic enhancement in hepatocellular carcinoma. Material and Methods. This retrospective study included 120 patients with pathologically verified hepatocellular carcinoma who had undergone ultrasound examination (using real time ultrasounds from different manufacturers, with 3.5 and 5 MHz probes). Ultrasound imaging focused on the size and appearance of the focal lesions, i. e. echostructure and presence or absence of posterior acoustic enhancement as areas of increased echogenicity behind the lesion. Results. Posterior acoustic enhancement was observed in 47.3% of all nodular hepatocellular carcinomas, whereas this ultrasound phenomenon was statistically significantly more common in the group of tumors from 3 to 5 cm in size. In the group of multinodular tumors, posterior acoustic enhancement was found in 70% of cases. Conclusion. The presence of posterior acoustic enhancement in the detection of focal hepatic lesions may be a significant finding in the diagnosis of hepatocellular carcinoma, especially in patients at risk for developing hepatocellular carcinoma (cirrhosis and chronic liver disease), as well as in monitoring interval growth in size of focal lesions using this ultrasound phenomenon.

scholarly journals Apparent diffusion coefficient for differentiating between benign and malignant hepatic focal lesions

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Sherif Abugamra ◽  
Aya Yassin ◽  
Asmaa Saber Mostafa Abdel-Rehim ◽  
Dina Sayed Sheha
Keyword(s):  
Hepatocellular Carcinoma ◽  
Diffusion Coefficient ◽  
Apparent Diffusion Coefficient ◽  
Focal Lesion ◽  
Benign Lesions ◽  
Focal Lesions ◽  
Significant Difference ◽  
Apparent Diffusion ◽  
Malignant Lesions ◽  
The Mean

Abstract Background The aim of this study was to prospectively evaluate the role of diffusion weight MRI (DWI) in the characterization of hepatic focal lesions by using apparent diffusion coefficient (ADC). Thirty patients (18 women, 12 men; mean age 48.5 years) with hepatic focal lesions were included in this study. Patients underwent DW MR imaging with the SPLICE sequence. ADC of each focal lesion carcinoma was calculated from DW MR Images obtained with low and high b values. ADCs were compared among pathological types of focal lesions. Results Among the 30 patients included in the study, 46 focal lesions were detected. Twenty-four lesions were metastatic lesions from primary cancer, 7 lesions were hepatocellular carcinoma (HCC), 9 lesions were hemangiomas, and 6 lesions were simple cysts. There was highly significant difference between the mean ADC of the malignant lesions (metastasis and HCC) and the mean ADC of benign lesions (hemangiomas and cysts). The ADC of malignant lesion was much less than that of benign lesion. The mean ADC of malignant lesions (n = 31) was 0.73 ± 0.19 × 10−3 mm2/s, and the mean ADC of benign lesions (n = 15) was 1.94 ± 0.68 × 10−3 mm2/s (p value < 0.001). There was no significant difference between the cysts and hemangiomas. There was no statistically significant difference between the metastases and hepatocellular carcinoma. Conclusion ADCs values were able to differentiate benign from malignant lesions. ADC should be considered in the work up of patients with hepatic focal lesions.

Role of MRI in Detecting and Characterizing Small Hepatic Focal Lesions

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Rania Ali Maarouf ◽  
Ali Haggag Ali ◽  
Mahmoud Abdelatif Onsy
Keyword(s):  
Tumor Staging ◽  
Left Lobe ◽  
Diagnostic Process ◽  
Liver Imaging ◽  
Focal Lesions ◽  
Focal Hepatic Lesions ◽  
Malignant Lesions ◽  
Hepatic Lesions ◽  
The Right

Abstract Background Despite the recent advances in liver imaging, the detection and characterization of small hepatic focal lesions is still a real challenge. Particularly in cancer patients where the characterization of a small HFL as thus the precise tumor staging is critical for optimal treatment planning. Aim of the Work To explore the effectiveness, and hence the clinical utility, of MRI detection and characterization of small focal hepatic lesions either only discovered on MRI or as a further work up of CT/US-indeterminate lesions. Patients and Methods We reviewed our database for individuals who underwent liver MR imaging between March 2018 and March 2019 for the evaluation of small hepatic lesions that were discovered for the first time or had been previously visualized on routinely performed CT and had been considered indeterminate. Results The present study included 44 patients of which 26 were males (59.1%) and 18 were females (40.9%). The age range of the study group was 19 to 77 years. The mean age for Malignant lesions was 51 years. The right lobe of liver was involved in 23 cases (52.3%), left lobe in 5 cases (11.4%) and both lobes in 16 cases (36.4%). There were 30 (68.18%) benign, 13 (29.54%) malignant lesions and 1 (2.3%) indeterminate, hemangiomas were predominant in benign lesions whereas hepatocellular carcinomas were predominant in malignant lesions. N'TRI could characterize 92% cases. Conclusion The diagnostic process of small hepatic focal lesions, either detection or characterization or both, continues to represent a challenge. Contrast-enhanced MR can accurately detect and characterize majority of small hepatic focal lesions.

scholarly journals Diagnostic Utility of Serum Ascites Lipid and Protein Gradients in Differentiation of Ascites

2019 ◽  
Vol 2019 ◽  
pp. 1-10
Author(s):  
Mukhyaprana Prabhu ◽  
Rahul Sai Gangula ◽  
Weena Stanley
Keyword(s):  
Ascitic Fluid ◽  
Clinical Laboratory ◽  
Statistical Significance ◽  
Hdl Cholesterol ◽  
Malignant Ascites ◽  
Screening Tests ◽  
Diagnostic Utility ◽  
Roc Curve Analysis ◽  
Significant Difference ◽  
Protein Gradients

Context. Ability of SAAG to differentiate malignant ascites from other aetiologies like tubercular peritonitis is a major problem. Alternate screening test is needed for differentiating ascites due to malignancy from those due to tubercular peritonitis. Aims. To study the diagnostic utility of serum ascites lipid gradients and serum ascites protein gradients in pathophysiological differentiation of ascites. Settings and Design. The present study is a prospective, descriptive, hospital-based, cross-sectional study. Methods and Material. The study was conducted on patients with ascites who were admitted to General Medicine Department, Kasturba Hospital, Manipal. The study included 60 patients with ascites of different etiologies (liver cirrhosis, tubercular peritonitis, and malignant ascites). All of them had undergone clinical, laboratory, and imaging investigations and were treated as per standard of care. All patients underwent abdominal paracentesis, and fluid samples were sent for analysis. Statistical Analysis Used. ANOVA, Kruskal-Wallis H test, and ROC curve analysis. Results. Among the gradients, only SAPG and SAAG had over all statistical significance (<0.005) among the groups, but no significance between malignancy and tubercular peritonitis had been observed. Similarly all the ascitic fluid parameters measured had an overall statistical significance (<0.005), but there was no significant difference observed between malignancy and tubercular peritonitis groups. However, ascitic fluid and serum HDL cholesterol had a statistical significance (<0.05) between malignancy and tubercular peritonitis. Conclusions. With a cut-off value of 4, SAPG is one of best screening tests in differentiation of cirrhotic with noncirrhotic ascites when compared with SAAG, whereas it is a poor parameter with high sensitivity and very low specificity in differentiation of malignant with nonmalignant ascites. Also the present study reveals HDL cholesterol levels in ascitic fluid to be a valuable marker with higher sensitivity and specificity in differentiation of malignancy and tuberculosis peritonitis (i.e., differentiation of low SAAG ascites).

Plasma Osteopontin Level as a Diagnostic Marker of Hepatocellular Carcinoma in Patients with Radiological Evidence of Focal Hepatic Lesions

2013 ◽  
Vol 99 (1) ◽  
pp. 100-107 ◽  
Author(s):  
Ashraf Khalil ◽  
Jamalat Elgedawy ◽  
Mohammed F Faramawi ◽  
Ashraf Elfert ◽  
Ibrahim Salama ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Malignant Tumors ◽  
Treatment Options ◽  
Alpha Fetoprotein ◽  
Egyptian Patients ◽  
Diagnostic Role ◽  
Focal Hepatic Lesions ◽  
Serum Alpha Fetoprotein ◽  
Hepatic Lesions

Aims Hepatocellular carcinoma is one of the most aggressive malignant tumors and has limited treatment options. Needle-guided biopsies have been utilized as a tool to diagnose malignant focal hepatic lesions. These techniques are discouraged because of their complications. Nowadays, alpha fetoprotein is the most widely used tumor marker for screening and diagnosis of hepatocellular carcinoma. Nevertheless, this marker has limitations. The diagnostic role of plasma osteopontin as an adjuvant or alternative marker to alpha fetoprotein to detect hepatocellular carcinoma in Egyptian patients with focal hepatic lesions was evaluated in this study. Subject and methods Eighty participants were recruited from the Egyptian National Liver Institute and were self-assigned to three groups, namely, focal hepatic lesions (n = 40), liver cirrhosis (n = 20), and controls (n = 20). Participants' plasma osteopontin and serum alpha fetoprotein levels were determined and were compared across the three groups. Results The discriminatory ability of plasma osteopontin for hepatocellular carcinoma was lower than that of alpha fetoprotein. Osteopontin and alpha fetoprotein were not correlated with each other. Neither the gender nor the age of the patients showed a significant association with plasma osteopontin level. Conclusion Measuring plasma osteopontin level alone has no advantage over serum alpha fetoprotein in patients with focal hepatic lesions due to chronic liver disease.

Correlation of serum PIVKA-II and AFP level with portal vein tumor thrombus and BCLC stage in newly diagnosed hepatocellular carcinoma patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16608-e16608
Author(s):  
Goutham Gandham ◽  
Hridya Jayamohanan ◽  
Bharadwaj Ponnada ◽  
Anil Kumar ◽  
Sudhindran S ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Portal Vein ◽  
Diagnostic Accuracy ◽  
Tumor Thrombus ◽  
Predictive Marker ◽  
Serum Levels ◽  
Portal Vein Tumor Thrombus ◽  
Newly Diagnosed ◽  
P Values ◽  
Significant Difference

e16608 Background: Protein Induced by Vitamin K Absence-II (PIVKA-II) is a tumor marker specific for hepatocellular carcinoma (HCC). PIVKA-II levels correspond with HCC oncogenesis and disease progression. Portal vein tumor thrombus (PVTT) in patients with HCC is a significant factor that affect treatment and prognosis. In this study we assessed the predictive value of PIVKA-II and AFP for vascular invasion and BCLC stage in newly diagnosed HCC patients. Methods: We retrospectively reviewed records of newly diagnosed HCC patients at a tertiary hospital in India between January 2019 to December 2019. Clinical details, BCLC stage, radiological imaging records, serum levels of PIVKA-II and AFP at the time of diagnosis were obtained from medical records. Diagnostic accuracy and cut-off value of PIVKA-II in patients with portal invasion were calculated using receiver operator curve (ROC) analysis. Multiple pairwise comparisions between BCLC stage with PIVKA-II and AFP levels were analysed using Kruskal-Wallis test. Results: Out of 162 newly diagnosed HCC patients 42(25.9%) were detected with PVTT on imaging such as contrast-enhanced computed tomography or magnetic resonance imaging at the time of diagnosis.120(74.1%) patients without PVTT were taken as controls for the analysis. Serum level of PIVKA-II in HCC patients with PVTT was significantly higher than in HCC patients without PVTT (1152.57 mAU/ml vs 146.39 mAU/ml; p = 0.001). AUROC of PIVKA-II was 0.796 (95%CI 0.70-0.892, p = 0.000).The optimal cut-off value of PIVKA-II was 271.81 mAU/ml with a sensitivity of 78.6% and specificity of 52.4%, and the diagnostic accuracy was 59.98%. AUROC of AFP was 0.619 (95%CI 0.59-0.72, p = 0.001). Median PIVKA-II value increased from BCLC stage A to D. Kruskal-Wallis test showed a significant difference of PIVKA-II levels between all stages except stage A and B (p values for stage A-B (0.297), A-C (0.000), A-D(0.000),whereas for AFP results were significant only between stages A and C (p values for stage A-B (0.348), A-C (0.003), A-D(0.206). Conclusions: Serum PIVKA-II level appears as a good predictive marker for PVTT and BCLC stage when compared to AFP which may guide therapeutic strategy and assessment of prognosis in newly diagnosed HCC patients.

Abdominal Ultrasonography in Myelofibrosis

1992 ◽  
Vol 33 (4) ◽  
pp. 343-346 ◽  
Author(s):  
T. M. J. Siniluoto ◽  
S. A. Hyvärinen ◽  
M. J. Päivänsalo ◽  
M. J. Alavaikko ◽  
I. J. I. Suramo
Keyword(s):  
Fine Needle Biopsy ◽  
Extramedullary Hematopoiesis ◽  
Primary Diagnosis ◽  
Definitive Diagnosis ◽  
Initial Diagnosis ◽  
Focal Lesions ◽  
Abdominal Ultrasonography ◽  
Focal Hepatic Lesions ◽  
Hepatic Lesions ◽  
Focal Splenic Lesions

The findings at abdominal ultrasonography (US) in 40 patients with myelofibrosis were reviewed, 20 patients being examined at initial diagnosis and 31 at later stages. Splenomegaly was found in 80% at initial diagnosis and in 97% at later stages. The spleen of 2 patients appeared homogeneously hypoechoic and inhomogeneous in one. Focal splenic lesions were seen in 5, and calcifications in 6. Mixed splenic lesions proved to be metastases in one and hyperechoic lesions in another patient were due to extramedullary hematopoiesis. Hepatomegaly was found in 25% at primary diagnosis and in 39% at later stages. Focal hepatic lesions were seen in 7 patients, and proved to be metastases in 3. The focal lesions in 2 of these patients were extramedullary hematopoiesis, which was hypoechoic in one and hyperechoic in the other. Ascites was seen in 4 patients and lymphadenopathy in one. US could not reliably differentiate between extramedullary hematopoiesis and malignancy. Fine-needle biopsy may be performed for definitive diagnosis.

scholarly journals Usefulness of contrast-enhanced ultrasound using perfluorobutanecontaining microbubbles as a planning for percutaneous biopsies of focal hepatic lesions: a prospective feasibility study

2019 ◽  
Vol 21 (2) ◽  
pp. 109 ◽  
Author(s):  
Sang Min Lee ◽  
Jung Hoon Kim ◽  
Hyun Kyung Yang ◽  
Hyo-Jin Kang ◽  
Joon Koo Han
Keyword(s):  
Target Lesion ◽  
Technical Failure ◽  
Mr Images ◽  
Point Scale ◽  
Focal Lesions ◽  
Technical Feasibility ◽  
Contrast Enhanced ◽  
Focal Hepatic Lesions ◽  
The Mean ◽  
Hepatic Lesions

Aims: To determine whether contrast-enhanced US using perfluorobutane-containing microbubbles (SEUS) would be helpful for planning a hepatic biopsy.Material and methods: This prospective study included 40 patients who planned to undergo hepatic biopsy for focal hepatic lesions. All patients underwent B-mode US followed by SEUS. The radiologist evaluated the number of detected lesions, presence of necrosis, conspicuity of target lesion and technical feasibility using 4-point scale. Technical failure and occurrence of change of the target were also assessed. Computer tomography (CT) or magnetic resonance (MR) images were the reference techniques. Results: The mean number of lesions detected on CT and MR images was 6.5±8.4. In 20 (50%) of 40 patients, more focal lesions were detected on SEUS. Targeted lesion was changed in sixpatients (15%) on SEUS. Mean number of detected lesions on SEUS was significantly higher comparing with B-US (5.1±6.2 vs. 2.8±3.8, p<0.001). Conspicuity of the targeted lesion was improved in 67.5% (27 of 40) on SEUS and significantly more visualized than B-US (3.6±0.8 vs. 2.8±0.9, p<0.001). In 7 more patients the necrosis within the lesion was visualized (17.5%) using SEUS. The technical feasibility on SEUS was significantly higher than B-US (2.3±1.0 vs. 3.3±0.9, p<0.001). Technical failure was observed in only one patient (2.5%).Conclusions: SEUS is a helpful technique for planning the hepatic biopsyin terms of detection, improving lesion conspicuity, tumor viable portion assessment and consequently higher operator confidence, compared with B-US.

scholarly journals Hepatocellular carcinoma presenting with pyrexia and leukocytosis: A case report

2017 ◽  
Vol 70 (1-2) ◽  
pp. 48-52
Author(s):  
Srdjan Stosic ◽  
Sanja Stojanovic ◽  
Stevan Idjuski ◽  
Jelena Stosic
Keyword(s):  
Hepatocellular Carcinoma ◽  
Case Report ◽  
Liver Abscess ◽  
Therapeutic Response ◽  
Left Lobe ◽  
Focal Lesion ◽  
Abdominal Ultrasonography ◽  
Focal Hepatic Lesions ◽  
Hepatic Lesions

Introducion. This type of hepatocellular carcinoma is characterized by fever and persistent leukocytosis. Case report. This is a report of a patient with a long term fever accompanied by persistent leukocytosis. Abdominal ultrasonography revealed a focal lesion in the left hepatic lobe, whereas, computed tomography/magnetic resonance imaging findings were consistent with a liver abscess. The patient received therapy for liver abscess, without improvement. He underwent left lobe segmentectomy 3, with histological features of hepatocellular carcinoma (pseudoglandular type). Conclusion. In patients with focal hepatic lesions accompanied with raised temeparature and persistent leukocytosis, without adequate therapeutic response, this clinicopathological type of hepatocellular carcinoma should be considered.

scholarly journals Liver-specific magnetic resonance contrast medium in the evaluation of chronic liver disease

2015 ◽  
Vol 13 (2) ◽  
pp. 326-329
Author(s):  
Marcio Augusto Correia Rodrigues dos Reis ◽  
Ronaldo Hueb Baroni
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Disease ◽  
Contrast Medium ◽  
Chronic Liver Disease ◽  
Hepatic Function ◽  
Chronic Liver ◽  
Hepatobiliary Phase ◽  
Hepatocellular Carcinomas ◽  
Focal Hepatic Lesions ◽  
Hepatic Lesions

ABSTRACT The hepatobiliary-specific contrast medium (gadoxetic acid – Primovist®) is primarily used to improve detection and characterization of focal hepatic lesions, such as in chronic liver disease patients with suspected hepatocellular carcinoma. Since the contrast medium is selectively taken up by functioning hepatocytes in the late hepatobiliary phase, it helps to detect typical hepatocellular carcinoma, which show low signal intensity on this phase. This imaging feature also assists in differentiating regenerative/dysplastic nodules from early hepatocellular carcinomas (with over 90% accuracy), as well as hypervascular hepatocellular carcinomas from arterial pseudo-enhancement foci. Future perspectives include its use in quantification of hepatic function and fibrosis.

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