Artificial Intelligence in Hepatology: A Narrative Review

There has been a tremendous growth in data collection in hepatology over the last decade. This wealth of “big data” lends itself to the application of artificial intelligence in the development of predictive and diagnostic models with potentially greater accuracy than standard biostatistics. As processing power of computing systems has improved and data are made more accessible through the large databases and electronic health record, these more contemporary techniques for analyzing and interpreting data have garnered much interest in the field of medicine. This review highlights the current evidence base for the use of artificial intelligence in hepatology, focusing particularly on the areas of diagnosis and prognosis of advanced chronic liver disease and hepatic neoplasia.

Influence of hepatic neoplasia on life expectancy in dogs

Background and Aim: The present study investigated the influence of liver tumor structure on life expectancy in dogs. Diseases of the liver comprise 5-25% of all non-communicable diseases in dogs, and primary hepatic tumors account for 0.6-1.3% of tumors. This research aimed to study the post-operative life span of animals with primary or metastatic tumors of the liver. Materials and Methods: During the study period, 7124 oncological operations were performed in our clinic. In total, 128 liver tumors were detected in live animals, while 323 were detected posthumously. Forty animals underwent surgery for various liver tumors. In dogs with primary liver tumors, the average age was 11.9 years and the average body weight was 15.5 kg, while in dogs with liver metastases, the mean age was 11.4 years and the average body weight was 24 kg. Results: The ratio of males to females among dogs with primary liver tumors was about 1:1 (ten females and nine males), while that among dogs with metastatic liver damage was clearly predominantly female (14 females and two males) because females often undergo surgery for cancerous mammary glands or ovaries. Conclusion: The size of tumors and the number of affected lobes had a significant effect on the post-operative life span. With a tumor size of <5 cm and a lesion covering less than two lobes of the liver, life expectancy was significantly longer and the prognosis was more favorable. In cases of large tumors or those affecting more than two lobes, life expectancy was significantly reduced and the prognosis was cautious to unfavorable.

Radiological findings of porcine liver after electrochemotherapy with bleomycin

Background Radiologic findings after electrochemotherapy of large hepatic blood vessels and healthy hepatic parenchyma have not yet been described. Materials and methods We performed a prospective animal model study with regulatory approval, including nine grower pigs. In each animal, four ultrasound-guided electroporated regions were created; in three regions, electrodes were inserted into the lumen of large hepatic vessels. Two types of electrodes were tested; variable linear- and fixed hexagonal-geometry electrodes. Ultrasonographic examinations were performed immediately and up to 20 minutes after the procedure. Dynamic computed tomography was performed before and at 60 to 90 minutes and one week after the procedure. Results Radiologic examinations of the treated areas showed intact vessel walls and patency; no hemorrhage or thrombi were noted. Ultrasonographic findings were dynamic and evolved from hyperechogenic microbubbles along electrode tracks to hypoechogenicity of treated parenchyma, diffusion of hyperechogenic microbubbles, and hypoechogenicity fading. Contrast-enhanced ultrasound showed decreased perfusion of the treated area. Dynamic computed tomography at 60 to 90 minutes after the procedure showed hypoenhancing areas. The total hypoenhancing area was smaller after treatment with fixed hexagonal electrodes than after treatment with variable linear geometry electrodes. Conclusions Radiologic findings of porcine liver after electrochemotherapy with bleomycin did not show clinically significant damage to the liver, even if a hazardous treatment strategy, such as large vessel intraluminal electrode insertion, was employed, and thus further support safety and clinical use of electrochemotherapy for treatment of hepatic neoplasia.

Cholangiocarcinoma in Young Cats

Background: Cholangiocellular carcinoma is a malignant tumor that occurs mainly in elderly dogs and cats. Primary hepatobiliary neoplasms are considered rare in felines, although cholangiocarcinoma is the most common tumor type among malignant liver tumors in the species. The objective of this work is to report two cases of cholangiocarcinoma in young domestic cats, with three years old, and to approach clinical and pathological aspects to promote awareness of this type of injury in young animals, with a focus on prevention of predisposing factors.Cases: A 3-year-old male domestic cat (cat 1) had a history of progressive weight loss, persistent vomiting, diarrhea, and episodes of seizure. At the clinical examination was noted moderate degree of jaundice. In the biochemical exams it was verified as alteration hypoproteinemia, increase of urea and hyponatremia. Abdominal ultrasonography revealed a formation in the left epigastric region measuring 8.0 x 5.0 cm, with a diffusely heterogeneous parenchyma, suggestive of hepatic neoplasia, in addition to the presence of free abdominal fluid. Cavity fluid analysis was suggestive of carcinoma. A 3-year-old male domestic cat (cat 2), with history of hyporexia, emaciation and vomiting was taken to care. Physical examination showed moderate dehydration, hypocorous mucosa and presence of abdominal mass on palpation. The animal's serum biochemical assessment were verified as changes, increasing AST. Ultrasonographic examination showed an abdominal mass, located caudally to the spleen, with irregular shape, measuring approximately 4.7 cm suggestive of hepatic neoplasia, in addition to the presence of abdominal fluid. The hepatic cytology performed by fine needle aspiration was suggestive of carcinoma. After the clinical worsening of two cats and due unfavorable prognosis, euthanasia and necropsy were performed. In the macroscopic analysis of cat 1, numerous nodules of whitish and sometimes "umbilicate" coloration were observed in the liver, measuring up to three cm in diameter, distributed randomly by the hepatic parenchyma and with a soft consistency at cut. An ovoid-wicking mass, measuring 6.0 x 7.0 x 5.0 cm in diameter and coloring ranging from white to light brown was checked together. In the macroscopic evaluation of cat 2, numerous coalescing masses of whitish coloring measuring up to 6.0 cm in diameter were observed covering almost every hepatic parenchyma and also affecting the pancreas, with a soft consistency at cut. The microscopic findings of both cats were compatible with the diagnosis of cholangiocarcinoma. Considering the immunohistochemical profile, in both cases there was positivity for the CK Pan antibody and CEA and negativity for the CK20, TTF-1, Hepatocyte specific antigen, CD10 and CD56 antibodies.Discussion: Cholangiocarcinomas usually occur in elderly animals, with a mean age of 9 years, so it may be suggested that the cause of the disease in cat 1 and 2 was possibly related to the early and continuous presence of carcinogens. The biliary duct trematod Platynosomum fastosum, the chemical agents plutonium and americium, intestinal parasites such as Ancylostoma spp. and Trichuris vulpis, as well as the occurrence of chronic inflammations independent of etiology are commonly involved in the occurrence of cholangiocarcinoma. Clinical and anatomopathological observations made evident that these two young cats, with three years old, had metastatic cholangiocarcinoma. Thus, veterinary providers should be aware that this tumor type can occur in young animals and is mindful of means of prevention and / or recommended treatment of predisposing factors.

Cholangiocarcinoma and hepatic myelolipoma incarcerated in a peritoneopericardial diaphragmatic hernia with pulmonary metastasis and carcinomatosis in a cat

Case summary A 14-year-old female neutered Persian-cross cat was presented with a 1 week history of anorexia and lethargy. On physical examination, marked tachypnoea and dyspnoea were evident. Radiographs of the thorax revealed a globoid-shaped cardiac silhouette with heterogeneous opacity consistent with a peritoneopericardial diaphragmatic hernia (PPDH), pulmonary nodules compatible with metastasis, seven sternal segments and a small liver in the cranial abdomen with loss of serosal detail. On echocardiography, there was no evidence of cardiac tamponade. Triple-phase CT angiography demonstrated a mixed soft tissue-, mineral- and fat-attenuated liver mass arising from the left hepatic lobes that showed a pronounced heterogeneous contrast-enhancement pattern within the pericardial sac, which was producing a marked mass effect on the adjacent structures. Additionally, there was an increase in attenuation of the mesenteric fat and peritoneal effusion. The pulmonary nodules were confirmed. Imaging findings were compatible with a malignant hepatic neoplasia incarcerated in a PPDH, lung metastasis and carcinomatosis. Owing to the poor prognosis, the cat was humanely euthanased. Histopathological diagnosis was cholangiocellular carcinoma and hepatic myelolipoma, pulmonary metastasis and carcinomatosis. Relevance and novel information Hepatic cholangiocarcinoma incarcerated in a PPDH with pulmonary metastasis and carcinomatosis has not been previously described. Suspicion of a hepatic neoplasia should be raised in cases of PPDH and pulmonary nodules.

Feline abdominal ultrasonography: what’s normal? what’s abnormal? The liver

Practical relevance: Abdominal ultrasound plays a vital role in the diagnostic work-up of many cats presenting to general and specialist practitioners. Ultrasound examination of the liver can be key in the diagnosis of diseases such as hepatic lipidosis and hepatic neoplasia. Clinical challenges: Despite ultrasonography being a commonly used modality, many practitioners are not comfortable performing an ultrasound examination or interpreting the resulting images. Even differentiating between normal variation and pathological changes can be challenging for all but the most experienced. When assessing the liver via ultrasound, a diffuse alteration in liver echogenicity may be difficult to detect unless the change is marked and, although comparisons can be made with the spleen and kidneys, this relies on these organs being normal. Equipment: Ultrasound facilities are readily available to most practitioners, although use of ultrasonography as a diagnostic tool is highly dependent on operator experience. Aim: This review, the first in an occasional series on feline abdominal ultrasonography, discusses ultrasonographic examination of the normal and diseased liver, with focus on the liver parenchyma. It is aimed at general practitioners who wish to improve their knowledge of and confidence in feline abdominal ultrasound and is accompanied by high-resolution images. Ultrasound-guided sampling of the liver is also covered. Future articles will discuss the biliary tree and hepatic vascular anomalies. Evidence base: Information provided in this article is drawn from the published literature and the author’s own clinical experience.