Quantification of Liver Fat Content after Radiofrequency Ablation for Liver Cancer: Correlation with Hepatic Perfusion Disorders

Purpose: To quantitatively investigate the correlation between liver fat content and hepatic perfusion disorders (HPD) after radiofrequency ablation (RFA) for liver cancer using magnetic resonance imaging (MRI)-determined proton density fat fraction (PDFF). Materials and methods: A total of 150 liver cancer patients underwent liver MRI examination within one month after RFA and at four months after RFA. According to the liver fat content, they were divided into non-, mild, moderate, and severe fatty liver groups. The liver fat content and hepatic perfusion disorders were determined using PDFF images and dynamic contrast-enhanced MRI images. The relationship between the liver fat content and HPD was investigated. Results: At the first postoperative MRI examination, the proportion of patients in the nonfatty liver group with hyperperfused foci (11.11%) was significantly lower than that in the mild (30.00%), moderate (42.86%), and severe fatty liver (56.67%) groups (p < 0.05), whereas the proportions of patients with hypoperfused foci (6.67%, 7.5%, 5.71%, and 6.67%, respectively) were not significantly different among the four groups (p > 0.05). In the nonfatty liver group, the liver fat content was not correlated with hyperperfusion abnormalities or hypoperfusion abnormalities. By contrast, in the three fatty liver groups, the liver fat content was correlated with hyperperfusion abnormalities but was not correlated with hypoperfusion abnormalities. At the second postoperative MRI examination, six patients in the nonfatty liver group were diagnosed with fatty liver, including two patients with newly developed hyperperfusion abnormalities and one patient whose hypoperfusion abnormality remained the same as it was in the first postoperative MRI examination. Conclusion: There was a high correlation between the liver fat content and hyperperfusion abnormalities after RFA for liver cancer. The higher the liver fat content was, the higher the was risk of hyperperfusion abnormalities. However, there was little correlation between liver fat content and hypoperfusion abnormalities, and the increase in postoperative liver fat content did not induce or alter the presence of hypoperfused foci.

The Role of Epigenetic Changes in the Progression of Alcoholic Steatohepatitis

Alcoholic steatohepatitis (ASH) is a progression hepatitis with severe fatty liver and its mortality rate for 30-days in patients are over 30%. Additionally, ASH is well known for one-fifth all alcoholic related liver diseases in the world. Excessive chronic alcohol consumption is one of the most common causes of the progression of ASH and is associated with poor prognosis and liver failure. Alcohol abuse dysregulates the lipid homeostasis and causes oxidative stress and inflammation in the liver. Consequently, metabolic pathways stimulating hepatic accumulation of excessive lipid droplets are induced. Recently, many studies have indicated a link between ASH and epigenetic changes, showing differential expression of alcohol-induced epigenetic genes in the liver. However, the specific mechanisms underlying the pathogenesis of ASH remain elusive. Thus, we here summarize the current knowledge about the roles of epigenetics in lipogenesis, inflammation, and apoptosis in the context of ASH pathophysiology. Especially, we highlight the latest findings on the roles of Sirtuins, a conserved family of class-III histone deacetylases, in ASH. Additionally, we discuss the involvement of DNA methylation, histone modifications, and miRNAs in ASH as well as the ongoing efforts for the clinical translation of the findings in ASH-related epigenetic changes.

Effects of Tamoxifen vs. Toremifene on fatty liver development and lipid profiles in breast Cancer

Background Tamoxifen (TAM) and Toremifene (TOR), two kinds of selective estrogen receptor modulators (SERMs), have equal efficacy in breast cancer patients. However, TAM has been proved to affect serum lipid profiles and cause fatty liver disease. The study aimed to compare the effects of TAM and TOR on fatty liver development and lipid profiles. Methods This study performed a retrospective analysis of 308 SERMs-treated early breast cancer patients who were matched 1:1 based on propensity scores. The follow-up period was 3 years. The primary outcomes were fatty liver detected by ultrasonography or computed tomography (CT), variation in fibrosis indexes, and serum lipid profiles change. Results The cumulative incidence rate of new-onset fatty liver was higher in the TAM group than in the TOR group (113.2 vs. 67.2 per 1000 person-years, p < 0.001), and more severe fatty livers occurred in the TAM group (25.5 vs. 7.5 per 1000 person-years, p = 0.003). According to the Kaplan-Meier curves, TAM significantly increased the risk of new-onset fatty liver (25.97% vs. 17.53%, p = 0.0243) and the severe fatty liver (5.84% vs. 1.95%, p = 0.0429). TOR decreased the risk of new-onset fatty liver by 45% (hazard ratio = 0.55, p = 0.020) and showed lower fibrotic burden, independent of obesity, lipid, and liver enzyme levels. TOR increased triglycerides less than TAM, and TOR increased high-density lipoprotein cholesterol, while TAM did the opposite. No significant differences in total cholesterol and low-density lipoprotein cholesterol are observed between the two groups. Conclusions TAM treatment is significantly associated with more severe fatty liver disease and liver fibrosis, while TOR is associated with an overall improvement in lipid profiles, which supports continuous monitoring of liver imaging and serum lipid levels during SERM treatment.

Serum HGF ,PCIII and PLT are Noninvasive Markers for the diagnosis of nonalcoholic fatty liver disease

Background/Aims: It was suggested that serum HGF,PCIII and PLT play important roles in nonalcoholic fatty liver disease (NAFLD). Thus, we aimed to evaluate their clinical utility in the diagnosis of patients with suspected NAFLD.Methods:300 Patients with NAFLD were compared to 102 matched controls.All were subjected to history taking, anthropometric measurements, and abdominal ultrasonography, as well as laboratory assessments of liver functions, fasting lipid profile, GLU, serum PLT, HGF and PCIII.Results:The levels of HGF,PCIII and PLT were higher in NAFLD cases than controls ,and with progressive increases as the severity of fatty liver increased（P<0.05）.HGF,PCIII and PLT were correlated with various clinical parameters and severity of NAFLD（P<0.05）.The optimal cut-off values for HGF in diagnosis of mild, moderate and severe fatty liver were 14.1pg/ml(AUROC 0.753,P＝0.004), 15.4pg/ml(AUROC 0.836, P < 0.001), 17.7pg/ml(AUROC 0.903, P < 0.001). PCIII had no value in differentiate mild from moderate fatty liver ,but its ability to diagnose severe fatty liver was significant. A cut-off value for PCIII to diagnose severe fatty liver was 7.9ng/L(AUROC 0.773).The optimal cut-off values for PLT in the diagnosis of mild, moderate and severe fatty liver were 194×10^9/L(AUROC 0.732), 195×10^9/L(AUROC 0.765), 200×10^9/L(AUROC 0.925), respectively with P < 0.001. When three indicators were tested together,the AUROC(95%CI)curve for diagnose NAFLD was 0.881(sensitivity0.760,specificity 0.873)(P<0.001) .Conclusion:.Combined detection of serum HGF, PCIII and PLT may be an effective non-invasive method for diagnosing NAFLD.

Epidemiologic Profile and Predictors of Fatty Liver: A Hospital-Based Study

Background: Non-alcoholic fatty liver is the most common cause of chronic liver disease with increasing prevalence globally. Settings and Design: The current study is an analytical case control study; conducted in ultrasonography outpatient clinic of Cairo University Hospital. Materials and Methods: 150 consented fatty liver cases and 564 controls were screened for fatty liver infiltration using abdominal ultrasonography. Receiver Operating Characteristics (ROC) curve analysis was performed to explore the discriminant ability of the developed model. Results: Among cases, Age, sex and residence matching contributes 32.7%, 36% and 31.3% mild, moderate and severe degree of fatty liver respectively. Cases showed significantly higher body mass index (BMI), waist circumference (WC), total cholesterol, triglyceride, low density lipoprotein (LDL), and lower high density lipoprotein (HDL) than controls. Cases demonstrated higher prevalence of hypertension (11.3% vs 8.3% respectively), and significantly higher prevalence of diabetes (22% vs. 9.2%) (p=0.03). Severe fatty liver cases were significantly older and had significantly higher WC, BMI, significantly higher association with diabetes mellitus, significantly higher levels of total cholesterol, triglycerides and LDL than non-severe degree cases. The significant predictors of sever fatty liver were BMI, total cholesterol and LDL (P = <0.001, R2 = 0.543). Conclusion: The developed regression equation expressed good validation and calibration. It utilizes an algorithm that can quickly and easily address patients with fatty liver. It would useful as a fast, inexpensive primary screening tool for severe fatty liver.