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Lee H, Hyun J, Eom K, Kim J. Computed Tomographic Findings of Liver Cirrhosis in Dogs: Comparison between Compensated and Decompensated Cirrhosis. Vet Sci 2024; 11:404. [PMID: 39330783 PMCID: PMC11435577 DOI: 10.3390/vetsci11090404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 08/19/2024] [Accepted: 08/28/2024] [Indexed: 09/28/2024] Open
Abstract
This study aimed to describe computed tomography (CT) characteristics of histologically confirmed cirrhosis and to compare these CT characteristics between compensated and decompensated cirrhosis. Sixteen dogs who underwent contrast CT and histopathological examinations were included; eleven dogs were assigned to the compensated group, and five dogs were assigned to the decompensated group. Irregular hepatic contours with a diffuse nodular distribution and hepatic lymph node enlargement are common concomitant features of cirrhotic livers on CT images. The enhancement patterns of the regenerative nodules and hepatic parenchyma were not significantly different from each other. Hypoattenuating areas with delayed contrast enhancement indicating fibrotic tissue were confirmed in 56.3% of cases. Hypoattenuating wedge-shaped area or nodule with minor or no contrast enhancement (histopathologically confirmed as focal necrosis) were confirmed in 37.5% of cases. Among CT variables, only normalized liver volume and portal vein-to-aorta ratio were significantly lower (p = 0.038 and 0.003, respectively) in the decompensated group. In conclusion, this study presented the CT features of cirrhosis and identified CT features that can discriminate between compensated and decompensated cirrhosis. Specifically, lower normalized liver volume and the portal vein-to-aorta ratio might be useful indicators for the progression of cirrhosis to the decompensated phase.
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Affiliation(s)
- Heesu Lee
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul 05029, Republic of Korea
| | - Jaeeun Hyun
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, Seoul 05029, Republic of Korea
| | - Kidong Eom
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul 05029, Republic of Korea
| | - Jaehwan Kim
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul 05029, Republic of Korea
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Kemp Bohan PM, O'Shea AE, Lee AJ, Chick RC, Newhook TE, Tran Cao HS, Allen CJ, Nelson DW, Clifton GT, Vauthey JN, Tzeng CWD, Vreeland TJ. Lymph node sampling in resectable hepatocellular carcinoma: national practice patterns and predictors of positive lymph nodes. Surg Oncol 2020; 36:138-146. [PMID: 33418464 DOI: 10.1016/j.suronc.2020.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/22/2020] [Accepted: 12/22/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Routine lymphadenectomy (LND) for resectable hepatocellular carcinoma (HCC) remains controversial. We evaluated national LND trends to identify pre-operative factors associated with node-positive disease to determine which patients might benefit from LND. METHODS We identified HCC patients in the National Cancer Database (NCDB) treated with surgical resection between 2004 and 2015. Demographic, operative, pathologic, and survival data were compared. Multivariable regression was performed to determine preoperative predictors of pathologic nodal disease. RESULTS Of 8095 total resected patients, 1442 (17.8%) underwent hepatectomy with LND. Patients who received LND had higher preoperative clinical T (T3-T4: 20.0% vs 12.1%, p < 0.001) and N (N1: 3.3% vs 0.6%, p < 0.001) stages. The strongest independent predictor of pathologic nodal disease was clinical N stage (OR 106.54, CI 44.10-257.42). Survival was highest in patients whose surgeons omitted LND or were found with LND to be node-negative on final pathology (p < 0.001). Clinical node positivity had high negative predictive value (97.9%) but moderate positive predictive value (56.3%) in estimating pathologic nodal status. CONCLUSIONS Defining preoperative clinical nodal status is imperative in HCC patients. Clinical node positivity was the strongest predictor of pathologic nodal disease and its associated worse prognosis. LND can be considered selectively in clinically node-positive patients.
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Affiliation(s)
| | - Anne E O'Shea
- Department of Surgery, Brooke Army Medical Center, Ft. Sam Houston, TX, USA
| | - Andrew J Lee
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Robert C Chick
- Department of Surgery, Brooke Army Medical Center, Ft. Sam Houston, TX, USA
| | - Timothy E Newhook
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Hop S Tran Cao
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Casey J Allen
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Daniel W Nelson
- Department of Surgical Oncology, William Beaumont Army Medical Center, El Paso, TX, USA
| | - G Travis Clifton
- Department of Surgery, Brooke Army Medical Center, Ft. Sam Houston, TX, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Ching-Wei D Tzeng
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Timothy J Vreeland
- Department of Surgery, Brooke Army Medical Center, Ft. Sam Houston, TX, USA; Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
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Hemophagocytic Lymphohistiocytosis Masquerading as Alcoholic Hepatitis. ACG Case Rep J 2020; 7:e00495. [PMID: 33324714 PMCID: PMC7732264 DOI: 10.14309/crj.0000000000000495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/14/2020] [Indexed: 11/17/2022] Open
Abstract
Hemophagocytic lymphohistiocytosis is a syndrome characterized by excessive immune activation. Timely diagnosis can be challenging, and prompt treatment is the only hope for survival. We present an adult patient with a history of alcohol dependence, who presented with fatigue, bilateral lower extremity edema, and orange-colored urine. Clinical workup revealed abnormal liver function tests, elevated ferritin, cytopenia, and lymphadenopathy. Eventually, he was diagnosed with hemophagocytic lymphohistiocytosis. This case report encourages gastroenterologists to maintain a high index of suspicion when a patient presents with liver failure, hyperferritinemia, and cytopenia because they may be the first healthcare professionals to evaluate these patients.
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Hikita H, Sato M, Endo M, Sato M, Soroida Y, Kobayashi T, Gotoh H, Iwai T, Nakagomi R, Tateishi R, Komuro T, Sone S, Koike K, Yatomi Y, Ikeda H. Disappearance of perihepatic lymph node enlargement after hepatitis C viral eradication with direct-acting antivirals. J Viral Hepat 2018; 25:329-334. [PMID: 29091333 DOI: 10.1111/jvh.12819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 09/19/2017] [Indexed: 12/09/2022]
Abstract
Perihepatic lymph node enlargement (PLNE) which has been shown to be negatively associated with hepatocellular carcinoma (HCC) occurrence is frequently observed in chronic liver disease; however, changes in the state of perihepatic lymph nodes after eradication of hepatitis C virus (HCV) have not been investigated yet. We aimed to evaluate this issue. We enrolled 472 patients with chronic HCV infection who achieved viral eradication with direct-acting antivirals (DAA). We investigated whether the status of perihepatic lymph nodes changed before and after HCV eradication (primary endpoint). We also evaluated the association between PLNE and clinical findings such as liver fibrosis or hepatocellular injury before HCV eradication (secondary endpoint). Perihepatic lymph node enlargement was detected in 164 of 472 (34.7%) patients before DAA treatment. Surprisingly, disappearance of PLNE was observed in 23.8% (39 patients) of all PLNE-positive patients after eradication of HCV. Disappearance of PLNE was not associated with baseline clinical parameters or changing rates of clinical findings before and after DAA treatment. At baseline, presence of PLNE was significantly associated with a lower serum HCV-RNA level (P = .03), a higher serum AST level (P = .004) and a higher ALT level (P < .001) after adjustment for sex and age. In conclusion, PLNEs became undetectable after DAA treatment in 23.8% of PLNE-positive patients. Further study with a longer follow-up period is needed to clarify the clinical importance of this phenomenon especially in relationship with the risk of HCC development.
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Affiliation(s)
- H Hikita
- Department of Clinical Laboratory Medicine, Tokyo, Japan
| | - Masaya Sato
- Department of Clinical Laboratory Medicine, Tokyo, Japan.,Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Momoe Endo
- Department of Clinical Laboratory Medicine, Tokyo, Japan
| | - Mamiko Sato
- Department of Clinical Laboratory Medicine, Tokyo, Japan
| | - Y Soroida
- Department of Clinical Laboratory Medicine, Tokyo, Japan
| | - T Kobayashi
- Department of Clinical Laboratory Medicine, Tokyo, Japan
| | - H Gotoh
- Department of Clinical Laboratory Medicine, Tokyo, Japan
| | - T Iwai
- Department of Clinical Laboratory Medicine, Tokyo, Japan
| | - R Nakagomi
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - R Tateishi
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - T Komuro
- Department of Clinical Laboratory Medicine, Tokyo, Japan
| | - S Sone
- Department of Clinical Laboratory Medicine, Tokyo, Japan
| | - K Koike
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Y Yatomi
- Department of Clinical Laboratory Medicine, Tokyo, Japan
| | - H Ikeda
- Department of Clinical Laboratory Medicine, Tokyo, Japan
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Sato M, Hikita H, Hagiwara S, Sato M, Soroida Y, Suzuki A, Gotoh H, Iwai T, Kojima S, Matsuura T, Yotsuyanagi H, Koike K, Yatomi Y, Ikeda H. Potential associations between perihepatic lymph node enlargement and liver fibrosis, hepatocellular injury or hepatocarcinogenesis in chronic hepatitis B virus infection. Hepatol Res 2015; 45:397-404. [PMID: 24849617 DOI: 10.1111/hepr.12361] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 04/03/2014] [Accepted: 05/15/2014] [Indexed: 02/08/2023]
Abstract
AIM Although perihepatic lymph node enlargement (PLNE) is frequently observed in chronic liver disease, little is known about PLNE in chronic hepatitis B virus (HBV) infection. We aimed to evaluate this issue. METHODS We originally enrolled a consecutive 502 patients with chronic HBV infection. Among them, 288 patients without history of interferon-based or nucleoside analog treatment and hepatocellular carcinoma (HCC) were primarily analyzed. RESULTS PLNE was detected in 27 of 288 (9.4%) patients, which was fewer than that in chronic hepatitis C patients but more than that in subjects undertaking a general health examination as previously reported. The presence of PLNE was significantly associated with a higher probability of having an aspartate aminotransferase (AST) platelet ratio index of more than 1.5 (11.1% vs 1.5%, P = 0.01), a higher AST level (38.0 vs 26.8 U/L, P = 0.001), a higher alanine aminotransferase level (50.1 vs 28.0 U/L, P < 0.0001), and a lower platelet count (18.6 vs 20.6 × 10(4) /μL, P = 0.048) after adjustment for sex and age. However, in our original sample (n = 502), PLNE was observed in 1.4% of the patients with HCC and/or its history whereas 9.2% of the patients without HCC, and the proportion was significantly lower in patients with HCC and/or its history (P = 0.03). CONCLUSION PLNE was associated with liver fibrosis and hepatocellular injury, but was negatively associated with HCC in chronic HBV infection.
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Affiliation(s)
- Masaya Sato
- Department of Clinical Laboratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Hikita H, Enooku K, Satoh Y, Yoshida H, Nakagawa H, Masuzaki R, Tateishi R, Soroida Y, Sato M, Suzuki A, Gotoh H, Iwai T, Yokota H, Koike K, Yatomi Y, Ikeda H. Perihepatic lymph node enlargement is a negative predictor for sustained responses to pegylated interferon-α and ribavirin therapy for Japanese patients infected with hepatitis C virus genotype 1. Hepatol Res 2013; 43:1005-12. [PMID: 23356977 DOI: 10.1111/hepr.12061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 12/10/2012] [Accepted: 12/25/2012] [Indexed: 02/01/2023]
Abstract
AIM Although perihepatic lymph node enlargement (PLNE) is reportedly associated with the negative outcome of interferon therapy for chronic hepatitis C, there were limitations in that the results were obtained in patients with various genotypes, viral loads and treatment regimens. We aimed to precisely clarify the significance of PLNE in interferon therapy for chronic hepatitis C. METHODS Between December 2004 and June 2005, 112 patients with hepatitis C virus (HCV) genotype 1 and HCV RNA of more than 100 KIU/mL were enrolled, who underwent pegylated interferon-α plus ribavirin therapy thereafter. PLNE was defined as a perihepatic lymph node of more than 1 cm in the longest axis by ultrasonography. RESULTS The sustained virological response (SVR) rate was lower in patients with PLNE (4/22, 18.2%) than in those without (37/90, 41.1%; P = 0.045) and viral load decline was smaller in patients with PLNE than in those without (P = 0.028). The proportion of PLNE positive patients was the smallest in the SVR group (P = 0.033) among the patient groups divided by the treatment outcome. PLNE was retained as a negative predictor for SVR by multivariate logistic regression analysis (P = 0.012). Furthermore, PLNE was not significantly associated with the mutations at HCV core protein and at interferon sensitivity-determining region, or interleukin-28B polymorphism in 45 patients with HCV genotype 1, enrolled between December 2011 and March 2012. CONCLUSION PLNE is a negative predictor for SVR in patients with HCV genotype 1 and HCV RNA of more than 100 KIU/mL treated with pegylated interferon-α plus ribavirin, independent of other known predictors for SVR.
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Affiliation(s)
- Hiromi Hikita
- Department of Clinical Laboratory Medicine, The University of Tokyo, Tokyo, Japan
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Gotoh H, Enooku K, Soroida Y, Sato M, Hikita H, Suzuki A, Iwai T, Yokota H, Yamazaki T, Koike K, Yatomi Y, Ikeda H. Perihepatic lymph node enlargement observed at a general health examination: A cross-sectional study. Hepatol Res 2013; 43:906-10. [PMID: 23279215 DOI: 10.1111/hepr.12029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 11/16/2012] [Accepted: 11/20/2012] [Indexed: 02/08/2023]
Abstract
AIM Although perihepatic lymph node enlargement (PLNE) is known as a common finding in chronic liver disease, it can be found occasionally at a general health examination. We aimed to clarify the clinical significance of PLNE in general. METHODS Between January 2008 and December 2011, 4234 subjects were enrolled, who underwent a general health examination at the University of Tokyo Hospital. RESULTS PLNE was observed in 69 (1.6%) subjects, among whom 17 (0.4%) had liver disorders and 13 (0.3%) had malignancy, one of whom had both. No disorders were determined in the remaining 40 subjects (0.9%). Among 17 subjects with liver disorder-associated PLNE, anti-hepatitis C virus (HCV) antibody was determined in 11 and serum alanine aminotransferase levels were less than 40 U/L in eight. Among 13 subjects with malignancy-associated PLNE, para-aortic lymph nodes were also enlarged in eight. Among 40 subjects with PLNE of unknown etiology, 27 could be followed up for the mean period of 2.08 years, where no underlying disorders were newly determined with largely unaltered size of PLNE. CONCLUSION The incidence of PLNE in the general population may vary with the prevalence of chronic liver disease, especially HCV infection. When PLNE is observed, liver disorders should be first surveyed including HCV infection even with normal serum alanine aminotransferase levels. PLNE with para-aortic lymph node enlargement may be suggestive of a malignant lesion. The incidence of PLNE of unknown etiology may be approximately 1% in the general population, which may be just followed up without further change.
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Affiliation(s)
- Hiroaki Gotoh
- Department of Clinical Laboratory Medicine, The University of Tokyo, Tokyo, Japan
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Fujii H, Ohnishi N, Shimura K, Sakamoto M, Ohkawara T, Sawa Y, Nishida K, Ohkawara Y, Kobata T, Yamaguchi K, Itoh Y. Case of autoimmune hepatitis with markedly enlarged hepatoduodenal ligament lymph nodes. World J Gastroenterol 2013; 19:1834-1840. [PMID: 23555173 PMCID: PMC3607761 DOI: 10.3748/wjg.v19.i11.1834] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 01/07/2013] [Accepted: 01/24/2013] [Indexed: 02/06/2023] Open
Abstract
Autoimmune hepatitis (AIH) is a necroinflammatory liver disease of unknown etiology. The disease is characterized histologically by interface hepatitis, biochemically by increased aspartate aminotransferase and alanine aminotransferase levels, and serologically by increased autoantibodies and immunoglobulin G levels. Here we discuss AIH in a previously healthy 37-year-old male with highly elevated serum levels of soluble interleukin-2 receptor and markedly enlarged hepatoduodenal ligament lymph nodes (HLLNs, diameter, 50 mm). Based on these observations, the differential diagnoses were AIH, lymphoma, or Castleman’s disease. Liver biopsy revealed the features of interface hepatitis without bridging fibrosis along with plasma cell infiltration which is the typical characteristics of acute AIH. Lymph node biopsy revealed lymphoid follicles with inflammatory lymphocytic infiltration; immunohistochemical examination excluded the presence of lymphoma cells. Thereafter, he was administered corticosteroid therapy: after 2 mo, the enlarged liver reached an almost normal size and the enlarged HLLNs reduced in size. We could not find AIH cases with such enlarged lymph nodes (diameter, 50 mm) in our literature review. Hence, we speculate that markedly enlarged lymph nodes observed in our patient may be caused by a highly activated, humoral immune response in AIH.
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Hikita H, Nakagawa H, Tateishi R, Masuzaki R, Enooku K, Yoshida H, Omata M, Soroida Y, Sato M, Gotoh H, Suzuki A, Iwai T, Yokota H, Koike K, Yatomi Y, Ikeda H. Perihepatic lymph node enlargement is a negative predictor of liver cancer development in chronic hepatitis C patients. J Gastroenterol 2013; 48:366-73. [PMID: 22790352 DOI: 10.1007/s00535-012-0635-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 06/19/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Perihepatic lymph node enlargement (PLNE) is a common ultrasound finding in chronic hepatitis C patients. Although PLNE is considered to reflect the inflammatory response to hepatitis C virus (HCV), its clinical significance remains unclear. METHODS Between December 2004 and June 2005, we enrolled 846 chronic hepatitis C patients in whom adequate ultrasound examinations had been performed. PLNE was defined as a perihepatic lymph node that was at least 1 cm in the longest axis by ultrasonography. We analyzed the clinical features of patients with PLNE and prospectively investigated the association between PLNE and hepatocellular carcinoma (HCC) development. RESULTS We detected PLNE in 169 (20.0%) patients. Female sex, lower body mass index (BMI), and HCV serotype 1 were independently associated with the presence of PLNE. However, there were no significant differences in liver function tests, liver stiffness, and hepatitis C viral loads between patients with and without PLNE. During the follow-up period (mean 4.8 years), HCC developed in 121 patients. Unexpectedly, patients with PLNE revealed a significantly lower risk of HCC development than those without PLNE (p = 0.019, log rank test). Multivariate analysis revealed that the presence of PLNE was an independent negative predictor of HCC development (hazard ratio 0.551, p = 0.042). In addition, the sustained viral response rate in patients who received interferon (IFN) therapy was significantly lower in patients with PLNE than in patients without PLNE. CONCLUSIONS Patients with PLNE had a lower risk of HCC development than those without PLNE. This study may provide new insights into daily clinical practice and the pathophysiology of HCV-induced hepatitis and hepatocarcinogenesis.
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Affiliation(s)
- Hiromi Hikita
- Department of Clinical Laboratory Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Perihepatic lymphadenopathy and the response to therapy in chronic hepatitis C patients(). J Ultrasound 2010; 13:164-7. [PMID: 23396905 DOI: 10.1016/j.jus.2010.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION To determine whether ultrasound (US) findings of perihepatic lymphadenopathy in patients with chronic hepatitis C (HCV) are predictive of failure to achieve sustained virological responses (SVR) to treatment with pegylated interferon (PEG-INF) alpha and ribavirin. MATERIALS AND METHODS The study population included 89 patients with HCV treated with PEG-INF and ribavirin in 2003-2007. US scans and liver biopsies were performed at baseline; US was repeated during treatment and 6 months after its completion. Patients with SVRs at the 6-month follow-up were classified as responders; all others (those with no response or shorter responses) were considered nonresponders. RESULTS Baseline US revealed perihepatic lymphadenopathy in 21.3% of the patients, and 31.6% of these patients were responders. In the responder subgroup, 16% of the patients experienced reductions in lymph node volume during treatment, whereas in the nonresponders, lymph node volume increased during treatment. In patients with no lymphadenopathy at baseline US, no lymph nodes were observed at US after the end of treatment, in either the responders or nonresponders. CONCLUSIONS US is becoming increasingly important in the follow-up of chronic HCV patients. In our study, patients with hilar lymphadenopathy were usually nonresponders, and at the end of treatment their lymph node volume was significantly greater than that observed in the responder subgroup.
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Mueller GC, Gemmete JJ, Carlos RC. Hepatic transplantation: pretransplant evaluation of donors and recipients. Semin Roentgenol 2005; 41:45-60. [PMID: 16376171 DOI: 10.1053/j.ro.2005.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Gisela C Mueller
- Department of Radiology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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Soresi M, Bonfissuto G, Sesti R, Riili A, Di Giovanni G, Carroccio A, Tripi S, Montalto G. Perihepatic lymph nodes and antiviral response in chronic HCV-associated hepatitis. ULTRASOUND IN MEDICINE & BIOLOGY 2004; 30:711-717. [PMID: 15219950 DOI: 10.1016/j.ultrasmedbio.2004.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2003] [Revised: 04/02/2004] [Accepted: 04/15/2004] [Indexed: 05/24/2023]
Abstract
To identify predictive factors of response to interferon alpha (IFN-alpha) plus ribavirin therapy in patients with chronic hepatitis C (CHC), the presence of lymphadenopathy (LyA) of the hepatoduodenal ligament and other variables were investigated. A total of 110 patients with histologically proven CHC were enrolled in this study. Ultrasound (US) was performed at the start and end of therapy and 6 months after stopping therapy. At baseline, LyA was present in 35 (43.7%) of 80 patients with alanine aminotransferase (ALT) values and grading was significantly higher than in the LyA-negative group. LyA was more frequent in nonresponders (nonR) than in relapsers (relR) or sustained responders (susR). Lymph node volume (LyV) was significantly lower in susR than in nonR or relR (p < 0.05). Under antiviral treatment, the reduction in LyV was significantly higher in nonR (p < 0.01); in susR and relR, it was not significantly reduced. LyA totally disappeared in two patients of the susR group. Logistic regression analysis confirmed only a positive association of susR with grading and a negative association with staging (p < 0.02 and p < 0.006). In conclusion, this study suggests that US evidence of LyA is useful in evaluating the severity of a given chronic hepatitis C, but it cannot be proposed as a predictive index of response to antiviral treatment.
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Soresi M, Bonfissuto G, Magliarisi C, Riili A, Terranova A, Di Giovanni G, Bascone F, Carroccio A, Tripi S, Montalto G. Ultrasound detection of abdominal lymph nodes in chronic liver diseases. A retrospective analysis. Clin Radiol 2003; 58:372-7. [PMID: 12727165 DOI: 10.1016/s0009-9260(03)00055-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To retrospectively evaluate the prevalence of lymph nodes of the hepato-duodenal ligament in a group of patients with chronic liver disease of various aetiologies and to investigate what clinical, aetiological and laboratory data may lead to their appearance. MATERIALS AND METHODS One thousand and three patients (554 men, 449 women) were studied, including 557 with chronic hepatitis and 446 with liver cirrhosis. The presence of lymph nodes near the trunk of the portal vein, hepatic artery, celiac axis, superior mesenteric vein and pancreas head was investigated using ultrasound. RESULTS Lymph nodes were detected in 394 out of the 1003 study patients (39.3%); their number ranged from one to four, with a diameter ranging between 0.8 and 4 cm. The highest prevalence was in the subgroup of patients with primary biliary cirrhosis (87.5%), followed by patients with hepatitis C virus (HCV; 42%), patients with HCV and hepatitis B virus (HBV; 41.3%), autoimmune hepatitis (40%), and HBV alone (21.2%). In the alcoholic and idiopathic subgroups prevalence was 9.5%, while in the non-alcoholic steatohepatitis and haemochromatosis subgroups it was 0%. HCV RNA was present in 97 out of 103 lymph node-positive patients and in 141 out of 168 lymph node-negative HCV-negative patients (p<0.003). Lymphadenopathy frequency increased as the liver disease worsened (chi(2) MH=74.3; p<0.0001). CONCLUSION Despite the limitations of a retrospective study, our data indicate a high prevalence of lymphadenopathy in liver disease patients; ultrasound evidence of lymph nodes of the hepato-duodenal ligament in a given liver disease may most likely suggest a HCV or an autoimmune aetiology and a more severe histological picture.
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Affiliation(s)
- M Soresi
- Cattedra di Medicina Interna, Università di Palermo, via del Vespro 141, 90127, Palermo, Italy
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