Role of portal color Doppler ultrasonography as noninvasive predictive tool for esophageal varices in cirrhotic patients

Background Esophageal varices (EV) is the most common apprehensive complication of portal hypertension in patients with cirrhotic liver. Guidelines recommend Upper gastro-intestinal endoscopic screening for EV in patients with newly diagnosed chronic cirrhosis (Imperiale et al. in Hepatology 45(4):870–878, 2007). Yet, it is invasive, time consuming and costly. To avoid unnecessary endoscopy, some studies have suggested Doppler ultrasound examination as simple, and noninvasive tool in prediction and assessment of severity of EV (Agha et al. in Dig Dis Sci 54(3):654–660, 2009). Our study was to assess the role of different Doppler indices of portal vein, hepatic and splenic arteries as a noninvasive tool for prediction of esophageal varices in cirrhotic patients. Results This prospective case control study was conducted on 100 cirrhotic liver patients and 100 of healthy volunteers as control group. Patients were subjected to clinical examination, upper gastrointestinal tract endoscopy, abdominal ultrasonography with duplex Doppler evaluation of different portal Doppler hemodynamic indices were done for each patient. The results revealed that portal vein diameter, hepatic artery pulsatility index, portal hypertensive index, portal vein flow velocity, portal congestion index have high sensitivity for prediction of EV. However, Splenic artery resistance index, hepatic artery resistance index HARI, liver vascular index and platelet count/spleen diameter have less sensitivity for prediction of EV. Conclusion Measuring the portal hemodynamic indices can help physicians as noninvasive predictors of EV in cirrhotic patients to restrict the need for unnecessary endoscopic screening especially when endoscopic facilities are limited.

Hepatocellular carcinoma in the non-cirrhotic liver

Liver cirrhosis is an established high-risk factor for HCC and the majority of patients diagnosed with HCC have cirrhosis. However, HCC also arises in non-cirrhotic livers in approximately 20 %of all cases. HCC in non-cirrhotic patients is often clinically silent and surveillance is usually not recommended. HCC is often diagnosed at an advanced stage in these patients. Current information about HCC in patients with non-cirrhotic liver is limited. Here we review the current knowledge on epidemiology, clinical features and imaging features of those patiens.

Hepatic adrenal rest tumor in a patient with multifactorial liver cirrhosis: a case report with CT and MRI findings and pathologic correlation

Background Adrenal rest tumor is an ectopic collection of adrenocortical cells in an extra-adrenal site, more frequently located around the kidney, retroperitoneum, spermatic cord, para-testicular region and broad ligament, but very rarely occurring also in the liver. Hepatic adrenal rest tumor poses a diagnostic challenge in differentiating it from hepatocellular carcinoma, particularly in a cirrhotic liver. Case presentation An 83-years-old male was referred to our hospital by his family doctor for hepatological evaluation due to multifactorial liver cirrhosis. Ultrasound revealed a centimetric hypoechoic nodule in the VI hepatic segment in the context of a liver with signs of cirrhosis and steatosis. The patient first underwent MRI and then CT, which showed a fat containing focal liver lesion in the subcapsular location of the right lobe, strictly adjacent to the homolateral adrenal gland. The nodule was hypervascular in the arterial phase, washed out in the portal-venous and transitional phases, resulting hypointense in the hepato-biliary phase at MR imaging. In the suspicion of a hepatocellular carcinoma, the nodule was surgically removed, and the patient’s postoperative course was unremarkable. The final histopathological diagnosis was of adrenal rest tumor of the liver. Conclusions Hepatic adrenal rest tumor is an extremely rare hepatic tumor, often without any clinical manifestation, that can also occur in the cirrhotic liver as in our case. Although there are not specific imaging findings, the possible diagnosis of HART should be considered when we observe a well-defined lesion in the subcapsular location of the right lobe, with fat containing, hypervascularity after contrast medium injection and vascular supply from the right hepatic artery.

Rapid Progression of Non-Alcoholic Fatty Liver Disease into Cirrhotic Liver in Trisomy 21 Patient: A Case Report and Brief Literature Review

Introduction/Objective Trisomy 21 (Down syndrome) is the most common chromosomal disorder. Among trisomy 21 patients in the pediatric setting, obesity is one of the most common conditions, with prevalence ranging from 23% to 70%. Trisomy 21 has several risk factors for obesity, including increased unfavorable dietary patterns, lower levels of physical activity, and other comorbidities. Epidemiologic studies found this increase in pediatric obesity along with an increased prevalence of non-alcoholic fatty liver disease (NAFLD). Furthermore, children with trisomy 21 have a higher prevalence of NAFLD than children without trisomy 21, even in the absence of obesity. As per literature, NAFLD is present in 64.3 percent of patients with Trisomy 21. Methods/Case Report We present a case of a 17-year-old female with trisomy 21 who was diagnosed with B-cell acute lymphoblastic leukemia (B-ALL) after being admitted due to abdominal pain and decreased appetite. The patient was found to have elevated liver enzymes with abnormal ultrasonography findings. MR images showed fatty liver infiltration with a hepatic fat fraction of 47%. Subsequently, a percutaneous liver biopsy was obtained. Microscopic examination showed minimal hepatic parenchyma with collapsed architecture replaced by abundant steatosis (approximately 90%). Portal triads showed mild lymphocytic inflammation and presence of neutrophils. No fibrosis was confirmed with the trichrome stain. She was then enrolled on AALL1731, a clinical trial for a therapy to treat B-ALL. A 4-month follow-up MR image showed hepatic steatosis. After 9 months, liver biopsy revealed cirrhotic liver along with portal lymphoplasmacytic inflammation, bile duct proliferation and mild macro vesicular steatosis. Results (if a Case Study enter NA) NA Conclusion This case report signifies the importance of histological evaluation of liver abnormalities to provide better treatment. It is vital to schedule close follow-ups in Trisomy 21 patient polpulation, because NAFLD can transform rapidly into a completely cirrhotic liver escpecially with acute lymphoblastic leukemia on chemotherapy. We also emphasizes early lifestyle modifications, including weight loss and proper diet.

A Radiomics Approach to Predict the Emergence of New Hepatocellular Carcinoma in Computed Tomography for High-Risk Patients with Liver Cirrhosis

Liver cirrhosis poses a major risk for the development of hepatocellular carcinoma (HCC). This retrospective study investigated to what extent radiomic features allow the prediction of emerging HCC in patients with cirrhosis in contrast-enhanced computed tomography (CECT). A total of 51 patients with liver cirrhosis and newly detected HCC lesions (n = 82) during follow-up (FU-CT) after local tumor therapy were included. These lesions were not to have been detected by the radiologist in the chronologically prior CECT (PRE-CT). For training purposes, segmentations of 22 patients with liver cirrhosis but without HCC-recurrence were added. A total of 186 areas (82 HCCs and 104 cirrhotic liver areas without HCC) were analyzed. Using univariate analysis, four independent features were identified, and a multivariate logistic regression model was trained to classify the outlined regions as “HCC probable” or “HCC improbable”. In total, 60/82 (73%) of segmentations with later detected HCC and 84/104 (81%) segmentations without HCC were classified correctly (AUC of 81%, 95% CI 74–87%), yielding a sensitivity of 72% (95% CI 57–83%) and a specificity of 86% (95% CI 76–96%). In conclusion, the model predicted the occurrence of new HCCs within segmented areas with an acceptable sensitivity and specificity in cirrhotic liver tissue in CECT.