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Prevalence and risk factors for impaired renal function among Asian patients with nonalcoholic fatty liver disease

Hepatobiliary & Pancreatic Diseases International 2024年第3期23卷 241-248页

作者： Chao Sun George Boon-Bee Goh Wan-Cheng Chow Wah-Kheong Chan grace Lai-Hung wong Wai-Kay Seto Yi-Hsiang Huang Han-Chieh Lin I-Cheng Lee Hye Won Lee Seung Up Kim Vincent Wai-Sun wong Jian-Gao Fan Center for Fatty Liver Disease Department of GastroenterologyXinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai Key Lab of Pediatric Gastroenterology and NutritionShanghai 200092China Department of Gastroenterology&Hepatology Singapore General HospitalSingaporeSingapore Gastroenterology and Hepatology Unit Department of MedicineFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia Department of Medicine and Therapeutics and State Key Laboratory of Digestive Disease The Chinese University of Hong KongHong KongChina Department of Medicine The University of Hong KongHong KongChina Institute of Clinical Medicine National Yang Ming Chiao Tung University School of MedicineTaipeiTaiwanChina Division of Gastroenterology and Hepatology Taipei Veterans General HospitalTaipeiTaiwanChina Faculty of Medicine National Yang Ming Chiao Tung University School of MedicineTaipeiTaiwanChina Department of Internal Medicine Yonsei University College of MedicineSeoulKorea

Background:Nonalcoholic fatty liver disease(NAFLD)is associated with impaired renal function,and both diseases often occur alongside other metabolic ***,the prevalence and risk factors for impaired renal function in patients with NAFLD remain *** objective of this study was to identify the prevalence and risk factors for renal impairment in NAFLD ***:All adults aged 18-70 years with ultrasound-diagnosed NAFLD and transient elastography examination from eight Asian centers were enrolled in this prospective *** fibrosis and cirrhosis were assessed by FibroScan-aspartate aminotransferase(FAST),Agile 3+and Agile 4 *** renal function and chronic kidney disease(CKD)were defined by an estimated glomerular filtration rate(eGFR)with value of<90 mL/min/1.73 m^(2) and<60 mL/min/1.73 m^(2),respectively,as estimated by the CKD-Epidemiology Collaboration(CKD-EPI)***:Among 529 included NAFLD patients,the prevalence rates of impaired renal function and CKD were 37.4%and 4.9%,*** multivariate analysis,a moderate-high risk of advanced liver fibrosis and cirrhosis according to Agile 3+and Agile 4 scores were independent risk factors for CKD(P<0.05).Furthermore,increased fasting plasma glucose(FPG)and blood pressure were significantly associated with impaired renal function after controlling for the other components of metabolic syndrome(P<0.05).Compared with patients with normoglycemia,those with prediabetes[FPG≥5.6 mmol/L or hemoglobin A1c(HbA1c)≥5.7%]were more likely to have impaired renal function(P<0.05).Conclusions:Agile 3+and Agile 4 are reliable for identifying NAFLD patients with high risk of *** glycemic control in the prediabetic stage might have a potential renoprotective role in these patients.

关键词： Nonalcoholic fatty liver disease Impaired renal function Agile 3+ Agile 4 Metabolic syndrome

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Epidemiology and Clinical Outcomes of Metabolic(Dysfunction)-associated Fatty Liver Disease

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Journal of Clinical and Translational Hepatology 2021年第6期9卷 972-982页

作者： Huapeng Lin Xinrong Zhang Guanlin Li grace Lai-Hung wong Vincent Wai-Sun wong Department of Medicine and Therapeutics State Key Laboratory of Digestive diseaseand Medical Data Analytics CentreThe Chinese University of Hong KongHong KongChina

Metabolic(dysfunction)-associated fatty liver disease(MAFLD)is currently the most common chronic liver disease and affects at least a quarter of the global adult *** has rapidly become one of the leading causes of hepatocellular carcinoma and cirrhosis in Western *** this review,we discuss the nomenclature and definition of MAFLD as well as its prevalence and incidence in different geographical *** cardiovascular disease remains the leading cause of death in MAFLD patients,the proportion of patients dying from hepatic complications increases sharply as the disease progresses to advanced liver fibrosis and *** addition,patients with MAFLD are at increased risk of various extrahepatic *** a causal relationship between MAFLD and extrahepatic cancers has not been established,clinicians should recognize the association and consider cancer screening(e.g.,for colorectal cancer)as appropriate.

关键词： Nonalcoholic fatty liver disease Nonalcoholic steatohepatitis Obesity Prevalence Incidence Hepatocellular carcinoma Cirrhosis

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Impact of antiviral therapy on post-hepatectomy outcome for hepatitis B-related hepatocellular carcinoma

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World Journal of Gastroenterology 2014年第20期20卷 6006-6012页

作者： Charing Ching Ning Chong grace Lai Hung wong Paul Bo San Lai Division of Hepato-biliary and Pancreatic Surgery Department of Surgery Prince of Wales Hospital the Chinese University of Hong Kong Institute of Digestive Disease and Department of Medicine and Therapeutics Prince of Wales Hospital the Chinese University of Hong Kong

The outcome after curative resection for hepatocellular carcinoma(HCC)remains unsatisfactory due to the high recurrence rate after *** patients with hepatitis B virus(HBV)-related HCC,which is the majority of patients with HCC in Asia,a high viral load is a strong risk factor for HCC *** is logical to believe that antiviral therapy may improve the postoperative outcome by promoting viral clearance and hepatocyte regeneration,as well as improving residual liver volume in HCC patients with hepatitis ***,the effect of antiviral therapy on clinical outcomes after liver resection in patients with HBV-related HCC remains to be *** are two main groups of antiviral treatment for HBV-oral nucleos(t)ide analogues and *** treatment reduces the overall incidence of HBV-related HCC in sustained ***,side effects may limit its long-term clinical ***(t)ide analogues carry fewer side effects and are potent in terms of viral suppression when compared to interferon and are typically implemented for patients with more advanced liver *** may also improve the outcome after curative resection for HBV-related *** are increasing evidence to suggest that antiviral therapy could suppress HBV,decrease the perioperative reactivation of viral replication,reduce liver injury,preserve the liver function before and after operation,and may lower the risk of HCC *** all,antiviral therapy may improve the survival after liver resection by reducing recurrence and delaying the liver damage by the virus,resulting in a higher chance of receiving aggressive salvage therapy during HCC recurrence.

关键词： Antiviral therapy Hepatitis B infection Hepatocellular carcinoma Hepatectomy Liver resection Outcome

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Update of liver fibrosis and steatosis with transient elastography (Fibroscan)

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Gastroenterology Report 2013年第1期1卷 19-26页

作者： grace Lai-Hung wong Institute of Digestive Disease The Chinese University of Hong KongHong Kong SARChina Department of Medicine and Therapeutics The Chinese University of Hong KongHong Kong SARChina

Background:Assessment of liver fibrosis and steatosis is now almost indispensable in most of the chronic liver diseases in order to determine prognosis and need for treatment,and to monitor disease progression and response to *** biopsy is limited by its invasiveness and patient *** elastography(TE;Fibroscan)is a non-invasive tool with satisfactory accuracy and reproducibility to estimate liver ***&Methods:To review the existing evidence concerning the clinical applications of TE in major liver diseases,including chronic hepatitis B and-C,non-alcoholic fatty liver disease(NAFLD),alcoholic liver disease,primary biliary cirrhosis and primary sclerosing ***:As alanine aminotransferase(ALT)is one of the major confounding factors of liver stiffness in chronic hepatitis B,an ALT-based algorithm has been developed and higher liver stiffness measurements(LSM)cut-off values for different stages of liver fibrosis should be used in patients with elevated ALT levels up to five times the upper limit of ***,falsely-high LSM results up to the cirrhotic range may occur during ALT *** is also useful predicting patient prognosis in the development of hepatocellular carcinoma(HCC),portal hypertension,postoperative complications in HCC patients and ***,failed acquisition of TE is common in obese ***,obese patients may have higher LSM results,even in the same stage of liver *** better evaluate NAFLD a new XL probe,with a larger probe with lower ultrasound frequency and deeper penetration,increases the success rate of TE in obese *** median LSM value with the XL probe was found to be lower than that by the conventional M probe,hence cut-off values were approximately 1.2 to 1.3 kilopascals lower than those of the M probe,suggesting its *** reveal that a novel ultrasonic controlled attenuation parameter is potentially useful to detect and quantify

关键词： cirrhosis hepatitis fatty liver histology liver biopsy liver stiffness measurement

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Validation model of fibrosis-8 index score to predict significant fibrosis among patients with nonalcoholic fatty liver disease

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World Journal of Gastroenterology 2022年第15期28卷 1563-1573页

作者： Thaninee Prasoppokakorn Wah-Kheong Chan Vincent Wai-Sun wong Panyavee Pitisuttithum Sanjiv Mahadeva Nik Raihan Nik Mustapha grace Lai-Hung wong Howard Ho-Wai Leung Pimsiri Sripongpun Sombat Treeprasertsuk Department of Medicine Division of GastroenterologyFaculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalThai Red Cross SocietyBangkok 10330Thailand Department of Medicine Division of GastroenterologyDivision of Gastroenterology and Hepatology UnitFaculty of MedicineUniversity of MalayaKuala Lumpur 50603Malaysia Department of Medicine and Therapeutics The Chinese University of Hong KongHong KongChina Department of Medicine Division of General Internal MedicineFaculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalThai Red Cross SocietyBangkok 10330Thailand Department of Pathology Hospital Sultanah BahiyahAlor SetarKedah 05460Malaysia Department of Anatomical and Cellular Pathology The Chinese University of Hong KongHong KongChina Department of Internal Medicine Prince of Songkla UniversityHat Yai 90110Thailand Department of Medicine Division of Gastroenterology and HepatologyStanford University School of MedicinePalo AltoCA 94305United States

BACKGROUND Identifying hepatic fibrosis is crucial for nonalcoholic fatty liver disease(NAFLD)*** fibrosis-8(FIB-8)score,recently developed by incorporating four additional variables into the fibrosis-4(FIB-4)score,showed better performance in predicting significant fibrosis in *** To validate the FIB-8 score in a biopsy-proven NAFLD cohort and compare the diagnostic performance of the FIB-8 and FIB-4 scores and NAFLD fibrosis score(NFS)for predicting significant *** We collected the data of biopsy-proven NAFLD patients from three Asian centers in three *** the patients with available variables for the FIB-4 score(age,platelet count,and aspartate and alanine aminotransferase levels)and FIB-8 score(the FIB-4 variables plus 4 additional parameters:The body mass index(BMI),albumin to globulin ratio,gamma-glutamyl transferase level,and presence of diabetes mellitus)were *** fibrosis stage was scored using nonalcoholic steatohepatitis CRN criteria,and significant fibrosis was defined as at least fibrosis stage *** A total of 511 patients with biopsy-proven NAFLD and complete data were included for *** these 511 patients,271(53.0%)were female,with a median age of 51(interquartile range:41,58)*** median BMI was 29(26.3,32.6)kg/m2,and 268(52.4%)had *** the 511 NAFLD patients,157(30.7%)had significant fibrosis(≥F2).The areas under the receiver operating characteristic curves of the FIB-8 and FIB-4 scores and NFS for predicting significant fibrosis were 0.774,0.743,and 0.680,*** FIB-8 score demonstrated significantly better performance for predicting significant fibrosis than the NFS(P=0.001)and was also clinically superior to FIB-4,although statistical significance was not reached(P=0.073).The low cutoff point of the FIB-8 score for predicting significant fibrosis of 0.88 showed 92.36%sensitivity,and the high cutoff point of the FIB-8 score for predicting significant fibrosis of 1.

关键词： Nonalcoholic fatty liver disease Fibrosis-8 score Fibrosis-4 score Nonalcoholic fatty liver disease fibrosis score

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Real-world Effectiveness and Tolerability of Interferonfree Direct-acting Antiviral for 15,849 Patients with Chronic Hepatitis C:A Multinational Cohort Study

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Journal of Clinical and Translational Hepatology 2024年第7期12卷 646-658页

作者： Fanpu Ji Sally Tran Eiichi Ogawa Chung-Feng Huang Takanori Suzuki Yu Jun wong Hidenori Toyoda Dae Won Jun Liu Li Haruki Uojima Akito Nozaki Makoto Chuma Cheng-Hao Tseng Yao-Chun Hsu Masatoshi Ishigami Takashi Honda Masanori Atsukawa Hiroaki Haga Masaru Enomoto Huy Trinh Carmen Monica Preda Phillip Vutien Charles Landis Dong Hyun Lee Tsunamasa Watanabe Hirokazu Takahashi Hiroshi Abe Akira Asai Yuichiro Eguchi Jie Li Xiaozhong Wang Jia Li Junping Liu Jing Liang Carla Pui-Mei Lam Rui Huang Qing Ye Hongying Pan Jiajie Zhang Dachuan Cai Qi Wang Daniel Q.Huang grace wong Vincent Wai-Sun wong Junyi Li Son Do Norihiro Furusyo Makoto Nakamuta Hideyuki Nomura Eiji Kajiwara Eileen L.Yoon Sang Bong Ahn Koichi Azuma Kazufumi Dohmen Jihyun An Do Seon Song Hyun Chin Cho Akira Kawano Toshimasa Koyanagi Aritsune Ooho Takeaki Satoh Kazuhiro Takahashi Ming-Lun Yeh Pei-Chien Tsai Satoshi Yasuda Yunyu Zhao Yishan Liu Tomomi Okubo Norio Itokawa Mi Jung Jun Toru Ishikawa Koichi Takaguchi Tomonori Senoh Mingyuan Zhang Changqing Zhao Raluca Ioana Alecu Wei Xuan Tay Pooja Devan Joanne Kimiko Liu Ritsuzo Kozuka Elena Vargas-Accarino Ai-Thien Do Mayumi Maeda Wan-Long Chuang Jee-Fu Huang Chia-Yen Dai Ramsey Cheung Maria Buti Junqi Niu Wen Xie Hong Ren Seng Gee Lim Chao Wu Man-Fung Yuen Jia Shang Qiang Zhu Yoshiyuki Ueno Yasuhito Tanaka Jun Hayashi Ming-Lung Yu Mindie H.Nguyen Department of Infectious Diseases The Second Affiliated Hospital of Xi’an Jiaotong UniversityXi’anShaanxiChina Division of Gastroenterology and Hepatology Department of MedicineStanford University Medical CenterPalo AltoCAUSA Department of General Internal Medicine Kyushu University HospitalFukuokaJapan Hepatobiliary Division Department of Internal MedicineKaohsiung Medical University HospitalKaohsiung Hepatitis Research Center College of Medicine and Center for Liquid Biopsy and Cohort ResearchKaohsiung Medical UniversityKaohsiung Department of Gastroenterology and Metabolism Nagoya City University Graduate School of Medical SciencesNagoyaJapan Gastroenterology&Hepatology Changi General HospitalSinghealthSingapore Singhealth Duke-NUS Medicine Academic Clinical Program Singapore Department of Gastroenterology Ogaki Municipal HospitalOgakiJapan Department of Internal Medicine Hanyang UniversityCollege of MedicineSeoulKorea Hanyang Institute of Bioscience and Biotechnology Hanyang UniversitySeoulKorea Department of Hepatology The Third People's Hospital of Kunming CityKunmingYunnanChina Department of Gastroenterology Internal MedicineKitasato University School of MedicineSagamiharaJapan Gastroenterological Center Yokohama City University Medical CenterYokohamaJapan Division of Gastroenterology and Hepatology Department of Internal MedicineE-Da Cancer HospitalKaohsiung Department of Gastroenterology and Hepatology Nagoya University Graduate School of MedicineNagoyaJapan Division of Gastroenterology and Hepatology Nippon Medical SchoolTokyoJapan Department of Gastroenterology Yamagata University Faculty of MedicineYamagataJapan Department of Transfusion Medicine and Department of Hepatology Osaka Metropolitan University Graduate School of MedicineOsakaJapan San Jose Gastroenterology San JoseCAUSA Gastroenterology&Hepatology Department Clinic Fundeni InstituteBucharestRomania Division of Gastroenterology and Hepatology University of WashingtonSeattleWAUSA Department of

Background and Aims:As practice patterns and hepatitis C virus(HCV)genotypes(GT)vary geographically,a global real-world study from both East and West covering all GTs can help inform practice policy toward the 2030 HCV elimination *** study aimed to assess the effectiveness and tolerability of DAA treatment in routine clinical practice in a multinational cohort for patients infected with all HCV GTs,focusing on GT3 and ***:We analyzed the sustained virological response(SVR12)of 15,849 chronic hepatitis C patients from 39 Real-World Evidence from the Asia Liver Consortium for HCV clinical sites in Asia Pacific,North America,and Europe between 07/01/2014–07/01/***:The mean age was 62±13 years,with 49.6%*** demographic breakdown was 91.1%Asian(52.9%Japanese,25.7%Chinese/Taiwan residents,5.4%Korean,3.3%Malaysian,and 2.9%Vietnamese),6.4%White,1.3%Hispanic/Latino,and 1%Black/***,34.8%had cirrhosis,8.6%had hepatocellular carcinoma(HCC),and 24.9%were treatment-experienced(20.7%with interferon,4.3%with direct-acting antivirals).The largest group was GT1(10,246[64.6%]),followed by GT2(3,686[23.2%]),GT3(1,151[7.2%]),GT6(457[2.8%]),GT4(47[0.3%]),GT5(1[0.006%]),and untyped GTs(261[1.6%]).The overall SVR12 was 96.9%,with rates over 95%for GT1/2/3/6 but 91.5%for ***12 for GT3 was 95.1%overall,98.2%for GT3a,and 94.0%for ***12 was 98.3%overall for GT6,lower for patients with cirrhosis and treatment-experienced(TE)(93.8%)but≥97.5%for tretment-naive patients regardless of cirrhosis *** multivariable analysis,advanced age,prior treatment failure,cirrhosis,active HCC,and GT3/4 were independent predictors of lower SVR12,while being Asian was a significant predictor of achieving ***:In this diverse multinational realworld cohort of patients with various GTs,the overall cure rate was 96.9%,despite large numbers of patients with cirrhosis,HCC,TE,and GT3/***12 for GT3/6 with cirrhosis and TE was lower but st

关键词： Hepatitis C virus Liver cirrhosis Hepatocellular carcinoma Genotype DAA REAL-C

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Non-invasive tests of non-alcoholic fatty liver disease

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Chinese Medical Journal 2022年第5期135卷 532-546页

作者： Guanlin Li Xinrong Zhang Huapeng Lin Lilian Yan Liang grace Lai-Hung wong Vincent Wai-Sun wong Department of Medicine and Therapeutics The Chinese University of Hong KongHong KongChina State Key Laboratory of Digestive Disease The Chinese University of Hong KongHong KongChina Medical Data Analytics Centre The Chinese University of Hong KongHong KongChina

For the detection of steatosis,quantitative ultrasound imaging techniques have achieved great progress in past *** resonance imaging proton density fat fraction is currently the most accurate test to detect hepatic *** blood biomarkers correlate with non-alcoholic steatohepatitis,but the accuracy is *** liver fibrosis,liver stiffness measurement by transient elastography(TE)has high accuracy and is widely used across the *** resonance elastography is marginally better than TE but is limited by its cost and *** blood biomarkers of fibrosis have been used in clinical trials and hold promise for selecting patients for treatment and monitoring treatment *** article reviews new developments in the non-invasive assessment of non-alcoholic fatty liver disease(NAFLD).Accumulating evidence suggests that various non-invasive tests can be used to diagnose NAFLD,assess its severity,and predict the *** studies are needed to determine the role of the tests as monitoring *** cannot overemphasize the importance of context in selecting appropriate tests.

关键词： Fatty liver Non-alcoholic fatty liver disease Non-alcoholic steatohepatitis Liver fibrosis Cirrhosis Transient elastography FibroScan Magnetic resonance imaging

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Advances in the diagnosis and treatment of liver fibrosis

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Hepatoma Research 2017年第8期3卷 156-169页

作者： Jenny Yeuk-Ki Cheng grace Lai-Hung wong Institute of Digestive Disease The Chinese University of Hong KongShatinHong Kong 999077China Department of Medicine and Therapeutics 9/F Prince of Wales HospitalShatinHong Kong 999077China State Key Laboratory of Digestive Disease The Chinese University of Hong KongShatinHong Kong 999077China.

Liver fibrosis is the center of diagnosis and management of essentially all chronic liver diseases. While liver biopsy examination still has a role in diagnosis and drug development, it is replaced by non-invasive assessments of liver biopsy in majority of the clinical scenarios. Radiological approaches, namely transient elastography, acoustic radiation force impulse imaging, shear wave elastography, magnetic resonance elastography provide accurate diagnosis of advanced fibrosis and cirrhosis. Serum test formulae based on common laboratory parameters or more specialized parameters including those commercially available panels FibroTest?, FibroMeter? and Enhanced Liver Fibrosis are also available. Combining different modalities may further improve the accuracy. The role of all these non-invasive assessments has been further expanded from diagnostic to prognostic, e.g. risk prediction of hepatocellular carcinoma (HCC) by LSM-HCC score. Treatment of liver fibrosis can be achieved by controlling the underlying diseases, with chronic viral hepatitis as the most established disease model. Currently there are multiple clinical trials evaluating different treatment options to improve fibrosis in patients with non-alcoholic fatty liver disease. Specific anti-fibrotic treatment targets e.g. direct downregulation of hepatic stellate cell, collagen synthesis inhibitors and transforming growth factor-βantagonists have been tested in laboratory and pending further studies in clinical settings.

关键词： Chronic hepatitis B chronic hepatitis C fatty liver transient elastography

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Detection of focal liver lesions in cirrhotic liver using contrast-enhanced ultrasound

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World Journal of Radiology 2009年第1期1卷 25-36页

作者： grace Lai-Hung wong Hui-Xiong Xu Xiao-Yan Xie Institute of Digestive Disease Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong KongChina Department of Medical Ultrasonics The First Affiliated HospitalInstitute of Diagnostic and Interventional UltrasoundSun Yat-Sen UniversityGuangzhou 510080Guangdong ProvinceChina

Patients with liver cirrhosis are at increased risk of hepatocellular carcinoma(HCC).Conventional or baseline ultrasound(BUS)is often used as the first-line tool for HCC surveillance or detection,but the accuracy of BUS in HCC detection or differentiation from other focal liver lesions(FLLs)is ***-enhanced ultrasound(CEUS)represents a recent revolution in the field of ultrasonography and it has become increasingly important in the detection and evaluation of *** CEUS,HCC typically exhibits arterial hyper-enhancement and portal-venous washout represented by hypoenhanced lesions in the portal venous and late *** detection rate of HCC was significantly higher with CEUS compared with *** regenerative or some dysplastic nodules may exhibit arterial hyperenhancement as they are differentiated from HCC by its iso-enhancing pattern in portal and late *** contrast-enhancement patterns of other different types of benign and malignant FLLs,as well as their detection rates with CEUS,were also discussed.

关键词： Contrast-enhanced ultrasound Cirrhosis Focal liver lesions Metastatic liver cancer Hepatocellular carcinoma

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Transient elastography: Kill two birds with one stone?

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World Journal of Hepatology 2013年第5期5卷 264-274页

作者： grace Lai-Hung wong Department of Medicine and Therapeutics and Institute of Digestive DiseaseThe Chinese University of Hong Kong

Assessment of liver fibrosis and steatosis is crucial in chronic liver diseases in order to determine the prognosis, the need of treatment, as well as monitor disease progression and response to treatment. Liver biopsy is limited by its invasiveness and patient acceptability. Transient elastography (TE, Fibroscan ) is a non-invasive tool with satisfactory accuracy and reproducibility to estimate liver fibrosis and steatosis. TE has been well validated in major liver diseases including chronic hepatitis B and C, non-alcoholic fatty liver disease, alcoholic liver disease, primary biliary cirrhosis, and primary sclerosing cholangitis. As alanine aminotransferase (ALT) is one of the major confounding factors of liver stiffness in chronic hepatitis B, an ALT-based algorithm has been developed and higher liver stiffness measurements (LSM) cutoff values for different stages of liver fibrosis should be used in patients with elevated ALT levels up to 5 times of the upper limit of normal. Otherwise falsely-high LSM results up to cirrhotic range may occur during ALT flare. TE is also useful in predicting patient prognosis such as development of hepatocellular carcinoma (HCC), portal hypertension, post-operative complications in HCC patients, and also survival. Unfortunately, failed acquisition of TE is common in obese patients. Furthermore,obese patients may have higher LSM results even in the same stage of liver fibrosis. The new XL probe, a larger probe with lower ultrasound frequency and deeper penetration, increases the success rate of TE in obese patients. The median LSM value with XL probe was found to be lower than that by the conventional M probe, hence cutoff values approximately 1.2 to 1.3 kPa lower than those of M probe should be adopted. Recent studies revealed a novel ultrasonic controlled attenuation parameter (CAP) of the machine is a useful parameter to detect even low-grade steatosis noninvasively. CAP may also be used to quantify liver steatosis by applying d

关键词： Biopsy Cirrhosis Fibrosis Hepatitis Fatty liver Steatosis of liver

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