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Liver stiffness and perfusion changes for hepatic sinusoidal obstruction syndrome in rabbit model

World Journal of Gastroenterology 2020年第7期26卷 706-716页

作者： Jaeseung Shin haesung yoon yoon Jin Cha Kyunghwa Han Mi-Jung Lee Myung-Joon Kim Hyun Joo Shin Department of Radiology Severance HospitalResearch Institute of Radiological ScienceYonsei University College of MedicineSeoul 03722South Korea Department of Pathology Gangnam Severance HospitalYonsei University College of MedicineSeoul 06273South Korea Department of Radiology Severance HospitalResearch Institute of Radiological ScienceCenter for Clinical Imaging Data ScienceSeoul 03722South Korea

BACKGROUND Hepatic sinusoidal obstruction syndrome(SOS)is caused by damage to hepatic sinusoidal endothelial cells that results in fibrous obliteration of intrahepatic venules and necrosis of *** the diagnosis is primarily based on nonspecific clinical features and invasive liver ***,noninvasive imaging methods are required for the early diagnosis and severity assessment of hepatic *** To determine the effectiveness of supersonic shear wave imaging(SSI)and dual energy computed tomography(DECT)for diagnosing hepatic SOS using a rabbit *** Among nine New Zealand white rabbits(3-4 kg,male),three in control group ingested normal saline for 20 d and six in the SOS group ingested 6-thioguanine(5 mg/kg/d)for 20 *** stiffness was measured using SSI on days 0,3,10,and *** the same days,liver perfusion was evaluated from virtual monochromatic images of 55 keV and iodine map using *** changes in the liver were assessed using *** pathology scores were compared between the two *** stiffness and perfusion parameters were compared according to the groups,days,and pathology *** Final pathology scores were significantly higher in the SOS than the control group(median 22 vs 2,P=0.024).No gross morphologic changes were seen in *** stiffness,Hounsfield Unit values,and iodine concentrations were higher in the SOS compared to the control group on days 10 and 20(all,P≤0.007).Compared to day 0,liver stiffness and perfusion parameters were higher on day 20 in the SOS group(all,P≤0.001).Correlation coefficients for liver stiffness(r=0.635),Hounsfield Unit values(r=0.587),and iodine concentration(r=0.611)with final pathology scores were positive without significance(all,P>0.05).CONCLUSION Liver stiffness and perfusion parameters were significantly increased in the livers of a rabbit SOS *** and DECT might aid in early diagnosis of hepatic SOS.

关键词： Hepatic sinusoidal obstruction syndrome Elasticity imaging techniques Iodine Computed tomography Liver Animals

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Periportal thickening on magnetic resonance imaging for hepatic fibrosis in infantile cholestasis

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World Journal of Gastroenterology 2020年第21期26卷 2821-2830页

作者： Myung Hwan Lee Hyun Joo Shin haesung yoon Seok Joo Han Hong Koh Mi-Jung Lee Department of Radiology Severance HospitalSeverance Pediatric Liver Disease Research GroupResearch Institute of Radiological ScienceYonsei University College of MedicineSeoul 03722South Korea Department of Surgery Severance HospitalSeverance Pediatric Liver Disease Research GroupYonsei University College of MedicineSeoul 03722South Korea Division of Gastroenterology Hepatology and NutritionDepartment of PediatricsSeverance Children’s HospitalSeverance Pediatric Liver Disease Research GroupYonsei University College of MedicineSeoul 03722South Korea

BACKGROUND Untreated neonatal cholestasis can progress to liver cirrhosis and end stage liver disease in infancy due to prolonged hepatocyte and biliary tree injury and may require liver ***,non-invasive evaluation of hepatic fibrosis is important in infants with *** To investigate the usefulness of periportal thickening(PT)measured on liver magnetic resonance imaging(MRI)for the assessment of hepatic fibrosis in infants with cholestasis including biliary atresia(BA).METHODS This retrospective study included infants less than 6 mo who underwent liver MRI and biopsy for the evaluation of infantile *** and spleen size were measured on *** assessment was based on aspartate transaminase to platelet ratio index(APRI).The grade of histopathologic fibrosis was assessed by the METAVIR grading *** and diagnostic performance of PT,normalized spleen size ratio(SR,using the upper normal size limit),and APRI for diagnosing hepatic fibrosis were obtained by receiveroperating characteristic(ROC)curve *** A total of 155 patients were included,110 of which were diagnosed with *** age at the time of MRI was 57.6±34.4 *** were positive correlations between fibrosis grade and PT and SR,even after adjusting age(all,P<0.001).For the diagnosis of significant fibrosis(METAVIR grade F2-F4),the area under the ROC curve was 0.899(95%CI:0.840–0.941)for PT(cutoff,4.2 mm),which was higher than 0.741(95%CI:0.664–0.808)for SR and 0.712(95%CI:0.634–0.782)for APRI(both,P<0.001).For the diagnosis of cirrhosis(F4),the area under the ROC curve was the highest with SR as 0.790(95%CI:0.718–0.852).CONCLUSION Liver MRI findings of PT and SR are useful to assess clinically significant hepatic fibrosis(F2 and higher)in infants with cholestasis including BA.

关键词： Infants Cholestasis Biliary atresia Liver Fibrosis Magnetic resonance imaging

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Liver intravoxel incoherent motion diffusion-weighted imaging for the assessment of hepatic steatosis and fibrosis in children

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World Journal of Gastroenterology 2018年第27期24卷 3013-3020页

作者： Hyun Joo Shin haesung yoon Myung-Joon Kim Seok Joo Han Hong Koh Seung Kim Mi-Jung Lee Department of Radiology Severance Hospital Severance Pediatric Liver Disease Research Group Research Institute of Radiological Science Yonsei University College of Medicine Department of Surgery Severance Hospital Severance Pediatric Liver Disease Research Group Yonsei University College of Medicine Division of Gastroenterology Hepatology and Nutrition Department of Pediatrics Severance Children's Hospital Severance Pediatric Liver Disease Research Group Yonsei University College of Medicine

AIM To evaluate the correlation between intravoxel incoherent motion(IVIM) diffusion-weighted imaging(DWI) parameters and the degree of hepatic steatosis and fibrosis in *** This retrospective study was approved by the institutional review board. The children(≤ 18 years) who underwent liver IVIM DWI with 8 b-values under the suspicion of hepatic steatosis or fibrosis from February 2013 to November 2016 were included. Subjects were divided into normal, fatty liver(FAT), and fibrotic liver(FIB) groups. The slow diffusion coefficient(D), fast diffusion coefficient(D*), perfusion fraction(f), and apparent diffusion coefficient(ADC) were measured. MR proton density fat fraction(PDFF), MR elastography(MRE), and IVIM values were *** A total of 123 children(median age of 12 years old, range: 6-18 years) were included, with 8 in the normal group, 93 in the FAT group, and 22 in the FIB group. The D* values were lower in the FIB group compared with those of the normal(P = 0.015) and FAT(P = 0.003) groups. The f values were lower in the FIB group compared with the FAT group(P = 0.001). In multivariate analyses, PDFF value was positively correlated with f value(β = 3.194, P < 0.001), and MRE value was negatively correlated with D* value(β =-7.031, P = 0.032). The D and ADC values were not influenced by PDFF or MRE *** In liver IVIM DWI with multiple b-values in children, there was a positive correlation between hepatic fat and blood volume, and a negative correlation between hepatic stiffness and endovascular blood flow velocity, while diffusion-related parameters were not affected.

关键词： Intravoxel incoherent motion Diffusionweighted imaging Fibrosis Fatty liver Pediatrics

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Predicting gastroesophageal varices through spleen magnetic resonance elastography in pediatric liver fibrosis

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World Journal of Gastroenterology 2019年第3期25卷 367-377页

作者： haesung yoon Hyun Joo Shin Myung-Joon Kim Seok Joo Han Hong Koh Seung Kim Mi-Jung Lee Department of Radiology Severance Hospital Severance Pediatric Liver Disease Research Group Research Institute of Radiological Science Yonsei University College of Medicine Department of Surgery Severance Hospital Severance Pediatric Liver Disease Research Group Yonsei University College of Medicine Division of Gastroenterology Hepatology and Nutrition Department of Pediatrics Severance Children's Hospital Severance Pediatric Liver Disease Research Group Yonsei University College of Medicine

BACKGROUND A recent retrospective study confirmed that hepatic stiffness and splenic stiffness measured with magnetic resonance elastography(MRE) are strongly associated with the presence of esophageal varices. In addition, strong correlations have been reported between splenic stiffness values measured with MRE and hepatic venous pressure gradients in animal models. However, most studies have been conducted on adult populations, and previous pediatric MRE studies have only demonstrated the feasibility of MRE in pediatric populations, while the actual clinical application of spleen MRE has been *** To assess the utility of splenic stiffness measurements by MRE to predict gastroesophageal varices in *** We retrospectively reviewed abdominal MRE images taken on a 3 T system in pediatric patients. Patients who had undergone Kasai operations for biliary atresia were selected for the Kasai group, and patients with normal livers and spleens were selected for the control group. Two-dimensional spin-echo echoplanar MRE acquisition centered on the liver, with a pneumatic driver at 60 Hz and a low amplitude, was performed to obtain hepatic and splenic stiffness values. Laboratory results for aspartate aminotransferase to platelet ratio index(APRI) were evaluated within six months of MRE, and the normalized spleen size ratio was determined with the upper normal size limit. All Kasai group patients underwent gastroesophageal endoscopy during routine follow-up. The MannWhitney U test, Kendall's tau b correlation and diagnostic performance analysis using the area under the curve(AUC) were performed for statistical *** The median spleen MRE value was 5.5 kPa in the control group(n = 9, age 9-18 years, range 4.7-6.4 kPa) and 8.6 kPa in the Kasai group(n = 22, age 4-18 years,range 5.0-17.8 kPa). In the Kasai group, the APRI, spleen size ratio and spleen MRE values were higher in patients with portal hypertension(n = 11) than in patients without(n =

关键词： Biliary atresia Magnetic resonance elastography Kasai operation Splenic stiffness Portal hypertension

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