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Role of microbubble ultrasound contrast agents in the non-invasive assessment of chronic hepatitis C-related liver disease

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World Journal of Gastroenterology 2006年第22期12卷 3461-3465页

作者： Scott Grier Adrian KP Lim nayna patel Jeremy FL Cobbold Howard C Thomas Isobel J Cox Simon D Taylor-Robinson Liver Unit St Mary's Hospital Campus Faculty of MedicineImperial College LondonLondonUnited Kingdom Department of Imaging Sciences Hammersmith Hospital Campus Faculty of MedicineImperial College LondonLondonUnited Kingdom

Patients who are chronically infected with the hepatitis C virus often develop chronic liver disease and assessment of the severity of liver injury is required prior to considering viral eradication therapy. This article examines the various assessment methods currently available from gold standard liver biopsy to serological markers and imaging. Ultrasound is one of the most widely used imaging modalities in clinical practice and is already a first-line diagnostic tool for liver disease. Microbubble ultrasound contrast agents allow higher resolution images to be obtained and functional assessments of microvascular change to be carried out. The role of these agents in quantifying the state of hepatic injury is discussed as a viable method of determining the stage and grade of liver disease in patients with hepatitis C. Although currently confined to specialist centres, the availability of microbubble contrast-enhanced ultrasound will inevitably increase in the clinical setting.

关键词： Hepatitis C Microbubble contrast agents Ultrasound

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Effect of nutritional counselling on hepatic,muscle and adipose tissue fat content and distribution in non-alcoholic fatty liver disease

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World Journal of Gastroenterology 2006年第36期12卷 5813-5819页

作者： E Louise Thomas Audrey E Brynes Gavin Hamilton nayna patel Adam Spong Robert D Goldin Gary Frost Jimmy D Bell Simon D Taylor-Robinson The Robert Steiner MR Unit MRC Clinical Sciences Centre Department of Nutrition and Dietetics The Robert Steiner MR Unit MRC Clinical Sciences Centre Faculty of Medicine Imperial College London Hammersmith Hospital Du Cane Rd London W12 0HS United Kingdom and Histopathology Department Faculty of Medicine Imperial College London St Mary's Hospital Praed Street London W2 1NY United Kingdom Faculty of Medicine Faculty of Medicine Imperial College London St Mary's Hospital Praed Street London W2 1NY United Kingdom

AIM： To assess the effectiveness of the current UK clinical practice in reducing hepatic fat （IHCL）.METHODS： Whole body MRI and IH MRS were obtained, before and after 6 mo nutritional counselling, from liver, soleus and tibialis muscles in 10 subjects with non-alcoholic fatty liver disease （NAFLD）.RESULTS： A 500 Kcal-restricted diet resulted in an average weight loss of 4% （-3.4 kg,） accompanied by significant reductions in most adipose tissue （AT） depots, including subcutaneous （-9.9%）, abdominal subcutaneous （-10.2%） and intra-abdominal- AT （-11.4%）. Intramyocellular lipids （IMCL） were significantly reduced in the tibialis muscle （-28.2%）. Decreases in both IHCL （-39.9%） and soleus IMCL （-12.2%） content were also observed, although these were not significant. Several individuals showed dramatic decreases in IHCL, while others paradoxically showed increases in IHCL content. Changes in body composition were accompanied by improvements in certain liver function tests： serum aspartate aminotransferase （AST） and alanine aminotransferase （ALT）. Significant correlations were found between decreases in IHCL and reductions in both intra-abdominal and abdominal subcutaneous AT. Improvements in liver function tests were associated with reductions in intra-abdominal AT, but not with changes in IHCL. CONCLUSION： This study shows that even a very modest reduction in body weight achieved through lifestyle modification can result in changes in body fat depots and improvements in LETs.

关键词： Intra-abdominal adipose tissue Intrahepatic fat Intramyocellular lipids Weiqht loss Magnetic resonance imaging

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Current and future applications of magnetic resonance imaging and spectroscopy of the brain in hepatic encepha-lopathy

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World Journal of Gastroenterology 2006年第19期12卷 2969-2978页

作者： VP Bob Graver M Alex Dresner Daniel M Forton Serena Counsell David J Larkman nayna patel Howard C Thomas Simon D Taylor-Robinson Hepatology Section Division of Medicine A St Mary's CampusFaculty of MedicineImperial College LondonSouth Wharf StreetLondon W2 1NYUnited Kingdom Imaging Sciences DepartmentClinical Sciences DivisionFaculty of MedicineImperial College LondonHammersmith HospitalDu Cane RoadLondon W12 0HSUnited Kingdom Imaging Sciences Department Clinical Sciences Division Faculty of MedicineImperial College LondonHammersmith HospitalDu Cane RoadLondon W12 0HSUnited Kingdom Hepatology Section Division of Medicine A St Mary's CampusFaculty of MedicineImperial College LondonSouth Wharf StreetLondon W2 1NYUnited Kingdom

Hepatic encephalopathy （HE） is a common neuropsychiatric abnormality, which complicates the course of patients with liver disease and results from hepatocellular failure and/or portosystemic shunting. The manifestations of HE are widely variable and involve a spectrum from mild subclinical disturbance to deep coma. Research interest has focused on the role of circulating gut-derived toxins, particularly ammonia, the development of brain swelling and changes in cerebral neurotransmitter systems that lead to global CNS depression and disordered function. Until recently the direct investigation of cerebral function has been difficult in man. However, new magnetic resonance imaging （MRI） techniques provide a non-invasive means of assessment of changes in brain volume （coregistered MRI） and impaired brain function （fMRI）, while proton magnetic resonance spectroscopy （^1H MRS） detects changes in brain biochemistry, including direct measurement of cerebral osmolytes, such as myoinositol, glutamate and glutamine which govern processes intrinsic to cellular homeostasis, including the accumulation of intracellular water. The concentrations of these intracellular osmolytes alter with hyperammonaemia. MRS-detected metabolite abnormalities correlate with the severity of neuropsychiatric impairment and since MR spectra return towards normal after treatment, the technique may be of use in objective patient monitoring and in assessing the effectiveness of various treatment regimens.

关键词： Hepatic encephalopathy Magnetic resonance imaging Magnetic resonance spectroscopy Diffusion weighted imaging Arterial spin labeling Functional MRI

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