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Nonalcoholic fatty liver disease and diabetes

World Journal of Diabetes 2022年第9期13卷 668-682页

作者： Maria Irene Bellini Irene Urciuoli giovanni Del Gaudio Giorgia Polti giovanni iannetti Elena Gangitano Eleonora Lori Carla Lubrano Vito Cantisani Salvatore Sorrenti Vito D’Andrea Department of Surgical Sciences Sapienza University of RomeRome 00161Italy Department of Radiological Sciences Oncology and PathologySapienza University of RomeRome 00161Italy Department of Experimental Medicine Section of Medical PhysiopathologyFood Science and EndocrinologySapienza University of RomeRome 00161Italy

Nonalcoholic fatty liver disease(NAFLD)is the most prevalent chronic liver disease in the world and represents a clinical-histopathologic entity where the steatosis component may vary in degree and may or may not have fibrotic *** key concept of NAFLD pathogenesis is excessive triglyceride hepatic accumulation because of an imbalance between free fatty acid influx and *** epidemiological,biochemical,and therapeutic evidence supports the premise that the primary pathophysiological derangement in most patients with NAFLD is insulin resistance;thus the association between diabetes and NAFLD is widely recognized in the *** NAFLD is the hepatic manifestation of a metabolic disease,it is also associated with a higher cardiovascular *** B-mode ultrasound is widely adopted as a first-line imaging modality for hepatic steatosis,although magnetic resonance imaging represents the gold standard noninvasive modality for quantifying the amount of fat in these *** of NAFLD patients depends on the disease severity,ranging from a more benign condition of nonalcoholic fatty liver to nonalcoholic *** from alcohol,a Mediterranean diet,and modification of risk factors are recommended for patients suffering from NAFLD to avoid major cardiovascular events,as per all diabetic *** addition,weight loss induced by bariatric surgery seems to also be effective in improving liver features,together with the benefits for diabetes control or resolution,dyslipidemia,and ***,liver transplantation represents the ultimate treatment for severe nonalcoholic fatty liver disease and is growing rapidly as a main indication in Western *** review offers a comprehensive multidisciplinary approach to NAFLD,highlighting its connection with diabetes.

关键词： Bariatric surgery Diabetes Hepatic steatosis Liver fibrosis Nonalcoholic fatty liver disease Nonalcoholic steatohepatitis

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Contrast-enhanced ultrasound Liver Imaging Reporting and Data System:Lights and shadows in hepatocellular carcinoma and cholangiocellular carcinoma diagnosis

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World Journal of Gastroenterology 2022年第27期28卷 3488-3502页

作者： Gianpaolo Vidili Marco Arru Giuliana Solinas Diego Francesco Calvisi Pierluigi Meloni Assunta Sauchella Davide Turilli Claudio Fabio Antonio Cossu Giordano Madeddu Sergio Babudieri Maria Assunta Zocco giovanni iannetti Enza Di Lembo Alessandro Palmerio Delitala Roberto Manetti Department of Medical Surgical and Experimental SciencesUniversity of SassariSassari 07100Italy Department of Biomedical Sciences Public Health-Laboratory of BiostatisticsUniversity of SassariSassari 07100Italy Department of Internal Medicine and Gastroenterology Fondazione Policlinico Universitario A.Gemelli IRCCSCatholic UniversityRome 00168Italy Ultrasound Unit Ospedale S.SpiritoPescara 65123Italy

BACKGROUND Contrast-enhanced ultrasound(CEUS)is considered a secondary examination compared to computed tomography(CT)and magnetic resonance imaging(MRI)in the diagnosis of hepatocellular carcinoma(HCC),due to the risk of misdiagnosing intrahepatic cholangiocarcinoma(ICC).The introduction of CEUS Liver Imaging Reporting and Data System(CEUS LI-RADS)might overcome this *** though data from the literature seems promising,its reliability in real-life context has not been well-established *** To test the accuracy of CEUS LI-RADS for correctly diagnosing HCC and ICC in *** CEUS LI-RADS class was retrospectively assigned to 511 nodules identified in 269 patients suffering from liver *** diagnostic standard for all nodules was either biopsy(102 nodules)or CT/MRI(409 nodules).Common diagnostic accuracy indexes such as sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)were assessed for the following associations:CEUS LR-5 and HCC;CEUS LR-4 and 5 merged class and HCC;CEUS LR-M and ICC;and CEUS LR-3 and *** frequency of malignant lesions in CEUS LR-3 subgroups with different CEUS patterns was also ***-rater agreement for CEUS LI-RADS class assignment and for major CEUS pattern identification was *** CEUS LR-5 predicted HCC with a 67.6%sensitivity,97.7%specificity,and 99.3%PPV(P<0.001).The merging of LR-4 and 5 offered an improved 93.9%sensitivity in HCC diagnosis with a 94.3%specificity and 98.8%PPV(P<0.001).CEUS LR-M predicted ICC with a 91.3%sensitivity,96.7%specificity,and 99.6%NPV(P<0.001).CEUS LR-3 predominantly included benign lesions(only 28.8%of malignancies).In this class,the hypo-hypo pattern showed a much higher rate of malignant lesions(73.3%)than the iso-iso pattern(2.6%).Inter-rater agreement between internal raters for CEUS-LR class assignment was almost perfect(n=511,k=0.94,P<0.001),while the agreement among raters from separate centres was subst

关键词： Contrast-enhanced ultrasound Liver Imaging Reporting and Data System Hepatocellular carcinoma Intrahepatic cholangiocarcinoma Cirrhosis Contrast-enhanced ultrasound Liver

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