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diagnosis of hepatocellular carcinoma

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World Journal of Gastroenterology 2009年第11期15卷 1301-1314页

作者： Asmaa I Gomaa Shahid A Khan Edward LS Leen Imam Waked simon d taylor-robinson department of Hepatology and Gastroenterology Division of Medicine Imperial College London St Mary's Hospital Campus South Wharf Road London W2 1NY United Kingdom National Liver Institute Menoufi ya University Shebeen ElKom 32111 Egypt Imaging Sciences department MRC Clinical Sciences Centre Imperial College London Hammersmith Hospital Campus Du Cane Road London W12 0HS United Kingdom

Hepatocellular carcinoma (HCC) is one of the commonest cancers worldwide, particularly in parts of the developing world, and is increasing in incidence. This article reviews the current modalities employed for the diagnosis of HCC, including serum markers, radiological techniques and histological evaluation, and summarises international guidelines for the diagnostic approach to HCC.

关键词： diagnosis Hepatocellular carcinoma Imaging Serum markers

Non-invasive means of measuring hepatic fat content

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World Journal of Gastroenterology 2008年第22期14卷 3476-3483页

作者： Sanjeev R Mehta E Louise Thomas Jimmy d Bell desmond G Johnston simon d taylor-robinson division of Medicine Imperial College London St Mary's Campus Praed Street London W2 1NY United Kingdom Imaging Sciences depart-ment Division of Clinical Sciences Imperial College London Hammersmith Campus Du Cane Road London W12 OHS United Kingdom

Hepatic steatosis affects 20% to 30% of the general adult population in the western world. Currently, the technique of choice for determining hepatic fat deposition and the stage of fibrosis is liver biopsy. However, it is an invasive procedure and its use is limited, particularly in children. It may also be subject to sampling error. Non-invasive techniques such as ultrasound, computerised tomography (CT), magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (1H MRS) can detect hepatic steatosis, but currently cannot distinguish between simple steatosis and steatohepatitis, or stage the degree of fibrosis accurately. Ultrasound is widely used to detect hepatic steatosis, but its sensitivity is reduced in the morbidly obese and also in those with small amounts of fatty infiltration. It has been used to grade hepatic fat content, but this is subjective. CT can detect hepatic steatosis, but exposes subjects to ionising radiation, thus limiting its use in longitudinal studies and in children. Recently, magnetic resonance (MR) techniques using chemical shift imaging have provided a quantitative assessment of the degree of hepatic fatty infiltration, which correlates well with liver biopsy results in the same patients. Similarly, in vivo 1H MRS is a fast, safe, non-invasive method forthe quantification of intrahepatocellular lipid (IHCL) levels. Both techniques will be useful tools in future longitudinal clinical studies, either in examining the natural history of conditions causing hepatic steatosis (e.g. non-alcoholic fatty liver disease), or in testing new treatments for these conditions.

关键词： Adipose tissue Ectopic fat Hepatic fat Insulin resistance Ultrasound Computerised tomography Magnetic resonance imaging Magnetic resonance spectroscopy

Use of second generation contrast-enhanced ultrasound in the assessment of focal liver lesions

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World Journal of Gastroenterology 2007年第45期13卷 5963-5970页

作者： Stanislas HX Morin Adrian KP Lim eremy FL Cobbold simon d taylor-robinson Sciences Hammersmith Hospital Campus Faculty of Medicine Imperial College London London United Kingdom Liver Unit St Mary's Hospital Campus Faculty of Medicine Imperial College London London United Kingdom Liver Unit St Mary’s Hospital Campus Faculty of Medicine Imperial College London London United Kingdom

Ultrasound (US) is often the first imaging modality employed in patients with suspected focal liver lesions. The role of US in the characterisation of focal liver lesions has been transformed with the introduction of specific contrast media and the development of specialized imaging techniques. Ultrasound now can fully characterise the enhancement pattern of hepatic lesions, similar to that achieved with contrast enhanced multiphasic computed tomography (CT) and magnetic resonance imaging (MRI). US contrast agents are safe, well-tolerated and have very few contraindications. Furthermore, real-time evaluation of the vascularity of focal liver lesions has become possible with the use of the newer microbubble contrast agents. This article reviews the enhancement pattern of the most frequent liver lesions seen, using the second generation US contrast media. The common pitfalls for each type of lesion are discussed. The recent developments in US contrast media and specific imaging techniques have been a major advance and this technique, in view of the intrinsic advantages of US, will undoubtedly gain popularity in the years to come.

关键词： Microbubble contrast agents Ultrasound Focal liver lesions

Current and future applications of in vitro magnetic resonance spectroscopy in hepatobiliary disease

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World Journal of Gastroenterology 2006年第30期12卷 4773-4783页

作者： I Jane Cox Amar Sharif Jeremy FL Cobbold Howard C Thomas simon d taylor-robinson Imaging Sciences department Division of Clinical Sciences Imperial College London Hammersmith Hospital Campus Du Cane Road London W12 OHS United Kingdom department of Medicine Division of Medi-cine Imperial College London St Mary's Campus London W2 United Kingdom

Nuclear magnetic resonance spectroscopy allows the study of cellular biochemistry and metabolism, both in the whole body in vivo and at higher magnetic field strengths in vitro. Since the technique is non-invasive and non-selective, magnetic resonance spectroscopy methodologies have been widely applied in biochemistry and medicine. In vitro magnetic resonance spectroscopy studies of cells, body fluids and tissues have been used in medical biochemistry to investigate pathophysiologi- cal processes and more recently, the technique has been used by physicians to determine disease abnormalities in vivo. This highlighted topic illustrates the potential of in vitro magnetic resonance spectroscopy in studying the hepatobiliary system. The role of in vitro proton and phosphorus magnetic resonance spectroscopy in the study of malignant and non-malignant liver disease and bile composition studies are discussed, particularly with reference to correlative in vivo whole-body magnetic resonance spectroscopy applications. In summary, magnetic resonance spectroscopy techniques can provide non-invasive biochemical information on disease severity and pointers to underlying pathophysiological processes. Magnetic resonance spectroscopy holds potential promise as a screening tool for disease biomarkers, as well as assessing therapeutic response.

关键词： Magnetic resonance spectroscopy Liver Hepatobiliary disease Membrane metabolism

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

Incidence and mortality of primary liver cancer in England and Wales: Changing patterns and ethnic variations

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World Journal of Gastroenterology 2014年第6期20卷 1544-1553页

作者： Nimzing G Ladep Shahid A Khan Mary ME Crossey Andrew V Thillainayagam simon d taylor-robinson Mireille B Toledano Gastroenterology and Hepatology Section Division of Diabetes Endocrinology and Metabolism Department of Medicine Imperial College London MRC-HPA Centre for Environment and Health Department of Epidemiology and Biostatistics School of Public Health Imperial College London

AIM: To explore recent trends, modes of diagnosis, ethnic distribution and the mortality to incidence ratio of primary liver cancer by subtypes in England and Wales.

关键词： Primary liver cancer Hepatocellular carcinoma Intrahepatic bile duct England and Wales Ethnicity

Hepatic steatosis and fibrosis: Non-invasive assessment

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World Journal of Gastroenterology 2016年第45期22卷 9880-9897页

作者： Rustam N Karanjia Mary ME Crossey I Jane Cox Haddy KS Fye Ramou Njie Robert d Goldin simon d taylor-robinson Liver Unit Division of Digestive Health Department of Surgery and Cancer Imperial College London St Mary’s Campus London W2 1NY United Kingdom Institute of Hepatology London Foundation for Liver Research 111 Coldharbour Lane London SE5 9NT United Kingdom Faculty of Life Sciences and Medicine King’s College London London SE5 9NT United Kingdom MRC Gambia Atlantic Road Fajara The Gambia

Chronic liver disease is a major cause of morbidity and mortality worldwide and usually develops over many years, as a result of chronic inflammation and scarring, resulting in end-stage liver disease and its complications. The progression of disease is characterised by ongoing inflammation and consequent fibrosis, although hepatic steatosis is increasingly being recognised as an important pathological feature of disease, rather than being simply an innocent bystander. However, the current gold standard method of quantifying and staging liver disease, histological analysis by liver biopsy, has several limitations and can have associated morbidity and even mortality. Therefore, there is a clear need for safe and noninvasive assessment modalities to determine hepatic steatosis, inflammation and fibrosis. This review covers key mechanisms and the importance of fibrosis and steatosis in the progression of liver disease. We address non-invasive imaging and blood biomarker assessments that can be used as an alternative to information gained on liver biopsy.

关键词： Hepatic steatosis Fibrosis Non-invasive assessment Blood biomarker Ultrasound

Imaging of liver cancer

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World Journal of Gastroenterology 2009年第11期15卷 1289-1300页

作者： Ben Ariff Claire R Lloyd Sameer Khan Mohamed Shariff Andrew V Thillainayagam devinder S Bansi Shahid A Khan simon d taylor-robinson Adrian KP Lim department of Imaging Imperial College Healthcare NHS Trust Charing Cross Hospital Campus Fulham Palace Road London W6 8RF United Kingdom department of Hepatology and Gastroenterology Division of Medicine Imperial College London St Mary's Hospital Campus South Wharf Road London W2 1NY United Kingdom

Improvements in imaging technology allow exploitation of the dual blood supply of the liver to aid in the identif ication and characterisation of both malignant and benign liver lesions. Imaging techniques available include contrast enhanced ultrasound, computed tomography and magnetic resonance imaging. This review discusses the application of several imaging techniques in the diagnosis and staging of both hepatocellular carcinoma and cholangiocarcinoma and outlines certain characteristics of benign liver lesions. The advantages of each imaging technique are highlighted, while underscoring the potential pitfalls and limitations of each imaging modality.

关键词： Hepatic cell carcinoma Cholangiocarcinoma Contrast enhanced ultrasound Computed tomography Magnetic resonance imaging

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