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Dynamic contrast enhanced ultrasound in differential diagnosis of hepatocellular carcinoma: A systematic review and meta-analysis

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World Journal of Gastrointestinal Oncology 2024年第6期16卷 2804-2815页

作者： Giorgio esposto Paolo Santini Fabrizio Termite Linda Galasso Irene Mignini Maria elena Ainora Antonio Gasbarrini Maria Assunta Zocco Department of CeMAD digestive disease Center Fondazione Policlinico Universitario A Gemelli IRCCSCatholic University of RomeRome 00168Italy Department of Fondazione Policlinico Universitario Agostino Gemelli IRCCS UniversitàCattolica del Sacro CuoreRome 00168Italy Department of medicina interna e gastroenterologia CEMAD Digestive Disease CenterFondazione Policlinico Universitario A Gemelli IRCCSUniversitàCattolica del Sacro CuoreRome 00168Italy

BACKGROUND Non-invasive differential diagnosis between hepatocellular carcinoma(HCC)and other liver cancer(*** or metastasis)is highly challenging and definitive diagnosis still relies on histological *** patterns of enhancement and wash-out of liver nodules can be used to stratify the risk of malignancy only in cirrhotic patients and HCC frequently shows atypical *** contrast-enhanced ultrasound(DCeUS)with standardized software could help to overcome these obstacles,providing functional and quantitative parameters and potentially improving accuracy in the evaluation of tumor *** To explore clinical evidence regarding the application of DCeUS in the differential diagnosis of liver *** A comprehensive literature search of clinical studies was performed to identify the parameters of DCeUS that could relate to histological *** accordance with the study protocol,a qualitative and quantitative analysis of the evidence was *** Rise time was significantly higher in HCC patients with a standardized mean difference(SMD)of 0.83(95%CI:0.48-1.18).Similarly,other statistically significant parameters were mean transit time local with a SMD of 0.73(95%CI:0.20-1.27),peak enhancement with a SMD of 0.37(95%CI:0.03-0.70),area wash-in area under the curve with a SMD of 0.47(95%CI:0.13-0.81),wash-out area under the curve with a SMD of 0.55(95%CI:0.21-0.89)and wash-in and wash-out area under the curve with SMD of 0.51(95%CI:0.17-0.85).SMD resulted not significant in fall time and wash-in rate,but the latter presented a trend towards greater values in HCC compared to intrahepatic *** DCeUS could improve non-invasive diagnosis of HCC,leading to less liver biopsy and early *** quantitative analysis needs to be applied on larger cohorts to confirm these preliminary results.

关键词： Dynamic contrast enhanced ultrasound Hepatocellular carcinoma Intracellular cholangiocarcinoma Quantitative ultrasound Liver cancer Time-intensity curve

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Shear-wave elastography to predict hepatocellular carcinoma after hepatitis C virus eradication:A systematic review and meta-analysis

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World Journal of Gastroenterology 2024年第10期30卷 1450-1460页

作者： Giorgio esposto Paolo Santini Linda Galasso Irene Mignini Maria elena Ainora Antonio Gasbarrini Maria Assunta Zocco CeMAD digestive disease Center Fondazione Policlinico Universitario“A.Gemelli”IRCCSCatholic University of RomeRome 00168Italy Fondazione Policlinico Universitario Agostino Gemelli IRCCS Fondazione Policlinico Universitario Agostino Gemelli IRCCS-UniversitàCattolica del Sacro CuoreRome 00168Italy medicina interna e gastroenterologia CEMAD Digestive Disease CenterUniversitàCattolica del Sacro CuoreFondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy

BACKGROUND direct-acting antiviral agents(DAAs)are highly effective treatment for chronic hepatitis C(CHC)with a significant rate of sustained virologic response(SVR).The achievement of SVR is crucial to prevent additional liver damage and slow down fibrosis *** assessment of fibrosis degree can be performed with transient elastography,magnetic resonance elastography or shear-wave elastography(SWe).Liver elastography could function as a predictor for hepato-cellular carcinoma(HCC)in CHC patients treated with *** To explore the predictive value of SWe for HCC development after complete clearance of hepatitis C virus(HCV).MeTHODS A comprehensive literature search of clinical studies was performed to identify the ability of SWe to predict HCC occurrence after HCV *** accordance with the study protocol,a qualitative and quantitative analysis of the evidence was *** At baseline and after 12 wk of follow-up,a trend was shown towards greater liver stiffness(LS)in those who go on to develop HCC compared to those who do not[baseline LS standardized mean difference(SMD):1.15,95%confidence interval(95%CI):020-2.50;LS SMD after 12 wk:0.83,95%CI:0.33-1.98].The absence of a statistically significant difference between the mean LS in those who developed HCC or not may be related to the inability to correct for confounding factors and the absence of raw source *** was a statist-ically significant LS SMD at 24 wk of follow-up between patients who developed HCC vs not(0.64;95%CI:0.04-1.24).CONCLUSION SWe could be a promising tool for prediction of HCC occurrence in patients treated with *** studies with larger cohorts and standardized timing of elastographic evaluation are needed to confirm these data.

关键词： Shear-wave elastography Hepatocellular carcinoma Hepatitis C virus Sustained virologic response

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effect of omeprazole on symptoms and ultrastructural esophageal damage in acid bile reflux

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World Journal of Gastroenterology 2005年第12期11卷 1876-1880页

作者： Carlo Calabrese Anna Fabbri Mauro Bortolotti Giovanna Cenacchi Scialpi Carlo Desiree Zahlane Mario Miglioli Giulio di Febo dipartimento di medicina interna e gastroenterologia

AIM: To value whether omeprazole could induce the healing of diS and regression of symptoms in patients with DGeR. MeTHODS: We enrolled 15 symptomatic patients with a pathological esophageal 24-h pH-metry and bilimetry. Patients underwent endoscopy and biopsies were taken from the distal esophagus. Specimens were analyzed at histology and transmission electron microscopy (TeM). Patients were treated with omeprazole 40 mg/d for 3 mo and then endoscopy with biopsies was repeated. Patients with persistent heartburn and/or with an incomplete recovery of diS were treated for 3 more months and endoscopy with biopsies was performed. ReSULTS: Nine patients had a non-erosive reflux disease at endoscopy (NeRD) while 6 had erosive esophagitis (eRD). At histology, of the 6 patients with erosive esophagitis, 5 had mild esophagitis and 1 moderate esophagitis. No patients with NeRD showed histological signs of esophagitis. After 3 mo of therapy, 13/15 patients (86.7%,Ped a complete recovery of diS and disappearance of heartburn. Of the 2 patients treated for 3 more months, complete recovery of diS and heartburn were achieved in one. CONCLUSION: Three or 6 mo of omeprazole therapy led to a complete regression of the ultrastructural esophageal damage in 86.7% and in 93% of patients with DGeR, NeRD and eRD respectively. The ultrastructural recovery of the epithelium was accompanied by regression of heartburn in all cases.

关键词： Duodenogastroesophageal reflux Gastroeso phageal reflux disease Transmission electron Microscopy dilated Intercellular Spaces Non-erosive reflux disease

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Dynamic contrast enhanced ultrasound in gastrointestinal diseases:A current trend or an indispensable tool?

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World Journal of Gastroenterology 2023年第25期29卷 4021-4035页

作者： Mattia Paratore Matteo Garcovich Maria elena Ainora Laura Riccardi Antonio Gasbarrini Maria Assunta Zocco medicina interna e gastroenterologia CEMAD Digestive Disease CenterFondazione Policlinico Universitario A.Gemelli IRCCSRome 00168Italy medicina interna e gastroenterologia CEMAD Digestive Disease CenterUniversità Cattolica del Sacro CuoreFondazione Policlinico Universitario A.Gemelli IRCCSRome 00168Italy

Contrast enhanced ultrasound(CeUS)has been widely implemented in clinical practice because of the enormous quantity of information it provides,along with its low cost,reproducibility,minimal invasiveness,and safety of the secondgeneration ultrasound contrast *** overcome the limitation of CeUS given by the subjective evaluation of the contrast enhancement behaviour,quantitative analysis of contrast kinetics with generation of time-intensity curves has been introduced in recent *** quantification of perfusion parameters[named as dynamic-CeUS(D-CeUS)]has several applications in gastrointestinal neoplastic and inflammatory ***,the limited availability of large studies and the heterogeneity of the technologies employed have precluded the standardisation of D-CeUS,which potentially represents a valuable tool for clinical practice in management of gastrointestinal *** this article,we reviewed the evidence exploring the application of D-CeUS in gastrointestinal diseases,with a special focus on liver,pancreas,and inflammatory bowel diseases.

关键词： Quantitative perfusion analysis Gastrointestinal diseases Time-intensity curve Multiparametric ultrasound

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Glucagon-like peptide-2 analogues for Crohn’s disease patients with short bowel syndrome and intestinal failure

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World Journal of Gastroenterology 2022年第44期28卷 6258-6270页

作者： Marco Pizzoferrato Pierluigi Puca Sara ennas Giovanni Cammarota Luisa Guidi UOC gastroenterologia Dipartimento di Scienze Mediche e ChirurgicheFondazione Policlinico Universitario Agostino Gemelli IRCCSRome 00168Italy dipartimento di medicina e Chirurgia Traslazionale UniversitàCattolica del Sacro CuoreRome 00168Italy

Short bowel syndrome(SBS)with intestinal failure(IF)is a rare but severe complication of Crohn’s disease(CD),which is the most frequent benign condition that leads to SBS after repeated surgical resections,even in the era of biologics and small ***-like peptide-2 analogues have been deeply studied recently for the treatment of *** drugs have a significant intestinotrophic effect and the potential to reduce the chronic dependence of SBSIF patients on parenteral support or *** has been approved for the treatment of SBS-IF,and apraglutide is currently in clinical *** use of these drugs was examined with a focus on their use in CD patients.

关键词： Short bowel syndrome Intestinal failure Crohn’s disease Glucagon-like peptide-2 analogues Teduglutide Apraglutide Glepaglutide

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Ileal lesions in patients with ulcerative colitis after ileo-rectal anastomosis:Relationship with colonic metaplasia

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World Journal of Gastroenterology 2008年第34期14卷 5290-5300页

作者： Livia Biancone emma Calabrese Giampiero Palmieri Carmelina Petruzziello Sara Onali Giuseppe Sigismondo Sica Marta Cossignani Giovanna Condino Kiron Moy Das Francesco Pallone Cattedra di gastroenterologia Dipartimento di Medicina InternaUniversità di "Tor Vergata" Cattedra di Anatomia ed Istologia Patologica Università di "Tor Vergata" Cattedra di gastroenterologia Dipartimento di Medicina InternaUniversità di "Tor Vergata" Cattedra di Chirurgia Generale Università di "Tor Vergata" Cattedra di gastroenterologia Dipartimento di Medicina Interna Università di "Tor Vergata" GI Unit Department of Gastroenterology & Hepatology University of Medicine & Dentistry of New Brunswick

AIM:To assess whether in ulcerative colitis (UC) patients with ileo-rectal anastomosis (IRA), ileal lesions may develop in the neo-terminal-ileum and their possible relation with phenotypic changes towards colonic epithelium. MeTHODS: A total of 19 patients with IRA under regular follow up were enrolled, including 11 UC and 8 controls (6 Crohn’s disease, CD; 1 familial adenomatous polyposis, FAP; 1 colon cancer, colon K). Ileal lesions were identifi ed by ileoscopy with biopsies taken from the ileum (involved and uninvolved) and from the rectal stump. Staining included He and immunohistochemistry using monoclonal antibodies against colonic epithelial protein CeP (Das-1) and human tropomyosin isoform 5, hTM5 (CG3). Possible relation between development of colonic metaplasia and ileal lesions was ***: Stenosing adenocarcinoma of the rectal stump was detected in 1 UC patient. The neo-terminal ileum was therefore investigated in 10/11 UC patients. Ileal ulcers were detected in 7/10 UC, associated with colonic metaplasia in 4/7 (57.1%) and Das-1 and CG3 reactivity in 3/4 UC. In controls, recurrence occurred in 4/6 CD, associated with colonic metaplasia in 3/4 and reactivity with Das-1 and CG3 in 2/3. CONCLUSION: Present fi ndings suggest that in UC, ileal lesions associated with changes towards colonic epithelium may develop also after IRA. Changes of the ileal content after colectomy may contribute to the development of colonic metaplasia, leading to ileal lesions both in the pouch and in the neo-terminal ileum after IRA.

关键词： Ulcerative colitis Ileo-rectal anastomosis Ileal lesions Colonic metaplasia

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different doses of consensus interferon plus ribavirin in patients with hepatitis C virus genotype 1 relapsed after interferon monotherapy:A randomized controlled trial

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World Journal of Gastroenterology 2006年第42期12卷 6861-6864页

作者： Giuseppe Alaimo Vito di Marco Donatella Ferraro Rosa di Stefano Salvatore Porrovecchio Francesca D’Angelo Vincenza Calvaruso Antonio Craxì Piero Luigi Almasio Cattedra di gastroenterologia Dipartimento Biomedico di Medicina Interna e Specialistica University of Palermo Italy Cattedra di Virologia Di-partimento di Igiene e Microbiologia University of Palermo Italy

AIM： To assess the efficacy of different schedules of consensus interferon （CIFN） plus ribavirin in retreating chronic hepatitis C patients who relapsed after recombinant interferon （rIFN） monotherapy. MeTHODS： Forty-five patients （34 males and 11 females） with chronic hepatitis due to hepatitis C virus （HCV） genotype 1 who relapsed after a previous course of rIFN monotherapy were randomized to receive 9 μg CIFN three times per week for 52 wk （group A, n = 22） or 18 μg CIFN three times per week for 52 wk （group B, n = 23） in combination with ribavirin 800 to 1200 mg daily for 52 wk （according to body weight）. Virological response was evaluated at week 24 （eRR）, at the end of treatment （eTR） and at 76 wk （SVR）. ReSULTS： By intention-to-treat analysis, subjects in group A had an eVR in 35% of cases, an eTR in 35% and a SVR in 27.3% of cases. Subjects in group B had an eVR in 32% of cases, an eTR in 35% and a SVR in 26.1% of cases. Treatment was stopped because of adverse effects （mostly intolerance） in 15 patients （6 in group A and 9 in group B）. IFN dose reduction was needed in 2 patients （1 in group A and 1 in group B）. Ribavirin dose was reduced in 2 patients in group A and 1 in group B respectively. Among the 15 subjects who received at least 80% of the intended schedule, the rate of SVR was 80% （6 in group A and 6 in group B）. CONCLUSION： CIFN in combination with ribavirin when given to HCV genotype 1 relapsers after rIFN monotherapy obtains an unsatisfactory rate of sustained viral clearance independently of dosage of the drug. This may be due to its scarce tolerability.

关键词： Interferon Ribavirin Hepatitis C virus Hepatitis C Relapser

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Serum chromogranin-A in hepatocellular carcinoma: diagnostic utility and limits

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World Journal of Gastroenterology 2005年第13期11卷 1987-1990页

作者： Aldo Spadaro Antonino Ajello Carmela Morace Agata Zirilli Graziella D'arrigo Carmelo Luigiano Francesco Martino Anna Bene Domenico Migliorato Santi Turiano Oscar Ferraù Maria Antonietta Freni dipartimento Clinico Sperimentale di medicina e Farmacologia dipartimento di Statistica dipartimento di Scienze Radiologiche Unità Operativa di gastroenterologia

AIM: The utility of serum alpha-fetoprotein (α-FP) for the detection of hepatocellular carcinoma (HCC) is questionable. High serum levels of chromogranin-A (CgA) have recently been reported in HCC. Impaired hepatic, renal, and heart functions influence circulating CgA. The aim of this study was to assess sensitivity and specificity of serum CgA as a marker of HCC in patients with liver cirrhosis (LC). MeTHODS: Serum CgA levels were measured by RIA in 339 patients of which 54 HCC, 132 LC, 45 chronic hepatitis (CH), 27 chronic heart failure (CHF), 36 chronic renal failure (CRF), 45 chronic inflammatory bowel disease (IBD) as disease controls and in 75 healthy controls. Patients with liver disease or IBD and concomitant renal and/or heart failure were excluded. Pearson correlation, non-parametric combination test and confidence interval analysis were used for statistical analysis. ReSULTS: Serum CgA above normal values (100 ng/mL) were found in 83% of HCC patients, in 48% of LC patients, in 20% of CH patients, in 33% of IBD patients, in 92% of CRF patients, in 100% of CHF patients, and in none of the healthy controls. The mean CgA values in HCC (769±1046), in LC (249±369), in CH (87±94), in CRF (1390±1401), in CHF (577±539), in IBD (146±287) were significantly higher than those in healthy controls (48±18). HCC patients had higher CgA values (Pents but did not differ from those with CRF or CHF. The 95% CI for the mean (250-1289 ng/mL) in HCC patients was selected as a CgA range and the lower value of such range was assumed as cut-off. Sensitivity and specificity of CgA, calculated in relation to the cut-off in patients with cirrhosis and HCC, were respectively 61% (CI 48-73%) and 82% (CI 75-88%). Serum a-FP values were >200 ng/mL in 21% of the HCC patients and in none of the LC patients. No significant correlation was found between a-FP and CgA in patients with HCC and in patients with cirrhosis. CONCLUSION: When HCC is suspected and a-FP

关键词： Chromogranin-A Hepatocellular carcinoma Liver cirrhosis Chronic hepatitis diagnosis

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A rare case of epiploic appendagitis in a patient affected by ulcerative colitis on vedolizumab therapy

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Gastroenterology Report 2022年第1期10卷 661-664页

作者： Daniela Pugliese Giuseppe Privitera Luigi Larosa Valentin Calvez diana Broglia Nicoletta de Matthaeis Alessandro Armuzzi CeMAD IBD UNITUnita Operativa Complessa di Medicina Interna e GastroenterologiaDipartimento di Scienze Mediche e ChirurgicheFondazione Policlinico Universitario“A.Gemelli”IRCCSRomeItaly dipartimento Universitario di medicina e Chirurgia Traslazionale Universita Cattolica del Sacro CuoreRomeItaly Fondazione Policlinico Universitario A.Gemelli IRCCS UOC di Radiodiagnostica Presidio ColumbusDipartimento di Diagnostica per immaginiRadioterapia Oncologica ed EmatologiaLargo Francesco VitoRomeItaly Universita Cattolica del Sacro Cuore RomeItaly IBD Center IRCCS Humanitas Research HospitalRozzanoMilanItaly Department of Biomedical Sciences Humanitas UniversityPieve EmanueleMilanItaly

Introduction epiploic appendagitis(eA)is an acute inflammation of the pedunculated mesenteric fat attached to the colonic surface,distinguished into two forms:primary eA,seemingly elicited by local ischaemic factors;and secondary eA(SeA),elicited by the inflammation of the adjacent organs,with diverticulitis being the most common trigger[1].Few case series have described the association between SeA and inflammatory bowel disease(IBD);however,information about clinical,laboratory and imaging findings,outcomes,and the impact of IBD-specific therapy were not *** first report the case of a woman affected by ulcerative colitis(UC)who developed a SeA during vedolizumab therapy(Figure 1A).

关键词： inflammation organs acute

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Chlamydia pneumoniae replicates in Kupffer cells in mouse model of liver infection

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World Journal of Gastroenterology 2006年第40期12卷 6453-6457页

作者： Antonella Marangoni Manuela Donati Francesca Cavrini Rita Aldini Silvia Accardo Vittorio Sambri Marco Montagnani Roberto Cevenini Sezione di Microbiologia DMCSS University of Bologna Bologna Italy dipartimento SMeTC University of Bologna Bologna Italy dipartimento di medicina interna e gastroenterologia University of Bologna Bologna Italy

AIM: To develop an animal model of liver infection with Chlamydia pneumoniae (C. pneumoniae) in intraperito-neally infected mice for studying the presence of chlamy-diae in Kupffer cells and ***: A total of 80 BALB/c mice were inoculated intraperitoneally with C. pneumoniae and sacrificed at various time points after infection. Chlamydiae were looked for in liver homogenates as well as in Kupffer cells and hepatocytes separated by liver perfusion with collagenase. C. pneumoniae was detected by both isola-tion in LLC-MK2 cells and fluorescence in situ hybridiza-tion (FISH). The releasing of TNFA-α by C. pneumoniae in vitro stimulated Kupffer cells was studied by enzyme-linked immunosorbent ***: C. pneumoniae isolation from liver homoge-nates reached a plateau on d 7 after infection when 6 of 10 animals were positive, then decreased, and became negative by d 20. C. pneumoniae isolation from sepa-rated Kupffer cells reached a plateau on d 7 when 5 of 10 animals were positive, and became negative by d 20. The detection of C. pneumoniae in separated Kupffer cells by FISH, confirmed the results obtained by culture. Isolated hepatocytes were always negative. Stimula-tion of Kupffer cells by alive C. pneumoniae elicited high TNF-α levels. CONCLUSION: A productive infection by C. pneumo-niae may take place in Kupffer cells and C. pneumoniae induces a local pro-inflammatory activity. C. pneumoniae is therefore, able to act as antigenic stimulus when local-ized in the liver. One could speculate that C. pneumoniaeinfection, involving cells of the innate immunity such as Kupffer cells, could also trigger pathological immune re-actions involving the liver, as observed in human patients with primary biliary cirrhosis.

关键词： Chlamydia pneumoniae Liver infection Kupffer cells Hepatocytes Culture-isolation Fluorescence in situ hybridization TNF-α Primary biliary cirrhosis

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