X-Ray-Computed Tomography: Implementation and Applications
Richard A. Robb in Three-Dimensional Biomedical Imaging, 2017
Figure 13 is a CT cross-sectional image of a patient’s chest scanned during breath-holding, and shows cancerous nodules in both lungs. The image has been “windowed” on the display console to show the fine contrast detail within the lungs (compared, for example, to Figure 9 where the full range of CT values is displayed and thus the small density pulmonary vessels cannot be seen). Figure 14 shows a CT liver scan following injection of contrast material. A large infiltrating metastatic carcinoma is demonstrated which was not evident on the precontrast scan. Figure 15 shows another CT image of an abdominal scan, demonstrating metastatic cancer of the liver. A needle is seen accurately positioned to perform a liver biopsy of the cancerous tissue. Figure 16 shows a “target” or “spot” CT scan of the retroperitoneal area, elucidating a small mass on the right adrenal gland. Figure 17 is a CT scan of the abdomen of the same patient whose thoracic CT scan is shown in Figure 13. Metastases from a primary carcinoma of the colon are shown in the liver in this image. Figure 18 is a scan of a different patient with colon cancer, demonstrating the effects on the right kidney of ureteral obstruction caused by cancer.
Medical Problems in Alcoholics
Frank Lynn Iber in Alcohol and Drug Abuse as Encountered in Office Practice, 2020
Fatty liver is manifest by hepatomegaly, which is most often tender and may produce the largest livers clinically encountered. There may or may not be liver test abnormalities of the magnitude noted in Section V.A. The larger livers may be associated with splenomegaly and minimal-sized esophageal varices. This lesion also seems to be associated with alcohol consumption and does not require malnutrition for its production. If imaging is performed, the fatty liver has many internal echoes on sonography, irregular uptake on scintography, and may have nodularity on CT scan, but these methods are not required for diagnosis. The liver biopsy is diagnostic. In this diagnosis the liver tests are never severely abnormal, the bilirubin is less than 50 μm/L (3 mg/dl), the ALT and AST are only elevated up to three times normal, and the alkaline phosphatase may be elevated up to five times normal. With abstinence this disease resolves over several months and of itself is not permanent. This lesion occurs in 80 to 90% of drinkers in the 100-g/day range and is often present with other lesions. It is more likely to be present in diabetics or in the obese.
Chronic viral hepatitis
Nizar Zein, Bret Lashner in The Year in Gastroenterology and Hepatology, 2005
Liver biopsy with staining is the traditional method of diagnosing and staging liver fibrosis and inflammatory activity. However, liver biopsy is invasive and has potential complications. For financial or medical reasons, many persons are unwilling or unable to undergo biopsy. Thus, efforts should be made to identify non-invasive predictors of the presence and severity of liver fibrosis. The present study is a step in the right direction. The biochemical markers that were incorporated in the FT and AT tests seem to be good surrogate markers for fibrosis and activity identified in liver biopsy specimens from HCV patients. These markers had a relatively good predictive value for the initial assessment prior to antiviral therapy and during follow-up after completion of treatment. If the results are confirmed in future studies, their availability in clinical practice will probably decrease the need for liver biopsy in HCV patients. These tests may also provide a necessary tool to screen larger populations of HCV patients for histological injury. The main shortcomings include the retrospective nature and potential selection bias, since only patients treated with antiviral medications were included.
Use of electron microscopy when screening liver biopsies from neonates and infants: experience from a single tertiary children’s hospital (1991-2017)
Published in Ultrastructural Pathology, 2020
Mikako Warren, Mai Shimura, Eric P. Wartchow, Shoji Yano
Liver biopsy is a standard procedure in the diagnosis and management of pediatric patients with liver disease.4,5 ESOGHAN Hepatology Comitte published the guideline for the indication of pediatric native liver biopsy. These diseases included neonatal cholestatic diseases, progressive familial intrahepatic cholestasis, Alagille syndrome, A1AT, acute liver failure, cryptogenic transaminasaemia, lysosomal acid lipase deficiency, nonalcoholic fatty liver diseases, autoimmune hepatitis, Wilson disease, drug-induced liver injury, sclerosing cholangitis, congenital disorders of glycosylation, congenital hepatic fibrosis, hepatitis B and C virus infection, cytomegalovirus infection, and Epstein-Barr virus infection.5 However, to our knowledge, no study has reported the actual number or the percentage of liver diseases. This study is unique because it presents the concrete numbers for both the indications and the diseases, and describes the role of EM.
Non-invasive diagnosis of nonalcoholic fatty liver disease: impact of age and other risk factors
Published in The Aging Male, 2020
Although abdominal ultrasonography is a useful and readily available tool in the diagnosis of hepatic steatosis, a definitive diagnosis of early fibrosis and NASH still requires liver biopsy [6]. However, liver biopsy is an invasive procedure with attending risk of complications [7]. Therefore, intensive efforts have been exerted to develop noninvasive biomarkers for the detection of the degree of fibrosis in patients with NAFLD. These biomarkers include clinical and biochemical parameters such as body mass index (BMI), presence of diabetes, alanine aminotransferase (ALT), aspartate aminotransferase (AST), AST/ALT ratio, and HOMA-IR, among others. Some scoring systems derived from aforementioned and some other parameters have been validated to reflect the degree of liver fibrosis noninvasively. The NAFLD, FIB4, BARD, and NIPPON scores are some examples of these scoring systems [8–10].
Noninvasive assessment and risk factors of liver fibrosis in patients with thalassemia major using shear wave elastography
Published in Hematology, 2019
Murtadha Al-Khabori, Shahina Daar, Said A. Al-Busafi, Humoud Al-Dhuhli, AlGhalya A. Alumairi, Moez Hassan, Sara Al-Rahbi, Umaima Al-Ajmi
Liver biopsy is a cornerstone in the evaluation of patients with liver diseases. However, it is an invasive procedure with a number of limitations [7]. These include potential morbidity and mortality, as well as susceptibility to inter-observer variability and sampling error. In addition, repeat biopsies are not well-tolerated and therefore not suitable for monitoring disease progression. According to international guidelines, fibrosis staging should be initially assessed using non-invasive measures including serum markers and elastography [8]. Shear Wave elastography (SWE) is an imaging technique which quantifies tissue stiffness by measuring the speed of the shear waves in tissue [9]. It is becoming an attractive technology for assessment of liver fibrosis as it is readily available, non-invasive, accurate, low cost, reproducible, and suitable for use in a variety of clinical settings. There are limited data about the role of Transient Elastography (TE) in the assessment of liver fibrosis in patients with TM and no data on the utility of the 2-D SWE imaging technique in such cases [10–13]. Therefore, the present study aimed to stage liver fibrosis in patients with TM using the 2-D SWE imaging technique in staging hepatic fibrosis and evaluating risk factors associated with significant fibrosis.
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