Although FNH tumors are benign, they might cause symptoms. Reson. Non-malignant causes of liver nodules are increasingly diagnosed by imaging characteristics alone (i.e., simple cysts, hepatic adenomas, FNH, and hemangiomas). This study will evaluate the diagnostic accuracy of LSN score in the identification of early cirrhosis, which may further determine whether this method can be used as an alternative in the assessment of CLD patients. Your message has been successfully sent to your colleague. Smith, A. D. et al. NAS system27 was used for pathological determination of NAFLD with fibrosis staging (fibrosis grade: F0F4). Symptoms usually do not develop until the mass is so big that it pushes on other organs. [3]. 4c), final liver surface line (Fig. Radiology 283, 711722 (2017). Malignant etiologies include metastatic lesions (including from colon and pancreatic cancers) as well as primary hepatocellular carcinoma. and JavaScript. Liver biopsy is currently considered as the reference standard for liver cirrhosis and staging of fibrosis, however, the invasive nature, high cost-effectiveness, sampling errors, variability in assignment of pathologic stage may limit its wide utilization. 61, 13371347 (2016). Our mission is to provide practice-focused clinical and drug information that is reflective of current and emerging principles of care that will help to inform oncology decisions. Accuracy of. Scientific Reports The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. to maintaining your privacy and will not share your personal information without difficulty sleeping. For more information, please refer to our Privacy Policy. In previous studies17,18, the LSN program has been assessed in the CT images without and with contrast enhancement, it has not yet been applied to MR images. Holmberg SD, Lu M, Rupp LB, et al. Liver cirrhosis reduces hepatic function and results in multiple complications induced by nodular regeneration and portal hypertension, including ascites, variceal bleeding, renal failure due to hepatorenal syndrome, hepatic encephalopathy, and spontaneous bacterial peritonitis. [17] Each individual term is categorized as yes if it was reported, no if not reported, or unclear if information was not enough to reach a conclusion. Takeaway. 10, 307318 (2013). Lonardo, A., Byrne, C. D., Caldwell, S. H., Cortez-Pinto, H. & Targher, G. Global epidemiology of nonalcoholic fatty liver disease: Meta-analytic assessment of prevalence, incidence, and outcomes. regenerating nodule, HCC . Simple cysts and hemangiomas may not need any further monitoring or can be tracked over time with repeat imaging. The settings for optimal window level were automatically or manually adjusted by using the mean signal intensity within liver parenchyma. Early stage of cirrhosis is of great value in the diagnosis and management in patients with chronic liver disease (CLD). Reson. MR image data in twenty-three NAFLD patients and seven normal controls were analyzed with developed LSN software. The diagnostic accuracy of F0 vs. F1-3 had 0.913 sensitivity and 0.571 specificity at a cut-off LSN score 1.34; F0&F1 vs. F2-F3 was 0.917 sensitivity and 0.667 specificity at a cut-off LSN score 1.43; and F1 vs. F2-F3 was 0.833 sensitivity and 0.727 specificity at a cut-off LSN score 1.48, respectively. Stage 1: Inflammation In this stage, the ongoing damage to liver cells from a number of agents and diseases cause the liver to get enlarged. Sulfur colloid imaging is not generally informative. The following information will be extracted from each included study: first author's last name, publication year, country, study design, mean age, male/female ratio, aetiology of CLD, reference standard and histopathological hepatic fibrosis staging system, imaging modalities, time interval between reference and LSN measurement, LSN measurement software, sample size, TP, FP, FN, TN, area under the receiver operating characteristic curve (AUROC), and cut-off values. Triggers. 4b). 24, 248254 (2009). The images or other third party material in this article are included in the articles Creative Commons license, unless indicated otherwise in a credit line to the material. Management of Clinical Problem Liver Nodules. The differential diagnosis for liver nodules is broad and can be broken down into malignant and non-malignant causes. Signs of systemic infection, such as splinter hemorrhages, may indicate endocarditis or lead you to suspect a liver abscess. To obtain How to cite this article: He Y, Yan Y, Zhang S. Quantitative liver surface nodularity score based on imaging for assessment of early cirrhosis in patients with chronic liver disease: A protocol for systematic review and meta-analysis. If Echinococcus or Entamoeba histolytica infection is confirmed, consultation with an Infectious Disease specialist is recommended. 2004. Radiol. You may be trying to access this site from a secured browser on the server. Malignant metastatic lesions are generally multiple, and imaging may detect a primary tumor within the abdomen; if a known primary tumor is not seen or known, biopsy of a liver lesion with the aid of imaging-guidance is usually possible for histologic diagnosis to determine the primary cancer. Brunt, E. M., Kleiner, D. E., Wilson, L. A., Belt, P. & Neuschwander-Tetri, B. [18]. Graduated from ENSAT (national agronomic school of Toulouse) in plant sciences in 2018, I pursued a CIFRE doctorate under contract with SunAgri and INRAE in Avignon between 2019 and 2022. Perihepatic diseases also may cause extrinsic alteration of the liver contour. Common causes include alcohol use disorder, hepatitis and non-alcohol related fatty liver disease. TP, FP, FN, TN will be extracted or calculated according to reported sensitivity and specificity to form a diagnostic 2 2 table. It is important to note, however, that current study included only NAFLD patients with 1H MR-quantified fibrosis and steatosis. The interesting features in this study are that the LSN scores are significant different among fibrosis grades. Fibrosis grades in subject population were as follows: F0 (total n=7 (23.3%); NC=7), F1 (n=11 (36.7%); SS=9 vs. NASH=2), F2 (n=9 (30.0%); SS=3 vs. NASH=6), F3 (n=3 (10.0%); SS=0 vs. NASH=3), and F4 (n=0 (0.0%)). Non-malignant causes of liver nodules include cysts (simple cysts and multiple cysts typically associated with polycystic kidney disease), hepatic adenomas, focal nodular hyperplasia (FNH), hemangiomas, regenerative nodules, and various infections, including bacterial liver abscesses and infections secondary to Shamseer L, Moher D, Clarke M, et al. Feeling full after eating only a small amount of food (early satiety) Nausea. Hepatology 2011;53:32535. If all cancer in the liver is completely removed, you will have the best outlook. Get new journal Tables of Contents sent right to your email inbox, http://creativecommons.org/licenses/by/4.0, Quantitative liver surface nodularity score based on imaging for assessment of early cirrhosis in patients with chronic liver disease: A protocol for systematic review and meta-analysis, Articles in Google Scholar by Yuhao He, MD, Other articles in this journal by Yuhao He, MD, Privacy Policy (Updated December 15, 2022). In NAFLD patients, several studies reported that NASH is histopathologically more severe than simple hepatic steatosis22,23. Diagnostic accuracy was determined by calculating the area under the receiver operating characteristics (ROC) curve. Tae-Hoon Kim and Ji Eon Kim contributed equally. Signs of shock should raise suspicion for ruptured hepatic adenoma with intraperitoneal hemorrhage or ruptured hepatic abscess with peritonitis. Third, the numbers of subject in each fibrosis grade were low. https://doi.org/10.1038/s41598-019-46442-y, DOI: https://doi.org/10.1038/s41598-019-46442-y. 36, 659666 (2016). No, liver hemangioma doesnt go away without treatment. Radiology 227, 8994 (2003). muscle weakness. Google Scholar. Parasites and viruses can infect the liver, causing inflammation that reduces liver function. All MR scans were performed with a 3T (Tesla) MRI system (Achieva; Philips Medical Systems, Best, The Netherlands) and a 32-channel array coil. Quantitative imaging biomarkers: a review of statistical methods for technical performance assessment. For the liver boundary detection, this study was used a novel region-based method for liver segmentation as level set method30, which was provided the local clustering criterion function with correction with intensity inhomogeneities (Fig. Article Clinical presentation The diagnosis is made either at screening for cirrhosis due to known risk factors, elevated liver enzymes, or discovered incidentally in an examination for non-specific symptoms (e.g. There was no significant difference between the averaged LSN values of the 2 observers. While a benign liver mass is non threatening, they can be a challenge to accurately diagnose. An examination of the skin for signs of chronic liver disease, including spider angiomas and palmar erythema, may inform you of the risk for hepatocellular carcinoma. It happens when scar tissue. Cirrhosis can be diagnosed by radiology testing such as computed tomography (CT), ultrasound or magnetic resonance imaging (MRI) or via a needle biopsy of the liver. . Clinical features and outcomes of cirrhosis due to non-alcoholic steatohepatitis compared with cirrhosis caused by chronic hepatitis C. J. Gastroenterol. They had no knowledge of the clinical outcome and access to the readings of the other. J Hepatol 1991;13:3724. [5] Thus, noninvasive methods for assessing cirrhosis and staging fibrosis have been developed and validated in the recent years, such as the noninvasive serum-based markers, elastography imaging with ultrasound (US), or magnetic resonance imaging (MRI) techniques, these techniques cannot replace histologic assessment due to the insufficiently accuracy or dedicated equipment requirement.[68]. Metab. ~Redemonstrated means same as before. Severe liver fibrosis or cirrhosis: accuracy of US for detectionanalysis of 300 cases. The value of component b is referred to a value accounting for the field bias. Macronodular cirrhosis is a type of cirrhosis, or scarring of the liver. The shortage of subject number raises issues about whether the patients is small on differences of different fibrosis stage on the basis of LSN scores. Because there is a risk of Echinococcus infection in those who raise sheep or swine, an employment or exposure history can be informative. et al. IEEE Trans. Google Scholar. Abbreviations: AUROC = area under the receiver operating characteristic curve, CLD = chronic liver disease, CT = computed tomography, FN = false-negative, FP = false-positive, LSN = liver surface nodularity, MDCT = multidetector computed tomography, MRI = magnetic resonance imaging, PRISMA-P = Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols, QUADAS-2 = Assessment of Diagnostic Accuracy Studies-2, ROC = receiver-operating-characteristic, SROC = summary receiver operating characteristic, TN = true-negative, TP = true-positive, US = ultrasound. Tang, A., Cloutier, G., Szeverenyi, N. M. & Sirlin, C. B. Ultrasound Elastography and MR Elastography for Assessing Liver Fibrosis: Part 2, Diagnostic Performance, Confounders, and Future Directions. Diagnosed at stage 3, the 1-year survival rate is 80%. As for laboratory studies, liver transaminases, alkaline phosphatase, and bilirubin levels are not necessarily helpful to determine an etiology for the liver nodule. ISSN 2045-2322 (online). Liver scintigraphy is also typically not needed for diagnosis as ultrasound and CT have superseded this imaging modality. In conclusion, this study developed MRI-suitable LSN quantification program and the LSN measurement is reproducible when applied to MR images in assessing fibrosis stage. CT scans can be used to screen for liver fibrosis and justify the use of more accurate diagnostic methods such as first-line serologic testing and the well-established and easily performed Fibroscan. Nguyen D, Talwalkar JA. With more patients undergoing diagnostic imaging, you will encounter patients with incidentally discovered liver nodules that may not require further inpatient work up as they are not related to the patients acute presentation. 40, 766775 (2015). When a liver hemangioma causes signs and symptoms, they may include: Pain in the upper right abdomen. Keedy A, Westphalen AC, Qayyum A, et al. The liver surface can be smooth or irregular 1. All authors contributed to this work. 1 and Table1). J. Magn. Prospective comparison of magnetic resonance imaging to transient elastography and serum markers for liver fibrosis detection. Our pathological and blood chemistry findings were similar to the characterizations as histologically advanced features, a higher NAS value, a higher fibrosis stage, and higher ALT level as contrasted with a NC group (Table1). Smith, A. D. et al. First, consider the clinical presentation of the patient to determine how to proceed with diagnostic workup. Some error has occurred while processing your request. The diagnostic performance of LSN score according to fibrosis grades was evaluated with receiver operating characteristics (ROC) curve analysis including of the area under the ROC curve (AUROC), sensitivity, and specificity. Cirrhosis . Furthermore, in the NAFLD patients with an initial diagnosis of early stage (compensated) fibrosis or cirrhosis, there are currently no validated non-invasive methods for predicting hepatic decompensation. If liver abscess is suspected, aspiration should be pursued (see liver abscess). However, these symptoms are nonspecific and in most instances are due to something . The difference between three groups was assessed by the KruskalWallis H test (p=0.001) with Mann-Whitneys U test as follows: aF0 vs. F1 (p=0.027); bF1 vs. F2&F3 (p=0.019); and cF2&F3 vs. F0 (p<0.001). Alpha-fetoprotein may be elevated in patients with hepatocellular carcinoma (see hepatocellular carcinoma). The LSN scores according to fibrosis grades (F0F3) were listed in Table3. Article LSN scores among three groups and fibrosis grades compared using KruskalWallis H test. However, there was no significant difference between both SS and NASH groups as follows: alanine aminotransferase (ALT, p=0.051), aspartate aminotransferase (AST, p=0.060), -glutamyl transpeptidase (GGT, p=0.078), fasting glucose (p=0.470), and triglyceride (TG, p=0.231). Fibrosis. http://creativecommons.org/licenses/by/4.0/, Reproducibility of MRI-derived liver surface nodularity score: analysis of patients with repeated MRI in various scanners, Liver surface nodularity on non-contrast MRI identifies advanced fibrosis in patients with NAFLD, Intraindividual comparison of MRI-derived liver surface nodularity score at 1.5T and 3T, Two-dimensional (2D) morphologic measurements can quantify the severity of liver disease in children with autosomal recessive polycystic kidney disease (ARPKD), Diagnostic value of MRI-derived liver surface nodularity score for the non-invasive quantification of hepatic fibrosis in non-alcoholic fatty liver disease. The ICCs were denoted on the basis of the levels of reliability as follows31: as poor (<0.4), moderate (0.4 to <0.6), good (0.6 to <0.8), and excellent (0.8 to 1.0). Google Scholar. Nat. Keyword Highlighting All rights reserved. The AUROC curves were F0 vs. F1-3 0.894 (95% CI 0.7701.000; p=0.002), F0&F1 vs. F2&F3 0.856 (95% CI 0.7170.996; p=0.001) and F1 vs. F2&F3 0.788 (95% CI 0.5950.981; p=0.019). This is a reliable sign of fibrosis, though it is subjective. The authors have no conflicts of interest to disclose. The liver does not usually store fat. Castera L. Noninvasive methods to assess liver disease in patients with hepatitis B or C. Gastroenterology 2012;142:1293302.e4.
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