Objective The present study was performed to clarify the ability of ultrasonography (US) and computed tomography (CT) to detect steatosis and advanced fibrosis in nonalcoholic steatohepatitis (NASH) patients, and to assess the influence of steatosis, fibrosis, and obesity on the radiological detection of steatosis and advanced fibrosis. Methods One hundred and eighteen biopsy proven NASH patients underwent US and CT within 6 months before or after biopsy. The ability of US and CT to detect histological steatosis and advanced fibrosis was assessed. To evaluate whether fibrosis and obesity interfered with the detection of moderate to severe histological steatosis by US and CT, we analyzed 88 NASH patients with moderate to severe steatosis. To evaluate interference with the detection of advanced fibrosis by steatosis and obesity, we analyzed 59 NASH patients with advanced fibrosis. Results The sensitivity of US for detecting moderate to severe histological steatosis in patients with mild histological fibrosis was 100%, but this was reduced to 77.8% in patients with advanced histological fibrosis (p=0.001). The sensitivity of CT was 69.8% in patients with mild histological fibrosis and 48.9% in those with advanced histological fibrosis (p=0.047). The sensitivity of US and CT for moderate to severe histological steatosis was similar in each body mass index group. The sensitivity for detecting advanced fibrosis was markedly decreased by severe steatosis and obesity in the case of both US and CT. Conclusion If we are aware of these disadvantages of US and CT, it is useful for diagnosing steatosis and fibrosis in NAFLD patients.

Imaging of Nonalcoholic Steatohepatitis: Advantages and Pitfalls of Ultrasonography and Computed Tomography

To elucidate if the presence of fatty liver in obesity influences hepatic insulin extraction under basal conditions, serum immunoreactive insulin (IRI) and C-peptide immunoreactivity (CPR) were measured in 20 obese patients with normal glucose tolerance and in 8 normal subjects. The obese patients were subdivided into two groups matched for age and body weight according to the presence or absence of fatty liver: 8 obese patients without fatty liver (OBN) and 14 with fatty liver (OBF). Basal levels of IRI and CPR were significantly greater in the obese patients than in the normals, but were similar in the two obese groups. In the OBF group, the CPR/IRI molar ratios, a relative measure of hepatic insulin uptake, were significantly lower than in the other two groups, while the ratios of the normal and OBN groups were similar. The CPR/IRI molar ratios in all obese patients correlated well with the degree of fatty liver (r=0.785, p<0.001). These results suggest that hepatic insulin extraction in a subgroup of obese patients is either reduced or indistinguishable from that of non-obese subjects, and that basal CPR/IRI molar ratio may serve as a useful indicator of the presence of fatty liver in simple obesity.

Altered Basal C-peptide/insulin Molar Ratios in Obese Patients with Fatty Liver

AIM To determine whether S-1 induces hepatic steatosis in patients being treated for pancreatic cancer. METHODS This retrospective study evaluated 22 patients who received oral S-1 as a first-line treatment for pancreatic cancer between January 2008 and July 2015 at the Ishikawa Prefectural Central Hospital. Patients underwent abdominal computed tomography (CT) scans before chemotherapy and within 3 mo from the start of treatment. CT numbers of the liver and spleen were measured before and after S-1 administration. Steatosis was diagnosed when the ratio of the CT number of the liver to that of the spleen (liver/spleen ratio) was < 0.9. RESULTS Median patient age was 68 years (range, 48-85 years), and median body mass index was 21 kg/m2 (range, 18-27 kg/m2). Of the 22 patients, six (27%) regularly consumed alcohol, and five (23%) had liver metastases. The mean ratio of CT number of the liver to the spleen was significantly higher before administration of S-1 (1.27 vs 1.09, P = 0.012) compared with after. Of the 22 patients, five (23%) had hepatic steatosis and 17 (77%) did not. The pretreatment demographic and clinical characteristics of these two groups showed no significant differences. The relationship between liver/spleen ratio and alanine transaminase activity in these patients. A statistically significant inverse correlation was observed (r = -0.417, P < 0.027). CONCLUSION Of the 22 patients with pancreatic cancer, five (23%) experienced S-1 induced hepatic steatosis. Care should be taken during S-1 treatment of patients with pancreatic cancer.

S-1 induced hepatic steatosis in patients with pancreatic cancer: Retrospective analysis.

From May 1990 through April 1997, endoscopic retrograde cholangiopancreatography (ERCP) was performed in 1210 patients, of whom 652 were chosen as subjects of this study. We devised a new morphologic classification of the papilla of Vater. Forms of the protuberance of the major papilla were classified into three types : spherical type, flat type and irregular type. The opening of the pancreaticobiliary duct was classified into two types : spot type and elongated type. The epithelium around the opening was classified into two types : granular type and villous type. We studied these forms, separate openings of the pancreaticobiliary duct, the presence of oral protrusion and frenulum, presence of anomalous connections of the pancreaticobiliary ducts, abnormal adherence of the cystic duct, relation to cholangiopancreatic diseases in flat and irregular types. We conclude that a larger proportion of cases were of the elongated and villous types and were of separate openings in the flat and irregular types than the spherical type. All cases of the flat and irregular types tended to have oral protrusion and many cases of the irregular types did not have a frenulum. An anomalous connection of the pancreaticobiliary duct was noted in one case of the flat type, and abnormal adherence of the cystic duct was noted in no cases of either the flat or irregular type. An association with pancreas cancer was noted in cases of the flat and irregular types. Therefore, if an unusual form of the papilla of Vater is confirmed, it may be necessary to perform further examinations of the pancreaticobiliary tract such as computed tomography and magnetic resonance cholangiopancreatography.

/pdf/morphological-classification-and-clinical-significance-of-2w3wrpyqxd.pdf

Morphological Classification and Clinical Significance of the Papilla of Vater by Endoscopic Retrograde Cholangiopancreatography

Tamoxifen is a potent antagonist of estrogen and evidently improves the prognosis of patients with estrogen receptor-positive breast cancer. However, although tamoxifen has been shown to induce hepatic steatosis in one-third of nonobese breast cancer patients, the pathogenic mechanisms have not yet been defined. Impaired fatty acid beta oxidation has been proposed as a possible pathogenic mechanism involved in tamoxifen-induced hepatic steatosis, because fatty acid beta oxidation activity is impaired in aromatase-deficient mice lacking intrinsic estrogen, and because either estradiol supplementation or administration of bezafibrate improved impaired beta oxidation activity to prevent the progression of hepatic steatosis. Previously, we investigated why tamoxifen is such a potent estrogen antagonist and found that the serum estradiol level was extremely low (<10 pg/ml) in most premenopausal breast cancer patients treated with tamoxifen. Therefore, tamoxifen is not merely an antagonist of estrogen but it also efficiently suppresses estrogen production in one-third of breast cancer patients treated with tamoxifen. Impaired activity of CYP17 alpha, which is the essential enzyme for estrogen synthesis, may contribute to the suppression of estrogen synthesis. From these observations, we deduced that an increased body mass index and a reduction in the ratio of pregnanetriol to pregnanediol concentrations in urine are two independent risk factors for the development of hepatic steatosis in tamoxifen-treated breast cancer patients.

Tamoxifen-Induced Nonalcoholic Steatohepatitis

肝疾患診断におけるcomputed tomography(以下CTと略す)の意義と限界を明らかにする目的で,瀰漫性肝疾患90例と腫瘤性肝疾患37例を対象として第3世後半のCT装置(GECT/T 8800)を用いて各疾患のCT像を比較検討した.肝硬変症ではRIスキャンで認められる右葉萎縮や左葉肥大などの所見は明らかで無く,脾臓前後径の増大,肝表面の凹凸,腹水の存在が特異的な所見であった.脂肪肝は全例で肝臓のCT値が低値を示し,肝臓と脾臓のCT値の比が0.9以下という基準は脂肪肝のスクリーニングとして有用と言えた.急性肝炎では肝内胆管拡張を認めない点が肝外閉塞性黄疸との鑑別に役立つと考えられた.SOLの存在診断能はRIスキャンより優れており,嚢胞に関しては質的診断も可能であった.現段階ではCTにより高度の脂肪,鉄沈着や広汎な壊死以外の肝組織学的変化を知ることは不可能であり,また固形腫瘤の質的診断も困難な場合が多い.

Evaluation of computed tomography in the diagnosis of liver discases

Endoscopic observation on the papilla of Vater

https://www.jstage.jst.go.jp/article/gee1973b/22/7/22_7_904/_pdf

The clinical value of glucagon for the premedication of upper gastrointestinal endoscopy

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Evaluation of computed tomography in the diagnosis of liver discases

Endoscopic observation on the papilla of Vater

The clinical value of glucagon for the premedication of upper gastrointestinal endoscopy