Download or read book The Non Invasive Liver Biopsy written by Mikael Forsgren and published by Linköping University Electronic Press. This book was released on 2017-04-19 with total page 126 pages. Available in PDF, EPUB and Kindle. Book excerpt: The liver is one of the largest organs within the human body and it handles many vital tasks such as nutrient processing, toxin removal, and synthesis of important proteins. The number of people suffering from chronic liver disease is on the rise, likely due to the present ‘western’ lifestyle. As disease develops in the liver there are pathophysiological manifestations within the liver parenchyma that are both common and important to monitor. These manifestations include inflammation, fatty infiltration (steatosis), excessive scar tissue formation (fibrosis and cirrhosis), and iron loading. Importantly, as the disease progresses there is concurrent loss of liver function. Furthermore, postoperative liver function insufficiency is an important concern when planning surgical treatment of the liver, because it is associated with both morbidity and mortality. Liver function can also be hampered due to drug-induced injuries, an important aspect to consider in drug-development. Currently, an invasive liver needle biopsy is required to determine the aetiology and to stage or grade the pathophysiological manifestations. There are important limitations with the biopsy, which include, risk of serious complications, mortality, morbidity, inter- and intra-observer variability, sampling error, and sampling variability. Cleary, it would be beneficial to be able investigate the pathophysiological manifestations accurately, non-invasively, and on regional level. Current available laboratory liver function blood panels are typically insufficient and often only indicate damage at a late stage. Thus, it would be beneficial to have access to biomarkers that are both sensitive and responds to early changes in liver function in both clinical settings and for the pharmaceutical industry and regulatory agencies. The main aim of this thesis was to develop and evaluate methods that can be used for a ‘non-invasive liver biopsy’ using magnetic resonance (MR). We also aimed to develop sensitive methods for measure liver function based on gadoxetate-enhanced MR imaging (MRI). The presented work is primarily based on a prospective study on c. 100 patients suffering from chronic liver disease of varying aetiologies recruited due to elevated liver enzyme levels, without clear signs of decompensated cirrhosis. Our results show that the commonly used liver fat cut-off for diagnosing steatosis should be lowered from 5% to 3% when using MR proton-density fat fraction (PDFF). We also show that MR elastography (MRE) is superior in staging fibrosis. Finally we presented a framework for quantifying liver function based on gadoxetate-enhanced MRI. The method is based on clinical images and a clinical approved contrast agent (gadoxetate). The framework consists of; state-of the-art image reconstruction and correction methods, a mathematical model, and a precise model parametrization method. The model was developed and validated on healthy subjects. Thereafter the model was found applicable on the chronic liver disease cohort as well as validated using gadoxetate levels in biopsy samples and blood samples. The liver function parameters correlated with clinical markers for liver function and liver fibrosis (used as a surrogate marker for liver function). In summary, it should be possible to perform a non-invasive liver biopsy using: MRI-PDFF for liver fat and iron loading, MRE for liver fibrosis and possibly also inflammation, and measure liver function using the presented framework for analysing gadoxetate-enhanced MRI. With the exception of an MREtransducer no additional hardware is required on the MR scanner. The liver function method is likely to be useful both in a clinical setting and in pharmaceutical trials.
Download or read book Magnetic Resonance Elastography written by Sudhakar K. Venkatesh and published by Springer. This book was released on 2014-10-01 with total page 143 pages. Available in PDF, EPUB and Kindle. Book excerpt: The first book to cover the groundbreaking development and clinical applications of Magnetic Resonance Elastography, this book is essential for all practitioners interested in this revolutionary diagnostic modality. The book is divided into three sections. The first covers the history of MRE. The second covers technique and clinical applications of MRE in the liver with respect to fibrosis, liver masses, and other diseases. Case descriptions are presented to give the reader a hands-on approach. The final section presents the techniques, sequence and preliminary results of applications in other areas of the body including muscle, brain, lung, heart, and breast.
Download or read book Liver Biopsy written by Nobumi Tagaya and published by BoD – Books on Demand. This book was released on 2012-11-21 with total page 304 pages. Available in PDF, EPUB and Kindle. Book excerpt: Liver biopsy is a procedure that involves obtaining a small piece of liver tissue, which is then analyzed in the laboratory. Liver biopsy may be used to evaluate a mass seen on images, diagnose unexplained liver diseases or abnormal liver function tests, and to determine the severity of the liver disease including hepatitis, fibrosis, and steatosis. Liver biopsy is an invasive procedure, and its complications are rare but potentially lethal. Therefore, it is necessary to perform liver biopsy safely from clinical aspect and to take specimen steadily from a pathological one. I hope this book addresses the future aspects of liver biopsy including role, indication, technique and evaluation. Furthermore, this book introduces new non-invasive alternatives including elastography and computer analysis of liver fibrosis.
Download or read book Ultrasound Elastography written by Monica Lupsor-Platon and published by BoD – Books on Demand. This book was released on 2020-03-04 with total page 148 pages. Available in PDF, EPUB and Kindle. Book excerpt: Elastography, the science of creating noninvasive images of mechanical characteristics of tissues, has been rapidly evolving in recent years. The advantage of this technique resides in the ability to rapidly detect and quantify the changes in the stiffness of soft tissues resulting from specific pathological or physiological processes. Ultrasound elastography is nowadays applied especially on the liver and breast, but the technique has been increasingly used for other tissues including the thyroid, lymph nodes, spleen, pancreas, gastrointestinal tract, kidney, prostate, and the musculoskeletal and vascular systems. This book presents some of the applications of strain and shear-wave ultrasound elastography in hepatic, pancreatic, breast, and musculoskeletal conditions.
Download or read book Liver Biopsy in Modern Medicine written by Yoshiaki Mizuguchi and published by BoD – Books on Demand. This book was released on 2011-10-10 with total page 392 pages. Available in PDF, EPUB and Kindle. Book excerpt: Liver biopsy, first performed by Paul Ehrlich in 1883, remains an important diagnostic procedure for the management of hepatobiliary disorders and the candidate/donated organ for transplantation. The book "Liver biopsy in Modern Medicine" comprises 21 chapters covering the various aspects of the biopsy procedure in detail and provides an up-to-date insightful coverage to the recent advances in the management of the various disorders with liver biospy. This book will keep up with cutting edge understanding of liver biopsy to many clinicians, physicians, scientists, pharmaceutics, engineers and other experts in a wide variety of different disciplines.
Download or read book Non Alcoholic Fatty Liver Disease written by Patrik Nasr and published by Linköping University Electronic Press. This book was released on 2019-09-25 with total page 98 pages. Available in PDF, EPUB and Kindle. Book excerpt: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease affecting approximately 25% of the global population and is commonly recognized as the hepatic manifestation of the metabolic syndrome. The histological spectrum of NAFLD ranges from isolated steatosis to non-alcoholic steatohepatitis (NASH), with risk of developing fibrosis and subsequent cirrhosis and hepatocellular carcinoma. The gold standard for diagnosing NAFLD is liver biopsy. However, because of its invasive nature, several non-invasive methods have been developed and validated in evaluating fat and fibrosis in patients with NAFLD. Liver fat content can be assessed using various methods. The conventional histopathological method consists of a visual semiquantitative approach in which the pathologist uses a four-point scale: grade 0 corresponds to fat deposition in <5% of hepatocytes and grade 1?3 (which is needed for the diagnosis of NAFLD) corresponds to ?5%. An alternate approach is to quantitatively assess steatosis using stereological point counting (SPC) – which rely on liver biopsy. However, in vivo proton magnetic resonance spectroscopy (1H-MRS) is a reliable noninvasive method that can be used to quantitatively assess total hepatic lipid content, or proton density fat fraction (PDFF). In Paper I we compared the conventional semiquantitative histological method (grade 0-3) with SPC and 1H-MRS. We found a strong positive correlation between 1H-MRS and SPC, whereas the correlations between 1H-MRS or SPC and histopathological grading were substantially weaker. Using the widely used cut-off value of PDFF ?5%, all participants were found to have steatosis (specificity 100%, sensitivity 53%). Reducing the cut-off value to 3% maintained 100% specificity while increasing sensitivity to 79%. In Paper IV we evaluated quantitative steatosis, by SPC, in 106 biopsy-proven NAFLD patients during a 20-year follow-up. SPC was independently associated with an increased risk of all-cause mortality and development of T2DM. Moreover, in the 59 patients with sequential biopsies (approximately 10 years apart), a reduction of quantitative hepatic steatosis decreased the all-time risk of developing T2DM. NASH is commonly seen as a histological feature portending a worse prognosis in NAFLD. Interestingly, no dual biopsy study has ever shown that NASH predicts fibrosis progression. Yet, NASH is seen as a surrogate marker in pharmaceutical trials – were resolution in NASH is equivalent to future resolution of fibrosis. In Paper II we conducted a long-term follow-up study (20 years) in a large cohort of biopsy-proven NAFLD patients (n=646), in a collaboration with Karolinska Institute. We could not ascertain that NASH had any effect on all-cause, or disease-specific mortality. However, higher stages of fibrosis predicted all-cause and disease specific mortality. In Paper III, we present 129 biopsy-proven NAFLD patients, in which we had prospective, longitudinal data. They were included between 1988 and 1993. All patients alive, were re-invited 2003-2005 and 2013-2015. Dual biopsies were present in 68 patients, and three consecutive biopsies were available in 33 patients. Results showed that NAFLD is a highly heterogeneous disease, with 9.3% developing end-stage liver disease and 16% progressing to advanced stages of fibrosis without any clinically significant baseline data predicting disease progression. In summary, when using 1H-MRS as a diagnostic method for NAFLD, the diagnostic cut-off should be reduced from 5% to 3%. Furthermore, quantitative amount of hepatic steatosis could be used to stratify patients with NAFLD related to future risk of developing T2DM. Moreover, we have shown that NASH does not predict future all-cause or disease-specific mortality nor end-stage liver disease, therefore a different surrogate marker should be used in clinical trials when assessing NAFLD improvement, so to not imbue false reliance in new therapies. Lastly, we have shown that NAFLD has a more dismal prognosis than previously reported, and that it is unexpectedly difficult to predict fibrosis progression in individual NAFLD patients, emphasizing the need for robust non-invasive biomarkers suitable to monitor large number of patients.
Download or read book Non Alcoholic Fatty Liver Disease written by Geoffrey C. Farrell and published by John Wiley & Sons. This book was released on 2013-02-06 with total page 438 pages. Available in PDF, EPUB and Kindle. Book excerpt: The sharp rise in cases of Non-alcoholic fatty liver disease is fast becoming one of the major concerns for hepatologists worldwide. This comprehensive clinical guide explains how to diagnose NAFLD and manage patients according to the best standards of care. Contributors from the world's leading institutions concentrate on patient care, drawing on their extensive experience.
Download or read book Liver Biopsy written by Hirokazu Takahashi and published by IntechOpen. This book was released on 2011-09-06 with total page 416 pages. Available in PDF, EPUB and Kindle. Book excerpt: Liver biopsy is recommended as the gold standard method to determine diagnosis, fibrosis staging, prognosis and therapeutic indications in patients with chronic liver disease. However, liver biopsy is an invasive procedure with a risk of complications which can be serious. This book provides the management of the complications in liver biopsy. Additionally, this book provides also the references for the new technology of liver biopsy including the non-invasive elastography, imaging methods and blood panels which could be the alternatives to liver biopsy. The non-invasive methods, especially the elastography, which is the new procedure in hot topics, which were frequently reported in these years. In this book, the professionals of elastography show the mechanism, availability and how to use this technology in a clinical field of elastography. The comprehension of elastography could be a great help for better dealing and for understanding of liver biopsy.
Download or read book Small Animal Laparoscopy and Thoracoscopy written by Boel A. Fransson and published by John Wiley & Sons. This book was released on 2021-12-20 with total page 480 pages. Available in PDF, EPUB and Kindle. Book excerpt: The newly revised Second Edition of Small Animal Laparoscopy and Thoracoscopy is a rigorous update of the first book to provide comprehensive and current information about minimally invasive surgery in dogs and cats. With a focus on techniques in rigid endoscopy, the book also includes guidance on additional surgeries outside the abdomen and chest. New chapters describe newly developed surgical techniques, while existing chapters have been thoroughly updated. The authors include detailed stepwise instructions for each procedure, including clinical photographs. Pre-operative considerations, patient positioning, portal placement, and postoperative care are also discussed, with key points of consideration outlined for each surgery. Purchasers of the book will also receive access to a companion website featuring video clips of the fundamental skills and surgical techniques described in the resource. The book also offers: An introduction to laparoscopic suturing and knot tying with accompanying video tutorials A thorough introduction to the equipment used in laparoscopic and thoracoscopic veterinary surgeries, including imaging equipment, surgical instrumentation, energy devices, and stapling equipment Clear explanations of foundational techniques in laparoscopy, including laparoscopic anesthesia, access techniques, contraindications, complications, and conversion Robust descriptions of fundamental techniques in thoracoscopy, including patient positioning, port placement, contraindications, complications, and conversion Discussions of a wide variety of laparoscopic and thoracoscopic surgical procedures Small Animal Laparoscopy and Thoracoscopy is an essential reference for veterinary surgeons, veterinary internal medicine specialists and residents, and small animal general practitioners seeking a one-stop reference for minimally invasive surgery in dogs and cats.
Download or read book Non Invasive Characterization of Liver Disease written by Markus Karlsson and published by Linköping University Electronic Press. This book was released on 2019-12-13 with total page 77 pages. Available in PDF, EPUB and Kindle. Book excerpt: There is a large and unmet need for diagnostic tool that can be used to characterize chronic liver diseases (CLD). In the earlier stages of CLD, much of the diagnostics involves performing biopsies, which are evaluated by a histopathologist for the presence of e.g. fat, iron, inflammation, and fibrosis. Performing biopsies, however, have two downsides: i) biopsies are invasive and carries a small but non-negligible risk for serious complications, ii) biopsies only represents a tiny portion of the liver and are thus prone to sampling error. Moreover, in the later stages of CLD, when the disease has progressed far enough, the ability of the liver to perform its basic function will be compromised. In this stage, there is a need for better methods for accurately measuring liver function. Additionally, measures of liver function can also be used when developing new drugs, as biomarkers for drug-induced liver injury (DILI), which is a serious drug-safety issue. Magnetic resonance imaging (MRI) is a non-invasive medical imaging modality, which have shown much promise with regards to characterizing liver disease in all of the abovementioned aspects. The aim of this PhD project was to develop and validate MR-based methods that can be used to non-invasively characterize liver disease. Paper I investigated if R2* mapping, a MR-method for measuring liver iron content, can be confounded by liver fat. The results show fat does affect R2*. The conclusion was therefore that fat must be taken into account when measuring small amounts of liver iron, as a small increase in R2* could be due to either small amounts of iron or large amounts of fat. Paper II examined whether T1 mapping, which is another MR-method, can be used for staging liver fibrosis. The results of previous research have been mixed; some studies have been very promising, whereas other studies have been less promising. Unfortunately, the results in Paper II belongs to the less promising studies. Paper III focused on measuring liver function by dynamic contrast-enhanced MRI (DCEMRI) using a liver specific contrast agent, which is taken up the hepatocytes and excreted to the bile. The purpose of the paper was to extend and validate a method for estimating uptake and efflux rates of the contrast agent. The method had previously only been applied in health volunteers. Paper II showed that the method can be applied to CLD patients and that the uptake of the contrast agent is lower in patients with advanced fibrosis. Paper IV also used studied liver function with DCE-MRI in patients with primary sclerosing cholangitis (PSC). PSC is a CLD where the bile ducts are attacked by the immune system. When diagnosing PSC patients, it is common to use magnetic resonance cholangiopancreatography (MRCP), which is a method for imaging the bile ducts. Paper IV examined if there was any correlation between number and severity of the morphological changes, seen on MRCP, and measures of liver function derived using DCE-MRI. However, the results showed no such correlation. The conclusion was that the results indicates that MRCP should not be used to predict parenchymal function. Paper V developed a method for translating DCE-MRI liver function parameters from rats to humans. This translation could be of value when developing new drugs, as a tool for predicting which drugs might cause drug-induced liver injury. In summary, this thesis has shown that multimodal quantitative MR has a bright future for characterizing liver disease from a range of different aspects.
Download or read book Liver Biopsy written by Hirokazu Takahashi and published by IntechOpen. This book was released on 2011-09-06 with total page 416 pages. Available in PDF, EPUB and Kindle. Book excerpt: Liver biopsy is recommended as the gold standard method to determine diagnosis, fibrosis staging, prognosis and therapeutic indications in patients with chronic liver disease. However, liver biopsy is an invasive procedure with a risk of complications which can be serious. This book provides the management of the complications in liver biopsy. Additionally, this book provides also the references for the new technology of liver biopsy including the non-invasive elastography, imaging methods and blood panels which could be the alternatives to liver biopsy. The non-invasive methods, especially the elastography, which is the new procedure in hot topics, which were frequently reported in these years. In this book, the professionals of elastography show the mechanism, availability and how to use this technology in a clinical field of elastography. The comprehension of elastography could be a great help for better dealing and for understanding of liver biopsy.
Download or read book Non Invasive Evaluation of Liver Steatosis Fibrosis and Cirrhosis in Hepatitis C Virus Infected Patients Using Unidimensional Transient Elastography Fibroscan written by Nana Makino and published by . This book was released on 2012 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Diagnosis of Liver Disease written by Etsuko Hashimoto and published by Springer. This book was released on 2019-07-18 with total page 304 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book guides practitioners in the assessment of patients with a liver problem. The emphasis is on the role of macro- and microscopic pathology in elucidating pathogenesis as well as identifying confounding features of image findings that may lead to a more elaborate differential diagnosis. If appropriate, the role of light and electron microscopic examination, along with the role of specific stains and molecular techniques, is illustrated. In addition, the concept of each liver disease is summarized briefly and its up-to-data is provided, and unresolved problems in diagnosis, treatment, and pathogenesis are clearly described.The approach in this book is a practical one with a focus on the evaluation of illustrative cases, simultaneously demonstrating cross-sectional images (ultrasonography, computed tomography, magnetic resonance imaging, and angiography), pathological findings, and peritoneoscopic images. The diagnosis and therapy are summed up in helpful tables, and association of clinical manifestations with image analysis and pathological findings is shown to be important in differential diagnosis and treatment. With the authors comprising internationally renowned experts, this book will serve as a useful source of information for medical students, physicians, internists, hepatologists, gastroenterologists, radiologists, and pathologists worldwide.
Download or read book Supporting People to Manage Their Health written by Judith Hoffman Hibbard and published by . This book was released on 2014-05 with total page 52 pages. Available in PDF, EPUB and Kindle. Book excerpt: This report introduces a behavioural concept known as patient activation, which captures an individual's skills, knowledge and confidence in taking on active roles. The report also introduces the patient activation measure, a mechanism for establishing individuals' capabilities and enabling services to be tailored to these needs.
Download or read book Liver Biopsy written by Hirokazu Takahashi and published by IntechOpen. This book was released on 2011-09-06 with total page 416 pages. Available in PDF, EPUB and Kindle. Book excerpt: Liver biopsy is recommended as the gold standard method to determine diagnosis, fibrosis staging, prognosis and therapeutic indications in patients with chronic liver disease. However, liver biopsy is an invasive procedure with a risk of complications which can be serious. This book provides the management of the complications in liver biopsy. Additionally, this book provides also the references for the new technology of liver biopsy including the non-invasive elastography, imaging methods and blood panels which could be the alternatives to liver biopsy. The non-invasive methods, especially the elastography, which is the new procedure in hot topics, which were frequently reported in these years. In this book, the professionals of elastography show the mechanism, availability and how to use this technology in a clinical field of elastography. The comprehension of elastography could be a great help for better dealing and for understanding of liver biopsy.
Download or read book Biomarkers in Liver Disease written by Victor R. Preedy and published by Springer. This book was released on 2017-07-14 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: In the past decade there has been a major sea change in the way disease is diagnosed and investigated due to the advent of high throughput technologies, such as microarrays, lab on a chip, proteomics, genomics, lipomics, metabolomics etc. These advances have enabled the discovery of new and novel markers of disease relating to autoimmune disorders, cancers, endocrine diseases, genetic disorders, sensory damage, intestinal diseases etc. In many instances these developments have gone hand in hand with the discovery of biomarkers elucidated via traditional or conventional methods, such as histopathology or clinical biochemistry. Together with microprocessor-based data analysis, advanced statistics and bioinformatics these markers have been used to identify individuals with active disease or pathology as well as those who are refractory or have distinguishing pathologies. New analytical methods that have been used to identify markers of disease and is suggested that there may be as many as 40 different platforms. Unfortunately techniques and methods have not been readily transferable to other disease states and sometimes diagnosis still relies on single analytes rather than a cohort of markers. There is thus a demand for a comprehensive and focused evidenced-based text and scientific literature that addresses these issues. Hence the formulation of Biomarkers in Disease The series covers a wide number of areas including for example, nutrition, cancer, endocrinology, cardiology, addictions, immunology, birth defects, genetics, and so on. The chapters are written by national or international experts and specialists.
Download or read book Liver Cirrhosis written by Georgios Tsoulfas and published by BoD – Books on Demand. This book was released on 2017-07-05 with total page 304 pages. Available in PDF, EPUB and Kindle. Book excerpt: Liver cirrhosis represents one of the major challenges for most physicians and surgeons on a global scale. This book provides practicing hepatologists, gastroenterologists and liver surgeons with a valuable tool in their efforts to understand the (molecular) mechanisms involved, be updated regarding the newest and less invasive diagnostic methods, and educate themselves about the challenges involved in the management of liver cirrhosis and its complications. The authors of this book represent a team of true global experts on the topic. In addition to the knowledge shared, the authors provide their personal clinical experience on a variety of different aspects of liver cirrhosis, giving us a well-rounded overview.