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Thứ Tư, 23 tháng 11, 2016

ARFI of FATTY LIVER and DIABETIC LIVER @ MEDIC CENTER

ABSTRACT:

Using Fibroscan 502 TOUCH and ARFI SIEMENS S2000 for evaluation of fatty liver infiltration and diabetic liver on 84 patients we realized that CAP could detect quantitatively fatty composition with high values of CAD in liver, but Fibroscan and ARFI had low values of SWE speed.

ĐẶT VẤN ĐỀ

Dùng siêu âm đàn hồi gồm Fibroscan 502 Touch và ARFI SIEMENS S 2000 cùng lúc để đánh giá gan thấm mỡ (fatty liver infiltration)  và gan bệnh nhân tiểu đường để khảo sát gan thấm mỡ và gan bệnh nhân tiểu đường ở người Việt nam.

Chúng tôi thực hiện 2 kỹ thuật Fibroscan (EchoSense) và ARFI Siemens cùng lúc trên 84 bệnh nhân gan thấm mỡ với hơn 1/3 bệnh nhân tiểu đường type 2, tuổi từ 20-55.

PHƯƠNG PHÁP-ĐỐI TƯỢNG

Thiết kế nghiên cứu cắt ngang, mô tả. 


Dùng siêu âm B-mode phát hiện và phân loại gan thấm mỡ  S1, S2, S3, và dựa vào thông số hóa sinh (triglycerid, cholesterol, lipid máu, ALT, HbA1c, tiểu cầu). Sau đó bệnh nhân được làm FibroScan và định lượng CAP [ độ nhiễm mỡ gan dựa trên “thông số giảm âm được kiểm soát” (Controlled Attenuation Parameter: CAP) bằng cách tính toán từ tín hiệu siêu âm trong phép đo độ cứng].Phần khảo sát ARFI gan thấm mỡ được làm sau phần khảo sát gan bằng B-mode.

KẾT QUẢ của thăm dò như trong bảng sau:


BÀN LUẬN


tương hợp không đồng đều giữa đánh giá siêu âm B-mode (S1,2,3) C A P của Fibroscan.




KẾT LUẬN:

1/ CAP của FIBROSCAN giúp định lượng mỡ trong gan  không cần phải sinh thiết.
2/ Tích tụ mỡ trong gan vẻ không làm tăng độ cứng   gan do đó không làm tăng tốc độ đàn hồi sóng biến dạng.

Đây chỉ là số liệu ban đầu, cần thực hiện với mẩu chọn lớn hơn.  CAP của FibroScan  giúp đánh giá định lượng mức độ gan thấm mỡ mà không phải sinh thiết gan, trong khi transient elastography của Fibroscan và máy siêu âm Siemens khảo sát độ đàn hồi của gan thấm mỡ với kết quả tương đương nhau, với tốc độ sóng biến dạng trong gan thấm mỡ không tăng.

TÀI LIỆU THAM KHẢO CHÍNH
Geoffrey C. Farrell, Arthur J. McCullough and Christopher P. Day: Non-Alcoholic Fatty liver Disease, Wiley-Blackwell, 2013.
Ioan Sporea, Ruxandra Mare, Raluca Lupușoru, Alexandra Sima, Roxana Șirli, Alina Popescu, Romulus Timar: Liver Stiffness Evaluation by Transient Elastography in Type 2 Diabetes Mellitus Patients with Ultrasound-proven Steatosis, J Gastrointestin Liver Dis, June 2016 Vol. 25 No 2: 167-174.
Yin-Yan Li, Xue-Mei Wang, Yi-Xia Zhang, Guo-Cheng Ou:Ultrasonic elastography in clinical quantitative assessment of fatty liver, World J Gastroenterol 2010 October 7; 16(37): 4733-4737.

Thứ Ba, 22 tháng 11, 2016

Diabetes Type 2 và SIÊU ÂM Elastography @ MEDIC HOA HAO CENTER

Ultrasound and transient elastography: Screening exams for type 2 diabetes mellitus patients

By Staff News Brief
Liver stiffness assessment should be routinely performed on individuals with Type 2 diabetes mellitus (DM), as these patients are susceptible to developing nonalcoholic fatty liver disease (NAFLD). Gastroenterologists from Romania recommend using ultrasound and elastography to identify and assess the severity of liver steatosis and fibrosis among their patients. Their study findings were published in the June 2016 issue of the Journal of Gastrointestinal Liver Disease.
Diabetes and obesity have reached epidemic proportions in Western societies, and the number of patients afflicted by either condition continues to rise. A large percentage of patients with DM are obese and may develop liver steatosis, the abnormal retention of triglycerides and lipids in liver cells. Patients who have NAFLD may develop nonalcoholic steatohepatis and subsequently liver cirrhosis.
Lead author Ioan Sporea, MD, of the Department of Gastroenterology and Hepatology of the Victor Babeş, a University of Medicine and Pharmacy in Timişoara, and colleagues, state that NAFLD will become one of the most important problems to confront hepatologists as a leading cause of liver cirrhosis. Biopsy, the gold standard for diagnosis, may become impractical to perform on all patients. Because inflammation can differentiate severe from simple steatosis, the authors conducted a study of nearly 300 patients to assess the extent and severity of liver steatosis using ultrasound, and of liver fibrosis using transient elastography.

(A) mild steatosis, (B) moderate steatosis, (C) severe steatosis
The 298 patients with Type 2 DM were enrolled in the study during a six month period in 2013. An additional 109 healthy volunteers and 43 hospitalized patients without liver disease completed the study cohort. Based on ultrasound findings, they were grouped into one of four steatosis categories ranging from none to severe. Liver stiffness as a marker of fibrosis was evaluated by transient elastography.
A total of 260 patients (87.2%) were identified as having steatosis: 44 patients had severe and 118 patients had moderate steatosis. 56, or 18.8% patients diagnosed with NAFLD had significant fibrosis. Liver stiffness suggestive of cirrhosis was identified in 41 (13.8%) patients. An evaluation to determine if risk of fibrosis increased in NAFLD patients who were obese and had type 2 DM determined that obesity, steatosis, higher alanine aminotransferase, and hypertriglyceridemia were independently associated with liver stiffness values. There were no significant differences between the mean liver stiffness value in obese, underweight, or normal weight individuals in the control group.
The authors recommend that ultrasound be used in daily practice to screen diabetic patients for steatosis because of its availability, low cost, rapid exam time of approximately five minutes, and diagnostic accuracy. They also recommend the use of ultrasound-based elastographic techniques; ie, transient elastography for liver fibrosis assessment.

REFERENCE

  1. Sporea I, Mare R, Lupuşoru R, et al. Liver stiffness evaluation by transient elastography in type 2 diabetes mellitus patients with ultrasound-proven steatosis. J Gastrointestin Liver Dis. 2016 25;2: 167-174.

Ultrasound and transient elastography: Screening exams for type 2 diabetes mellitus patients.  Appl Radiol. 
By Staff News Brief| July 18, 2016
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NGUYÊN LÝ và ỨNG DỤNG LÂM SÀNG SIÊU ÂM ĐÀN HỒI TRONG BỆNH LÝ GAN LAN TỎA

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Abstract

Accurate assessment of the degree of liver fibrosis is important for estimating prognosis and deciding on an appropriate course of treatment for cases of chronic liver disease (CLD) with various etiologies. Because of the inherent limitations of liver biopsy, there is a great need for non-invasive and reliable tests that accurately estimate the degree of liver fibrosis. Ultrasound (US) elastography is considered a non-invasive, convenient, and precise technique to grade the degree of liver fibrosis by measuring liver stiffness. There are several commercial types of US elastography currently in use, namely, transient elastography, acoustic radiation force impulse imaging, supersonic shear-wave imaging, and real-time tissue elastography. Although the low reproducibility of measurements derived from operator-dependent performance remains a significant limitation of US elastography, this technique is nevertheless useful for diagnosing hepatic fibrosis in patients with CLD. Likewise, US elastography may also be used as a convenient surveillance method that can be performed by physicians at the patients’ bedside to enable the estimation of the prognosis of patients with fatal complications related to CLD in a non-invasive manner.