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Thứ Tư, 14 tháng 12, 2016
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
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:
Có tương hợp không đồng đều giữa đánh giá siêu âm B-mode
(S1,2,3) và C A
P của Fibroscan.
KẾT LUẬN:
1/ CAP của FIBROSCAN giúp định lượng mỡ trong gan mà không cần phải sinh thiết.
2/ Tích tụ mỡ trong gan có vẻ không làm tăng độ cứng mô 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
- ARFI GAN BỆNH NHÂN TIỂU ĐƯỜNG TYPE 2 TẠI MEDIC HÒA HẢO, NGUYỄN THỊ HỒNG ANH- NGUYỄN THIỆN HÙNG
THAM KHẢO:
- DOWNLOAD HERE
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
- 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
Categories: Section
About the Author
Staff News Brief
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.
Roles for Longitudinal Surveillance
To date, the majority of elastography studies have focused on evaluating the cross-sectional performance with respect to the histological fibrosis grade or HVPG. However, an important but undervalued use of elastography is the ability to repeatedly measure liver stiffness. The roles of elastography as longitudinal perspectives with respect to the prediction of the long-term prognosis of the disease and monitoring of clinical courses with or without treatment are well known. In particular, these approaches can be used to non-invasively estimate the prognosis of the patients with fatal complications related to CLD, such as variceal bleeding and decompensation.
A longitudinal follow-up of elastography has been proposed as a way to establish the tailored management strategies by providing more detailed prognostic information [40]. For example, the concept of cirrhosis has recently changed from dynamic to bidirectional. In other words, cirrhosis patients may recover if antiviral therapy can be applied properly. At this time, the ideal approach to assess histological outcomes during treatment is serial liver biopsy; however, this is not possible in most cases. Instead, the measurement of liver stiffness by elastography is very useful for monitoring the changes in liver fibrosis during the antiviral treatment [41,42]. In terms of portal hypertension, elastography may also be used to predict the development of variceal bleeding by using a hybrid parameter, the liver stiffness-spleen diameter to platelet ratio score (LSPS) defined as the product of liver stiffness and the maximum spleen diameter divided by the platelet count [43]. According to risk stratification based on LSPS, a different prophylactic treatment for the prevention of variceal bleeding should be considered for patients with an LSPS value higher than 6.5 points [44].
US Elastography: Weaknesses and Strengths
The most significant challenge facing US elastography is the issue of measurement reproducibility. A number of studies concerning this issue have been published; however, many investigators have brought up questions about this issue due to the inherent limitations of US such as the operator-dependent performance. Transient elastography is a highly reproducible and user-friendly technique [45], and liver stiffness measurement by transient elastography does not require a learning curve: even a novice can obtain a reliable result after a single training session [46]. However, because liver stiffness measurements can be influenced significantly by steatosis, obesity, lower degrees of hepatic fibrosis [45], necroinflammation of hepatocytes [47], cholestasis [48], elevated central venous pressure [49], and even postprandial conditions [50], it should be carefully applied when used as an alternative measurement of liver stiffness instead of liver biopsy.
In the case of ARFI, the overall reproducibility is also not bad, having an intraclass correlation coefficient (ICC) value for the interrater observation of 0.81 and an ICC for the intrarater observation of 0.90. However, gender (women), high body mass index, ascites, and lower degree of liver disease (noncirrhotic patients) are considered factors that impede the reproducibility of ARFI [51]. In the case of SSI, the inter- and intraobserver agreements have ICC values of 0.88 and 0.94, respectively, which are similar to the results of ARFI imaging [52].
Despite the issues described above, US elastography has many advantages in clinical fields. The most important aspect is convenience, as is the case with most ultrasonography examination techniques. Indeed, US elastography is fast, easy to use, and portable, so much so that it can be performed at the patient’s bedside. Likewise, because it does not use ionizing radiation, US elastography is relatively safe, even in patients who repeatedly undergo the procedure. US elastography is also less expensive than MR elastography [53]. Going forward, the most important strength of US elastography is the availability of a large amount of accumulated clinical data that have demonstrated its clinical usefulness, although most of these data are related to transient elastography.
Conclusions
Measurement of liver stiffness using various technical developments is evolving to overcome its limitations. Recently, the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) published an informative guideline for the use of US elastography [54,55] that deals with the relevant technology and clinical applications. Along with the basic principles for use, these guidelines include the practical advantages and disadvantages of US elastography as well as recommendations for the examination of various body parts. According to these guidelines, US elastography is useful to assess the severity of liver fibrosis in patients with diffuse liver disease and particularly to distinguish patients with nil to mild fibrosis from those with significant fibrosis, although some of the newer techniques must be validated through clinical studies. At present, however, US elastography for the differentiation of focal hepatic lesions is not recommended.
In conclusion, US elastography is useful for diagnosing hepatic fibrosis in patients with CLD and may be used as a convenient and non-invasive surveillance method to estimate the prognosis of patients with fatal complications related to CLD. Accordingly, the development of a standardized method for liver stiffness measurement and technical improvements should be a priority for the clinical application of US elastography. Together, these efforts will significantly enhance the clinical implications of US elastography.
41. Fung J, Lai CL, Wong DK, Seto WK, Hung I, Yuen MF. Significant changes in liver stiffness measurements in patients with chronic hepatitis B: 3-year follow-up study. J Viral Hepat 2011;18:e200–e205.
Chủ Nhật, 13 tháng 11, 2016
Chủ Nhật, 9 tháng 10, 2016
Thứ Tư, 5 tháng 10, 2016
Basic Concepts of Doppler Frequency Spectrum Analysis and Ultrasound Blood Flow Imaging
DOWNLOAD FULLTEXT THEO LINK
John S. Pellerito, MD, FACR, FSRU, FAIUM , Joseph F. Polak,
MD, MPH
Góc Doppler = là góc tạo bởi phương ngắm hay đường ngắm Doppler [Doppler line
of sight] và trục dòng máu chảy. Xem minh họa dưới đây.
Thứ Ba, 30 tháng 8, 2016
AIUM PRACTICE GUIDELINE on J U M 9-2016
- AIUM PRACTICE GUIDELINE
- AIUM PRACTICE GUIDELINE
AIUM Practice Parameter for the Performance of Ultrasound Vascular Mapping for Preoperative Planning of Dialysis Access
Journal of Ultrasound in Medicine September 2016 35:1-10;doi:10.7863/ultra.35.9.1-a - AIUM PRACTICE GUIDELINE
AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Neonatal and Infant Spine
Journal of Ultrasound in Medicine September 2016 35:1-11;doi:10.7863/ultra.35.9.1-b - AIUM PRACTICE GUIDELINE
AIUM Practice Parameter for the Performance of a Thyroid and Parathyroid Ultrasound Examination
Journal of Ultrasound in Medicine September 2016 35:1-11;doi:10.7863/ultra.35.9.1-c - AIUM PRACTICE GUIDELINE
AIUM Practice Parameter for the Performance of Selected Ultrasound-Guided Procedures
Journal of Ultrasound in Medicine September 2016 35:1-40;doi:10.7863/ultra.35.9.1-d
AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Extracranial Cerebrovascular System
Journal
of Ultrasound in Medicine September
2016 35:1-11;doi:10.7863/ultra.35.9.1
5
Thứ Bảy, 20 tháng 8, 2016
Thứ Bảy, 13 tháng 8, 2016
VIÊM RUỘT DƯ VÀ K DẠ DÀY
DOWNLOAD appendicitis and gastric cancer
ABSTRACT Primary non-carcinoid
adenocarcinoma of the appendix is rare. Likewise, distant
metastatisis of another organ or system cancer is even more rare.
Generally, gastric adenocarcinoma may clinically be detected while it
is spreaded. A 31-year-old man who had no specific medical history
was admitted to the clinic with complaint of right lower abdominal
quadrant pain and rebound tenderness over McBurney’s point.
Laparotomy was performed for a diagnosis of acute appendicitis.
Histopathological examination revealed an obstruction of the
appendicular lumen due to adenocarcinoma metastasis. Correspondingly,
the patient was re-evaluated to detect the primary malignancy focus
and underwent inoperable gastric adenocarcinoma diagnosis. As our
knowledge, there is only one other example in the literature; a
patient with undiagnosed gastric cancer who had an acute appendicitis
as the first clinical manifestation of an upper gastrointestinal
malignancy. Thus we want to share this unusual, interesting and
complicated case.
Key words: Acute appendicitis, Gastric
adenocarcinoma, Distant metastasis, Diagnostic laparoscopy
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