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Purpose: To compare contrast-enhanced ultrasonography (CEUS) using Sonazoid with Gd-EOB-DTPA-enhanced MRI (EOB-MRI) in the diagnosis of liver metastases in patients with colorectal cancer.Methods: A total of 69 patients diagnosed with or suspected of having liver metastasis were enrolled. These hepatic lesions were diagnosed by histopathological examination after surgical resection or based on follow-up using various imaging modalities. The diagnostic accuracies of CEUS and EOB-MRI were compared.Results: One hundred thirty-three lesions were detected. Of these lesions, 109 were diagnosed as liver metastases. Of the 133 lesions, 90.2% were detected on CEUS, and 98.5% on EOB-MRI. One hundred nine lesions were diagnosed as liver metastasis. The areas under the receiver operating characteristic curve for diagnosis were 0.906 and 0.851 on CEUS and EOB-MRI, respectively (p = 0.41). Sensitivity, specificity, positive predictive value (PPV), negative predictive value, and overall accuracy were 90.8%, 84.5%, 97.1%, 67.1%, and 90.2%, respectively, for CEUS, and 95.4%, 70.8%, 93.7%, 77.3%, and 91%, respectively, for EOB-MRI.Conclusions: CEUS has a higher specificity and PPV for the diagnosis of liver metastasis than EOB-MRI. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:138-144, 2017. [ABSTRACT FROM AUTHOR]

ABSTRACT Sclerosing angiomatoid nodular transformation (SANT) is a recently recognized benign vascular lesion of the spleen. Detection of SANT as an incidentaloma has increased due to improvements in imaging techniques. However, a definitive diagnosis of SANT on CT or MRI remains difficult. We report the use of contrast-enhanced ultrasonography with Sonazoid in a case of SANT in a 50-year-old woman, with gross and microscopic pathologic correlations. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 42:103-107, 2014 [ABSTRACT FROM AUTHOR]

The bile duct of Luschka (BDL) is an anatomic anomaly that is an important cause of bile leakage after bile duct surgery. We report a case of bile duct carcinoma with dilated BDL that was diagnosed by ultrasonography (US). An 83-year-old man presented with an obstructive jaundice. US on admission revealed the presence of a solid hypoechoic mass in the bile duct at the hepatic duct confluence and a branch of the bile duct, about 2-4 mm in diameter, distinct from the dilated right anterior hepatic duct slightly upstream of the tumor. This branch had a spiral structure, extended along the gallbladder bed on the surface of segment 5 (S5) of the liver, and emanated small branches that entered the hepatic parenchyma. There has been no previous report of delineation of BDL by preoperative US. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound 41:558-562, 2013. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effectiveness of contrast-enhanced ultrasonography (CEUS) using Sonazoid for the diagnosis of the local recurrence after treatment for hepatocellular carcinoma (HCC) by comparing it with dynamic CT. Methods: Seventy-one patients with 87 HCC lesions (mean +/- SD; 19.5 +/- 9.6 mm) underwent CEUS using Sonazoid and dynamic CT after radiofrequency ablation (n = 55), transcatheter arterial chemoembolization (n = 22), or radiofrequency ablation combined with transcatheter arterial chemoembolization (n = 10). Two hepatologists (observer 1; 10 years of experience, and 2; 20 years of experience) reviewed the CEUS and dynamic CT images independently and evaluated presence or absence of the local recurrence. Diagnostic performance for the local recurrence was assessed using receiver operating characteristic curve analysis. Results: The Az value for dynamic CT was significantly lower in observer 1 than 2 (p < 0.05). The sensitivity of CEUS was 79% in observer 1 and 83.9% in observer 2, and that of dynamic CT was 83.9% and 90.3%, respectively. The specificity of CEUS was 96%, and that of dynamic CT was 92%, in both observers. Conclusion: This study suggests that CEUS using Sonazoid is less affected by the observer's experience and is more accurate in the diagnosis of local recurrence after treatment for HCC than dynamic CT. [ABSTRACT FROM AUTHOR]

Background: Host and viral factors can promote the development of fulminant hepatitis B (FHB), but there have been no case–control studies for figuring out virological parameters that can distinguish FHB. Methods: In a case–control study, virological factors associated with the development of FHB were sought in 50 patients with FH developed by transient hepatitis B virus (HBV) infection (FH-T) and 50 with acute self-limited hepatitis B (AHB) who were matched for sex and age. In addition, 12 patients with FH developed by acute exacerbation (AE) of asymptomatic HBV carrier (ASC) (FH-C) were also compared with 12 patients without FH by AE of chronic hepatitis B (AE-C). Results: Higher HBV DNA levels, subgenotype B1/Bj, A1762T/G1764A, G1896A, G1899A and A2339G mutation were significantly more frequent ( P < 0.05), while hepatitis B e-antigen was less frequent in the FH-T patients than AHB. In multivariate analysis, G1896A mutation (odds ratio [OR], 13.53; 95% confidence interval [CI], 2.75–66.64), serum HBV DNA more than 5.23 log copies/mL (OR, 5.14; 95% CI, 1.10–24.15) and total bilirubin more than 10.35 mg/mL (OR, 7.81; 95% CI, 1.77–34.51) were independently associated with a fulminant outcome by transient HBV infection. On the other hand, in comparison with the patients between FH-C and AE-C groups, there was no significant difference of virological factors associated with the development of FHB. Conclusion: A number of virological factors have been defined that may distinguish FH-T from AHB in a case–control study. The pathogenic mechanism of FHB between transient HBV infection and AE of ASC would be different. [ABSTRACT FROM AUTHOR]

Abstract: Aim: This study was to investigate the immunomodulatory effects of ribavirin combined with interferon (IFN)-alpha 2b (R+IFN) compared with consensus IFN monotherapy (IFN-Con) in chronic hepatitis C (CHC) patients. Patients and methods: Thirty-four adult patients with biopsy-proven CHC, who were infected with HCV genotype 2a or 2b, were studied. A 24-week regimen of IFN-alpha 2b (6MU daily for 2 weeks followed by 6MU tiw for 22 weeks) and ribavirin (600–800mg/day for 24 weeks) was given to 17 patients. The other 17 patients were treated with a 24-week regimen of IFN-Con (18MU daily for 2 weeks followed by 18MU tiw for 22 weeks). Flow cytometric determination of cytoplasmic IFN-gamma and IL-4 expression in peripheral blood CD4+ T cells was performed, and the percentage of IFN-gamma+ and IL-4− (Th1), IFN-gamma− and IL-4+ (Th2) cells were calculated before and 3, 7, 14, and 28 days after the start of therapy. Results: In the R+IFN group, the percentage of Th1 cell peaked on day 3, and then decreased to near baseline by day 14, while the percentage of Th2 cell did not change. In the IFN-Con group, the percentage of Th1 cell peaked on day 14 and the percentage of Th2 cell peaked on day 3, and then decreased to near baseline by day 14. Conclusions: Our results suggest that ribavirin induces an early immune response by peripheral blood CD4+ T cells in CHC patients. [Copyright &y& Elsevier]

Background/Aims: Bovine lactoferrin (bLF) has been shown to prevent the infection of cultured hepatocytes by hepatitis C virus (HCV). The present study attempted to clarify the effects of long-term administration of bLF on serum parameters, including immunomodulatory cytokines, in patients with chronic hepatitis C (CHC). Methods: Sixty-three CHC patients were randomly assigned into 2 groups. At an oral dose of 600 mg/day, bLF was administered for 12 months to 36 patients (bLF group), while no bLF was given to the remaining 27 patients (control group. Serum levels of alanine aminotransferase, HCV-RNA, IL-10, and IL-18 were evaluated, as well as CD4-positive T cell subsets in the peripheral blood. Results: The serum IL-18 level was increased by bLF administration, but not in the control group. After 3 months of bLF treatment, it was significantly higher than before bLF administration, but it decreased gradually thereafter. The percentage of interferon (IFN)-gamma+ and IL-4− (Th1) cells in the peripheral blood increased along with the serum IL-18 level, although the change was not statistically significant. The other parameters did not change significantly during the study period in both groups. Conclusions: These results suggest that oral administration of bLF to CHC patients for up to 3 months can produce a Th1-cytokine dominant environment in the peripheral blood that favors the eradication of HCV by IFN therapy. [Copyright &y& Elsevier]

Background: Peripheral hepatic blood flow has not been investigated using contrast-enhanced ultrasound. The aim of this study was to assess the characteristics of peripheral blood flow within the liver parenchyma using Levovist in patients with alcoholic liver disease (ALD)., Methods: The study population comprised 160 patients: 7 normal control subjects (NC), 89 with chronic viral hepatitis (CVH), 8 with alcoholic liver injury (ALI), 18 with viral liver cirrhosis without portosystemic shunting (VLCwoPSS) plus 11 with PSS (VLCwPSS), and 12 with alcoholic liver cirrhosis without PSS (ALCwoPSS) plus 15 with PSS (ALCwPSS). First, continuous spectral Doppler ultrasound was performed to assess peripheral blood flow within the liver parenchyma. We defined the arrival time (AT) as the time when signals began to increase in the region of interest after the injection of Levovist, whereas the peak time (PT) was the time between the AT and the maximum signal. Second, stimulated acoustic emission imaging was compared between the liver parenchyma and the right kidney at 20 sec, 90 sec, and 5 min after injection of Levovist., Results: The average AT was as follows: NC, 18.4 sec; CVH, 18.7 sec; ALI, 15.5 sec; VLCwoPSS, 18.2 sec; VLCwPSS, 12.5 sec; ALCwoPSS, 13.5 sec; and ALCwPSS, 12.7 sec. In patients with ALI and cirrhosis (excluding VLCwoPSS), the AT was earlier than in NC and CVH. The average PT was as follows: NC, 18.3 sec; CVH, 19.4 sec; ALI, 20.3 sec; VLCwoPSS, 19.3 sec; VLCwPSS, 9.0 sec; ALCwoPSS, 10.7 sec; and ALCwPSS, 4.9 sec. In patients with cirrhosis (excluding VLCwoPSS), the PT was earlier than in the other groups. As PSS developed, the PT of ALC became much earlier. In NC, the stimulated acoustic emission study showed no enhancement of the liver parenchyma at 20 sec. However, most of the patients with ALD showed marked enhancement of the liver at 20 sec. It is interesting that only slight enhancement of the liver was seen in ALCwPSS, although NC showed marked liver enhancement at 5 min., Conclusions: Our results suggest that ALD is accompanied by regional hepatic and systemic hemodynamic changes, such as hyperdynamic circulation and arterialization of the liver, before progression to cirrhosis.