Investigation of the Relationship between Fatty Pancreas and Cholecystectomy Using Noncontrast Computed Tomography

IntroductionFatty pancreas, which can be evaluated with radiological methods, is a frequently overlooked finding. The aim of this study was to use noncontrast computed tomography (CT) to evaluate whether there was a relationship between fatty pancreas and cholecystectomy, similar to the relationship between fatty liver and cholecystectomy, which has been previously shown in literature.MethodsThe study included 46 cases who underwent cholecystectomy and 74 age- and gender-matched control subjects. All the cases were scanned with noncontrast CT. Regions of interest were defined in the liver and pancreas, and density measurements were taken from four anatomic regions in the liver and three anatomic regions in the pancreas by two experienced radiologists in the same session with consensus. Cases in which the pancreas density was evaluated as <0.7 of the spleen density were accepted as quantitatively steatosis positive. In addition, visual evaluations were made, and anthropometric measurements were taken.ResultsDensity and ratio values measured at the level of the pancreas body were determined to be statistically significantly lower in the cholecystectomy group than in the control group (P = .045 and P = .025, respectively). In the visual evaluation of fatty pancreas, the frequency 27 of 46 (50.7%) in the cholecystectomy group was statistically significantly higher than that of the control group at 27 of 74 (36.5%) (P = .017). Although the quantitative assessment showed that pancreatic steatosis frequency was higher in the cholecystectomy group, there was no statistically significant difference between the groups (P = .543).ConclusionUsing CT in the present study, higher rates of fatty liver and fatty pancreas were determined in cholecystectomy cases than in the normal population. Longitudinal studies of an extensive population will be able to better evaluate the relationship between cholecystectomy and fatty pancreas.     

[11C]acetate PET as a tool for diagnosis of liver steatosis

Purpose

To investigate [¹¹C]acetate PET-surrogate parameter of fatty acid synthase activity—as suitable tool for diagnosis and monitoring of liver steatosis.

Methods

In this retrospective study, data were obtained from 83 prostatic carcinoma patients from 1/2008 to 1/2014. Mean HU was calculated from unenhanced CT of all patients from liver with liver HU less than 40 as threshold for liver steatosis. SUV_max of the liver and of the blood pool in thoracic aorta (as background for calculation of a liver/background ratio [SUV_l/b]) was measured. t test was used with a P < 0.05 considered as statistically significant difference and ROC analysis was used for calculating specificity and sensitivity.

Results

19/83 patients (20%) had diagnosis of hepatic steatosis according to CT. Uptake of [¹¹C]acetate was significantly higher in patients with hepatic steatosis as compared to control group (SUV_max 7.96 ± 2.0 vs. 5.48 ± 2.3 [P < 0.001]). There was also a significant correlation between both SUV_max (r = − 0.52, P < 0.001) and SUV_l/b (r = − 0.59, P < 0.001) with the density (HU) of the liver. In ROC analysis for detection of liver steatosis SUV_max (threshold: 5.86) had a sensitivity of 94% and specificity of 69% with an AUC of 0.81. Increasing body mass index is correlated with the severity of steatosis.

Conclusion

We showed for the first time that hepatic steatosis associates with increased [¹¹C]acetate uptake. Also, severity of steatosis correlates with [¹¹C]acetate uptake. [¹¹C]acetate uptake PET seems promising for the assessment of liver steatosis.

     

18F-FDG PET/CT观察慢性肝炎及肝硬化患者肝脏葡萄糖代谢功能变化

目的 探讨应用¹⁸F-FDG PET/CT观察慢性肝炎及肝硬化患者肝脏葡萄糖代谢功能变化的价值。方法 回顾性分析50例慢性肝炎患者(肝炎组)、36例肝硬化患者(肝硬化组)及31例肝功能正常者(对照组)的¹⁸F-FDG PET/CT资料。比较肝炎组、肝硬化组及对照组全肝平均标准摄取值(SUVmean)、全肝体积(HV)及全肝糖酵解值(GHG)的差异。结果 3组间全肝SUVmean及GHG差异均有统计学意义(P均< 0.01)。肝硬化组SUVmean及GHG低于肝炎组(P均< 0.001)及对照组(P=0.012、0.014),肝炎组SUVmean及GHG高于对照组(P=0.042、0.046)。3组间HV差异无统计学意义(P=0.58)。结论 ¹⁸F-FDG PET/CT检查指标全肝SUVmean及GHG可有效反映慢性肝炎及肝硬化患者肝脏葡萄糖代谢功能变化。     

Diagnostic Accuracy of Computed Tomography to Exclude Pheochromocytoma: A Systematic Review,Meta-analysis,and Cost Analysis

ObjectivesTo assess the diagnostic accuracy of unenhanced computed tomography (CT) attenuation values to exclude a pheochromocytoma in the diagnostic work-up of patients with an adrenal incidentaloma and to model the associated difference in diagnostic costs.MethodsThe MEDLINE and Embase databases were searched from indexing to September 27, 2018, and studies reporting the proportion of pheochromocytomas on either side of the 10–Hounsfield unit (HU) threshold on unenhanced CT were included. The pooled proportion of pheochromocytomas with an attenuation value greater than 10 HU was determined, as were the modeled financial costs of the current and alternative diagnostic approaches.ResultsOf 2957 studies identified, 31 were included (N=1167 pheochromocytomas). Overall risk of bias was low. Heterogeneity was not observed between studies (Q=11.5, P=.99, I²=0%). The pooled proportion of patients with attenuation values greater than 10 HU was 0.990 (95% CI, 0.984-0.995). The modeled financial costs using the new diagnostic approach were €55 (～$63) lower per patient.ConclusionPheochromocytomas can be reliably ruled out in the case of an adrenal lesion with an unenhanced CT attenuation value of 10 HU or less. Therefore, determination of metanephrine levels can be restricted to adrenal tumors with an unenhanced CT attenuation value greater than 10 HU. Implementing this novel diagnostic strategy is cost-saving.     

Relationship of hepatic steatosis severity and coronary artery disease characteristics assessed by coronary CT angiography

The objective of this study was to investigate the relationship between the severity of hepatic steatosis and coronary artery disease characteristics assessed by coronary computed tomography (CT) angiography. This retrospective analysis consisted of 2028 patients. Hepatic steatosis was evaluated by liver attenuation on unenhanced CT and the patients were divided into four groups (≥60 HU, 54–59 HU, 43–53 HU, ≤42 HU). Coronary calcification was calculated using the Agatston method. Obstructive disease was defined as ≥50 % stenosis assessed by CT. A high-risk plaque was defined by a remodeling index >1.1 and low attenuation (<30 HU). Patients with a segment involvement score >4 were determined to have extensive disease. Logistic regression analysis was performed to study multivariate associations. Severity of hepatic steatosis was associated with coronary calcification (p = 0.02), obstructive disease (p < 0.0001), presence of a high-risk plaque (p = 0.0001) and extensive disease (p = 0.001) in the univariate analysis. However, the relationships were attenuated in the multivariate analysis with the exception of obstructive disease (p = 0.04). Liver attenuation of <54 HU was significantly associated with obstructive coronary artery disease independent of conventional risk factors such as age, sex, diabetes mellitus, hypertension, dyslipidemia and smoking (hepatic attenuation 43–53 HU, odds ratio 1.52, 95 % confidence interval 1.11–2.10, p = 0.01; ≤42 HU, odds ratio 1.65, 95 % confidence interval 1.10–2.45, p = 0.02). Although conventional risk factors were stronger predictors of coronary calcification and plaque formation, the severity of hepatic steatosis remained an independent risk factor for obstructive coronary artery disease. Coronary CT angiography may play a potential role in risk stratification for patients with hepatic steatosis.     

Assessment of the Hallmarks of Wilson Disease in CT Scan Imaging

IntroductionOwing to nonspecific clinical symptoms, Wilson disease (WD) diagnosis is often missed or delayed; hence, many patients reach end-stage liver disease. When cirrhosis takes place, it is difficult to distinguish between WD and other causes of cirrhosis by imaging alone. This study outlines abdominal computed tomography (CT) imaging findings that occur more frequently in patients with WD cirrhosis.Material and MethodsFifty-seven patients with WD who had referred for liver transplantation took part in this study and underwent dynamic liver CT examination before transplantation. Qualitative and quantitative parameters including liver density, contour irregularity, dysmorphia, hypertrophy of caudate lobe, presence of focal parenchymal lesion, thickness of perihepatic fat layer, periportal thickness, lymphadenopathy, and other associated findings were recorded and evaluated.ResultsAmong these patients, 85.9% had contour irregularity, 28% had hepatic dysmorphia, and periportal thickening and cholelithiasis were found in 25.5% and 12.3% of patients, respectively. Splenomegaly, lymphadenopathy, and portosystemic shunting were observed in all patients. Also, hyperdense nodules (>20 mm) and honeycomb pattern were detected in 65.2% and 15.2% of patients, respectively, in the arterial phase. In the portal phase, these findings were detected only in 13% and 4.3% of patients. Hypertrophy of caudate lobe was seen only in 12.2% of patients.ConclusionWD-associated cirrhosis has many CT imaging findings, although most of them are nonspecific. Some findings, such as hyperdense nodules and honeycomb pattern in non–contrast-enhanced CT scan and arterial phase of triphasic CT scan with lack of hypertrophy of caudate lobes, are hallmarks of WD.     

Ultrasound Detection of Liver Fibrosis in Individuals with Hepatic Steatosis Using the Homodyned K Distribution

Acoustic structure quantification (ASQ) based on the analysis of ultrasound backscattered statistics has been reported to detect liver fibrosis without significant hepatic steatosis. This study proposed using ultrasound parametric imaging based on the parameter α of the homodyned K (HK) distribution for staging liver fibrosis in patients with significant hepatic steatosis. Raw ultrasound image data were acquired from patients (n = 237) to construct B-mode and HK α parametric images, which were compared with the focal disturbance (FD) ratio obtained from ASQ on the basis of histologic evidence (METAVIR fibrosis score and hepatic steatosis severity). The data were divided into group I (n = 173; normal to mild hepatic steatosis) and group II (n = 64; with moderate to severe hepatic steatosis) for statistical analysis through one-way analysis of variance and receiver operating characteristic (ROC) curve analysis. The results showed that the HK α parameter monotonically decreased as the liver fibrosis stage increased (p < .05); concurrently, the FD ratio increased (p < .05). For group I, the areas under the ROC (AUROCs) obtained using the FD ratio and the α parameter (AUROC_FD and AUROC_α) were, respectively, 0.56 and 0.55, 0.68 and 0.68, 0.64 and 0.64 and 0.62 and 0.62 for diagnosing liver fibrosis ≥F1, ≥F2, ≥F3 and ≥F4. The values of AUROC_FD and AUROC_α for group II were, respectively, 0.88 and 0.91, 0.81 and 0.81, 0.77 and 0.76 and 0.78 and 0.73 for diagnosing liver fibrosis ≥F1, ≥F2, ≥F3 and ≥F4. As opposed to previous studies, ASQ was found to fail in characterizing liver fibrosis in group I; however, it was workable for identifying liver fibrosis in patients with significant hepatic steatosis (group II). Compared with ASQ, HK imaging provided improved diagnostic performance in the early detection of liver fibrosis coexisting with moderate to severe hepatic steatosis. Ultrasound HK imaging is recommended as a strategy to evaluate early fibrosis risk in patients with significant hepatic steatosis.     

肝硬化门脉高压患者门-腔分流状态对肝脏血流灌注的影响

目的应用肝脏CT血流灌注扫描和多层螺旋CT门静脉造影技术(CTPV),评价肝硬化患者门-腔静脉之间侧支循环的形成情况对肝脏血流灌注的影响。方法对我院101例肝硬化合并门静脉高压患者作CT血流灌注扫描和多层螺旋CT门静脉造影。计算肝血流灌注参数,分析不同类型门-腔静脉侧支循环类型的肝脏血流灌注血流参数改变。结果门静脉-上腔静脉分流组,肝血流量(HBF):(115.2±30.8)ml·100ml-1·min-1;肝动脉血流量(HAF):(29.8±21.1)ml·100ml-1·min-1;肝动脉指数(HPI):0.248±0.142;门静脉血流量(PVF):(85.3±23.6)ml·100ml-1·min-1。脾/胃-肾静脉分流组,HBF:(124.6±36.1)ml·100ml-1·min-1;HAF:46.6/29.1ml·100ml-1·min-1;HPI:0.365±0.175;PVF:(77.9±27.2)ml·100ml-1·min-1。门-腔静脉分流术后组,HBF:(101.9±36.5)ml·100ml-1·min-1;HAF:(46.0±21.4)ml·100ml-1·min-1;HPI:0.449±0.183;PVF:(55.8±22.5)ml·100ml-1·min-1。组间差异具有统计学意义,P<0.05。结论肝功能分级和分流方式两个变量对肝血流灌注有独立影响作用。     

Presence of Liver Steatosis Is Associated With Greater Diabetes Remission After Gastric Bypass Surgery

OBJECTIVEType 2 diabetes mellitus (T2DM) is characterized by insulin resistance (IR) and β-cell dysfunction. Ectopic fat accumulation in liver and muscle causes IR. Since bariatric and metabolic surgery significantly improves fatty liver disease, we hypothesized that coexistence of liver steatosis (i.e., when hepatic IR contributes in T2DM) would be associated with greater diabetes improvement after surgery.RESEARCH DESIGN AND METHODSA total of 519 patients with T2DM who underwent Roux-en-Y gastric bypass and simultaneous liver biopsy and had a minimum 5-year follow-up were analyzed to assess the independent association between biopsy-proven liver steatosis and postoperative long-term diabetes remission (glycated hemoglobin <6.5% [48 mmol/mol] off medications).RESULTSOf the 407 patients with biopsy-proven liver steatosis, long-term diabetes remission was achieved in 211 (52%) patients compared with remission in 44 out of 112 (39%) patients without steatosis (P = 0.027). In multivariable analysis, presence of liver steatosis was an independent predictor of long-term diabetes remission (odds ratio 1.96 [95% CI 1.04–3.72]; P = 0.038). Hepatocyte ballooning, lobular inflammation, or fibrosis at baseline did not predict diabetes remission.CONCLUSIONSThis study, for the first time, suggests that in patients with T2DM who are considering bariatric and metabolic surgery, coexistence of liver steatosis is associated with better long-term glycemic outcomes. Furthermore, our data suggest that there are distinct variants of T2DM in which metabolic responses to surgical weight loss are different. A subgroup of patients whose T2DM is characterized by the presence of hepatic steatosis (presumably associated with worse IR) experience better postoperative metabolic outcomes.     

原发性肝癌肝脏灌注的多层螺旋CT对照研究

目的探讨原发性肝癌MSCT肝血流灌注各参数的变化规律.方法对10例正常和13例临床诊断为原发性肝癌患者,经右侧肘静脉以6 ml/s的速率注射对比剂40 ml,行肝血流灌注扫描.应用去卷积算法模式计算肝血流量(HBF)、血容量(HBV)、平均通过时间(MTT)、毛细血管表面通透性(PS)和肝动脉灌注指数(HAI)等.根据各参数图评价正常与原发性肝癌血流动力学状态.结果全部受试者均按要求完成检查.13例肝肿瘤患者HAI、BF明显高于正常组[HAI值:0.19±0.06 vs 0.58±0.20,P=0.000;HBF值:(131.31±38.25) ml/(100 ml·min) vs (344.52±95.42) ml/(100 ml*min),P=0.002)];MTT较正常组明显缩短[(12±2)s vs (8±4)s,P=0.028];HBV[(27.49±11.48) ml/100 ml vs (28.67±16.81) ml/100 ml,P=0.913]与PS[(28.09±15.50) ml/(100 ml·min) vs (31.36±23.98) ml/(100ml·min),P=0.678]两组间无明显统计学差异.结论 MSCT肝血流灌注参数HAI、HBF和MTT在正常和肝癌组织之间存在明显差异,可用于评价肝癌的血供状态.     

64排螺旋CT血管造影评价肝硬化血管改变及侧支循环

目的 探讨MSCTA评价肝硬化肝脏血管的异常改变及侧支循环形成的价值。 方法 对168例肝硬化患者(肝硬化组)及120例无肝硬化的患者(对照组)行肝区三期MSCTA,应用MIP和VR进行重建,并对获得的图像进行对照分析。 结果 肝硬化组和对照组门静脉1级和肝静脉1级血管的显示差异无统计学意义(P分别为0.51、0.08),肝动脉、门静脉、肝静脉分级显示差异均有统计学意义(P<0.01)。肝硬化组肝动脉、门静脉起始部增粗85例,分支纤细、纡曲98例,门静脉癌栓形成9例,海绵变性8例,肝动脉持续显影55例、门静脉持续显影57例;对照组3例肝动脉、门静脉起始部增粗,2例分支纤细、纡曲,4例肝动脉持续显影,3例门静脉持续显影。肝硬化组交通支开放总数258支,其中食管胃底静脉曲张196例(196/258,75.97%),对照组仅2例见腹膜后分流。 结论 64排CT三期血管成像可准确、全面显示肝 硬化血管的异常改变及门体分流,尤其能较早、较全面地显示食管胃底静脉曲张,为临床提供更多可靠的诊断和治疗依据。     

Laparoendoscopic single-site cholecystectomy: A randomized controlled study

Abstract

This study reports the initial experience with laparoendoscopic single-site (LESS) cholecystectomy and compares it with laparoscopic cholecystectomy (LC) through a randomized controlled trial. Sixty selective patients diagnosed with cholelithiasis or polyp lesion of the gallbladder (PLG) were randomly divided into two groups undergoing either LESS cholecystectomy or LC separately. The clinical data about operations and recovery of the two groups were compared. In the LESS group 28 of 30 patients underwent LESS cholecystectomy successfully and the remaining two (6.7%) were converted to standard laparoscopic surgery. LC was successfully performed in all patients in the control group. Mean operative time of LESS cholecystectomy group and LC group was 55.6 ± 25.7 versus 42.7 ± 18.6 (p < 0.05). Mean postoperative hospital stay was 3.7 ± 1.3 versus 3.8 ± 0.8 days (p < 0.05). Mean pain index was 2.8 ± 0.6 versus 3.7 ± 1.1 (p < 0.05). A questionnaire revealed that the mean scores of satisfaction with the operation were 8.9 ± 0.7 versus 8.1 ± 1.5 (p < 0.05). LESS cholecystectomy is safe, feasible, minimally invasive, and cosmetic. It is a reasonable alternative to selective patients with uncomplicated cholelithiasis and PLG. But larger controlled studies are still needed.     

64层螺旋CT灌注成像评价梗阻性黄疸肝血流动力学变化

目的 采用64层螺旋CT灌注成像研究梗阻性黄疸肝脏血流动力学的变化.方法 对21例梗阻性黄疸患者和18名正常志愿者行64层螺旋CT肝脏灌注扫描,应用灌注软件获得肝脏灌注参数:肝动脉灌注量(ALP)、门脉灌注量(PVP)、肝脏灌注指数(HPI)、血流量(BF)、血容量(BV)和渗透性(P),并进行统计学分析.结果 梗阻性黄疸组的ALP、HPI较对照组升高,差异有统计学意义(P<0.05),并随黄疸程度的加重呈逐渐升高的趋势;中重度黄疸组的ALP与轻度黄疸组比较差异有统计学意义;梗阻性黄疸组的BV和P较对照组降低,其中中重度黄疸组的BV值与对照组比较差异有统计学意义(P<0.05),轻度黄疸和中重度黄疸组P值与对照组比较差异有统计学意义(P<0.05);PVP与BF组间比较差异无统计学意义(P>0.05).结论 64层螺旋CT肝脏灌注成像能够反映梗阻性黄疸的肝脏血流灌注改变,对临床的早期诊断和治疗有重要价值.     

应用64层螺旋CT智能触发技术优化肝脏双动脉期扫描

目的 探讨64层螺旋CT对比剂追踪智能触发技术(ABT)在肝脏双动脉期扫描中的技术优化.方法 将200例接受64层螺旋CT肝脏平扫加增强扫描的患者随机分为四组各50例;其中三组患者采用ABT技术启动动脉早期扫描,触发监测点设为腹腔干层面的降主动脉,CT触发阀值分别采用110、140、170 HU,触发后延时5 s开始动脉早期扫描,延时20 s开始动脉晚期扫描;另一组患者动脉早期扫描用固定延时(注射对比剂后)20 s,动脉晚期延时35 s.测量肝实质的强化CT值及腹腔干层面的降主动脉、肝固有动脉的CT值作为评判动脉早期成像质量的指标.结果 ABT三组中,140 HU触发组符合优化的动脉早期成像(43/50,86.00%)高于110 HU触发组(35/50,70.00%)及170 HU触发组(32/50,64.00%);固定延时扫描组符合率最低(28/50,56.00%),四组之间优化的动脉早期成像的符合率差异有显著统计学意义(P<0.01).结论 在触发阀值为140 HU时,64层螺旋CT肝脏智能触发增强扫描技术可获取最佳双动脉期增强效果.     

Circulating PCSK9 is associated with liver biomarkers and hepatic steatosis

BackgroundIn parallel to the increasing prevalence of metabolic syndrome, the prevalence of hepatic steatosis has also increased dramatically worldwide. Hepatic steatosis is a major risk factor of hepatic cirrhosis, cardiovascular disease and type 2 diabetes. Circulating levels of proprotein convertase subtilisin/kexin type 9 (PCSK9) have been positively associated with the metabolic syndrome. However, the association between PCSK9 and the liver function is still controversial.ObjectiveThe objective of this study is to investigate the association between circulating PCSK9 levels and the presence of hepatic steatosis, as well as with liver biomarkers in a cohort of healthy individuals.MethodsTotal PCSK9 levels were measured by an in-house ELISA using a polyclonal antibody. Plasma albumin, alkaline phosphatase, ALT, AST, total bilirubin and GGT were measured in 698 individuals using the COBAS system. The presence of hepatic steatosis was assessed using ultrasound liver scans.ResultsIn a multiple regression model adjusted for age, sex, insulin resistance, body mass index and alcohol use, circulating PCSK9 level was positively associated with albumin (β = 0.102, P = 0.008), alkaline phosphatase (β = 0.201, P < 0.0001), ALT (β = 0.238, P < 0.0001), AST (β = 0.120, P = 0.003) and GGT (β = 0.103, P = 0.007) and negatively associated with total bilirubin (β = -0.150, P < 0.0001). Tertile of circulating PCSK9 was also associated with hepatic steatosis (OR 1.48, 95% CI 1.05–2.08, P = 0.02).ConclusionOur data suggest a strong association between PCSK9 and liver biomarkers as well as hepatic steatosis. Further studies are needed to explore the role of PCSK9 on hepatic function.     

Reader agreement and accuracy of ultrasound features for hepatic steatosis

Purpose

The purpose of the study is to assess the reader agreement and accuracy of eight ultrasound imaging features for classifying hepatic steatosis in adults with known or suspected hepatic steatosis.

Methods

This was an IRB-approved, HIPAA-compliant prospective study of adult patients with known or suspected hepatic steatosis. All patients signed written informed consent. Ultrasound images (Siemens S3000, 6C1HD, and 4C1 transducers) were acquired by experienced sonographers following a standard protocol. Eight readers independently graded eight features and their overall impression of hepatic steatosis on ordinal scales using an electronic case report form. Duplicated images from the 6C1HD transducer were read twice to assess intra-reader agreement. Intra-reader, inter-transducer, and inter-reader agreement were assessed using intraclass correlation coefficients (ICC). Features with the highest intra-reader agreement were selected as predictors for dichotomized histological steatosis using Classification and Regression Tree (CART) analysis, and the accuracy of the decision rule was compared to the accuracy of the radiologists’ overall impression.

Results

45 patients (18 males, 27 females; mean age 56 ± 12 years) scanned from September 2015 to July 2016 were included. Mean intra-reader ICCs ranged from 0.430 to 0.777, inter-transducer ICCs ranged from 0.228 to 0.640, and inter-reader ICCs ranged from 0.014 to 0.561. The CART decision rule selected only large hepatic vein blurring and achieved similar accuracy to the overall impression (74% to 75% and 68% to 72%, respectively).

Conclusions

Large hepatic vein blurring, liver–kidney contrast, and overall impression provided the highest reader agreement. Large hepatic vein blurring may provide the highest classification accuracy for dichotomized grading of hepatic steatosis.

     

Effect of Phentermine on Hepatic Steatosis in Bariatric Surgery: A Pilot Study

ObjectiveHepatic steatosis is associated with increased surgical complications in bariatric surgery patients. We aimed to evaluate the effect of phentermine in reducing hepatic steatosis, adipose tissue, and surgical complications in patients undergoing bariatric surgery.MethodsThis was a two-arm, double-blind, randomized, controlled pilot trial of 64 adult subjects with BMI >35 kg/m² selected for bariatric surgery randomized into phentermine group (15 mg once daily) or placebo group for 8 weeks. Both groups adhered to a hypocaloric diet (500 calories/day) and an individualized exercise program. The primary endpoint was reducing the frequency of hepatic steatosis measured by ultrasound and reducing adipose tissue through fat mass in total kilograms or percentage. Key secondary points were the prevalence of surgical complications. Baseline and final biochemical parameters and blood pressure too were assessments.ResultsIn the phentermine group, the frequency of hepatic steatosis decreased by 19%, and the percentage of patients with a normal ultrasound increased from 9% to 28% (p = 0.05). Likewise, the decrease in fat mass in kilograms was more significant in the phentermine group (56.1 kg vs. 51.8 kg, p = 0.02). A significant reduction in the HOMA-IR index was observed regardless of weight loss. No differences in surgical complications were observed between groups. Phentermine was well-tolerated; no differences were observed in the frequency of adverse events between the groups.ConclusionsPhentermine decreased the proportion of individuals with hepatic steatosis by 19% and promoted a more significant fat mass loss in kilograms among candidates for bariatric surgery.     

兔肝动脉碘分数与肝动脉指数的相关性

目的 探讨能谱CT多期扫描计算的肝动脉碘分数(AIF)与肝CT灌注的肝动脉指数(HAI )的相关性及一致性。方法 选取日本大耳白兔15只,行肝CT灌注扫描获得HAI后,以能谱CT多期扫描获取AIF,以相关性分析观察两者之间的相关性,以Bland-Altman图观察两者之间的一致性。结果 肝CT灌注扫描的HAI为0.26±0.02,能谱CT扫描计算的AIF为0.25±0.02,两者之间的相关系数为0.979(P<0.05),两者的一致性较好。结论 AIF与HAI相关性、一致性较好,能谱CT扫描可观察肝血流动力学。     

血生化、超声、CT、1H MRS定量诊断脂肪肝的综合对照实验研究

目的比较生化、超声、CT、1H MRS检查在脂肪肝诊断中的临床价值。方法选用45只健康新西兰大白兔,采用高脂高糖饲料加酒精饮料建立不同程度脂肪肝模型,应用生化、超声、CT及1H MRS多种临床诊断手段,观测多个变量指标,并进行对照研究。组间差异采用单因素方差分析和LSD检验,相关性采用等级相关分析。结果在所选择的18个观测指标中,血清谷草转氨酶、胆固醇、甘油三脂、超声衰减系数、肝CT值、肝/竖脊肌密度比率、1H MRS脂肪峰值、脂肪波峰下面积、脂/水波峰下面积比率、脂肪百分比等10个指标存在组间差异性,且与脂肪肝分级具有显著性相关,其中血清胆固醇、超声衰减系数、肝CT值和1H MRS脂肪曲线下面积分别是生化、超声、CT、MRS诊断方法中与脂肪肝分级相关系数最高的观测指标,相关系数分别为0.886、0.483、-0.764、0.558。结论在脂肪肝的临床诊断中,生化、CT检查的应用价值高于超声波和1HMRS检查。