新型生长抑素类似物SOM230减轻胆总管结扎大鼠肝纤维化

目的 应用胆总管结扎大鼠肝纤维化模型,观察长效生长抑素类似物SOM230对胆管结扎所致大鼠肝纤维化的治疗作用.方法 雄性SD大鼠80只,随机分为模型组、高剂量预防组(80 mg/kg SOM230)、低剂量预防组(8 mg/kg SOM230)、假手术组及正常对照组.分别在术后第2周和第4周取心脏血及肝组织,观察肝组织...     

Gd-EOB-DTPA-enhanced magnetic resonance imaging for bile duct intraductal papillary mucinous neoplasms

AIM: To investigate gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) of intraductal papillary mucinous neoplasms of the bile duct (IPMN-B).METHODS: The imaging findings of five cases of IPMN-B which were pathologically confirmed at our hospital between March 2012 and May 2013 were retrospectively analyzed. Three of these cases were diagnosed by duodenal endoscopy and biopsy pathology, and two cases were diagnosed by surgical pathology. All five patients underwent enhanced and non-enhanced computed tomography (CT), magnetic resonance cholangiopancreatography, and Gd-EOB-DTPA-enhanced MRI; one case underwent both Gd-EOB-DTPA-enhanced MRI and positron emission tomography-CT. The clinical data and imaging results for these cases were compared and are presented.RESULTS: Conventional imaging showed diffuse dilatation of bile ducts and multiple intraductal polypoid and papillary neoplasms or serrated changes along the bile ducts. In two cases, Gd-EOB-DTPA-enhanced MRI revealed dilated biliary ducts and intraductal tumors, as well as filling defects caused by mucin in the dilated bile ducts in the hepatobiliary phase. Gd-EOB-DTPA-enhanced MRI in one case clearly showed a low-signal tumor in the hepatobiliary phase, similar to what was seen by positron emission tomography-CT. In two patients, routine inspection was unable to discern whether the lesions were inflammation or tumors. However, Gd-EOB-DTPA-enhanced MRI revealed a pattern of gradual enhancement during the hepatobiliary phase, and the signal intensity of the lesions was lower than the surrounding liver parenchyma, suggesting tissue inflammation in both cases, which were confirmed by surgical pathology.CONCLUSION: Gd-EOB-DTPA-enhanced MRI reveals the intraductal mucin component of IPMN-B in some cases and the extent of tumor infiltration beyond the bile ducts in invasive cases.     

Dose-related effects of dexamethasone on liver damage due to bile duct ligation in rats

INTRODUCTIONObstruction of bile ? ow through the extrahepatic biliary system results in development of oxidant injury, hepatic fibrosis, biliary cirrhosis, and portal hypertension[1,2]. Patients with obstructive jaundice are at significant risk for severe…     

肝纤维化的MR功能成像研究

长期以来,临床多以肝活检组织病理学检查作为诊断肝纤维化的金标准,但其有一定的创伤性及盲目性。MR功能成像研究如MR灌注成像、MR弥散成像、MR波谱分析、磁化传递对比、磁共振弹性成像在肝纤维化、肝硬化的诊断、治疗及预后的评价方面发挥着重要的作用,它们各具优缺点,应进行合理的选用及相互对照验证。     

Heme oxygenase-1 overexpression increases liver injury after bile duct ligation in rats

AIM： To investigate the effects of heme oxygenase-1 （HO-1） against oxidant-induced injury caused by bile duct ligation （BDL）.

METHODS： Either cobalt protoporphyrin （CoPP）, a HO-1 inducer, or saline were injected intraperitoneally in male SD-rats. Three days later, BDL or sham-operations were performed. Rats were sacrificed 3 wk after BDL and livers were harvested for histology. Fibrosis was evaluated by sirius red staining and image analysis. Alpha-smooth muscular actin, which indicates activation of stellate cells, was detected by immunohistochemical staining, and q/tokine and collagen- Iα （Col- I α） mRNA expression was detected using RNase protection assays.
RESULTS： Serum alanine transaminase increased 8-fold above normal levels one day after BDL. Surprisingly, enzyme release was not reduced in rats receiving CoPP. Liver fibrosis was evaluated 3 wk after BDL and the sirius red-positive area was found to be increased to about 7.8%. However, in CoPP pretreated rats sirius redpositive areas were increased to about 11.7% after BDL. Collagen-1 α and TGF-β mRNA increased significantly by BDL. Again, this effect was increased by HO-1 overexpression.
CONCLUSION： Hepatic fibrosis due to BDL is not reduced by the HO-1 inducer CoPP. In contrast, HO-1 overexpression increases liver injury in rats under conditions of experimental chronic cholestasis.     

磁共振扩散成像在诊断家兔肝纤维化中的应用

目的 评价磁共振扩散成像在诊断家兔肝纤维化中的作用.方法 选用普通级家兔58只,随机分为对照组和实验组.实验组腹腔注射四氯化碳建立家兔肝纤维化模型,然后行磁共振扩散成像.磁共振扩散成像采用自旋-回波平面成像序列,分别取扩散敏感梯度(b值)为300、500进行扫描,通过软件处理获得表观扩散系数(ADC)值以及指数表观扩散系数(EADC)值,磁共振检查后取家兔肝脏行病理检查,并按病理学分期分组,用SPSS 11.0统计软件分析.结果 在磁共振扩散成像结果中,b值为300时,对照组(SO)ADC值为(2.460±0.424)×10-3,实验组(S1～S4)ADC值分别为(2.170±0.311)×10-3,(1.950±0.248)×10-3,(1.635±0.296)×10-3,(1.566±0.353)×10-3,对照组EADC值为0.102±0.044,实验组(S1-S4)EADC值分别为0.167±0.047,0.183±0.042,0.216±0.054,0.219±0.048.对照组和实验组ADC值以及EADC值差异有统计学意义(F=12.13,P=0.0006;F=10.06,P=0.004).b值为500时,对照组ADC值为(2.044±0.215)×10-3,实验组(S1～S4)ADC值分别为(1.907±0.223)×10-3,(1.785±0.232)×10-3(1.542±0.268)×103(1.312±0.212)×10-3.对照组EADC值为0.1106±0.069,实验组(S1～S4)EADC值分别为0.1764±0.073,0.1889±0.056,0.2421±0.079,0.2657±0.037.对照组和实验组ADC值以及EADC值差异有统计学意义(F=14.57,P=0.0002;F=10.42,P=0.003).同时,b值为300、500时,实验组中S1组与S4组ADC值差异均有统计学意义(P=0.03,P=0.044),其余实验组间差异无统计学意义(P>0.05).结论 ADC值以及EADC值可能是肝纤维化诊断和量化的一个潜在标准.     

Perfusion magnetic resonance imaging of the liver

Perfusion magnetic resonance imaging (MRI) studies quantify the microcirculatory status of liver parenchyma and liver lesions, and can be used for the detection of liver metastases, assessing the effectiveness of antiangiogenic therapy, evaluating tumor viability after anticancer therapy or ablation, and diagnosis of liver cirrhosis and its severity. In this review, we discuss the basic concepts of perfusion MRI using tracer kinetic modeling, the common kinetic models applied for analyses, the MR scanning t...     

Dietary glycine blunts liver injury after bile duct ligation in rats

AIM： To investigate the effects of （dietary） glycine against oxidant-induced injury caused by bile duct ligation （BDL）.
METHODS： Either a diet containing 5% glycine or a standard diet was fed to male Sprague-Dawley （SD） rats. Three days later, BDL or sham-operation was performed. Rats were sacrificed 1 to 3 d after BDL. The influence of deoxycholic acid （DCA） in the presence or absence of glycine on liver cells was determined by measurement of calcium and chloride influx in cultivated Kupffer cells and lactate dehydrogenase （LDH） activity was determined in the supernatant of cultivated hepatocytes.
RESULTS： Serum alanine transaminase levels increased to about 600 U/L 1 d alter BDL. However, enzyme release was blunted by about two third in rats receiving glycine. Release of the alkaline phosphatase and aspartate aminotransferase was also blocked significantly in the group fed glycine. Focal necrosis was observed 2 d after BDL. Glycine partially blocked the histopathological changes. Incubation of Kupffer cells with DCA led to increased intracellular calcium that could be blocked by incubation with glycine. However, systemic blockage of Kupffer cells with gadolinium chloride had no effects on transaminase release. Incubation of isolated hepatocytes with DCA led to a significant release of LDH after 4 h. This release was largely blocked when incubation with glycine was performed.
CONCLUSION： These data indicate that glycine significantly decreased liver injury, most likely by a direct effect on hepatocytes. Kupffer cells do not appear to play an important role in the pathological changes caused by cholestasis.     

Diffusion-weighted magnetic resonance imaging and micro-RNA in the diagnosis of hepatic fibrosis in chronic hepatitis C virus

BACKGROUND Diffusion-weighted magnetic resonance imaging has shown promise in the detection and quantification of hepatic fibrosis. In addition, the liver has numerous endogenous micro-RNAs(miRs) that play important roles in the regulation of biological processes such as cell proliferation and hepatic fibrosis.AIM To assess diffusion-weighted magnetic resonance imaging and miRs in diagnosing and staging hepatic fibrosis in patients with chronic hepatitis C.METHODS This prospective study included 208 patients and 82 age-and sex-matched controls who underwent diffusion-weighted magnetic resonance imaging of the abdomen, miR profiling, and liver biopsy. Pathological scoring was classified according to the METAVIR scoring system. The apparent diffusion coefficient (ADC) and miR were calculated and correlated with pathological scoring.RESULTS The ADC value decreased significantly with the progression of fibrosis, from controls(F0) to patients with early fibrosis(F1 and F2) to those with late fibrosis(F3 and F4)(median 1.92, 1.53, and 1.25 × 10~(-3) mm~2/s, respectively)(P = 0.001).The cut-off ADC value used to differentiate patients from controls was 1.83 × 10~(-3) mm~2/s with an area under the curve(AUC) of 0.992. Combining ADC and miR-200 b revealed the highest AUC(0.995) for differentiating patients from controls with an accuracy of 96.9%. The cut-off ADC used to differentiate early fibrosis from late fibrosis was 1.54 × 10~(-3) mm~2/s with an AUC of 0.866. The combination of ADC and miR-200 b revealed the best AUC(0.925) for differentiating early fibrosis from late fibrosis with an accuracy of 80.2%. The ADC correlated with miR-200 b(r =-0.61, P = 0.001), miR-21(r =-0.62, P = 0.001), and miR-29(r = 0.52,P = 0.001).CONCLUSION Combining ADC and miRs offers an alternative surrogate non-invasive diagnostic tool for diagnosing and staging hepatic fibrosis in patients with chronic hepatitis C.     

Simultaneous bile duct and portal venous branch ligation in two-stage hepatectomy

Hepatectomy is an effective surgical treatment for multiple bilobar liver metastases from colon cancer;however,one of the primary obstacles to completing surgical resection for these cases is an insufficient volume of the future remnant liver,which may cause postoperative liver failure.To induce atrophy of the unilateral lobe and hypertrophy of the future remnant liver,procedures to occlude the portal vein have been conventionally used prior to major hepatectomy.We report a case of a 50-year-old woman in wh...     

磁共振成像与超声造影在肝移植术后缺血性胆管病变中的应用

缺血性胆管病变(ITBL)是导致肝移植术后移植肝功能不良和肝衰竭中最难处理的一种胆道并发症,其发病率为5％ ～ 15％[1].目前对ITBL诊断主要依靠影像学方法,内镜下逆行胰胆管造影术(ERCP)和经皮肝穿刺胆道造影(PTC)是金标准[2-3],但其存在并发症和有创性.磁共振胰胆管成像(MRCP)在肝移植术后胆道并发症诊断方面发挥着重要的作用,其临床价值得到了广泛的认可.超声造影(CEUS)在肝移植术前及术后胆道及血管并发症等的检查中有一定的应用,且其在肝移植术后ITBL的诊断方面已有初步研究[4-7].     

Liver magnetic resonance imaging: State of the art

Magnetic resonance imaging (MRI) has now been used for about three decades to characterize the human liver in a non-invasive way, that is without the need of using ionizing radiation or removing tissue samples. During the past few years, technical progress has been considerable and novel applications of MRI have been implemented in the clinic. The beginning of a new decade offers an excellent opportunity for having fi ve experts to present their view on the current status of MRI (and magnetic resonance spec...     

Participation of bone marrow cells in biliary fibrosis after bile duct ligation

BACKGROUND AND AIM: Bone marrow derived cells are involved in the process of hepatic fibrosis secondary to chronic injury. However, it is not yet known how quickly this event occurs in acute fibrosis models. The purpose of this study was to determine the role of bone marrow cells in rapid fibrosis following bile duct ligation in mice using green fluorescent protein (GFP) expressing bone marrow cells. METHOD: After whole body irradiation, 1 x 10(6) donor whole bone marrow cells from green fluorescent protein(+/-) mice were transplanted into C57BL/6 recipients via the tail vein. Four weeks after bone marrow transplantation, chimeric mice were subjected to common bile duct ligation, and livers of these animals were histologically examined after bile duct ligation using anti-fibroblast specific protein (FSP)-1 antibody and anti-alpha-smooth muscle actin (alpha-SMA) antibody. RESULTS: Periductal fibrosis consisting of fibroblast specific protein-positive cells was demonstrated histologically as early as day 7. Most of the fibrotic cells were green fluorescent protein-negative, however, a significant number of cells were green fluorescent protein-positive and some were also anti-FSP or alpha-SMA-positive. CONCLUSION: Differentiation of bone marrow derived cells into activated fibroblast and myofibroblast-like phenotypes occurs in the very early course of periductal fibrosis following bile duct ligation, suggesting a new strategy for prevention of biliary fibrosis by inhibiting migration of bone marrow cells to liver.     

胆管梗阻患者的磁共振成像与超声影像比较

目的探讨超声和磁共振成像胰胆管水成像（MRCP）诊断梗阻性黄疸的差异。方法选择经过磁共振成像（MRI、MRCP）和超声检查并经过手术证实为梗阻性黄疸患者45例，分析两种影像学判定梗阻部位和疾病定性的准确性。结果对于结石，MRI结合MRCP定位的准确率为95．56％；超声的准确率为77．78％。MRI（MRCP）和超声定性的准确率不具有统计学差异（χ^2=1．083，P〉0．05），但超声准确率（96．15％）大于磁共振。对于恶性梗阻，MRI（MRCP）和超声定位的准确率分别为94．74％和68．42％（χ^2=4．38，P〈0．05）。结论超声对于结白的诊断敏感性高，但对于良恶性病变所致黄疸的定性和定位，磁共振成像（MRI、MRCP）则更具有优势。     

Bile duct hamartomas （von Mayenburg complexes） mimicking liver metastases from bile duct cancer： MRC findings

We present a case of a 72-year-old man with a common bile duct cancer, who was initially believed to have multiple liver metastases based on computed tomography findings, and in whom magnetic resonance cholangiography (MRC) revealed a diagnosis of bile duct hamartomas. At exploration for pancreaticoduodenectomy, liver palpation revealed disseminated nodules at the surface of the liver. These nodules showed gray-white nodular lesions of about 0.5 cm in diameter scattered on the surface of both liver lobes, which were looked like multiple liver metastases from bile duct cancer. Frozen section of the liver biopsy disclosed multiple bile ducts with slightly dilated lumens embedded in the collagenous stroma characteristics of multiple bile duct hamartomas (BDHs). Only two reports have described the MRC features of bile duct hamartomas. Of all imaging procedures, MRC provides the most relevant features for the imaging diagnosis of bile duct hamartomas.     

Benign focal liver lesions: The role of magnetic resonance imaging

Liver lesions are common findings in radiologists’ daily routine. They are a complex category of pathology that range from solitary benign lesions to primary liver cancer and liver metastases. Benign focal liver lesions can arise from different liver cell types: Epithelial (hepatocytes and biliary cells) and nonepithelial (mesenchymal cells). Liver magnetic resonance imaging (MRI) is a fundamental radiological method in these patients as it allows with its multiparametric approach optimal non-invasive tissue characterization. Furthermore, advanced liver MRI techniques such as diffusion-weighted imaging and hepatobiliary contrast agents have improved the detection of focal liver lesions and can be highly effective in differentiating pseudotumor from tumors, as well as benign from malignant lesions, and can also be used for differential diagnosis. Although histological examination can be useful in making a definitive diagnosis, MRI is an important modality in the diagnosis of liver lesions with a significant impact on patient care. This aim of this review is to provide a comprehensive overview of benign liver lesions on MRI.