Real-time tissue elastography for evaluation of hepatic fibrosis and portal hypertension in nonalcoholic fatty liver diseases

The aim of this study was to prospectively measure liver stiffness with real-time tissue elastography in patients with nonalcoholic fatty liver diseases (NAFLD) and to compare the result with the clinical assessment of fibrosis using histological stage. One hundred and eighty-one prospectively enrolled patients underwent real-time tissue elastography, with the first 106 being analyzed as the training set and the remaining 75 being evaluated as the validation set. Hepatic and splenic elastic ratios were calculated and compared with stage of histological fibrosis. Portal hypertension (PH) was assessed. Real-time tissue elastography cut-off values by stage in the training set were 2.47 for F1, 2.67 for F2, 3.02 for F3, and 3.36 for F4. Using these cut-off values, the diagnostic accuracy of hepatic fibrosis in the validation set was 82.6%-96.0% in all stages. Only portal fibrosis correlated with the hepatic elastic ratio by multivariate analysis. The area under the receiver operating characteristic curve of elastic ratio better correlated than serum fibrosis markers in both early and advanced fibrosis stages. Patients with PH, defined by splenic elasticity, had early fibrosis. Patients with severe PH were found only in the group with cirrhosis. Conclusion: Real-time tissue elastography is useful in evaluating hepatic fibrosis and PH in patients with NAFLD. (HEPATOLOGY 2012).     

Recognition of bisphosphonate-related osteonecrosis of the jaw among oral and maxillofacial radiologists: results from a questionnaire-based survey in Japan

Objectives

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is becoming common in Japan. Oral and maxillofacial radiologists must diagnose BRONJ in general practice. However, little information on how to recognise BRONJ is available. The purpose of this study, therefore, was to confirm the recognition of BRONJ among Japanese oral and maxillofacial radiologists.

Methods

A questionnaire including 14 main queries and relevant branch queries was created and sent to 29 Japanese institutions employing oral and maxillofacial radiologists.

Results

A large number of patients (705) with BRONJ during the last 3 years were reported by 23 institutions (25 responders) that participated in our survey. The rate of osteonecrosis of the jaw associated with intravenous bisphosphonates was almost identical to that associated with oral bisphosphonates. This finding was inconsistent with worldwide data. About half of the responders felt that the diagnosis of BRONJ based on imaging was difficult. No specific modality was selected for identifying the early signs of BRONJ, although 19 responders selected multi-detector computed tomography followed by magnetic resonance imaging as the best modality for determining the extent of BRONJ. Almost all responders felt that the detection of early signs and determination of lesion extent on imaging were important roles of oral and maxillofacial radiologists.

Conclusions

Oral and maxillofacial radiologists recognised their roles in BRONJ diagnosis; however, insufficient evidence regarding the accomplishment of these roles is available. Japanese oral and maxillofacial radiologists must accumulate a large number of BRONJ images, analyse them in cooperation with one another and share the information obtained from their analysis.     

Occurrence of clinical depression during combination therapy with pegylated interferon alpha or natural human interferon beta plus ribavirin

Aim: The onset of depression symptoms during pegylated interferon α plus ribavirin (PEG‐IFN/RBV) combination therapy has led to treatment discontinuation in some cases. In the present study, we conducted a questionnaire survey during treatment to determine whether natural human interferon β plus ribavirin (IFNβ/RBV) therapy is associated with a lower incidence of depression symptom onset compared with PEG‐IFN/RBV therapy. Methods: Seventy‐seven patients with chronic hepatitis C received PEG‐IFN/RBV (PR) or IFNβ/RBV (FR) therapy. A questionnaire survey was administered at the start of treatment, and at 4 and 12 weeks, using the Beck Depression Inventory II (BDI‐II) and the Pittsburgh Sleep Quality Index (PSQI). Results: BDI‐II scores in the PR group increased at 4 and 12 weeks, but remained unchanged in the FR group. At 12 weeks, the mean BDI‐II score and incidence of abnormalities with a BDI‐II score of ≥14 were significantly lower in the FR group than in the PR group. BDI‐II scores during IFNβ/RBV therapy in 11 patients currently using antidepressants remained unchanged up to 12 weeks. None of these 11 patients required addition or dose increases of antidepressants, and there was no evidence of worsened depression symptoms. Nine PR patients had BDI‐II scores of ≥14 and PSQI scores of ≥11 at 12 weeks. Conclusions: IFNβ/RBV therapy was associated with a lower incidence of depression symptom onset during treatment. In patients already diagnosed with depression, there was no evidence that IFNβ/RBV therapy caused any worsening of symptoms, indicating that IFNβ/RBV therapy is safe for patients with depression.