Journal Article

Pathophysiological analysis of nonalcoholic fatty liver disease by evaluation of fatty liver changes and blood flow using xenon computed tomography : can early-stage nonalcoholic steatohepatitis be distinguished from simple steatosis?

KOBAYASHI Minoru, IKEDA Hiroki, MAEYAMA Shiro, SASE Shigeru, ITOH Fumio, MATSUMOTO Nobuyuki, SUZUKI Michihiro, MATSUNAGA Kotaro, OKUSE Chiaki, TAKAHASHI Hideaki, SHIGEFUKU Ryuta

2012

Overview

Introduction Effective noninvasive tests that can distinguish early-stage nonalcoholic steatohepatitis (NASH) from simple steatosis (SS) have long been sought. Our aim was to determine the possibility of noninvasively distinguishing early-stage NASH from SS. Materials and methods We used Fick’s principle and the Kety–Schmidt equation to determine the hepatic tissue blood flow (TBF) in 65 NASH patients who underwent xenon computed tomography (Xe-CT). We calculated the lambda value (LV), i.e., Xe gas solubility coefficient, in liver and blood. We assessed the histological severity of fatty changes and fibrosis on the basis of Brunt’s classification. Liver biopsy revealed SS in 9 patients and NASH in 56 patients. NASH stages 1 and 2 were classified as early-stage NASH (Ea-NASH; 38 patients) and stages 3 and 4 as advanced-stage NASH (Ad-NASH; 18 patients). We evaluated the differences in LV and TBF among the 3 groups. Results LV was significantly lower in the Ad-NASH group than in the SS and Ea-NASH groups. Portal venous TBF (PVTBF) was significantly lower in the Ea-NASH group than in the SS group, and PVTBF was lower in the Ad-NASH group than in the Ea-NASH group. Total hepatic TBF (THTBF) was significantly different between the SS and Ea-NASH groups and between the SS and Ad-NASH groups. Conclusions In conclusion, measurements of TBF and LV are useful for evaluating the pathophysiological progression of NASH. In addition, these measurements can facilitate the differential diagnosis of SS and Ea-NASH, which may not be distinguishable by other means.

• Publisher: Springer Japan,Springer,Springer Nature B.V
• Subject: Abdominal Surgery / Adult / Aged / Biliary Tract / Blood flow / Colorectal Surgery / CT imaging / Diagnosis / Diagnosis, Differential / Fatty Liver - diagnosis / Fatty Liver - physiopathology / Female / Gastroenterology / Hepatic tissue blood flow / Hepatology / Humans / Liver - blood supply / Liver - physiopathology / Liver diseases / Male / Medicine / Medicine & Public Health / Middle Aged / Non-alcoholic Fatty Liver Disease / Nonalcoholic steatohepatitis / Original Article—Liver / Pancreas / Regional Blood Flow / Severity of Illness Index / Simple steatosis / Solubility / Surgical Oncology / Tomography, X-Ray Computed - methods / Xenon - chemistry / Xenon computed tomography / Young Adult