Esteatose hepática na obesidade infantil: investigação por imagem / Hepatic steatosis in obese children: imaging investigation

Objetivos: revisar a esteatose hepática em crianças obesas, com ênfase na sua investigação por imagem.Fonte de dados: revisão na literatura sobre o assunto, utilizando as bases de dados PubMed, SciELO e LILACS.Síntese dos dados: na população pediátrica, a esteatose hepática tem uma prevalência global de 2,6%, podendo alcançar índices alarmantes em crianças obesas, que variam de 23% a 53%. Essa ?nova? doença, anteriormente considerada uma afecção quase exclusiva dos adultos, chama a atenção da comunidade científica. A esteatose hepática não alcoólica, doença assintomática e progressiva, constitui uma das complicações hepáticas mais prevalentes, podendo evoluir para esteato-hepatite e até mesmo para cirrose. Neste sentido, é de suma importância o diagnóstico precoce e não invasivo dessa doença, através dos diferentes métodos de imagem existentes, entre os quais destacamos a ultrassonografia, a tomografia computadorizada e a ressonância magnética. Conclusões: dentre as vantagens e desvantagens próprias de cada método de imagem, a ressonância magnética é considerada a melhor modalidade no diagnóstico e quantificação da infiltração gordurosa hepática. No entanto, a investigação por imagem poderá ser iniciada com um método menos sofisticado, como a ultrassonografia, que é uma alternativa mais acessível e econômica.

Aims: To review hepatic steatosis in obese children, with emphasis on the imaging investigation.Source of data: Literature review about the topic, using the PubMed, SciELO and LILACS databases.Summary of the findings: Among pediatric population, hepatic steatosis has a 2.6% world prevalence and can reach striking rates in obese children, ranging from 23 to 53%. Such ?new? disease, previously regarded as a condition affecting mostly adults, has aroused attention of scientific community. Non-alcoholic hepatic steatosis, an asymptomatic and progressive disease, constitutes one of the most prevalent hepatic complications as it may lead to steatohepatitis and even cirrhosis. Accordingly, the early and noninvasive diagnosis of this disease is of great importance through different imaging methods available, among which we highlight ultrasonography, computed tomography and magnetic resonance. Conclusions: Considering the advantages and disadvantages of every diagnostic imaging method currently available, magnetic resonance is considered the best imaging procedure for diagnosis and quantification of fatty liver infiltration. However, imaging investigation may be initiated by a less sophisticated method, such as ultrasonography, which is an easier and less expensive approach.

The Importance of Gases in Portal Veins and Liver Parenchyme is Characterized by Liver Ultrasonography in Full-term Neonates with Necrotizing Enterocolitis

PURPOSE: Although early treatment of neonatal necrotizing enterocolitis (NEC) is very important, there exists no definite way of diagnosing NEC at an early stage. Previous reports argue that gases in portal veins and liver parenchyme are detected by liver ultrasonography (USG) even when no symptoms corresponding to NEC are provoked. This study demonstrates the importance of liver USG for early diagnosis of NEC. METHODS: Abdominal USG was performed on 1381 newborn infants who were admitted to the neonatal intensive care unit of Soonchunhyang University Cheonan Hospital between February 2003 and September 2005. Twelve infants were diagnosed with NEC by liver USG and their individual pathologies were compared. RESULTS: All of the patients described here were full-term and the most frequent symptom observed was watery diarrhea; four had no symptoms at all. Severe metabolic acidosis was seen in two patients, a rise of C-reactive protein (CRP) in five patients and rotavirus antigen positivity in five patients. One of the patients showed portal vein gas, pneumatosis intestinalis and ileus in a simple abdominal radiography and another patient showed ileus only. However, all of the other 10 patients presented with no abnormal symptoms, according to simple abdominal radiography. CONCLUSION: NEC should be considered in neonates with gases present in portal veins, intestinal walls and liver parenchyme, as detected by liver USG even when no symptoms corresponding to NEC are provoked.

Reserch on cavernous degenerarion and hypertension of portal vein in children / 中国康复理论与实践

@# ObjectiveTo discuss etiology, pathology, clinical manifestations, diagnosis, management and prognosis of cavernous degenerarion and hypertension of portal vein.MethodsThe clinical and image data of 7 children with cavernous degeneration and hypertension of portal vein were veviewed.ResultsHematemesis, melena and splenomegaly were the major presentations. The diagnosis was confirmed by color Doppler ultrasonography except 4 cases had angiography. All cases underwent splenectomy and transection of the gastric fundus and esophageal veins. Five of them had an additional portalcaval shunt.ConclusionCongenital factors may play some role in the development of cavernous degeneration and hypertension of portal vein in children. For the disase discussed this paper the image examination is the main diagnostic method, and the management is same with portal hyertension and the prognosis is closely related to the liver function.

99mTc-DTPA Galactosyl Human Serum Albumin Scintigraphy in Mushiroom Poisoning Patient: Comparison with Liver Ultrasonography / 대한핵의학회잡지

99mTc-galactosyl human serum albumin (Tc-GSA) is a radiopharmaceutical that binds to asialoglycoprotein receptors, which are specifically present in the hepatocyte membrane. Because these receptors are decreased in hepatic parenchymal damage, the degree of Tc-GSA accumulation in the liver correlates with findings of liver function test. Hepatic images were performed with Tc-GSA in patients with acute hepatic dysfunction by Amantia Subjunquillea poisoning, and compared with these of liver ultrasonography (USG). Tc-GSA (185 MBq, 3 mg of GSA) was injected intravenously, and dynamic images were recorded for 30 minutes. Time-activity curves for the heart and liver were generated from regions of interest for the whole liver and precordium. Degree of hepatic uptake and clearance rate of Tc-GSA were generated by visual interpretation and semiquantitative analysis parameters (receptor index: LHL15 and index of blood clearance: HH15). Visual assessment of GSA scintigraphy revealed mildly decreased liver uptake in all of subjects. The mean LHL15 and HH15 were 0.886 and 0.621, graded as mild dysfunction in 2, and mild to moderate dysfunction in 1 subject. In contrast, liver USG showed no remarkable changes of hepatic parenchyme. Tc-GSA scintigraphy was considered as a useful imaging modality in the assessment of the hepatic dysfunction.

Diagnosis of Inflammatory Pseudotumor of Liver by the Doppler and Ultrasonography / 中华超声影像学杂志

Ten patients with 12 inflammatory pseudotumor of the liver (IPL) lesions were routinely examined by gray scale uhrasonography(B-US),color Doppler (CD)and pulscd Doppler(PD). All of them in B-US were hypoechoic pattern with inhomogeneity,and one of them displayed helo-like,margin, suggesting malignant tumor. However, the irregular shape with calabash-like was found in 10 IPL lesions by B-US, being different from liver cancer.The color blood flow and arterial spectrum were detected by CD and PD in the margin 3 of 9 IPL lesions,and the resistant index was less than 0.5 in 2 of 3 IPL with Doppler signals, 6 of them were suggested to lack of blood supply, the manifistations of Doppler were consistent with pathology of IPL. Therefore, 8 lesions were considered to be benign lesions by Doppler US and the accuracy for the diagnosis of IPL was 56%(5/9)by using Doppler combined with B-US.