Acoustic radiation force impulse elastography and liver fibrosis risk scores in severe obesity

ABSTRACT Objective: Identifying significant fibrosis is crucial to evaluate the prognosis and therapeutic interventions in patients with nonalcoholic fatty liver disease (NAFLD). We assessed the performance of acoustic radiation force impulse (ARFI) elastography, APRI, FIB-4, Forns, NFS and BARD scores in determining liver fibrosis in severe obesity. Subjects and methods: A prospective study included 108 patients undergoing bariatric surgery. Liver biopsy specimens were obtained intraoperatively and classified according to the NAFLD Activity Score. Patients were assessed with serological markers and shear wave velocity of the liver was measured with the Siemens S2000 ultrasound system preoperatively. Optimal cut-off values were determined using the area under the receiver operating characteristic curves (AUROC). Results: In the entire cohort prevalence of NAFLD was 80.6%, steatohepatitis 25.9% and significant fibrosis 19.4%. The best tests for predicting significant fibrosis were FIB-4 and Forns scores (both AUROC 0.78), followed by APRI (AUROC 0.74), NFS (AUROC 0.68), BARD (AUROC 0.64) and ARFI (AUROC 0.62). ARFI elastography was successful in 73% of the patients. Higher body mass index (BMI) correlated with invalid ARFI measurements. In patients with BMI < 42 kg/m2, ARFI showed 92.3% sensitivity and 82,6% specificity for the presence of significant fibrosis, with AUROC 0.86 and cut-off 1.32 m/s. Conclusions: FIB-4 and Forns scores were the most accurate for the prediction of significant fibrosis in bariatric patients. Applicability and accuracy of ARFI was limited in individuals with severe obesity. In patients with BMI < 42 kg/m2, ARFI elastography was capable for predicting significant fibrosis with relevant accuracy.

Síndrome de Mauriac / Mauriac syndrome

Síndrome de Mauriac pode ocorrer em crianças com diabetes mellitus tipo 1 de difícil controle e é caracterizada por baixa estatura, atraso puberal, hepatomegalia e características cushingoides. Relatamos o caso de um menino diabético de 14 anos, que apresentou hepatomegalia, baixa estatura, atraso puberal, aminotransferases elevadas, lipídeos séricos elevados e difícil controle metabólico. Ultrassom abdominal confirmou a hepatomegalia; biópsia hepática foi compatível com glicogenose. A função hepática anormal, lipídeos séricos elevados e hepatomegalia decresceram depois do controle metabólico. Concluímos que hepatomegalia pode ser vista em pacientes diabéticos como acúmulo de glicogênio resultante do consumo excessivo de alimentos e insulina. Na glicogenose hepática os achados patológicos melhoram quando há o controle glicêmico...