Intravoxel incoherent motion imaging for diagnosing and staging the liver fibrosis and inflammation.

PURPOSE: To evaluate the diagnostic accuracy of intravoxel incoherent motion (IVIM) model parameters for the diagnosis and staging of liver fibrosis and inflammation in patients with chronic hepatitis B. METHODS: Fifty-four patients with chronic hepatitis B and 42 healthy volunteers were included in the study. All subjects were examined by 3 T magnetic resonance imaging. Diffusion-weighted imaging was undertaken with sixteen b values. IVIM parameters [D (true diffusion coefficient), D* (pseudo-diffusion coefficient), f (perfusion fraction)] were calculated. Histological evaluation of biopsy samples was considered the reference standard for the staging of liver fibrosis and inflammation. Differences in IVIM parameters between patient and control groups were analyzed. In the patient group, fibrosis stage and inflammation grade groups were analyzed with respect to IVIM parameters. The correlation was assessed between IVIM parameters and Ishak-modified scale of fibrosis stages and inflammation grades. RESULTS: The D was significantly lower in the patient group than the control group, p = 0.038 with Cohen's d effect size of 0.452. D was significantly different between fibrosis stage levels. D values decreased in fibrosis stages from the minimal to moderate to marked fibrosis. Fibrosis grades significantly negatively correlated with D and D* values, p = 0.001, and 0.021, respectively. In addition, inflammation grades negatively correlated with f values, p = 0.047. CONCLUSION: D values measured with IVIM imaging may help to diagnose liver fibrosis. IVIM imaging could be an alternative to liver biopsy for the staging of liver fibrosis.

Evaluation of hepatitis B virus transmission and antiviral therapy among hepatitis B surface antigen-positive pregnant women.

AIM: The aim of the present study was to assess the potential risk of hepatitis B virus (HBV) vertical transmission among Turkish parturient women and to evaluate the efficacy and safety of antiviral agents. MATERIAL AND METHODS: Data were collected retrospectively from 114 HBV-infected pregnant women and their infants in eight health institutions in Turkey. RESULTS: The baseline characteristics of the women were: mean age, 28.3 ± 5.2 years; alanine aminotransferase, 57.4 ± 139.0 U/L; aspartate aminotransferase, 56.6 ± 150.0 U/L; and HBV DNA, 8.3 × 10(7) ± 2.6 × 10(8) copies/mL. Family history of HBV infection was detected in 53.5% (n = 61). In total, 60 (52.6%) pregnant women received tenofovir (60.0%), lamivudine (33.3%) or telbivudine (6.7%) therapy at the median gestational age of 22.2 ± 8.5 (1-36) weeks. All infants were vaccinated and hepatitis B immune globulin was administered, with 81 of them (71.1%) available for follow-up. After completion of HBV vaccination course, 71 (87.7%) infants had protective anti-HBs levels, three (3.7%) were hepatitis B surface antigen-positive, and seven (8.6%) were hepatitis B surface antigen-negative with nonprotective anti-HBs levels. Five of the infants had low gestational birthweight but no other birth defects were observed. CONCLUSION: According to our results, viral load may not be the only effecting factor for transmission of HBV to children of infected mothers. Pregnant women with high viral load should be followed-up closely during pregnancy. They should begin to take tenofovir or telbivudine, which are category B drugs for pregnancy, at the beginning of the third trimester at the latest. We need new treatment strategies; and close follow-up of mothers and children is another important issue.

[Comparison of quantitative hepatitis B virus DNA levels in serum and liver biopsy samples of chronic hepatitis B patients]. / Kronik hepatit B hastalarinin serum ve karaciger biyopsi örneklerinde hepatit B virus DNA düzeyinin karsilastirilmasi.

Chronic hepatitis B (CHB) is an important health problem worldwide. Relapses in CHB patients, even treated, create a major problem in patient management. The aims of this study were the detection of quantitative levels of hepatitis B virus (HBV) DNA in the sera and liver biopsy specimens of CHB patients and the comparison of the results. A total of 69 patients (49 male, 20 female; age range: 19-68 years, mean age: 36.91+11.03 years) who were prediagnosed as CHB in the Infectious Diseases and Clinical Microbiology Department of Kocaeli University (northwestern region of Turkey) were included to this prospective study. HBV-DNA levels of all of the patients were initially measured in the routine laboratory of our hospital by using a commercial real-time polymerase chain reaction (RQ-PCR; iCycler IQ System, BioRad Laboratories) and the mean HBV-DNA level (Serum DNA #2) was detected as 5.6E+6 +/- 8.5E+6 copies/mL. The mean level of ALT in CHB patients was 79.59 +/- 69.7. In our study the HBV-DNA levels of the serum and liver biopsy specimens were also measured by using an "in-house" real-time PCR (RT-PCR) (Techne Quantica, London, UK). Nucleic acid extractions were performed with the use of QIAamp DNA Mini Kit (Qiagen Inc, Hilden, Germany) according to the manufacturer's recommendations. The primers were specific for the X gene region of HBV (forward primer: 5'-TTCGCTTCACCTCTGCACG-3', reverse primer: 5'-CCCAACTCCCAGTCTTTAA-3'; probe: 5'-AATGTCAACGACCGACCTT GAGGCA-pBHQ-3'). Statistical analysis was carried out with Spearman rank analysis. With the use of "in-house" real-time PCR, mean levels of HBV-DNA were found to be 8.99E+6 +/- 3.1E+7 copies/mL in the liver biopsy samples, and 4E+6 +/- 4.4E+6 copies/ mL in serum samples (Serum DNA 1). There were significant positive correlations between the results obtained from in-house (Serum DNA 1) and commercial RT-PCR (Serum DNA 2) (r = 0.300; p = 0.024) methods. Although HBV-DNA levels in the liver tissues were found higher than those in serum samples, no correlation between the HBV-DNA levels of liver biopsy and serum samples (both serum DNA 1 and 2) was detected. This result was attributed to the standardization problems of in-house RT-PCR. In conclusion, liver biopsies performed at the beginning of the therapy to detect the grade of chronic liver disease, would also be searched by means of quantitative HBV-DNA levels, however, since the determination of HBV-DNA load in liver tissues may be difficult, standardized sensitive methods should be used for this purpose.