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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?

  • Original Article—Liver, Pancreas, and Biliary Tract
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Abstract

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.

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Acknowledgments

The authors wish to thank the technical assistants at the Imaging Center of St. Marianna University School of Medicine Hospital for their assistance.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan

    Ryuta Shigefuku, Hideaki Takahashi, Minoru Kobayashi, Hiroki Ikeda, Kotaro Matsunaga, Chiaki Okuse, Nobuyuki Matsumoto, Michihiro Suzuki & Fumio Itoh

  2. Shiodome Medical Examination Clinic, Tokyo, Japan

    Shiro Maeyama

  3. Anzai Medical Company Ltd (SS), Tokyo, Japan

    Shigeru Sase

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  1. Ryuta Shigefuku
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  2. Hideaki Takahashi
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Correspondence to Michihiro Suzuki.

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Shigefuku, R., Takahashi, H., Kobayashi, M. et al. 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?. J Gastroenterol 47, 1238–1247 (2012). https://doi.org/10.1007/s00535-012-0581-4

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