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Ultrasound Helps Predict Liver Damage in Non-Alcoholic Fatty Liver Disease (NAFLD)
An ultrasound technique called transient elastography can accurately detect liver damage in most patients with NAFLD, a condition that often accompanies obesity and type 2 diabetes...
Color Doppler ultrasound indices can predict disease-free survival of breast cancer patients during neoadjuvant chemotherapy...
Ultrasound Aids Early Ovarian Cancer Detection
Serum biomarkers identified through proteomic analysis, coupled with contrast-enhanced ultrasound, ultimately may provide a means for early diagnosis of ovarian cancer...
Showing patients their medical images produced mixed results in motivating patients to change risky behavior...
Ultrasound Helps Predict Liver Damage in Non-Alcoholic Fatty Liver Disease (NAFLD)
An ultrasound technique called transient elastography can accurately detect liver damage in most patients with NAFLD, a condition that often accompanies obesity and type 2 diabetes...
An ultrasound technique called transient elastography can accurately detect liver damage in most patients with non-alcoholic fatty liver disease (NAFLD), a condition that often accompanies obesity and type 2 diabetes, a new study found.
Transient elastography (TE) accurately measured levels of liver stiffness, an indication of the amount of fibrosis, in more than 97% of patients with a body mass index below 30 kg/m2 and in 75% of obese patients, according to a report in the February issue of Hepatology.
"The adoption of transient elastography could potentially spare two-thirds of NAFLD patients from liver biopsies," Victor de Lédinghen, MD, PhD, of Hôpital Haut-Lévêque, in Pessac Cedex, France, and colleagues wrote. "Since the prevalence of NAFLD is high in many affluent countries, this approach would be cost saving."
Non-alcoholic fatty liver disease has become more common as the incidence of metabolic syndrome and obesity has grown. The condition can progress to cirrhosis and hepatocellular carcinoma, particularly among patients with non-alcoholic steatohepatitis (NASH), in which fat in the liver causes inflammation and tissue damage.
Liver biopsy is typically used to determine levels of inflammation and fibrosis associated with NASH, but the procedure carries a small risk of hemorrhage, puncture of other internal organs, infection, and spread of cancer cells. Transvenous liver biopsy carries an additional risk of adverse reaction to the contrast material.
These problems, in addition to the mixed results due to sampling variance biopsies sometimes deliver, have researchers searching for alternative methods of determining the extent of liver fibrosis.
Lédinghen and colleagues compared the accuracy of TE to biochemical tests for the diagnosis of fibrosis and cirrhosis in 246 NAFLD patients who underwent liver biopsies between May 2003 and April 2009 at University Hospital of Pessac and Prince of Wales Hospital in Hong Kong. The accuracy of the TE measurements was validated by biopsy results. Of the patients, 31 (12.6%) had advanced fibrosis and 25 (10.2%) had cirrhosis.The liver stiffness measurements of patients with F0, F1, F2, F3, and F4 stages of fibrosis were 5.7, 6.8, 7.8, 11.8, and 25.1 kPa, respectively (P<0.0001, by analysis of variance).
TE was accurate for predicting fibrosis in patients with liver stiffness of at least 7.9 kPa; measurement and accuracy were not affected by hepatic steatosis, necroinflammation, and obesity. The most disagreement between the results of the TE and biopsy methods occurred in patients with short liver biopsy lengths and mild or no fibrosis.
In patients with complete biochemical data, the accuracy of TE was compared with that of other means of predicting liver stiffness, and was found to be more reliable than aspartate aminotransferase–to–alanine aminotransferase ratio, aspartate aminotransferase–to–platelet ratio index, FIB-4, BARD, and NAFLD fibrosis scores.
The authors cautioned that the results of the liver biopsies potentially could have been influenced by sampling bias and that referral patients enrolled in the study may have had more advanced liver disease than the general population. They also noted that a significant proportion of obese patients were not analyzed because a liver stiffness measurement could not be obtained.
In an accompanying editorial, Leon Adams, PhD, of the University of Western Australia, noted that the majority of individuals with NAFLD will not develop liver-related morbidity or die from liver disease.
"Thus", he wrote, "the difficulty facing the managing physician is predicting which patients are at greatest risk of developing cirrhosis, thus identifying those who will benefit most from specific treatments, more intensive therapy, and monitoring."
The new study, he wrote, suggests that TE is effective at excluding advanced fibrosis and cirrhosis in patients with NAFLD. However, he argues that the technique requires further validation in obese and morbidly obese populations and that sensitivity of the test is likely to vary between differing patient populations, different medical personnel administering the test, and underlying prior probability of fibrosis.
"Lastly," he concluded, "if noninvasive markers are going to form part of the routine assessment of the millions of individuals with NAFLD, the expense and availability of each modality may play a decisive role in which the noninvasive method is most appropriately taken up by community physicians and specialty hepatologists."
Article written by staff at medpagetoday.com and adapted for the purposes of this newsletter.
Color Doppler Ultrasound Predicts Survival of Breast Cancer Patients
Color Doppler ultrasound indices can predict disease-free survival of breast cancer patients during neoadjuvant chemotherapy...
Color Doppler ultrasound indices can predict disease-free survival of breast cancer patients during neoadjuvant chemotherapy, according to research published in the European Journal of Radiology.
In a prospective study of 50 patients, researchers found that patients with higher intratumoral blood velocity on color Doppler scans after chemotherapy were twice as likely to have their cancer recur or metastasize than those who showed decreased velocity after surgery.
"Tumor flow velocity measured by Doppler ultrasound can be used as an independent marker of disease-free survival in patients with breast cancer," wrote a research team led by Dr. Gurpreet Singh of All India Institute of Medical Sciences (AIIMS) in New Delhi, India.
Seeking to examine the role of color Doppler ultrasound in evaluating change in blood-flow velocity in locally advanced and inflammatory breast cancer before and after neoadjuvant chemotherapy, the researchers enrolled 50 consecutive breast cancer patients with a mean age of 46 (Eur J Rad).
All patients received Doppler ultrasound of their breast tumors using an EnVisor ultrasound system (Philips Healthcare, Andover, MA). Doppler indices such as pulsatility index (PI), resistive index (RI), and peak systolic velocity (PSV) were recorded by an experienced radiologist, according to the researchers.
Any changes to Doppler parameters following three cycles of chemotherapy were graded on a four-point scale: grade 1 (increase, no change, or decrease of less than 25% in Doppler parameters), grade 2 (25% to 50% decrease), grade 3 (more than 50% decrease but not complete tumor disappearance), and grade 4 (complete disappearance of Doppler flow).
The researchers followed patients for 24 months after treatment and compared Doppler scores with clinical findings. On the color Doppler ultrasound performed prior to therapy, all 50 patients had hypervascular signals.
Of the 16 patients who experienced an increase in PSV after chemotherapy, 11 (68.75%) had ipsilateral recurrence, contralateral disease, locoregional disease recurrence, and distant metastasis, compared with five (31.25%) who had a decrease of PSV after chemotherapy.
The differences were judged to be statistically significant (p < 0.05). Neither pulsatility index nor resistive index was found to correlate with clinical response to treatment.
"Color Doppler has the potential for precisely directed blood flow velocity measurement and also offers unique functional information that may be of importance in terms of overall disease-free survival of women with breast cancer," the researchers wrote.
Article written by staff at auntminnie.com and adapted for the purposes of this newsletter.
Ultrasound Aids Early Ovarian Cancer Detection
Serum biomarkers identified through proteomic analysis, coupled with contrast-enhanced ultrasound, ultimately may provide a means for early diagnosis of ovarian cancer...
Serum biomarkers identified through proteomic analysis, coupled with contrast-enhanced ultrasound, ultimately may provide a means for early diagnosis of ovarian cancer, researchers say.
"Exciting preliminary data have shown that specific combinations of peptides from molecules, such as BRCA2, exist in the serum of epithelial ovarian cancer patients," Sonia Dutta, MD, of Mount Sinai School of Medicine in New York, and colleagues reported in the February American Journal of Roentgenology.
This discovery suggests that "highly discriminatory proteins" may serve as biomarkers for early epithelial cell ovarian cancer, although the findings must be further validated, the authors wrote.
Despite advances in surgery and chemotherapy, survival from advanced stage ovarian cancer is only 30%, and the authors cite a "dire need" for a validated screening method to detect the disease early.
Unsuccessful efforts find a biomarker for this deadly malignancy have focused primarily on a single cancer-specific marker, which the authors concede is a "mission impossible."
Impediments to the identification of cancer-specific markers include the molecular heterogeneity that characterizes different tumors, the sharing of pathophysiologic events among cancer and other diseases, and low marker production and concentration.
To overcome these difficulties, a new approach known as proteomics is being used to analyze the entire protein complement of a cell.
The rationale for this analytical technique lies in a significantly greater understanding of the tumor microenvironment. It is now known that tumor cells participate in complex interactions with surrounding structures and other cell populations.
"This biochemical cross-talk is hypothesized to generate a cascade of specific and sensitive biomarkers elaborated directly from the tumor cell population, indirectly from the interacting non-tumor cells or extracellular molecules, or a specific product of the microecology," they explained.
In fact, the most specific cancer markers may turn out to be molecules that normally are not malignant but that have been modified by that tumor microenvironment -- clipped, cleaved, phosphorylated, or glycosylated -- and carry a detailed picture of the local pathophysiology.
Previous techniques used in the hunt for markers, such as two-dimensional gel electrophoresis, were unable to detect these altered or clipped molecules, which occupy the low molecular weight range of the proteome.
Mass spectrometry, which is most sensitive in the low molecular weight range, is now a tool used to explore these modified protein molecules and has already revealed a vast number of previously unknown biomarkers.
The next steps, the researchers explained, will be to develop capture reagents that can measure the markers and, using reverse-phase protein array, to further characterize proteins of interest.
But any diagnostic information gained through proteomic analysis must be verified by some imaging technique. Conventional ultrasound has proven inadequate, but pulse-inversion harmonic ultrasound currently appears to differentiate malignant from benign lesions.
For example, although the time to peak enhancement with contrast-enhanced ultrasound is similar in benign and malignant masses, a small study found that malignant lesions have:
- Greater peak enhancement (23.3 versus 12.3 dB, P<0.01)
- Longer half wash-out time (139.9 versus 46.3 seconds, P<0.01)
- Greater area under the enhancement curve (2,012.9 versus 523.9 seconds,P=0.07)
The authors noted that these enhancement kinetics data were from just 17 patients and are therefore limited, but stated that the technique "shows great promise."
In addition, the diagnostic capacity of ultrasound can be further increased by the use of intravenous contrast agents, which may help visualize the early microvascular changes typical of malignancy.
The researchers predicted that, by using a combination of clinically relevant biomarkers identified through proteomic analyses plus contrast-enhanced ultrasound, "we will likely be able to shift from an era of diagnosing advanced-stage ovarian cancer to that of early-stage disease and, most important, save the lives of many women."
Article written by staff at medpagetoday.com and adapted for the purposes of this newsletter.
Medical Images Unlikely to Change Risky Behavior, Study Shows
Showing patients their medical images produced mixed results in motivating patients to change risky behavior...
If you show an obese person a medical image of their plaque-clogged arteries, will it help motivate them to get more exercise? Not necessarily, although you might have better luck getting smokers to change their ways, according to a new review of literature from the Cochrane Collaboration.
Showing patients their medical images produced mixed results in motivating patients to change risky behavior, although it did inspire change in some areas, such as by inducing smokers to quit, according to the study conducted by Gareth Hollands and colleagues from King's College London (Cochrane Database of Systematic Reviews, 2010, Issue 1).
The group evaluated the effects of showing and explaining medical images to patients, and the effectiveness of this approach in terms of motivating individuals to change unhealthy behaviors. Applicable behaviors included smoking cessation, skin self-examination, sun protection behavior, dietary intake, physical activity, and medication usage.
Reviewers evaluated nine trials involving 1,371 adults. Overall, results were mixed. The most positive association was found in smoking cessation, which was addressed by three studies that featured ultrasound or CT arterial images to assess cardiovascular risk. The researchers found that smokers who saw their own medical images were nearly three times as likely to quit as those who didn't, with a pooled odds ratio of 2.81 favoring the intervention.
However, other studies did not show a positive association. For example, a trial that showed electron-beam CT images to patients in an effort to improve their levels of physical activity failed to produce a change in behavior, with no statistically significant difference between the control and intervention groups.
Another study evaluated showing versus not showing coronary CT images in a group of 56 postmenopausal women with very-low-risk coronary calcification scores. They found that measures of cardiac health such as systolic blood pressure and total cholesterol declined significantly in the control group but not in the imaging group.
Outside of imaging, Hollands and colleagues reviewed four trials that studied nonclinical populations to see if showing individuals ultraviolet photography of skin damage could compel them to engage in sun protection behavior, such as reducing sun exposure, using sunscreen, or stopping the use of tanning beds. Only one of these four studies found that the intervention group successfully modified their behavior compared to controls, finding that patients were almost five times as likely to perform skin self-exams after seeing the ultraviolet images.
"Behavior is very difficult to change, and many interventions which on a common-sense level would be thought likely to be effective in changing behavior, are not shown to be," Hollands said. "Given the difficulty of changing behavior, we would not say we were greatly surprised by the results."
Due to the limited nature of the available evidence and the mixed results that were found, reviewers said no strong statements could be made about the effectiveness of communicating medical imaging results to change health behavior. Only three trials in clinical populations were similar enough in terms of setting, intervention, and outcome to allow meta-analysis, the reviewers noted.
"We suggest, however, that targeted interventions using medical imaging technologies may be effective in certain contexts, or as applied to certain behaviors, but that this should be considered on an intervention-by-intervention basis, and not assumed as a general principle," they concluded.
Article written by staff at auntminnie.com and adapted for the purposes of this newsletter.
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