Hiroaki Yoshizumi

Study of portal vein thrombosis in patients with idiopathic portal hypertension in Japan.

Abstract: Background/Aims: The aim of this study was to elucidate the incidence and clinical manifestations of portal vein thrombosis (PVT) in patients with idiopathic portal hypertension (IPH) in Japan during long‐term follow‐up.

How to characterize non‐hypervascular hepatic nodules on contrast‐enhanced computed tomography in chronic liver disease: Feasibility of contrast‐enhanced ultrasound with a microbubble contrast agent

Background and Aim:  Although hypervascular appearance is characteristic in hepatocellular carcinoma (HCC), hepatic nodules without hypervascular appearance are sometimes found in patients with chronic liver disease (CLD). The aim of the present study was to clarify the efficacy of contrast‐enhanced ultrasound (CEUS) with Levovist to characterize small, non‐hypervascular hepatic nodules on contrast‐enhanced computed tomography (CECT) in patients with CLD.

Hemodynamic features of gastrorenal shunt: a Doppler study in cirrhotic patients with gastric fundal varices.

RATIONALE AND OBJECTIVES Little is known about the hemodynamics of gastrorenal shunt (GRS), a major drainage route of gastric fundal varices (FV), in patients with FV. The aim of this study was to clarify the hemodynamic features of GRS on Doppler sonography in relation to the grading and bleeding of FV. MATERIALS AND METHODS The study subjects consisted of 69 cirrhotic patients with FV. Diameter, flow velocity (FVe), and flow volume (FVo) of GRS were measured by Doppler ultrasound (US). The detection rate was compared to contrast-enhanced computed tomography (CECT), and percutaneous transhepatic portography (PTP) was used in six patients without GRS on CECT. RESULTS The use of CECT detected GRS in 60 of 69 patients, and US, 58 of 69 patients. A false-negative result for detecting GRS on both CECT and US was found in one patient after PTP. The diameter, FVe, and FVo of GRS increased according to the endoscopic grade of FV: F1 (7.2+/-1.3 mm, 9.8+/-1.1 cm/s, 358.3+/-123.4 ml/min), F2 (9.9+/-3.3 mm, 12.8+/-5.1 cm/s, 701.7+/-411.3 ml/min), and F3 (11.8+/-2.4 mm, 17.9+/-8.3 cm/s, 1706.6+/-989.5 ml/min). A significant difference was seen between F1 and F3 (diameter, P=.0022; FVe, P=.0133; FVo, P=.0007) and between F2 and F3 (FVe, P=.0112; FVo, P<.0001). FVe of GRS was significantly higher in bleeders (16.7+/-8.1 cm/s) than in nonbleeders (12.2+/-5.4 cm/s, P=.017), whereas the diameter and FVo were not significant. CONCLUSION Hemodynamics of GRS on Doppler sonograms reflected the grading and bleeding of FV. Doppler US may be valuable as a noninvasive method to evaluate the severity of FV.

Pre-treatment hemodynamic features involved with long-term survival of cirrhotic patients after embolization of gastric fundal varices.

PURPOSE To clarify the pre-treatment hemodynamic features involved in the long-term survival of cirrhotic patients with gastric fundal varices (FV) after balloon-occluded retrograde transvenous obliteration (B-RTO). MATERIALS AND METHODS Eighty-one cirrhotic patients with medium- or large-grade FV treated by B-RTO were enrolled in this retrospective study. Pre-treatment flow volume ratio between gastric vein and portal trunk (GP-R) was obtained by Doppler ultrasound. RESULTS The cumulative survival rate was 90% at 1 year, 74.8% at 3 years, 57.2% at 5 years, and 45.8% at 7 years without recurrence in a median period of 1148.5 days The survival was poorer in patients with HCC (47% at 3 years, 9.4% at 5 years, p<0.0001) than without (89.2% at 3 years, 81.9% at 5 years, 67.5% at 7 years), in patients with Child B/C (57.7% at 3 years, 42.1% at 5 years, 28.1% at 7 years, p=0.0016) than with Child A (91.8% at 3 years, 71.5% at 5 years, 62.1% at 7 years), and in patients with GP-R > or = 1.0 (58.9% at 3 years, p=0.0485) than with GP-R<1.0 (76.3% at 3 years, 62% at 5 years, 49.6% at 7 years). Multivariate analysis identified the presence of HCC (hazard ratio, 12.486; 95% CI, 4.08-38.216; p<0.0001), Child B/C (hazard ratio, 3.41; 95% CI, 1.594-7.15; p=0.0051) and GP-R > or = 1.0 (hazard ratio, 2.701; 95% CI, 1.07-6.15; p=0.0221) as independent factors for poor prognosis. CONCLUSION GP-R > r= 1.0 on Doppler ultrasound before B-RTO may be a predictive indicator for poor prognosis in cirrhotic patients with FV after B-RTO, in addition to the presence of HCC and severe liver damage.

Ring-shaped appearance in liver-specific image with Levovist: a characteristic enhancement pattern for hypervascular benign nodule in the liver of heavy drinkers

Abstract: Background/Aims: The aim was to clarify the features of contrast‐enhanced ultrasound (CEUS) with Levovist for diagnosis of hypervascular benign nodules in the liver of heavy drinkers.

Carbon dioxide-based portography: An alternative to conventional imaging with the use of iodinated contrast medium

Background and Aim:  To clarify the efficacy of carbon dioxide (CO2) as a contrast material to evaluate portal vein images by percutaneous transhepatic portography (PTP).

Similarities and differences in the clinical features between cardia varices and esophageal varices.

Little is known about the clinical features of cardia varices (CV). The aim was to examine the background, bleeding risk, and post‐treatment outcomes of CV in patients with portal hypertension.