Kyoko Masaki

Calcitriol for bone disease in patients with cirrhosis of the liver

Background : Osteoporosis is associated with cirrhosis of the liver, but the effects of therapy for osteoporosis associated with cirrhosis are still controversial.

Calcitriol for bone loss in patients with primary biliary cirrhosis

Abstract: Because osteoporosis is a common complication of primary biliary cirrhosis, we evaluated the effects of calcitriol (1α, 25-dihydroxyvitamin D3) on bone mineral density in 34 women with primary biliary cirrhosis (stage I disease in 16 patients, stage II in 9, stage III in 4, and stage IV in 5). Patients were assigned randomly to receive calcitriol (0.5 mg twice a day) or not. Bone mineral density of the lumbar vertebrae was measured by dual-energy X-ray absorptiometry at least twice during a period of 12–43 months. The mean annual change in bone mineral density was 0.1% in the treatment group and −3.1% in the control group. The median annual change (with 25th and 75th percentiles) in bone mineral density was 0.3% (−0.5%, 1.9%) in the treated group and −3.1% (−4.1%, −2.1%) in the control group. This difference between the two groups was significant (P = 0.0007, Mann-Whitney U-test). Our findings suggest that calcitriol prevents bone loss and may be an effective treatment for osteoporosis in patients with primary biliary cirrhosis.

Osteopenia in primary biliary cirrhosis and cirrhosis of the liver in women, evaluated by dual-energy X-ray absorptiometry.

To study bone involvement in primary biliary cirrhosis (PBC), we used dual-energy X-ray absorptiometry to measure bone mineral density (BMD) in Japanese women with PBC and with cirhosis of the liver. In both groups, in each decade up to 60 years of age, the mean BMD of the lumbar spine was not significantly different from that in healthy Japanese women; however, in patients aged 60 years or more, the level was significantly lower both in the patients with PBC (P<0.001) and in those with cirrhosis of the liver (P<0.01). Patients with PBC were also examined by single-photon absorptiometry. The BMD of the radius in the patients with PBC was less changed than that of the lumbar vertebrae; thus, the bone changes in PBC seem to be greater in spongy than in cortical bone.

Longitudinal changes of bone mineral content with age in patients with cirrhosis of the liver

Abstract: Bone disorders are associated with cirrhosis. Knowledge of the natural course of bone changes in cirrhosis could help in decision-making about medical treatment. We carried out one measurement of bone mineral density (BMD) in 184 Japanese patients (98 men and 86 women) with cirrhosis by dual-energy X-ray absorptiometry. Differences in BMD values means ± SD between the 98 cirrhotic men and 283 healthy men of the same age reported in another study were not significant. In the 86 cirrhotic women, BMD tended to show a greater decrease with age than in healthy controls reported elsewhere. Differences in BMD values (means ± SD) between 622 healthy women reported elsewhere and our patients were not significant for women up to age 60 years, but at 60 years or more, the mean BMD in cirrhotic women (0.692 ± 0.100) was lower than that in healthy women (0.749 ± 0.101; P < 0.01). In 61 of the 184 patients (31 men and 30 women), the bone mineral content (BMC) of lumbar vertebrae was measured at least twice, at intervals of 10–72 months. In this longitudinal part of the study, the group mean of estimated annual change for cirrhotic men was −0.4%, close to that of healthy men (−0.2%). This mean in cirrhotic women was −2.8%, significantly different from that of healthy women (−1.1%; P < 0.05). As expected, cirrhotic women were the most likely to lose BMC, and many needed prompt treatment.

Two cases of focal nodular hyperplasia of the liver : Value of scintigraphy with Tc-99m GSA and positron emission tomography with FDG

Focal nodular hyperplasia (FNH) of the liver is relatively rare, and can be difficult to differentiate from other benign tumors arising in the liver. We describe a 23-year-old woman and a 25-year-old man with FNH. They were hospitalized for further evaluation of a space-occupying lesion in the liver. Scintigraphy with Tc-99m diethylenetriaminepentaacetic acid galactosyl human serum albumin (Tc-99m GSA) revealed increased radioactivity in the tumor in one patient and radioactivity similar to that in the normal part of liver in the other. F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) showed uptake similar to that of the normal liver in both patients. FNH was diagnosed on the basis of angiographic findings and histological findings in liver biopsy specimens. Our results show that scintigraphy with Tc-99m GSA and FDG-PET may provide information helpful in the diagnosis of FNH.

Diagnosis of chronic liver disease from liver scintiscans by artificial neural networks

Artificial neural networks were used in the diagnosis of chronic liver disease based on liver scintiscanning. One hundred and thirty-seven patients with chronic liver disease (12 with chronic persistent hepatitis, 39 with chronic aggressive hepatitis, and 86 with cirrhosis) and 25 healthy controls were studied. Sixty-five subjects (10 healthy controls, 20 patients with chronic hepatitis, and 35 patients with cirrhosis of the liver) were used in the establishment of a neural network. Liver scintiscans were taken starting 20 min after the intravenous injection of 111 MBq of Tc-99m-phytate. The neural network was used to evaluate five items judged from information on liver scintiscans: the ratio of the sizes of the left and right lobes, splenomegaly, radioactivity in the bone marrow, deformity of the liver and distribution of radioactivity in the liver. The neural network was designed to distinguish between three liver conditions (healthy liver, chronic hepatitis and cirrhosis) on the basis of these five items. The diagnostic accuracy with the neural network was 86% for patients with chronic hepatitis and 93% for patients with cirrhosis. With conventional scoring, the accuracy was 77% for patients with chronic hepatitis and 87% for patients with cirrhosis. Our findings suggest that artificial neural networks may be useful for the diagnosis of chronic liver diseases from liver scintiscans.

Transient liver accumulation of Tc-99m phytate in hepatocellular carcinoma after percutaneous ethanol injection

PURPOSE We report that colloid liver scanning gave early evidence of the return to normal of Kupffer cell functions after ethanol injections into the liver. PATIENT AND METHODS A 71-year-old man with hepatocellular carcinoma received percutaneous ethanol injections twice of 15 mL of ethanol, 1 week apart. RESULTS Abdominal CT after the second injection showed an irregularly shaped low-density area in the left side of the tumor, extending outside the tumor. Liver imaging with To-99m phytate 10 days later showed increased activity at the corresponding site. Thirty days after the second injection, liver imaging did not show high activity. CONCLUSIONS Ethanol that leaked into the normal part of the liver probably temporarily activated Kupffer cell function.

Longitudinal changes with age in bone mineral density of patients with primary biliary cirrhosis

Abstract Bone disorders are associated with primary biliary cirrhosis and cirrhosis of the liver. We used dual-energy X-ray absorptiometry to study bone involvement in primary biliary cirrhosis and in cirrhosis of the liver by measurement of the bone mineral density of lumbar vertebrae in Japanese patients. Some patients were monitored to identify how bone mineral density changed with age, as a first step in the establishment of suitable treatment. The mean bone mineral density of lumbar vertebrae L 2 –L 4 in 150 women (64 with primary biliary cirrhosis and 86 with cirrhosis) was calculated. The bone mineral density of these vertebrae of 61 patients (31 with primary biliary cirrhosis and 30 with cirrhosis) was measured more than once during a period of 8–72 months. In women with primary biliary cirrhosis or cirrhosis of the liver, the bone mineral density tended to decrease with age faster than the reference values published elsewhere. At 50 years or more, the patients with primary biliary cirrhosis had a mean significantly lower than the reference values. At 60 years or more, the cirrhotic patients had a mean significantly lower than the reference value. The mean annual change in the mean bone mineral density was −3.5% in women with primary biliary cirrhosis and −2.4% in women with cirrhosis, significantly different from the reference value (−1.1%). This finding suggests that treatment for prevention of bone loss is needed for older women with primary biliary cirrhosis or cirrhosis of the liver.