Naichaya Chamroonkul

Comparison between Computer Tomography and Magnetic Resonance Imaging in the Diagnosis of Small Hepatocellular Carcinoma

Background: Hepatocellular carcinomas (HCCs) less than 2 cm in diameter generally demonstrate a good outcome after curative therapy. However, the diagnosis of small HCC can be problematic and requires one or more dynamic imaging modalities. This study aimed to compare the sensitivity and agreement between CT and MRI for the diagnosis of small HCCs. Methods: CT and/or MRI scans of HCCs (1-2 cm) diagnosed by histopathology or typical vascular pattern according to the 2005 AASLD criteria were blindly reviewed by an abdominal radiologist. The reports were defined as conclusive/typical when arterial enhancement and washout during the portal/delayed phases were observed and as inconclusive when typical vascular patterns were not observed. The sensitivity and Cohen’s kappa (k) for agreement were calculated. Results: In 27 patients, 27 HCC nodules (1-2 cm) were included. Diagnosis with a single-imaging modality (CT or MRI) was 81 % versus 48 % (p = 0.01). The CT sensitivity was significantly higher than MRI (78 % versus 52 %, p = 0.04). Among 27 nodules that underwent both CT and MRI, a discordance in typical enhancement patterns was found (k = 0.319, p = 0.05). In cases with inconclusive CT results, MRI gave only an additional 3.7 % sensitivity to reach a diagnosis. In contrast, further CT imaging following inconclusive MRI results gave an additional 29.6 % sensitivity. Conclusions: A single typical imaging modality is sufficient to diagnose small HCCs. Compared with MRI, multiphasic CT has a higher sensitivity. The limitations of MRI could be explained by the greater need for patient cooperation and the types of MRI contrast agent.

Association between Specific Single Nucleotide Polymorphisms, Clinical Features and Severe Hepatitis in Dengue Patients

Objective: This study aimed to identify predictors associated with severe hepatitis, especially genetic features, among dengue patients. Material and Methods: One hundred seventy nine dengue patients from the years 2009-2014 were identified from the hospital inpatient database. Their baseline characteristics, laboratory data and hospital course were recorded and analyzed. Seventy five patients had been tested for specific single nucleotide polymorphisms either the Janus kinase 1 (Jak1) or the cluster of differentiation 209 genes. Results: Most of the identified study patients were female (64.8%), 74.3% had elevated liver enzymes, 48.6% of whom showed mild hepatitis. Serum aspartate aminotransferase was predominate over serum alanine aminotransferase (ALT) in most patients. Myalgia was the most common initial presentation (65.4%). Severe hepatitis (ALT ≥10 times the upper limit of normal) was associated with a higher intensive care unit (ICU) admission rate (26.3%) and complications (36.8%). There was significant elevation of liver enzymes among patients with initial platelets <50,000/microliter and albumin <3.5 gram (g)%. An initial serum albumin <3.5 g% had an odds ratio=4.16, 95% confidence interval 1.41-12.27 in association with severe hepatitis. No difference in specific single nucleotide polymorphisms was found between the severe liver involvement group and the mild group. J Health Sci Med Res 2020;38(3):159-175 doi: 10.31584/jhsmr.2020734 www.jhsmr.org Jandee S, et al. Severe Hepatitis in Dengue Patients Journal of Health Science and Medical Research J Health Sci Med Res 2020;38(3):159-175 160 Conclusion: Liver involvement among dengue infection is frequent, mostly manifesting as mild transaminitis. Patients with severe hepatitis usually have poorer clinical outcomes due to complications and often require ICU admission. Initial serum albumin <3.5 g% appears to be a predictor associated with severe hepatitis and bad outcomes. The genetic susceptibility needs more study.