Tilmann Graeter

Association of adiponectin with hepatic steatosis: a study of 1,349 subjects in a random population sample.

BackgroundObjective of the present study was to examine the association between adiponectin and hepatic steatosis, and other biochemical and anthropometric parameters in healthy subjects.ResultsA total of 1349 subjects (age 18–65 years) underwent ultrasound examination of the liver. Mean adiponectin concentration for the study collective was 11.35 ± 6.28 μg/mL. The following parameters were assessed for their association with adiponectin: body-mass index (BMI); age; sex; arterial blood pressure; nicotine use; alcohol consumption; physical activity; metabolic syndrome; total, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol; triglycerides; aspartate aminotransferase (AST); alanine aminotransferase (ALT); γ-glutamyltransferase (GGT); alkaline phosphatase (AP); C-reactive protein (CRP); insulin sensitivity according to the Homeostasis Model Assessment (HOMA); random blood glucose; and the degree of steatosis of the liver. The numerical differences in the variables influencing adiponectin returned in the descriptive analysis were confirmed at bivariate analysis for BMI, ALT, AST, GGT, AP, total and HDL cholesterol, triglycerides, CRP, arterial blood pressure, metabolic syndrome, nicotine use and alcohol consumption. The logistic regression of the multivariate analysis showed that male sex, hepatic steatosis, BMI, metabolic syndrome, tobacco smoking and CRP correlate negatively with adiponectin, while age, moderate alcohol consumption and HDL cholesterol exhibit a positive association.ConclusionsThe results of the present study confirm the findings of previous research. Adiponectin correlates negatively with cardiometabolic risk factors and is an independent indicator for non-alcoholic fatty liver disease (NAFLD).

Proposal of an ultrasonographic classification for hepatic alveolar echinococcosis: Echinococcosis multilocularis Ulm classification-ultrasound

AIM To establish an ultrasonographic classification based on a large sample of patients with confirmed hepatic alveolar echinococcosis (AE). METHODS Clinical data and ultrasonography (US) findings of 185 patients (100 males; 85 females; mean age at diagnosis: 51.4 ± 17.6 years; mean age at time of US examination: 58.7 ± 18.2 years) were retrospectively reviewed with respect to the US morphology of hepatic AE lesions. The sonomorphological findings were grouped according to a five-part classification scheme. RESULTS Application of the new classification resulted in the following distribution of sonomorphological patterns among the patients examined: hailstorm (54.1%); pseudocystic (13.5%); ossification (13.0%); hemangioma-like (8.1%); and metastasis-like (6.5%). Only 4.9% of lesions could not be assigned to a sonomorphological pattern. CONCLUSION The sonomorphological classification proposed in the present study facilitates the diagnosis, interpretation and comparison of hepatic alveolar echinococcosis in routine practice and in the context of scientific studies.

Diagnostics in cystic echinococcosis: Serology versus ultrasonography

BACKGROUND/AIMS Cystic echinococcosis (CE) is the most widespread zoonosis worldwide. The objective of the present study was to compare diagnostic methods in the work-up of suspected cystic echinococcosis of the liver. MATERIALS AND METHODS Data from a total of 68 patients were compiled and analyzed. RESULTS A diagnosis of cystic echinococcosis was made in 36.8% of patients. Broken down according to WHO criteria, patients with at least one echinococcus cyst were determined in 12.0% of cases to exhibit cysts consistent with stage 1 disease (CE1), while in 24.0%, cysts consistent with CE2 and CE3 were identified. CE4 and CE5 cysts were identified in 32.0% and 8.0% of patients, respectively. Solitary cysts were found in 60.0% of patients with cystic echinococcosis, while in patients with at least one cystic lesion, there were most often multiple cysts. The indirect hemagglutination test (IHA) and echinococcus-specific immunoglobulin E (IgE) concentration showed a higher sensitivity (60.9%, 68.4%) than did the enzyme-linked immunosorbent assay (ELISA) for Echinococcus multilocularis (Em2+) and total IgE (11.1%, 38.9%). The respective specificities of all four serological methods lay between 83.9% and 88.9%. CONCLUSION Our data show that ultrasound remains the diagnostic method of choice in the work-up of cystic lesions of the liver suspected to be due to Echinococcus granulosus. Serological methods can serve an adjunctive role.

Parameters affecting different acoustic radiation force impulse applications in the diagnosis of fibrotic liver changes

AIM To analyze the virtual touch tissue quantification (VTTQ) and virtual touch imaging quantification (VTIQ) techniques, and identify possible factors that may influence VTTQ and VTIQ measurements. METHODS One hundred and eighty-six (104 women/82 men) of 323 subjects met the inclusion criteria (age > 18 years, no history of chronic or gastrointestinal disease, body-mass index (BMI) < 30 kg/m², a fasting period of at least three hours, no history of hepatotoxic pharmaceuticals, alcohol consumption < 24 g/d in men and < 12 g/d in women, and normal findings upon ultrasound examination of the abdomen). Measurements were taken at depths of 50 mm with VTTQ, 15 mm and 25 mm with VTIQ in the right hepatic lobe, and at 15 mm with only VTIQ in the left hepatic lobe. The examiner acquired six measurements per position, thereby giving 24 measurements in total. RESULTS The 95% confidence intervals of mean were 1.23-1.29 m/s for VTTQ and 1.29-1.37 m/s, 1.17-1.23 m/s, and 1.48-1.57 m/s for VTIQ in a depth of 15 mm and 25 mm in the right hepatic lobe and 15 mm in the left hepatic lobe. Only superficial measurements in the right hepatic lobe with the VTIQ method exhibited an effect of age on shear wave velocity. Measurements acquired using the 6C1 probe with the VTTQ method showed no dependence on BMI. By comparison, BMI influenced measurements taken with the VTIQ method using the 9L4 probe in the superficial and deep areas of the right hepatic lobe, as well as in the left hepatic lobe (P = 0.0160, P = 0.0019, P = 0.0173, respectively). Gender influenced measurements at depths of 50 mm with VTTQ and 25 mm with VTIQ in the right hepatic lobe (P = 0.0001, P = 0.0269). Significant differences were found between measurements with the 6C1 (VTTQ) and 9L4 probes (VTIQ) (P = 0.0067), between superficial and deep measurements (P < 0.0001), and between the right and left lobes of the liver (P < 0.0001). CONCLUSION Measurements in the right lobe and deep regions are preferable. Gender differences must be considered. BMI must be considered when assessing VTIQ technology.

Thyroid dysfunction and hepatic steatosis in overweight children and adolescents

Overt or subclinical hypothyroidism is a common finding in adult populations affected by non‐alcoholic fatty liver disease (NAFLD). Currently, there are only sparse data available on the association of thyroid dysfunction and NAFLD in obese children and adolescents.

Assessment of liver size by ultrasonography

To determine liver span sonographically in a randomly selected population sample and identify factors that affect liver size.

Acoustic radiation force imaging of the thyroid—generation of reference values by Virtual Touch Imaging and Quantification

OBJECTIVES To investigate potential subject-related confounding factors for thyroid acoustic radiation force impulse (ARFI) elastography. METHODS AND MATERIALS A total of 194 subjects participated in the study. RESULTS The standard values in the right lobe were 2.52±0.35m/s (ventral half) and 2.43±0.40m/s (dorsal half). In the left lobe, velocities of 2.56±0.37m/s (ventral) and 2.48±0.42m/s (dorsal) were noted. A clear difference was observed between measurement values in the ventral and dorsal half (P<.0001). By contrast, none of the other factors exerted any effect on the measurements. CONCLUSIONS ARFI-Virtual Touch Imaging and Quantification appears to be a suitable and relatively robust method for examining the thyroid gland.

Algorithm guided outlining of 105 pancreatic cancer liver metastases in Ultrasound

Manual segmentation of hepatic metastases in ultrasound images acquired from patients suffering from pancreatic cancer is common practice. Semiautomatic measurements promising assistance in this process are often assessed using a small number of lesions performed by examiners who already know the algorithm. In this work, we present the application of an algorithm for the segmentation of liver metastases due to pancreatic cancer using a set of 105 different images of metastases. The algorithm and the two examiners had never assessed the images before. The examiners first performed a manual segmentation and, after five weeks, a semiautomatic segmentation using the algorithm. They were satisfied in up to 90% of the cases with the semiautomatic segmentation results. Using the algorithm was significantly faster and resulted in a median Dice similarity score of over 80%. Estimation of the inter-operator variability by using the intra class correlation coefficient was good with 0.8. In conclusion, the algorithm facilitates fast and accurate segmentation of liver metastases, comparable to the current gold standard of manual segmentation.

Evaluation of the Value of Contrast-Enhanced Ultrasound (CEUS) within Radiology Departments in Germany

Purpose Contrast-enhanced ultrasound (CEUS) has been established for many years and has become an increasingly important cornerstone of the diagnostic imaging of various organ systems. However, this modality is rarely performed by radiologists and is primarily employed by other medical disciplines. The goal of this questionnaire study is to present the current value of CEUS in radiology and to encourage reevaluation of the method within this medical discipline. Materials and Methods 560 directors of radiology departments throughout Germany were contacted and given a 3-page questionnaire. The questionnaire included 37 questions on 5 different topics (general structures, CEUS and interdisciplinarity, CEUS in pediatric radiology, education/professional development, outlook) to assess the value of ultrasound (US) and in particular CEUS in radiology. Results The response rate was 42.3 %. A statistical analysis of the answers was performed, including subgroup analysis. Overall, it could be shown that CEUS is performed in comparatively few radiology departments (26.6 %), while the current value of the modality is given an average to high range of importance even by radiologists. More than half of all participating radiologists (54.9 %) would like this method to be included in the requirements catalog for the specialist examination. Conclusion The nationwide questionnaire to evaluate CEUS within radiology departments in Germany had a very high response rate, which reflects the assessment of this topic by radiologists. There is a substantial discrepancy between the currently low utilization of CEUS in radiology and the high ranking of CEUS by many radiologists. The analyses of the replies point out important aspects of professional policy regarding this topic within the radiology community. Key points  · The high response rate reflects the assessment of this topic by radiologists.. · The questionnaire study depicts the currently low use of CEUS in radiology.. · CEUS is given a high range of importance by radiologists.. Citation Format · Graeter T, Kratzer W, Seufferlein T et al. Evaluation of the Value of Contrast-Enhanced Ultrasound (CEUS) within Radiology Departments in Germany. Fortschr Röntgenstr 2017; 189: 748 - 759.