The Fourth Department of Internal Medicine, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
Hepatol Res. 2005 Oct;33(2):97-9. doi: 10.1016/j.hepres.2005.09.013. Epub 2005 Oct 10.
Non alcoholic steatohepatitis (NASH) is one of the representative liver diseases in the developed countries. Diagnosis of NASH is dependent on histological findings from liver biopsy. Usefulness of contrast ultrasound with Levovist for diagnosis of NASH is described.
Clinical study: Ultrasound contrast agent, Levovist of 2.5g was injected intravenously. The liver was scanned at 5, 10, 15, 20, 30, 40, and 50min after Levovist injection in different planes using a contrast specific ultrasound mode. Changes in microbubble accumulation in the liver were evaluated. The signal intensity from regions of interest (ROI) on the contrast images was measured and accumulation and decrescence of microbubbles were estimated using the time intensity curves (TICs). The image data and TICs were evaluated by blind reviewers. Fifteen patients with NASH, 8 with alcoholic steatohepatitis (ASH), 45 with non alcoholic fatty liver (NAFL), 10 with chronic hepatitis C (CHC) and 10 healthy volunteers were studied. Animal study: Methionine-choline-deficient diet (MCDD) fed rats were used for NASH model. Correlation between microbubble accumulation and morphological and functional changes of sinusoidal endothelium and macrophage was evaluated.
The maximum intensity of contrast ultrasound was decreased and time course decrescence was more rapid in NASH than the other groups. These changes were correlated to the degree of centrilobular and pericellular fibrosis but not to steatosis in histological study. Disturbance of microbubble accumulation was correlated with sinusoidal function rather than morphological changes such as fibrosis and parenchymatitis in the animal studies.
The Levovist contrast study enables differential diagnosis between NASH and other diseases that provoke steatosis and fibrosis.
非酒精性脂肪性肝炎（NASH）是发达国家代表性的肝脏疾病之一。NASH 的诊断依赖于肝活检的组织学发现。本文描述了超声造影剂 Levovist 对 NASH 诊断的应用价值。
临床研究：静脉注射 2.5g 超声造影剂 Levovist。在不同切面，采用对比专用超声模式，于注射后 5、10、15、20、30、40 和 50min 对肝脏进行扫描。评估肝脏中微泡积聚的变化。在对比图像上测量感兴趣区域（ROI）的信号强度，并使用时间强度曲线（TIC）估计微泡的积聚和消散。盲法评估员对图像数据和 TIC 进行评估。共研究了 15 例 NASH 患者、8 例酒精性脂肪性肝炎（ASH）患者、45 例非酒精性脂肪肝（NAFL）患者、10 例慢性丙型肝炎（CHC）患者和 10 名健康志愿者。动物研究：使用蛋氨酸-胆碱缺乏饮食（MCDD）喂养大鼠作为 NASH 模型。评估微泡积聚与窦状内皮细胞和巨噬细胞的形态和功能变化之间的相关性。
与其他组相比，NASH 患者的超声造影最大强度降低，时间过程衰减更快。这些变化与小叶中心和细胞周纤维化的程度相关，但与组织学研究中的脂肪变性无关。在动物研究中，微泡积聚的紊乱与窦状功能障碍相关，而与纤维化和实质炎等形态变化无关。
Levovist 对比研究有助于鉴别 NASH 与其他引起脂肪变性和纤维化的疾病。
