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Presence of minimal perihepatic fluid in magnetic resonance cholangiopancreatography as a marker of liver function test impairment

Yıl 2021, Cilt: 20 Sayı: 1, 13 - 18, 14.05.2021
https://doi.org/10.17941/agd.927772

Öz

Background and Aims: Perihepatic fluid caused by liver and non-liver pathologies can be observed through imaging. This condition is not specific to a particular pathology and can occur with different mechanisms. This study aimed to investigate the relationship between the presence of minimal perihepatic fluid in magnetic resonance cholangiopancreatography and liver function tests and biliary obstruction, which is one of the etiological factors that can be detected through magnetic resonance cholangiopancreatography. Materials and Methods: Patients who underwent magnetic resonance cholangiopancreatography in the department of radiology in our hospital in 2017 were retrospectively screened. Sixty-two patients with minimal peripheral fluid were included in the study group, and randomly selected 62 patients without perihepatic fluid were included in the control group. Liver function tests (aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase, lactate dehydrogenase, total/direct/indirect bilirubin) of the patient and control groups were compared. Perihepatic fluid thickness, distribution pattern, localization according to liver lobes, presence and degree of intrahepatic bile duct dilatation, and presence of choledocholitiasis, periportal edema, perisplenic fluid were recorded, and the relationship with perihepatic fluid was evaluated. Results: All laboratory values except lactate dehydrogenase were significantly higher in the patient group than in the control group (p = 0.131 and p ≤ 0.011, respectively). The number of patients with higher laboratory values was higher in the patient group than in the control group (p ≤ 0.037). The difference between the two groups as regards intrahepatic bile duct dilatation and presence of perisplenic fluid was significant (p = 0.01 and p < 0.001, respectively). Alkaline phosphatase values correlated with the degree of intrahepatic bile duct dilatation (r = 0.349, p = 0.05). Conclusions: The presence of minimal fluid around the liver detected by magnetic resonance cholangiopancreatography may indicate impairment in liver function tests and should alert clinicians of pathologies that can cause cholestasis.

Kaynakça

  • 1- Lee JW, Kim S, Kwack SW, et al. Hepatic capsular and subcapsular pathologic conditions: demonstration with CT and MR imaging. Radiographics 2008;28:1307-23.
  • 2- Kim S, Kim TU, Lee JW, et al. The perihepatic space: comprehensive anatomy and CT features of pathologic conditions. Radiographics 2007;27:129-43.
  • 3- Brink JA, Wagner BJ. Pathways for the Spread of Disease in the Abdomen and Pelvis. In: Hodler J, Kubik-Huch RA, von Schulthess GK, editors. Diseases of the Abdomen and Pelvis 2018-2021: Diagnostic Imaging - IDKD Book. Cham (CH): Springer; 2018. Chapter 6.
  • 4- Barrowman JA. Hepatic lymph and lymphatics. In: McIntyre N, Benhamou JP, Bircher J, Rizzetto M, Eds. Oxford Textbook of Clinical Hepatology. Oxford University Press, New York, 1991 (p.37-40).
  • 5- Trutmann M, Sasse M. The lymphatics of the liver. Anat Embryol 1994;190:201-9.
  • 6- Ohtani O, Ohtani Y. Lymph circulation in the liver. Anat Rec (Hoboken) 2008;291:643-52.
  • 7- Popper H, Schaffner F. Liver structure and function. New York: McGraw-Hill 1957.
  • 8- Ohtani Y, Wang BJ, Poonkhum R, Ohtani O. Pathways for movement of fluid and cells from hepatic sinusoids to the portal lymphatic vessels and subcapsular region in rat livers. Arch Histol Cytol 2003;66:239-52.
  • 9- Rosa G, Segato G, Mantovani-Orsetti G, et al. The lymphatic system of the liver in the physiopathology of experimental acute cholestasis. VII. Cholesterol. Acta Chir Ital 1966;22(Suppl 2):295-302.
  • 10- Alıcan F, Hardy JD. Lymphatic transport of bile pigments and alkaline phosphatase in experimental common duct obstruction. Surgery 1962;52:366-72.
  • 11- Cameron GR, Muzaffar HS. Disturbances of structure and function in the liver as the result of biliary obstruction. J Pathol Bacteriol 1958;75:333-49.
  • 12- Giannini EG, Testa R, Savarino V. Liver enzyme alteration: a guide for clinicians. CMAJ 2005;172:367-79.
  • 13- Erden A, Orgodol H, Savran B, Erden İ. Karaciğer enzim düzeyleri ile perihepatik sıvı prevelansı arasındaki ilişkinin değerlendirilmesi. 30. Ulusal Radyoloji Kongresi, TURKRAD 2009, 4-9 Kasım, Antalya.
  • 14- Rappaport AM. Diseases of the Liver. In: Schiff L Eds. Anatomic considerations. 2nd Edition, Lippincott Company-Asian Edition Hakko Co. Ltd., Philadelphia, 1-46.
  • 15- Collins JD, Disher AC, Shaver ML, Miller TQ. Imaging the hepatic lymphatics: experimental studies in swine. J Natl Med Assoc 1993;85:185-91.
  • 16- Deimer EE. Lymphatic anatomy. In; Clinical radiology of the liver, p. 55. Edited by H. Herlinger H, Lunderquist A, Wallace S. Marcel Dekker, New York, 1983.
  • 17- Ohtani O, Murakami T. Peribiliary portal system in the rat liver as studied by the injection replica scanning electron microscopic method. Scanning Microsc 1978: 241-4.
  • 18- Barrowman JA, Granger DN. Effects of experimental cirrhosis on splanchnic microvascular fluid and solute exchange in the rat. Gastroenterology 1984;87:165-72.
  • 19- Arrivé L, Derhy S, Dlimi C, et al. Noncontrast magnetic resonance lymphography for evaluation of lymph node transfer for secondary upper limb lymphedema. Plast Reconstr Surg 2017;140:806e-11e.
  • 20- Koslin DB, Stanley RJ, Berland LL, et al. Hepatic perivascular lymphedema: CT appearance. AJR Am J Roentgenol 1988;150:111-3.
  • 21- Chen CJ, Chang WH, Shih SC, et al. Clinical presentation and outcome of hepatic subcapsular fluid collections. J Formos Med Assoc 2009;108:61-8.

Karaciğer fonksiyon testleri bozukluğu göstergesi olarak Manyetik Rezonans Kolanjiyopankreatografide minimal perihepatik sıvı varlığı

Yıl 2021, Cilt: 20 Sayı: 1, 13 - 18, 14.05.2021
https://doi.org/10.17941/agd.927772

Öz

Giriş ve Amaç: Karaciğer ve karaciğer dışı patolojilere bağlı görüntülemede perihepatik alanda sıvı görülebilmektedir. Belirli bir patolojiye spesifik olmayan bu durum değişik mekanizmalar ile oluşabilmektedir. Bu çalışmanın amacı manyetik rezonans kolanjiyopankreatografide minimal perihepatik sıvı varlığı ile karaciğer fonksiyon testleri ve manyetik rezonans kolanjiyopankreatografide ortaya koyulabilecek etiyolojik faktörlerden olan biliyer obstrüksiyon ile arasındaki ilişkiyi araştırmaktır. Gereç ve Yöntem: Hastanemiz Radyoloji bölümünde 2017 yılında manyetik rezonans kolanjiyopankreatografi yapılan hastalar retrospektif olarak tarandı. Minimal perihepatik sıvısı olan 62 hasta çalışma grubuna, perihepatik sıvısı olmayan ve rastgele seçilen 62 hasta kontrol grubuna dahil edildi. Hasta ve kontrol grubuna ait karaciğer fonksiyon testleri (aspartat aminotransferaz, alanin aminotransferaz, alkalen fosfataz, gama-glutamil transpeptidaz, laktat dehidrogenaz, total/direkt/indirekt bilirübin) karşılaştırıldı. Perihepatik sıvı kalınlığı, dağılım paterni, karaciğer loblarına göre lokalizasyonu, intrahepatik safra kanallarında genişleme varlığı ve derecesi, koledok taşı, periportal ödem, perisplenik sıvı varlığı kaydedildi ve perihepatik sıvı ile arasındaki ilişki değerlendirildi. Bulgular: Perihepatik sıvısı olan hasta grubunda laktat dehidrogenaz dışında tüm laboratuvar değerleri kontrol grubuna göre anlamlı olarak yüksekti (p = 0.131 ve p ≤ 0.011, sırasıyla) ve perihepatik sıvısı olan grupta kontrol grubuna göre daha fazla hastada laboratuvar değerlerinde yükseklik saptandı (p ≤ 0.037). İntrahepatik safra kanallarında genişleme ve perisplenik sıvı varlığı açısından iki grup arasındaki fark istatistiksel olarak anlamlı idi (p = 0.01 ve p < 0.001, sırasıyla). Alkalen fosfataz değerleri ile intrahepatik safra kanalları genişleme derecesi korelasyon göstermekteydi (r = 0.349, p = 0.05). Sonuç: Manyetik rezonans kolanjiyopankreatografide karaciğer çevresinde minimal düzeyde sıvı varlığı karaciğer fonksiyon testlerinde bozukluğa işaret edebilir ve kolestaza neden olabilecek patolojiler açısından uyarıcı olmalıdır.

Kaynakça

  • 1- Lee JW, Kim S, Kwack SW, et al. Hepatic capsular and subcapsular pathologic conditions: demonstration with CT and MR imaging. Radiographics 2008;28:1307-23.
  • 2- Kim S, Kim TU, Lee JW, et al. The perihepatic space: comprehensive anatomy and CT features of pathologic conditions. Radiographics 2007;27:129-43.
  • 3- Brink JA, Wagner BJ. Pathways for the Spread of Disease in the Abdomen and Pelvis. In: Hodler J, Kubik-Huch RA, von Schulthess GK, editors. Diseases of the Abdomen and Pelvis 2018-2021: Diagnostic Imaging - IDKD Book. Cham (CH): Springer; 2018. Chapter 6.
  • 4- Barrowman JA. Hepatic lymph and lymphatics. In: McIntyre N, Benhamou JP, Bircher J, Rizzetto M, Eds. Oxford Textbook of Clinical Hepatology. Oxford University Press, New York, 1991 (p.37-40).
  • 5- Trutmann M, Sasse M. The lymphatics of the liver. Anat Embryol 1994;190:201-9.
  • 6- Ohtani O, Ohtani Y. Lymph circulation in the liver. Anat Rec (Hoboken) 2008;291:643-52.
  • 7- Popper H, Schaffner F. Liver structure and function. New York: McGraw-Hill 1957.
  • 8- Ohtani Y, Wang BJ, Poonkhum R, Ohtani O. Pathways for movement of fluid and cells from hepatic sinusoids to the portal lymphatic vessels and subcapsular region in rat livers. Arch Histol Cytol 2003;66:239-52.
  • 9- Rosa G, Segato G, Mantovani-Orsetti G, et al. The lymphatic system of the liver in the physiopathology of experimental acute cholestasis. VII. Cholesterol. Acta Chir Ital 1966;22(Suppl 2):295-302.
  • 10- Alıcan F, Hardy JD. Lymphatic transport of bile pigments and alkaline phosphatase in experimental common duct obstruction. Surgery 1962;52:366-72.
  • 11- Cameron GR, Muzaffar HS. Disturbances of structure and function in the liver as the result of biliary obstruction. J Pathol Bacteriol 1958;75:333-49.
  • 12- Giannini EG, Testa R, Savarino V. Liver enzyme alteration: a guide for clinicians. CMAJ 2005;172:367-79.
  • 13- Erden A, Orgodol H, Savran B, Erden İ. Karaciğer enzim düzeyleri ile perihepatik sıvı prevelansı arasındaki ilişkinin değerlendirilmesi. 30. Ulusal Radyoloji Kongresi, TURKRAD 2009, 4-9 Kasım, Antalya.
  • 14- Rappaport AM. Diseases of the Liver. In: Schiff L Eds. Anatomic considerations. 2nd Edition, Lippincott Company-Asian Edition Hakko Co. Ltd., Philadelphia, 1-46.
  • 15- Collins JD, Disher AC, Shaver ML, Miller TQ. Imaging the hepatic lymphatics: experimental studies in swine. J Natl Med Assoc 1993;85:185-91.
  • 16- Deimer EE. Lymphatic anatomy. In; Clinical radiology of the liver, p. 55. Edited by H. Herlinger H, Lunderquist A, Wallace S. Marcel Dekker, New York, 1983.
  • 17- Ohtani O, Murakami T. Peribiliary portal system in the rat liver as studied by the injection replica scanning electron microscopic method. Scanning Microsc 1978: 241-4.
  • 18- Barrowman JA, Granger DN. Effects of experimental cirrhosis on splanchnic microvascular fluid and solute exchange in the rat. Gastroenterology 1984;87:165-72.
  • 19- Arrivé L, Derhy S, Dlimi C, et al. Noncontrast magnetic resonance lymphography for evaluation of lymph node transfer for secondary upper limb lymphedema. Plast Reconstr Surg 2017;140:806e-11e.
  • 20- Koslin DB, Stanley RJ, Berland LL, et al. Hepatic perivascular lymphedema: CT appearance. AJR Am J Roentgenol 1988;150:111-3.
  • 21- Chen CJ, Chang WH, Shih SC, et al. Clinical presentation and outcome of hepatic subcapsular fluid collections. J Formos Med Assoc 2009;108:61-8.
Toplam 21 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Makaleler
Yazarlar

Diğdem Öz Bu kişi benim 0000-0001-8873-3476

Elif Peker Bu kişi benim 0000-0003-3585-6848

İlknur Can Bu kişi benim 0000-0002-5904-2980

Gül Erden Bu kişi benim 0000-0002-9518-5428

İlhan Erden Bu kişi benim 0000-0002-6274-3841

Yayımlanma Tarihi 14 Mayıs 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 20 Sayı: 1

Kaynak Göster

APA Öz, D., Peker, E., Can, İ., Erden, G., vd. (2021). Karaciğer fonksiyon testleri bozukluğu göstergesi olarak Manyetik Rezonans Kolanjiyopankreatografide minimal perihepatik sıvı varlığı. Akademik Gastroenteroloji Dergisi, 20(1), 13-18. https://doi.org/10.17941/agd.927772

test-5