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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Kwo PY, Cohen SM, Lim JK. ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. Am J Gastroenterol. 2017;112(1):18-35. Review/Other-Dx N/A To assist gastroenterologists and primary care providers in the interpretation of normal and abnormal liver chemistries as well as an approach to prioritize and evaluate those who present with abnormal liver chemistries. No results stated in abstract. 4
2. Neuschwander-Tetri BA, Unalp A, Creer MH, Nonalcoholic Steatohepatitis Clinical Research N. Influence of local reference populations on upper limits of normal for serum alanine aminotransferase levels. Arch Intern Med 2008;168:663-6. Review/Other-Dx N/A To establish the causes of the variability in laboratory-defined ULN using results of analyses of samples distributed to clinicallaboratories as part of annual accreditation by the College of American Pathologists (CAP). No results stated in abstract. 4
3. Pettersson J, Hindorf U, Persson P, et al. Muscular exercise can cause highly pathological liver function tests in healthy men. Br J Clin Pharmacol 2008;65:253-9. Observational-Dx 15 patients To investigate the effect of intensive muscular exercise (weightlifting) on clinical chemistry parameters reflecting liver function in healthy men. Five out of eight studied clinical chemistry parameters (AST, ALT, LD, CK and myoglobin) increased significantly after exercise (P < 0.01) and remained increased for at least 7 days postexercise. Bilirubin, gamma GT and ALP remained within the normal range. 4
4. Arshad T, Golabi P, Henry L, Younossi ZM. Epidemiology of Non-alcoholic Fatty Liver Disease in North America. Curr Pharm Des 2020;26:993-97. Review/Other-Dx N/A To discuss the epidemiology of the non-alcoholic fatty liver disease in North America. No results stated in abstract. 4
5. Cotter TG, Rinella M. Nonalcoholic Fatty Liver Disease 2020: The State of the Disease. Gastroenterology 2020;158:1851-64. Review/Other-Dx N/A To provide an update on the epidemiology, clinical and prognostic features, and diagnostic approach to patients with NAFLD. No results stated in abstract. 4
6. Chen CL, Cheng YF, Yu CY, et al. Living donor liver transplantation: the Asian perspective. Transplantation 2014;97 Suppl 8:S3. Review/Other-Dx N/A To review a case of a living liver donor transplantation. No results stated in abstract. 4
7. Singh D, Das CJ, Baruah MP. Imaging of non alcoholic fatty liver disease: A road less travelled. Indian J Endocrinol Metab 2013;17:990-5. Review/Other-Dx N/A To review the imaging of non alcoholic fatty liver disease. No results stated in abstract. 4
8. Hernaez R, Lazo M, Bonekamp S, et al. Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta-analysis. Hepatology 2011;54:1082-90. Meta-analysis 49 studies To perform a systematic review and meta-analysis of the diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver. The overall sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of ultrasound for the detection of moderate-severe fatty liver, compared to histology (gold standard), were 84.8% (95% confidence interval: 79.5-88.9), 93.6% (87.2-97.0), 13.3 (6.4-27.6), and 0.16 (0.12-0.22), respectively. The area under the summary receiving operating characteristics curve was 0.93 (0.91-0.95). Reliability of ultrasound for the detection of fatty liver showed kappa statistics ranging from 0.54 to 0.92 for intrarater reliability and from 0.44 to 1.00 for interrater reliability. Sensitivity and specificity of ultrasound was similar to that of other imaging techniques (i.e., computed tomography or magnetic resonance imaging). Statistical heterogeneity was present even after stratification for multiple clinically relevant characteristics. Good
9. Saadeh S, Younossi ZM, Remer EM, et al. The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterology 2002;123:745-50. Observational-Dx N/A To evaluate the role of radiological modalities in establishing the diagnosis of nonalcoholic steatohepatitis (NASH). Patients with NASH had greater aspartate aminotransferase levels (P = 0.03), greater ferritin levels (P = 0.05), more hepatocyte ballooning (P < 0.0001), and more fibrosis (P = 0.002). None of the radiological features distinguished between NASH and other types of NAFLD. No radiological modality detected the presence of hepatocyte ballooning, Mallory's hyaline, or fibrosis, which are important features in the diagnosis of NASH. The presence of >33% fat on liver biopsy was optimal for detecting steatosis on radiological imaging. 3
10. Lee SS, Park SH, Kim HJ, et al. Non-invasive assessment of hepatic steatosis: prospective comparison of the accuracy of imaging examinations. J Hepatol 2010;52:579-85. Observational-Dx 161 patients To prospectively compare the accuracy of computed tomography (CT), dual gradient echo magnetic resonance imaging (DGE-MRI), proton magnetic resonance spectroscopy ((1)H-MRS), and ultrasonography (US) for the diagnosis and quantitative estimation of HS. DGE-MRI and (1)H-MRS significantly outperformed CT and US for the diagnosis of HS5%. DGE-MRI showed a tendency of higher accuracy than the other examinations for diagnosing HS >or= 30%. The cross-validated sensitivity and specificity of DGE-MRI at the optimal cut-off were 76.7% and 87.1%, respectively, for diagnosing HS >or= 5% and 90.9% and 94%, respectively, for diagnosing HS >or= 30%. The cross-validated Bland-Altman 95% limits of agreement between the estimated degree of HS on imaging examinations and the histologic degree of HS, were the narrowest with DGE-MRI, yielding -12.7% to 12.7%. 3
11. van Werven JR, Marsman HA, Nederveen AJ, et al. Assessment of hepatic steatosis in patients undergoing liver resection: comparison of US, CT, T1-weighted dual-echo MR imaging, and point-resolved 1H MR spectroscopy. Radiology 2010;256:159-68. Observational-Dx 46 patients To compare the diagnostic performance of ultrasonography (US), computed tomography (CT), T1-weighted dual-echo magnetic resonance (MR) imaging, and point-resolved proton (hydrogen 1[(1)H]) MR spectroscopy in the assessment of hepatic steatosis in patients undergoing liver resection. At histopathologic examination, 23 patients had no (0%-5%) macrovesicular steatosis, 11 had mild (5%-33%), nine had moderate (33%-66%), and three had severe (>66%). MR imaging and (1)H MR spectroscopic measurements of hepatic fat had stronger correlation with histopathologic steatosis assessment (r = 0.85, P < .001 and r = 0.86, P < .001, respectively) than did US (r = 0.66, P < .001) and CT (r = -0.55, P < .001). Only T1-weighted MR imaging and (1)H MR spectroscopy showed differences across steatosis grades: none versus mild (P = .001 for both), mild versus moderate (P < .001 for both), and moderate versus severe (P = .04 and .01, respectively). Sensitivity of US, CT, T1-weighted MR imaging, and (1)H MR spectroscopy was 65% (13 of 20), 74% (17 of 23), 90% (19 of 21), and 91% (21 of 23), respectively, and specificity was 77% (17 of 23), 70% (14 of 20), 91% (20 of 22), and 87% (20 of 23), respectively. 2
12. Walas MK, Skoczylas K, Gierblinski I. Standards of the Polish Ultrasound Society - update. The liver, gallbladder and bile ducts examinations. J Ultrason 2012;12:428-45. Review/Other-Dx N/A To present a recommended liver, gallbladder and bile ducts ultrasound technique which indicates an optimal positioning of the patient for the exam as well as the sites of the ultrasound transducer application. No results stated in abstract. 4
13. Mancini M, Prinster A, Annuzzi G, et al. Sonographic hepatic-renal ratio as indicator of hepatic steatosis: comparison with (1)H magnetic resonance spectroscopy. Metabolism 2009;58:1724-30. Review/Other-Dx N/A To determine the diagnostic performance of ultrasound (US) in the quantitative assessment of steatosis by comparison with proton magnetic resonance spectroscopy ((1)H-MRS) as a reference standard. The hepatic fat content by (1)H-MRS analysis ranged from 0.10% to 28.9% (median value, 4.8%). Ultrasound H/R was correlated with the degree of steatosis on (1)H-MRS (R(2)= 0.92; P < .0001), whereas no correlation with (1)H-MRS was found for hepatic mean gray level and hepatic-portal blood echo-intensity ratio. A receiver operating characteristic curve identified the H/R of 2.2 as the best cutoff point for the prediction of (1)H-MRS of at least 5%, yielding measures of sensitivity and specificity of 100% and 95%, respectively. 4
14. Webb M, Yeshua H, Zelber-Sagi S, et al. Diagnostic value of a computerized hepatorenal index for sonographic quantification of liver steatosis. AJR Am J Roentgenol 2009;192:909-14. Observational-Dx 111 patients To assess sonography as an objective tool for the quantification of liver steatosis. A significant correlation was found between histologic steatosis and the hepatorenal sonographic index (r = 0.82, p < 0.001). The validity of the hepatorenal sonographic index for the diagnosis of fatty liver was compared with liver biopsies with a steatosis level > 5%. The area under the receiver operating characteristic curve was 99.2% (95% CI, 98-100%). The optimal hepatorenal sonographic index cutoff point for the prediction of steatosis > 5% was 1.49, with sensitivity of 100% and specificity of 91%. The optimal hepatorenal sonographic index cutoff point for the prediction of steatosis >/= 25% was 1.86, with sensitivity of 90% and specificity of 90%. The optimal hepatorenal sonographic index cutoff point for the prediction of steatosis >/= 60% was 2.23, with sensitivity of 90% and specificity of 93%. 4
15. Cocciolillo S, Parruti G, Marzio L. CEUS and Fibroscan in non-alcoholic fatty liver disease and non-alcoholic steatohepatitis. World J Hepatol 2014;6:496-503. Observational-Dx 48 patients To determine intra-hepatic blood flow and liver stiffness in patients with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) using contrast-enhanced ultrasound and fibroscan. In the PV, the Peak%, RBV and RBF were significantly reduced in the NAFLD and NASH patients compared with the controls (Peak%: NAFLD 26.3 +/- 6.6, NASH 28.1 +/- 7.3 vs controls 55.8 +/- 9.9, P < 0.001; RBV: NAFLD 4202.3 +/- 3519.7, NASH 3929.8 +/- 1941.3 vs controls 7473 +/- 3281, P < 0.01; RBF: NAFLD 32.5 +/- 10.8, NASH 32.7 +/- 12.1 vs controls 73.1 +/- 13.9, P < 0.001). The TTP in the PV was longer in both patient groups but reached statistical significance only in the NASH patients compared with the controls (NASH 79.5 +/- 37.8 vs controls 43.2 +/- 30, P < 0.01). In the LP, the Peak%, RBV and RBF were significantly reduced in the NAFLD and NASH patients compared with the controls (Peak%: NAFLD 43.2 +/- 7.3, NASH 41.7 +/- 7.7 vs controls 56.6 +/- 6.3, P < 0.001; RBV: NAFLD 4851.5 +/- 2009, NASH 5069.4 +/- 2292.5 vs controls 6922.9 +/- 2461.5, P < 0.05; RBF: NAFLD 55.7 +/- 10.1, NASH 54.5 +/- 12.1 vs controls 75.9 +/- 10.5, P < 0.001). The TTP was longer in both patient groups but did not reach statistical significance. The MTT in both the PV and LP in the NAFLD and NASH patients was not different from that in the controls. Liver stiffness was significantly increased relative to the controls only in the NASH patients (NASH: 6.4 +/- 2.2 vs controls 4.6 +/- 1.5, P < 0.05). 3
16. Dietrich CF, Lee JH, Gottschalk R, et al. Hepatic and portal vein flow pattern in correlation with intrahepatic fat deposition and liver histology in patients with chronic hepatitis C. AJR Am J Roentgenol 1998;171:437-43. Observational-Dx 135 patients To determine the dependence of the flow pattern of hepatic and portal veins in relation to histologic features in patients with chronic hepatitis C. The hepatocyte fat content was the only variable associated with an independent effect on the type of flow pattern (monophasic versus triphasic; odds ratio, 16.26; 95% confidence interval, 6.38-41.45; p < .0001). A pronounced undulation in the portal vein was associated with portal inflammation but not with other parameters of the histologic activity index or the intrahepatic fat deposition. 3
17. Tarzamni MK, Khoshbaten M, Sadrarhami S, et al. Hepatic Artery and Portal Vein Doppler Indexes in Non-alcoholic Fatty Liver Disease Before and After Treatment to Prevent Unnecessary Health Care Costs. Int J Prev Med 2014;5:472-7. Observational-Dx 48 patients To test whether hepatic haemodynamics assessed by Doppler ultrasonography can be a predictor of response to therapy in patients with non-alcoholic fatty liver disease (NAFLD) to prevent further unnecessary diagnostic tests and interventions. Forty eight subjects with NAFLD were included in the study during 21 months, out of which 22 (39.1% male - mean age: 37.6 +/- 8.3) responded to the treatment and formed the basis of this study. Mean hepatic artery RI increased significantly from 0.60 +/- 0.07 to 0.83 +/- 0.27before and after treatment, however, there was no significant differences between hepatic artery PI or PVW. 4
18. Shi KQ, Tang JZ, Zhu XL, et al. Controlled attenuation parameter for the detection of steatosis severity in chronic liver disease: a meta-analysis of diagnostic accuracy. J Gastroenterol Hepatol 2014;29:1149-58. Meta-analysis 9 studies To assess the performance of CAP. The summary sensitivities and specificities values were 0.78 (95% confidence interval [CI], 0.69-0.84) and 0.79 (95% CI, 0.68-0.86) for >/= S1, 0.85 (95% CI, 0.74-0.92) and 0.79 (95% CI, 0.71-0.85) for >/= S2, and 0.83 (95% CI, 0.76-0.89) and 0.79 (95% CI, 0.68-0.87) for >/= S3. The HSROCs were 0.85 (95% CI, 0.81-88) for >/= S1, 0.88 (95% CI, 0.85-0.91) for >/= S2, and 0.87 (95% CI, 0.84-0.90) for >/= S3. Following a "positive" measurement (over the threshold value) for >/= S1, >/= S2, and >/= S3, the corresponding post-test probabilities for the presence of steatosis (pretest probability was 50%) were 78%, 80% and 80%, respectively; if the values were below these thresholds ("negative" results), the post-test probabilities were 22%, 16%, and 17%, respectively. Good
19. Lawrence DA, Oliva IB, Israel GM. Detection of hepatic steatosis on contrast-enhanced CT images: diagnostic accuracy of identification of areas of presumed focal fatty sparing. AJR Am J Roentgenol. 199(1):44-7, 2012 Jul. Observational-Dx 500 patients To determine the diagnostic accuracy of identifying focal areas of increased density along the gallbladder fossa or in the periphery of segment IV for diagnosing hepatic steatosis. The criterion of relative liver-spleen attenuation difference diagnosed 38 cases. The criterion of absolute liver attenuation less than 40 HU diagnosed 44 cases. Of these cases, hepatic steatosis was diagnosed on the portal venous phase in 23 cases (kappa = 1.0), with no false-positive cases. The criterion of relative liver-spleen attenuation difference yielded sensitivity, specificity, positive predictive value, and negative predictive value of 60.5%, 100%, 100%, and 96.9%, respectively. The criterion of absolute liver attenuation less than 40 HU yielded sensitivity, specificity, positive predictive value, and negative predictive value of 52.5%, 100%, 100%, and 95.7%, respectively. 3
20. Park SH, Kim PN, Kim KW, et al. Macrovesicular hepatic steatosis in living liver donors: use of CT for quantitative and qualitative assessment. Radiology 2006;239:105-12. Observational-Dx 154 patients To determine prospectively the diagnostic performance of unenhanced computed tomography (CT) in the assessment of macrovesicular steatosis in potential donors for living donor liver transplantation by using same-day biopsy as a reference standard. Limits of agreement were -14% to 14% for CT(L)(/S) and CT(L)(-S) and -13% to 13% for CT(LP). Performance in diagnosing macrovesicular steatosis of 30% or greater was not significantly different among indices (P > .05). Cutoff values of 0.9, -7, and 58 were determined for CT(L)(/S), CT(L)(-S), and CT(LP), respectively, and provided a balance between sensitivity and specificity. Cutoff values of 0.8, -9, and 42 were determined for CT(L)(/S), CT(L)(-S), and CT(LP), respectively, and yielded 100% specificity for all indices, with corresponding sensitivities of 82%, 82%, and 73% for CT(L)(/S), CT(L)(-S), and CT(LP), respectively. 2
21. Kodama Y, Ng CS, Wu TT, et al. Comparison of CT methods for determining the fat content of the liver. AJR Am J Roentgenol 2007;188:1307-12. Observational-Dx 88 patients To assess which of a number of methods of measuring attenuation on CT scans is best for prediction of hepatic fat content. On unenhanced and contrast-enhanced CT images, all associations between pathologic fat content and attenuation measurements were significant (p < 0.0001). All series of R2 values for unenhanced CT scans were much higher than those for contrast-enhanced CT scans. The R2 values of liver-only measurement were higher than those of hepatic values normalized with splenic values on both unenhanced (0.646-0.649 > 0.523, 0.565) and contrast-enhanced (0.516 > 0.242, 0.344) CT. 3
22. Ricci C, Longo R, Gioulis E, et al. Noninvasive in vivo quantitative assessment of fat content in human liver. J Hepatol 1997;27:108-13. Observational-Dx 67 patients with steatosis To develop a noninvasive method for the quantification of the hepatic fat content in vivo. A linear correlation (r=0.99, p<0.001) linked CTD and the increasing percentage of fat-equivalent material. A CTD calibration curve was derived as a reference for the in vivo determinations. In 29 consecutive patients with steatosis diagnosed by histology, CTD was linearly correlated (r=0.83, p<0.001) with the hepatic fat content (HFC) expressed as percent of the whole liver, obtained by a computerized histomorphometric analysis. Based on the calibration curve obtained in 29 subjects who underwent liver biopsy, 38 additional consecutive steatotic patients were examined and the degree of hepatic fat content was calculated. The HFC was linearly correlated (r=-0.86, p<0.001) with the liver-to-spleen ratio. 3
23. Birnbaum BA, Hindman N, Lee J, Babb JS. Multi-detector row CT attenuation measurements: assessment of intra- and interscanner variability with an anthropomorphic body CT phantom. Radiology 2007;242:109-19. Review/Other-Dx N/A To determine the dependence of absolute computed tomographic (CT) attenuation values on multi-detector row CT scanner type, convolution kernel, and tube current by using an anthropomorphic phantom. Tube current had no significant effect (P>.4) on observed tissue attenuation. Significant (P<.0001) differences were observed between imaging regimens with respect to mean attenuation for each tissue type. Convolution kernel modification had an inconsistent effect on tissue attenuation, depending on the scanner. All multi-detector row CT scanners displayed intrascanner variability in tissue attenuation (minimum range: 8.4 HU for fat tissue with the Sensation 16; maximum range: 63.4 HU for liver tissue with the Sensation 64). The scanners behaved differently at the lower range of the CT number scale, where 0-HU cyst attenuation ranged from -15.7 to 23.9 HU and one vendor's equipment showed significantly lower mean attenuation values. 4
24. Koplay M, Sivri M, Erdogan H, Nayman A. Importance of imaging and recent developments in diagnosis of nonalcoholic fatty liver disease. World J Hepatol 2015;7:769-76. Review/Other-Dx N/A To analyze the diagnostic accuracy and limitations of the imaging methods and recent developments in the diagnosis of NAFLD. No results stated in abstract. 4
25. Johnston RJ, Stamm ER, Lewin JM, Hendrick RE, Archer PG. Diagnosis of fatty infiltration of the liver on contrast enhanced CT: limitations of liver-minus-spleen attenuation difference measurements. Abdom Imaging 1998;23:409-15. Observational-Dx 78 patients To investigate whether liver-minus-spleen (L-S) attenuation differences can accurately diagnose fatty infiltration of the liver on contrast-enhanced computed tomography (CT). The L-S attenuation differences varied significantly, depending on both injection rate and timing of measurements. For the fast-injection group, the optimal L-S threshold for diagnosing fatty infiltration ranged from -43 to -33 Hounsfield units (HU) for early (79 s) and late measurements (106 s), respectively. For the slow-injection group, the optimal threshold ranged from -31 to -25 HU (80 and 112 s, respectively). In addition, sensitivity was not very high (range = 0.54-0.71) for either injection protocol at any measurement time because of significant overlap of L-S values between normal and fatty infiltration patients. Moderate and severe fatty infiltration were more reliably diagnosed than mild fatty infiltration by this method. 3
26. Li Q, Dhyani M, Grajo JR, Sirlin C, Samir AE. Current status of imaging in nonalcoholic fatty liver disease. World J Hepatol 2018;10:530-42. Review/Other-Dx N/A To review the current status of imaging methods for NAFLD risk stratification and management, including their diagnostic accuracy, limitations, and practical applicability. No results stated in abstract. 4
27. Chen J, Talwalkar JA, Yin M, Glaser KJ, Sanderson SO, Ehman RL. Early detection of nonalcoholic steatohepatitis in patients with nonalcoholic fatty liver disease by using MR elastography. Radiology 2011;259:749-56. Observational-Dx 58 patients To investigate the diagnostic accuracy (area under the receiver operating characteristic curve [AUROC]) of magnetic resonance (MR) elastography for the early detection of nonalcoholic steatohepatitis (NASH) among patients with nonalcoholic fatty liver disease (NAFLD). The mean hepatic stiffness for patients with simple steatosis (2.51 kPa) was less (P = .028) than that for patients with inflammation but no fibrosis (3.24 kPa). The mean hepatic stiffness for patients with inflammation but no fibrosis was less (P = .030) than that for patients with hepatic fibrosis (4.16 kPa). Liver stiffness had high accuracy (AUROC = 0.93) for discriminating patients with NASH from those with simple steatosis, with a sensitivity of 94% and a specificity 73% by using a threshold of 2.74 kPa. 4
28. Idilman IS, Aniktar H, Idilman R, et al. Hepatic steatosis: quantification by proton density fat fraction with MR imaging versus liver biopsy. Radiology 2013;267:767-75. Observational-Dx 70 patients To determine utility of proton density fat fraction (PDFF) measurements for quantifying the liver fat content in patients with nonalcoholic fatty liver disease (NAFLD), and compare these results with liver biopsy findings. Mean PDFF calculated with MR imaging was 18.1% +/- 9.5 (standard deviation). Close correlation for quantification of hepatic steatosis was observed between PDFF and liver biopsy (r = 0.82). PDFF was effective in discriminating moderate or severe hepatic steatosis from mild or no hepatic steatosis, with area under the curve of 0.95. The correlation between biopsy and PDFF-determined steatosis was less pronounced when fibrosis was present (r = 0.60) than when fibrosis was absent (r = 0.86; P = .02). 4
29. Kuhn JP, Hernando D, Munoz del Rio A, et al. Effect of multipeak spectral modeling of fat for liver iron and fat quantification: correlation of biopsy with MR imaging results. Radiology 2012;265:133-42. Observational-Dx 95 patients To investigate the effect of the multipeak spectral modeling of fat on R2* values as measures of liver iron and on the quantification of liver fat fraction, with biopsy as the reference standard. Mean steatosis grade at biopsy ranged from 0% to 95%. Biopsy specimens in 26 of 97 patients (27%) showed liver iron (15 mild, six moderate, and five severe). In all 71 samples without iron, a strong increase in the apparent R2* was observed with increasing steatosis grade when single-peak modeling of fat was used (P=.001). When multipeak modeling was used, there were no differences in the apparent R2* as a function of steatosis grading (P=.645), and R2* values agreed closely with those reported in the literature. Good correlation between fat fraction and steatosis grade was observed (rS=0.85) both without and with spectral modeling. 3
30. Reeder SB, Cruite I, Hamilton G, Sirlin CB. Quantitative Assessment of Liver Fat with Magnetic Resonance Imaging and Spectroscopy. J Magn Reson Imaging 2011;34:729-49. Review/Other-Dx N/A To discuss assessment of liver fat with magnetic resonance imaging and spectroscopy. No results stated in abstract. 4
31. Wells SA. Quantification of hepatic fat and iron with magnetic resonance imaging. Magn Reson Imaging Clin N Am 2014;22:397-416. Review/Other-Dx N/A To review MRI techniques used to assess liver fat and iron. No results stated in abstract. 4
32. Raptis DA, Fischer MA, Graf R, et al. MRI: the new reference standard in quantifying hepatic steatosis?. Gut. 61(1):117-27, 2012 Jan. Observational-Dx N/A To assess non-invasive imaging modalities including MRI and CT and compare the quantitative amount of fat with data provided by the pathologist and a chemical lipid assay in leptin-deficient mouse livers. The authors designed lipid/liver mixtures at various ratios to mimic a wide range of fat liver contents. Small-animal and human MRI detected this fat with a high correlation to the actual fat contents. Mouse livers assessed by human MRI correlated best with total intrahepatic fat by chemical lipid analysis (r=0.975). Human CT, the pathologist's assessment and the automated software were less reliable (r=-0.873, 0.512 and 0.873, respectively). There was a significant correlation of the MRI fat quantification with several parameters of liver injury, and MRI data could predict mouse survival after ischaemia/reperfusion injury. In patients undergoing major liver resection, higher liver fat content was associated with more serious postoperative complications, such as liver or multiorgan failure and sepsis, necessitating admission to the intensive care unit. 4
33. Roldan-Valadez E, Favila R, Martinez-Lopez M, Uribe M, Rios C, Mendez-Sanchez N. In vivo 3T spectroscopic quantification of liver fat content in nonalcoholic fatty liver disease: Correlation with biochemical method and morphometry. J Hepatol 2010;53:732-7. Observational-Dx 18 patients To perform a diagnostic evaluation of spectroscopy by comparing its measurement of total lipid content with that from liver biopsies and morphometry in normal subjects and patients with nonalcoholic fatty liver disease. Using a cut-off value >5% for fat content, 8 patients presented with steatosis and 10 patients presented with normal liver fat content. A significant correlation was observed between fat spectroscopy and lipid content (r=0.876, p<0.001). A lower and non-significant correlation was observed between lipid content and morphometry (r=0.190, p>0.05). 3
34. Breu AC, Patwardhan VR, Nayor J, et al. A Multicenter Study Into Causes of Severe Acute Liver Injury. Clin Gastroenterol Hepatol 2019;17:1201-03. Review/Other-Dx N/A To determine the most common causes of an ALT and/or AST level >/=1000 IU/L, along with their relative frequencies; (2) to determine differences in etiology based on hospital type (liver transplant center, community hospital, Veterans Affairs hospital); and (3) to confirm or disprove the differential heuristic that ischemic hepatitis, acute viral hepatitis, and acetaminophen toxicity are the most common etiologies No results stated in abstract. 4
35. Tapper EB, Sengupta N, Bonder A. The Incidence and Outcomes of Ischemic Hepatitis: A Systematic Review with Meta-analysis. Am J Med 2015;128:1314-21. Meta-analysis 24 studies To run an analysis regarding the incidence and outcomes of ischemic hepatitis. The pooled average age of the included patients was 64.2 years, and their mean peak aspartate aminotransferase level, alanine aminotransferase level, and total bilirubin were 2423 IU/L, 1893 IU/L, and 2.55 mg/dL, respectively. Ischemic hepatitis was present in 2 of every 1000 admissions; including 2.5 of every 100 intensive care unit admissions and 4 of 10 admissions associated with an aminotransferase level >10 times the upper limit of normal. The pooled proportions of patients with ischemic hepatitis who had a predisposing acute cardiac event or sepsis were 78.2% and 23.4%, respectively. The proportion of patients with a documented hypotensive event of any duration was 52.9%. Overall, the pooled rate of survival to discharge was 51% (range 23.1%-85.7%). Good
36. Bashir MR, Horowitz JM, Kamel IR, et al. ACR Appropriateness Criteria® Chronic Liver Disease. J Am Coll Radiol 2020;17:S70-S80. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for chronic liver disease. No results stated in abstract. 4
37. Park SJ, Kim JD, Seo YS, et al. Computed tomography findings for predicting severe acute hepatitis with prolonged cholestasis. World J Gastroenterol 2013;19:2543-9. Observational-Dx 412 patients To evaluate the significance of computed tomography (CT) findings in relation to liver chemistry and the clinical course of acute hepatitis. The mean age of patients was 34.4 years, and the most common cause of hepatitis was hepatitis A virus (77.4%). The mean GWT was 5.2 mm. The number of patients who had findings of arterial heterogeneity, periportal tracking, lymph node enlargement > 7 mm, and ascites was 294 (80.1%), 348 (84.7%), 346 (84.5%), and 56 (13.6%), respectively. On multivariate logistic regression, male gender [odds ratio (OR) = 2.569, 95%CI: 1.477-4.469, P = 0.001], toxic hepatitis (OR = 3.531, 95%CI: 1.444-8.635, P = 0.006), level of albumin (OR = 2.154, 95%CI: 1.279-3.629, P = 0.004), and GWT (OR = 1.061, 95%CI: 1.015-1.110, P = 0.009) were independent predictive factors for severe hepatitis. The level of bilirubin (OR = 1.628, 95%CI: 1.331-1.991, P < 0.001) and GWT (OR = 1.172, 95%CI: 1.024-1.342, P = 0.021) were independent factors for prolonged cholestasis in multivariate analysis. 3
38. Murakami T, Baron RL, Peterson MS. Liver necrosis and regeneration after fulminant hepatitis: pathologic correlation with CT and MR findings. Radiology 1996;198:239-42. Observational-Dx 3 patients To characterize computed tomographic (CT) and magnetic resonance (MR) findings of liver necrosis and regeneration after fulminant hepatitis. Regions of liver necrosis demonstrated low attenuation on CT scans before contrast material was administered and enhanced to attenuation equal to or greater than that of liver regeneration on postcontrast CT images. Conversely, nodular liver regeneration demonstrated hyperattenuation on precontrast and hypoattenuation on postcontrast CT images, which simulated neoplastic lesions. The necrotic liver parenchyma was seen as high and low intensity on T2- and T1-weighted MR images, respectively, whereas areas of regeneration appeared as hypo- and hyperintense. 3
39. Yoo SM, Lee HY, Song IS, Lee JB, Kim GH, Byun JS. Acute hepatitis A: correlation of CT findings with clinical phase. Hepatogastroenterology 2010;57:1208-14. Observational-Dx 85 patients To evaluate the incidences of various multi-detector CT (MDCT) findings in acute viral hepatitis A (AHA) and to determine if there are associations between these CT findings and the clinical phases of AHA. Small lymph node enlargement in the hepatoduodenal ligament area, perihepatic fat infiltration, gallbladder (GB) changes (wall thickening, contraction, or an undulating inner margin), periportal edema, hepatomegaly, splenomegaly and pelvic fluid collection were noted in 98.8%, 76.5%, 75.3%, 43.5%, 22.4%, 52.9% and 56.5% of the patients, respectively. Fat infiltration, periportal edema, and pelvic fluid collection were most frequent in group 2. GB changes were least frequent in group 1. 4
40. Ryan MF, Hamilton PA, Sarrazin J, Chu P, Benjaminov O, Lam K. The halo sign and peripancreatic fluid: useful CT signs of hypovolaemic shock complex in adults. Clin Radiol 2005;60:599-607. Observational-Dx 498 patients To report two new, useful computed tomography (CT) signs of the hypovolaemic shock complex (HSC) in adults admitted after blunt abdominal trauma: the halo sign (ring of fluid around a collapsed intra-hepatic inferior vena cava (IVC)), and peripancreatic retroperitoneal fluid. The most common features involved the vascular compartment: diminished IVC diameter n = 27 a positive halo sign n = 21 diminished anteroposterior diameter of the aorta n = 13 and abnormal vascular enhancement n = 10. Peripancreatic retroperitoneal fluid in the absence of pancreatic injury, pancreatitis or pancreatic disease was observed in eight patients. Hollow visceral abnormalities included: diffuse increased mucosal enhancement of both the small and large bowel n = 19 diffuse thickening of the small bowel wall n =11 and small bowel dilatation n = 7. Solid visceral abnormalities included both decreased and or increased enhancement. Several concomitant intra- and extra-abdominal injuries were also identified. 3
41. Crespo S, Bridges M, Nakhleh R, McPhail A, Pungpapong S, Keaveny AP. Non-invasive assessment of liver fibrosis using magnetic resonance elastography in liver transplant recipients with hepatitis C. Clinical Transplantation. 27(5):652-8, 2013 Sep-Oct. Observational-Dx 54 patients To investigate the utility of elastography in staging liver fibrosis in transplant recipients with hepatitis C. On biopsy, 27 patients had METAVIR fibrosis score 0-1; 12 had a 3 or 4. There was significant correlation between histologic fibrosis and shear stiffness (R(2) = 0.588, p < 0.0001). Using a cutoff value of 3.5 kPa, elastography was 91% sensitive and 72% specific in differentiating fibrosis scores of >/=3 from 0 to 1. The AUC of elastography in predicting a fibrosis score of >/=3 was 0.92. Multivariate analysis revealed no correlation between the grade of histologic inflammation and liver stiffness measured by magnetic resonance elastography (R(2) = 0.265, p = 0.47). 3
42. Venkatesh SK, Xu S, Tai D, Yu H, Wee A. Correlation of MR elastography with morphometric quantification of liver fibrosis (Fibro-C-Index) in chronic hepatitis B. Magn Reson Med 2014;72:1123-9. Observational-Dx 32 patients To evaluate the correlation of MR Elastography (MRE) with morphometric assessment of liver fibrosis in chronic hepatitis B (CHB). MRE showed excellent correlation with both Fibro-C-Index (r = 0.78, 95% confidence interval [CI], 0.59-0.88, P < 0.001) and histologic staging (rho = 0.87, 95% CI, 0.72-0.94, P < 0.0001). Significant differences in MRE (P = 0.0001) and Fibro-C-Index (P = 0.003) among different stages of liver fibrosis was found. MRE and Fibro-C-Index had similar accuracies for differentiating fibrosis stages: >/=F1 (0.87 versus 0.81, P = 0.6), >/=F2 (0.95 versus 0.94, P = 0.78), >/=F3 (0.98 versus 0.96, P = 0.76), and F4 (1.00 versus 0.92, P = 0.10). 3
43. Chundru S, Kalb B, Arif-Tiwari H, Sharma P, Costello J, Martin DR. MRI of diffuse liver disease: characteristics of acute and chronic diseases. [Review]. Diagn Interv Radiol. 20(3):200-8, 2014 May-Jun. Review/Other-Dx N/A To review the MRI techniques and diagnostic features associated with acute and chronic liver disease. No results stated in abstract. 4
44. Kawamoto S, Soyer PA, Fishman EK, Bluemke DA. Nonneoplastic liver disease: evaluation with CT and MR imaging. Radiographics 1998;18:827-48. Review/Other-Dx N/A To discuss nonneoplastic liver disease evaluation with CT and MR imagin. No results stated in abstract. 4
45. Martin DR, Seibert D, Yang M, Salman K, Frick MP. Reversible heterogeneous arterial phase liver perfusion associated with transient acute hepatitis: findings on gadolinium-enhanced MRI. J Magn Reson Imaging 2004;20:838-42. Observational-Dx 6 patients To assess a possible correlation between active acute hepatitis and the development of abnormal liver perfusion demonstrated as heterogeneous enhancement on arterial phase gadolinium-enhanced MRI. Arterial phase gadolinium-enhanced MRI showed abnormal irregular liver perfusion in the setting of acute hepatitis, and the degree of irregularity, as well as the persistence of irregular enhancement into the venous phase, correlated with the clinical severity of the disease. 3
46. Matsui O, Kadoya M, Takashima T, Kameyama T, Yoshikawa J, Tamura S. Intrahepatic periportal abnormal intensity on MR images: an indication of various hepatobiliary diseases. Radiology 1989;171:335-8. Review/Other-Dx N/A To review intrahepatic periportal abnormal intensity on MR images. No results stated in abstract. 4
47. Proujansky R, Vinton N. Acute Hepatitis. Adolesc Med 1995;6:437-46. Review/Other-Dx N/A To characterize the clinical features of each of these disorders emphasizing recognition and diagnosis. No results stated in abstract. 4
48. Sharma P, Kitajima HD, Kalb B, Martin DR. Gadolinium-enhanced imaging of liver tumors and manifestations of hepatitis: pharmacodynamic and technical considerations. Top Magn Reson Imaging 2009;20:71-8. Review/Other-Dx N/A To outline the technical requirements needed to perform reproducible contrast-enhanced liver imaging and describes the important imaging features for assessing liver disease with conventional and alternate gadolinium-based contrast media. No results stated in abstract. 4
49. Holbert BL, Baron RL, Dodd GD, 3rd. Hepatic infarction caused by arterial insufficiency: spectrum and evolution of CT findings. AJR Am J Roentgenol 1996;166:815-20. Review/Other-Dx 18 patients To determine the CT imaging appearances of liver infarction due to arterial insufficiency and to attempt to understand reasons for apparent discrepancy of appearance in prior reports. Of 55 lesions identified, 53 could be classified into three shapes--wedge-shaped (18), rounded or oval (26), or irregularly shaped low-attenuation lesions paralleling bile ducts (9). The other two lesions were flat hypodense areas along the posterior aspect of the medial left hepatic lobe. Wedge-shaped lesions were peripherally located; rounded lesions were either peripheral (10) or central (26). The caudate lobe was spared except in one patient. Of 16 serially followed wedge-shaped lesions, four evolved into rounded lesions. No rounded lesions became wedge-shaped. 4
50. Haimerl M, Verloh N, Zeman F, et al. Gd-EOB-DTPA-enhanced MRI for evaluation of liver function: Comparison between signal-intensity-based indices and T1 relaxometry. Sci. rep.. 7:43347, 2017 03 07. Review/Other-Dx N/A To discuss Gd-EOB-DTPA-enhanced MRI for evaluation of liver function. No results stated in abstract. 4
51. Kukuk GM, Schaefer SG, Fimmers R, et al. Hepatobiliary magnetic resonance imaging in patients with liver disease: correlation of liver enhancement with biochemical liver function tests. Eur Radiol. 24(10):2482-90, 2014 Oct. Observational-Dx 51 patients To evaluate hepatobiliary magnetic resonance imaging (MRI) using Gd-EOB-DTPA in relation to various liver function tests in patients with liver disorders. Pre-contrast LSCR values correlated with total bilirubin (r = -0.39; p = 0.005), GGT (r = -0.37; p = 0.009), AST (r = -0.38; p = 0.013), ALT (r = -0.29; p = 0.046), PT (r = 0.52; p < 0.001), GLDH (r = -0.55; p = 0.044), INR (r = -0.42; p = 0.003), and MELD Score (r = -0.53; p < 0.001). After administration of Gd-EOB-DTPA bilirubin (r = -0.45; p = 0.001), GGT (r = -0.40; p = 0.004), PT (r = 0.54; p < 0.001), AST (r = -0.46; p = 0.002), ALT (r = -0.31; p = 0.030), INR (r = -0.45; p = 0.001) and MELD Score (r = -0.56; p < 0.001) significantly correlated with LSCR. RLE correlated with bilirubin (r = -0.40; p = 0.004), AST (r = -0.38; p = 0.013), PT (r = 0.42; p = 0.003), GGT (r = -0.33; p = 0.020), INR (r = -0.36; p = 0.011) and MELD Score (r = -0.43; p = 0.003). 3
52. Poetter-Lang S, Bastati N, Messner A, et al. Quantification of liver function using gadoxetic acid-enhanced MRI. Abdom Radiol (NY) 2020;45:3532-44. Review/Other-Dx N/A To describe the current role of GA-enhanced MRI in quantifying liver function in a variety of hepatobiliary disorders. No results stated in abstract. 4
53. Yang M, Zhang Y, Zhao W, Cheng W, Wang H, Guo S. Evaluation of liver function using liver parenchyma, spleen and portal vein signal intensities during the hepatobiliary phase in Gd-EOB-D TPA-enhanced MRI. BMC Med Imaging 2020;20:119. Observational-Dx 120 patients To investigate whether liver parenchyma, spleen and portal vein signal intensities can evaluate liver function in patients with cirrhosis and determine which is the best parameter. Significant differences were observed in the liver parenchyma SI, LPC and LSC among the groups. These values all decreased gradually from normal livers to Child-Pugh class C cirrhotic livers (P < 0.001). The portal vein SI constantly and slightly increased from normal livers to Child-Pugh class C cirrhotic livers, but no differences were found among the groups in the portal vein SI and PSC (P > 0.05). LPC showed a stronger correlation with the Child-Pugh score and MELD score than LSC and the liver parenchyma SI. The order of the AUCs of these parameters, from largest to smallest, was as follows: LPC, LSC, and liver parenchyma SI (P > 0.05). 4
54. Hindman NM, Arif-Tiwari H, Kamel IR, et al. ACR Appropriateness Criteria R Jaundice. Journal of the American College of Radiology. 16(5S):S126-S140, 2019 May.J. Am. Coll. Radiol.. 16(5S):S126-S140, 2019 May. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for jaundice. No abstract available. 4
55. Ferin P, Lerner RM. Contracted gallbladder: a finding in hepatic dysfunction. Radiology 1985;154:769-70. Review/Other-Dx 35 patients To review ultrasound examinations of patients with acute hepatitis. After the acute phase of their hepatitis had resolved, four patients had normal gallbladders on US. One patient who did not recover was found at autopsy to have a normal but contracted gallbladder. 4
56. Heller MT, Tublin ME. The role of ultrasonography in the evaluation of diffuse liver disease. Radiol Clin North Am 2014;52:1163-75. Review/Other-Dx N/A To review the role of ultrasonography in the evaluation of diffuse liver disease. No results stated in abstract. 4
57. Juttner HU, Ralls PW, Quinn MF, Jenney JM. Thickening of the gallbladder wall in acute hepatitis: ultrasound demonstration. Radiology 1982;142:465-6. Observational-Dx 36 patients To determine the thickness of the gallbladder wall. The mean thickness in 13 patients with SGOT and SGPT above 500 IU was 3.5 mm, compared to 2.6 mm in 13 patients with levels below 500 IU. This difference is statistically significant (P less than 0.01). 4
58. Kurtz AB, Rubin CS, Cooper HS, et al. Ultrasound findings in hepatitis. Radiology 1980;136:717-23. Review/Other-Dx N/A To review ultrasound finding in hepatitis. No results stated in abstract. 4
59. Mortele KJ, Segatto E, Ros PR. The infected liver: radiologic-pathologic correlation. Radiographics 2004;24:937-55. Review/Other-Dx N/A To review the radiologic-pathologic correlation of an infected liver. No results stated in abstract. 4
60. Claudon M, Dietrich CF, Choi BI, et al. Guidelines and good clinical practice recommendations for Contrast Enhanced Ultrasound (CEUS) in the liver - update 2012: A WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultrasound Med Biol. 2013;39(2):187-210. Review/Other-Dx N/A To provide general advice on the use of all currently clinically available ultrasound contrast agents (UCA). No results stated in abstract. 4
61. Newsome PN, Cramb R, Davison SM, et al. Guidelines on the management of abnormal liver blood tests. Gut 2018;67:6-19. Review/Other-Dx N/A To provide guidelines for the management of abnormal liver blood tests. No results stated in abstract. 4
62. Tapper EB, Lok AS. Use of Liver Imaging and Biopsy in Clinical Practice. N Engl J Med 2017;377:756-68. Review/Other-Dx N/A To study the use of liver imaging and biopsy in clinical practice. No results stated in abstract. 4
63. Atkinson CJ, Lisanti CJ, Schwope RB, et al. Mild asymptomatic intrahepatic biliary dilation after cholecystectomy, a common incidental variant. Abdom Radiol. 42(5):1408-1414, 2017 05. Observational-Dx 77 patients To evaluate the prevalence of intra- and extrahepatic ductal dilatation in asymptomatic individuals after cholecystectomy. Cholecystectomy patient duct patterns: normal ducts 26% (20/77); intra- and extrahepatic dilation 31.2% (24/77); intrahepatic dilation only 18.2% (14/77); extrahepatic dilation only 24.7% (19/77). Control patient duct patterns: normal ducts 88.3% (68/77); intra- and extrahepatic dilation 2.6% (2/77); intrahepatic dilation only 2.6% (2/77); extrahepatic dilation only 6.5% (5/77). All intrahepatic ductal dilatation was mild. Total intrahepatic dilation: 49.4% (cholecystectomy); 5.2% (control patients). The relative risk of intrahepatic ductal dilation in cholecystectomy patients was 9.5:1. Increased prevalence of intra- and extrahepatic dilation in cholecystectomy patients was statistically significant (p < 0.0001). Average extrahepatic duct was 7.8 mm (cholecystectomy) and 5.3 mm (control patients) (p < 0.001). 3
64. Isherwood J, Garcea G, Williams R, Metcalfe M, Dennison AR. Serology and ultrasound for diagnosis of choledocholithiasis. Ann R Coll Surg Engl. 96(3):224-8, 2014 Apr. Observational-Dx 195 patients To determine which radiological or serological parameters best predicted CBD stones. Raised ALP levels on admission demonstrated a correlation with CBD stones (AUC: 0.619, odds ratio [OR]: 3.16, p=0.06). At ultrasonography, a dilated CBD (OR: 3.76, p<0.001) and intrahepatic duct dilation (OR: 5.56, p<0.001) were highly significant predictors. However, only 37% of patients had a dilated CBD on ultrasonography. Ongoing elevation of LFT parameters, particularly ALP (AUC: 0.707, OR: 4.64, p<0.001) and ALT (AUC: 0.646, OR: 5.40, p<0.001), displayed a significant correlation with CBD stones. 3
65. Schofer JM.. Biliary causes of postcholecystectomy syndrome. [Review]. J Emerg Med. 39(4):406-10, 2010 Oct. Review/Other-Dx N/A To review the biliary causes of postcholecystectomy syndrome and present a suggested diagnostic workup. A number of biliary causes are discussed, including choledocholithiasis, bile duct injury and biliary leaks, cystic duct and gallbladder remnants, sphincter of Oddi dysfunction, and biliary ascariasis. The ED workup should focus on differentiating biliary from non-biliary causes of the patient's symptoms. 4
66. Hinrichs H, Hinrichs JB, Gutberlet M, et al. Functional gadoxetate disodium-enhanced MRI in patients with primary sclerosing cholangitis (PSC). Eur Radiol. 26(4):1116-24, 2016 Apr. Observational-Dx 61 patients To assess the value of variable flip angle-based T1 liver mapping on gadoxetate disodium-enhanced MRI in patients with primary sclerosing cholangitis (PSC) for evaluation of global and segmental liver function, and determine a possible correlation with disease severity. Significant changes of T1 relaxation times between non-enhanced and gadoxetate disodium-enhanced MRI at HP1 and HP2 could be observed in all liver segments (p < 0.0001). A significant correlation of T1 reduction could be observed with LFTs, MELD and Mayo Risk Score (p < 0.05). 3
67. Haimerl M, Verloh N, Fellner C, et al. MRI-based estimation of liver function: Gd-EOB-DTPA-enhanced T1 relaxometry of 3T vs. the MELD score. Sci. rep.. 4:5621, 2014 Jul 08. Review/Other-Dx N/A To discuss MRI-based estimation of liver function. No results stated in abstract. 4
68. Nakamura S, Awai K, Utsunomiya D, et al. Chronological evaluation of liver enhancement in patients with chronic liver disease at Gd-EOB-DTPA-enhanced 3-T MR imaging: does liver function correlate with enhancement?. Jpn J Radiol. 30(1):25-33, 2012 Jan. Observational-Dx 125 patients To investigate the chronological relationship between scan delay and liver enhancement for the hepatobiliary phase on Gd-EOB-DTPA-enhanced MRI and evaluate the effects of liver function on liver enhancement. There was not significant difference in RLE and lesion detectability at 15 and 20 min. RLE in the Child-Pugh C group was significantly lower than in the Child-Pugh A and B groups. The serum albumin level and prothrombin time were significantly correlated with the liver enhancement. 3
69. Smith AD, Veniero JC. Gd-EOB-DTPA as a functional MR cholangiography contrast agent: imaging gallbladder filling in patients with and without hepatobiliary dysfunction. J Comput Assist Tomogr. 35(4):439-45, 2011 Jul-Aug. Observational-Dx 100 patients To evaluate cystic duct patency on hepatobiliary-phase magnetic resonance (MR) images after intravenous gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) administration. Contrast accumulated in the gallbladder in 80% of patients (n = 100) with hepatobiliary-phase MR imaging at a median of 22 minutes (range, 15-83 minutes). Absence of contrast accumulation in the gallbladder (n = 20) was associated with hepatobiliary imaging less than 30 minutes after contrast administration, gallbladder contraction, cholelithiasis, elevated liver function tests, elevated bilirubin, and cirrhosis. 4
70. Zare M, Kargar S, Akhondi M, Mirshamsi MH. Role of liver function enzymes in diagnosis of choledocholithiasis in biliary colic patients. Acta Med Iran. 49(10):663-6, 2011. Observational-Dx 350 patients To assess role of liver functional test in diagnosis of common bile duct stone in patients with cholecystitis and help in their management. Mean of AST. ALT, ALP and total and direct bilirubin were had no significant differences between two study groups. In logistic regression analysis, after entering into the model only CBD diameter (OR: 20; P=0.00) and elevated serum level of ALT (OR: 2; P=0.04) were remained into the model and were known as independent predictor of cholelithiasis. 3
71. Al-Jiffry BO, Elfateh A, Chundrigar T, et al. Non-invasive assessment of choledocholithiasis in patients with gallstones and abnormal liver function. World J Gastroenterol. 19(35):5877-82, 2013 Sep 21. Observational-Dx 896 patients To find a non-invasive strategy for detecting choledocholithiasis before cholecystectomy, with an acceptable negative rate of endoscopic retrograde cholangiopancreatography. Seventy-eight point five percent of patients had laparoscopic cholecystectomy directly with no further investigations. Twenty-one point five percent had abnormal liver function tests, of which 52.8% had normal ultrasound results. This strategy avoided unnecessary magnetic resonance cholangiopancreatography in 47.2% of patients with abnormal liver function tests with a negative endoscopic retrograde cholangiopancreatography rate of 10%. It also avoided un-necessary endoscopic retrograde cholangiopancreatography in 35.2% of patients with abnormal liver function. 4
72. Suarez AL, LaBarre NT, Cotton PB, Payne KM, Cote GA, Elmunzer BJ. An assessment of existing risk stratification guidelines for the evaluation of patients with suspected choledocholithiasis. Surg Endosc. 30(10):4613-8, 2016 10. Observational-Dx 71 patients To evaluate the performance characteristics of published guidelines in predicting choledocholithiasis and to determine the impact of laboratory trends on diagnostic accuracy. On presentation, 71 of the 173 eligible patients (41.4 %) met ASGE high-probability criteria for choledocholithiasis. Of these, only 39 (54.9 %) were found to have a choledocholithiasis on confirmatory testing. Conversely, of the 102 patients (58.6 %) who were classified as low or intermediate probability, 32 (31.4 %) had choledocholithiasis. Overall, the accuracy of the guidelines was 63 % (sensitivity 54.9 %; specificity 68.6 %). Incorporating a second set of laboratory tests did not improve accuracy (62.7 %), and a significant decline in liver function tests did not reliably predict spontaneous stone passage. 4
73. Gurusamy KS, Giljaca V, Takwoingi Y, et al. Ultrasound versus liver function tests for diagnosis of common bile duct stones. [Review]. Cochrane Database Syst Rev. (2)CD011548, 2015 Feb 26. Meta-analysis 5 studies ; 523 participants To determine and compare the accuracy of ultrasound versus liver function tests for the diagnosis of common bile duct stones. Five studies including 523 participants reported the diagnostic accuracy of ultrasound. One studies (262 participants) compared the accuracy of ultrasound, serum bilirubin and serum alkaline phosphatase in the same participants. All the studies included people with symptoms. One study included only participants without previous cholecystectomy but this information was not available from the remaining studies. All the studies were of poor methodological quality. The sensitivities for ultrasound ranged from 0.32 to 1.00, and the specificities ranged from 0.77 to 0.97. The summary sensitivity was 0.73 (95% CI 0.44 to 0.90) and the specificity was 0.91 (95% CI 0.84 to 0.95). At the median pre-test probability of common bile duct stones of 0.408, the post-test probability (95% CI) associated with positive ultrasound tests was 0.85 (95% CI 0.75 to 0.91), and negative ultrasound tests was 0.17 (95% CI 0.08 to 0.33).The single study of liver function tests reported diagnostic accuracy at two cut-offs for bilirubin (greater than 22.23 mumol/L and greater than twice the normal limit) and two cut-offs for alkaline phosphatase (greater than 125 IU/L and greater than twice the normal limit). This study also assessed ultrasound and reported higher sensitivities for bilirubin and alkaline phosphatase at both cut-offs but the specificities of the markers were higher at only the greater than twice the normal limit cut-off. The sensitivity for ultrasound was 0.32 (95% CI 0.15 to 0.54), bilirubin (cut-off greater than 22.23 mumol/L) was 0.84 (95% CI 0.64 to 0.95), and alkaline phosphatase (cut-off greater than 125 IU/L) was 0.92 (95% CI 0.74 to 0.99). The specificity for ultrasound was 0.95 (95% CI 0.91 to 0.97), bilirubin (cut-off greater than 22.23 mumol/L) was 0.91 (95% CI 0.86 to 0.94), and alkaline phosphatase (cut-off greater than 125 IU/L) was 0.79 (95% CI 0.74 to 0.84). No study reported the diagnostic accuracy of a combination of bilirubin and alkaline phosphatase, or combinations with ultrasound. M
74. Fuhrmann I, Brunn K, Probst U, et al. Proof of principle: Estimation of liver function using color coded Doppler sonography of the portal vein. Clin Hemorheol Microcirc. 70(4):585-594, 2018. Observational-Dx N/A To test the relationship between clinical liver function tests based on MRI and breath testing and blood flow in the portal vein. Using CCDS, all patients show a hepatopetal portal blood flow. The portal vein velocity is decreasing with progression of liver damage and there was a significant correlation of portal velocity with SI post (r = 0.411, p = 0.024). However, the portal velocity did not correlate significantly with the 13C-MBT readout (r = 0.233; p = 0.216), SI pre (r = 0.271, p = 0.147) or the relative enhancement (r = 0.303; p = 0.103). 4
75. Sackey K. Hemolytic anemia: Part 1. Pediatr Rev 1999;20:152-8; quiz 59. Review/Other-Dx N/A To discuss the diagnosis and therapy of hemolytic anemia. No results stated in abstract. 4
76. Pashankar D, Schreiber RA. Jaundice in older children and adolescents. Pediatr Rev 2001;22:219-26. Review/Other-Dx N/A To discuss jaundice in older children and adolescents. No results stated in abstract. 4
77. Lewis JH. Drug-induced liver disease. Med Clin North Am 2000;84:1275-311, x. Review/Other-Dx N/A To discuss incidence, diagnosis, risk factors, clinical presentations, hepatitis, and vascular injury. No results stated in abstract. 4
78. Pasha TM, Lindor KD. Diagnosis and therapy of cholestatic liver disease. Med Clin North Am 1996;80:995-1019. Review/Other-Dx N/A To discuss the diagnosis and therapy of cholestatic liver disease. No results stated in abstract. 4
79. Tongdee T, Amornvittayachan O, Tongdee R. Accuracy of multidetector computed tomography cholangiography in evaluation of cause of biliary tract obstruction. J Med Assoc Thai. 2010; 93(5):566-573. Observational-Dx 50 patients Retrospective study to evaluate accuracy of MDCT cholangiography in evaluation of cause of biliary tract obstruction. Sensitivity, specificity, PPV, and NPV of MDCT cholangiography for detection of calculus, benign stricture, and malignancy were 91.7%-100%, except for sensitivity and PPV for detection of benign stricture, which were 66.7% and 66.7% respectively. MDCT cholangiography is a fast, noninvasive technique that offers high diagnostic accuracy in evaluation of cause of biliary tract obstruction. 3
80. Qayyum A, Tamm EP, Kamel IR, et al. ACR Appropriateness Criteria® Staging of Pancreatic Ductal Adenocarcinoma. J Am Coll Radiol 2017;14:S560-S69. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for staging of pancreatic ductal adencarcinoma. No results stated in abstract. 4
81. Singh S, Venkatesh SK, Wang Z, et al. Diagnostic performance of magnetic resonance elastography in staging liver fibrosis: a systematic review and meta-analysis of individual participant data. [Review]. Clinical Gastroenterology & Hepatology. 13(3):440-451.e6, 2015 Mar. Review/Other-Dx 12 Studies including 697 patients To assess the diagnostic accuracy of MRE for staging liver fibrosis in patients with chronic liver diseases (CLD). We analyzed data from 12 retrospective studies, comprising 697 patients (mean age, 55 +/- 13 y; 59.4% male; mean BMI, 26.9 +/- 6.7 kg/m(2); 92.1% with <1 year interval between MRE and biopsy; and 47.1% with hepatitis C). Overall, 19.5%, 19.4%, 15.5%, 15.9%, and 29.7% patients had stage 0, 1, 2, 3, and 4 fibrosis, respectively. The mean area under the receiver-operating curve values (and 95% confidence intervals) for the diagnosis of any (>/=stage 1), significant (>/=stage 2), advanced fibrosis (>/=stage 3), and cirrhosis, were as follows: 0.84 (0.76-0.92), 0.88 (0.84-0.91), 0.93 (0.90-0.95), and 0.92 (0.90-0.94), respectively. A similar diagnostic performance was observed in stratified analysis based on sex, obesity, and etiology of CLD. The overall rate of failure of MRE was 4.3% 4
82. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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