Background and Objectives Sinusoidal obstruction syndrome (SOS) / hepatic veno-occlusive disease (VOD) is a serious complication after hematopoietic stem cell transplantation (HSCT). Incidence of SOS/VOD after HSCT varies from 5 to 60%1-4, and mortality rate was 80%2, if it's with multiorgan failure. Difibrotide is only a drug for SOS/VOD treatment, approved by the Ministry of Health, Labour and Welfare in Japan. Early diagnosis, and prompt initiation of defibrotide thought to be successful treatment of SOS/VOD5. The diagnostic criteria of SOS/VOD were based on clinical findings, such as body weight gain and hyperbirilubinemia. Recently, ultrasonography (US) has been suggested as one of modalities to diagnose SOS/VOD. We previously reported the usefulness of original US scoring system, which includes assessing hepatomegaly, ascites, and blood flow alteration. It is called Hokkaido US-based scoring system (HokUS) -106 in diagnosing SOS/VOD. And it has been suggested as one of criteria to diagnose SOS in European federation of bone marrow transplantation (EBMT) guideline 20237. However, 10 findings of HokUS-10 are rather many, and prominent findings are needed for diagnosing SOS/VOD.To identify prominent findings of HokUS-10 for diagnosing SOS. Materials and Methods The patients who underwent HSCT from Jan. 2008 to June 2019 in our institution were retrospectively analyzed. HokUS-10 were applied to the patients before HSCT and on day 14, 28 or when the signs of SOS appeared after HSCT (Fig.1). SOS was clinically diagnosed by the modified Seattle8 or the Baltimore criteria9 or the EBMT criteria10. Patients developed SOS within 21 days after HSCT was categorized as classical SOS, and byond 21 days was as late-onset SOS. HokUS-10 consists of 10 parameters were used SOS/VOD diagnosis (Table 1) US was performed using PVT-375 BT (center frequency, 3.75 MHz), PVT-674 BT (center frequency, 6 MHz), and PVT-704 BT (center frequency, 7.5 MHz) equipped with Aplio™ XV/XG/500/Xario/i800/i700 (Canon Medical Systems Corp., Otawara, Japan), by 5 registered medical sonographers (1∼26 years experiment of US) .To clarify most prominent parameters in HokUS-10, diagnostic performance and Odds ratio were analyzed in classical and late-onset SOS. Results Four hundred and forty-one until day 21 and 421 patients after day 22 of HSCT were enrolled. Of whom, 30 and 22 patients were diagnosed by clinically as classical and late-onset SOS, respectively. Ascites showed highest sensitivity as 100% in both classical and late-onset SOS. Highest positive predictive value as 100% was seen in hepatofugal portal vein blood flow signal. Odds ratio, of classical and late-onset SOS of moderate amount of ascites, appearance of PUV blood flow signal, PUV dilatation, decrease of PV blood flow velocity, and GB wall thickness were 317.3 and 85.5, 41.6 and 32.1, 29.7 and 27.8, 12.6 and 30.6, and 27.4 and 6.6, respectively, in descending order. Summary and Future Perspectives Prominent findings of HokUS-10 for diagnosing both of clinical and late-onset SOS were moderate amount of ascites, PUV dilatation, and appearance of PUV blood flow signal in descending order. Also, in classical SOS, GB wall thickening, and in late-onset SOS decrease of PV blood flow velocity were followed by prominent findings.

Background and Objectives Sinusoidal obstruction syndrome (SOS) / hepatic veno-occlusive disease (VOD) is a serious complication after hematopoietic stem cell transplantation (HSCT). Incidence of SOS/VOD after HSCT varies from 5 to 60%1-4, and mortality rate was 80%2, if it's with multiorgan failure. Difibrotide is only a drug for SOS/VOD treatment, approved by the Ministry of Health, Labour and Welfare in Japan. Early diagnosis, and prompt initiation of defibrotide thought to be successful treatment of SOS/VOD5. The diagnostic criteria of SOS/VOD were based on clinical findings, such as body weight gain and hyperbirilubinemia. Recently, ultrasonography (US) has been suggested as one of modalities to diagnose SOS/VOD. We previously reported the usefulness of original US scoring system, which includes assessing hepatomegaly, ascites, and blood flow alteration. It is called Hokkaido US-based scoring system (HokUS) -106 in diagnosing SOS/VOD. And it has been suggested as one of criteria to diagnose SOS in European federation of bone marrow transplantation (EBMT) guideline 20237. However, 10 findings of HokUS-10 are rather many, and prominent findings are needed for diagnosing SOS/VOD. To identify prominent findings of HokUS-10 for diagnosing SOS. Materials and Methods The patients who underwent HSCT from Jan. 2008 to June 2019 in our institution were retrospectively analyzed. HokUS-10 were applied to the patients before HSCT and on day 14, 28 or when the signs of SOS appeared after HSCT (Fig.1). SOS was clinically diagnosed by the modified Seattle8 or the Baltimore criteria9 or the EBMT criteria10. Patients developed SOS within 21 days after HSCT was categorized as classical SOS, and byond 21 days was as late-onset SOS. HokUS-10 consists of 10 parameters were used SOS/VOD diagnosis (Table 1) US was performed using PVT-375 BT (center frequency, 3.75 MHz), PVT-674 BT (center frequency, 6 MHz), and PVT-704 BT (center frequency, 7.5 MHz) equipped with Aplio™ XV/XG/500/Xario/i800/i700 (Canon Medical Systems Corp., Otawara, Japan), by 5 registered medical sonographers (1∼26 years experiment of US) . To clarify most prominent parameters in HokUS-10, diagnostic performance and Odds ratio were analyzed in classical and late-onset SOS. Results Four hundred and forty-one until day 21 and 421 patients after day 22 of HSCT were enrolled. Of whom, 30 and 22 patients were diagnosed by clinically as classical and late-onset SOS, respectively. Ascites showed highest sensitivity as 100% in both classical and late-onset SOS. Highest positive predictive value as 100% was seen in hepatofugal portal vein blood flow signal. Odds ratio, of classical and late-onset SOS of moderate amount of ascites, appearance of PUV blood flow signal, PUV dilatation, decrease of PV blood flow velocity, and GB wall thickness were 317.3 and 85.5, 41.6 and 32.1, 29.7 and 27.8, 12.6 and 30.6, and 27.4 and 6.6, respectively, in descending order. Summary and Future Perspectives Prominent findings of HokUS-10 for diagnosing both of clinical and late-onset SOS were moderate amount of ascites, PUV dilatation, and appearance of PUV blood flow signal in descending order. Also, in classical SOS, GB wall thickening, and in late-onset SOS decrease of PV blood flow velocity were followed by prominent findings. Sinusoidal obstruction syndrome (SOS) / hepatic veno-occlusive disease (VOD) is a serious complication after hematopoietic stem cell transplantation (HSCT). Incidence of SOS/VOD after HSCT varies from 5 to 60%1-4, and mortality rate was 80%2, if it's with multiorgan failure. Difibrotide is only a drug for SOS/VOD treatment, approved by the Ministry of Health, Labour and Welfare in Japan. Early diagnosis, and prompt initiation of defibrotide thought to be successful treatment of SOS/VOD5. The diagnostic criteria of SOS/VOD were based on clinical findings, such as body weight gain and hyperbirilubinemia. Recently, ultrasonography (US) has been suggested as one of modalities to diagnose SOS/VOD. We previously reported the usefulness of original US scoring system, which includes assessing hepatomegaly, ascites, and blood flow alteration. It is called Hokkaido US-based scoring system (HokUS) -106 in diagnosing SOS/VOD. And it has been suggested as one of criteria to diagnose SOS in European federation of bone marrow transplantation (EBMT) guideline 20237. However, 10 findings of HokUS-10 are rather many, and prominent findings are needed for diagnosing SOS/VOD. To identify prominent findings of HokUS-10 for diagnosing SOS. The patients who underwent HSCT from Jan. 2008 to June 2019 in our institution were retrospectively analyzed. HokUS-10 were applied to the patients before HSCT and on day 14, 28 or when the signs of SOS appeared after HSCT (Fig.1). SOS was clinically diagnosed by the modified Seattle8 or the Baltimore criteria9 or the EBMT criteria10. Patients developed SOS within 21 days after HSCT was categorized as classical SOS, and byond 21 days was as late-onset SOS. HokUS-10 consists of 10 parameters were used SOS/VOD diagnosis (Table 1) US was performed using PVT-375 BT (center frequency, 3.75 MHz), PVT-674 BT (center frequency, 6 MHz), and PVT-704 BT (center frequency, 7.5 MHz) equipped with Aplio™ XV/XG/500/Xario/i800/i700 (Canon Medical Systems Corp., Otawara, Japan), by 5 registered medical sonographers (1∼26 years experiment of US) . To clarify most prominent parameters in HokUS-10, diagnostic performance and Odds ratio were analyzed in classical and late-onset SOS. Four hundred and forty-one until day 21 and 421 patients after day 22 of HSCT were enrolled. Of whom, 30 and 22 patients were diagnosed by clinically as classical and late-onset SOS, respectively. Ascites showed highest sensitivity as 100% in both classical and late-onset SOS. Highest positive predictive value as 100% was seen in hepatofugal portal vein blood flow signal. Odds ratio, of classical and late-onset SOS of moderate amount of ascites, appearance of PUV blood flow signal, PUV dilatation, decrease of PV blood flow velocity, and GB wall thickness were 317.3 and 85.5, 41.6 and 32.1, 29.7 and 27.8, 12.6 and 30.6, and 27.4 and 6.6, respectively, in descending order. Prominent findings of HokUS-10 for diagnosing both of clinical and late-onset SOS were moderate amount of ascites, PUV dilatation, and appearance of PUV blood flow signal in descending order. Also, in classical SOS, GB wall thickening, and in late-onset SOS decrease of PV blood flow velocity were followed by prominent findings.

Hypoechoic halo is a typical ultrasound finding in giant cell arteritis (GCA), but it may be a false positive due to arteriosclerosis. Therefore, we focused on the segmental distribution of GCA lesions, defined the luminal irregularity in long-axis images as the string of beads sign, and examined its diagnostic ability. As a result, the C-statistic of hypoechoic halo and string of beads sign was better than that of hypoechoic halo alone (1.00 vs. 0.89). Based on the above, the diagnostic ability of GCA can be improved by adding the string of beads sign to the conventional hypoechoic halo. The addition of the string of beads sign, an ultrasound finding inspired by the segmental distribution of giant cell arteritis lesions, to the conventional hypoechoic halo may improve diagnostic performance.image

Sinusoidal obstruction syndrome (SOS) is a fatal complication of hematopoietic stem cell transplantation (HSCT). Previously, we established a scoring system (Hokkaido ultrasound-based scoring system-10; HokUS-10) comprising 10 ultrasound parameters for SOS diagnosis. In HokUS-10, the portal vein time-averaged flow velocity (PV TAV) and hepatic artery resistive index (HA RI) are measured using subcostal scanning. However, measurement errors and delineation difficulties occur. Therefore, we aimed to prospectively evaluate PV TAV and HA RI measurements obtained via intercostal scanning as an alternative method to subcostal scanning and determine their cutoff values. HokUS-10 was administered before and after HSCT. PV TAV and HA RI were measured on subcostal and right intercostal scans. We performed 366 scans on 74 patients. The median value (range) of PV TAV in the main and right portal veins was 15.0 cm/s (2.2–49.6 cm/s) and 10.5 cm/s (1.6–22.0 cm/s), respectively. A low correlation was observed between the two values (r = 0.39, p < 0.01). The highest diagnostic value of the right portal vein was less than 8.0 cm/s. The median value (range) of HA RI in the proper and right hepatic arteries was 0.72 (0.52–1.00) and 0.70 (0.51–1.00), respectively. A strong correlation was observed between the two values (r = 0.65, p < 0.01). The highest diagnostic value of the right HA RI was 0.72 or higher. Quantitative measurement of PV TAV and HA RI using intercostal scanning can be appropriately performed as an alternative method to using subcostal scanning.

This study presents the case of man who underwent ultrasonography (US) for the diagnosis and follow-up of cystitis glandularis with severe intestinal metaplasia. We believe that our study makes a significant contribution to the literature because the findings of cystitis glandularis that forms a mass is relatively rare.

We present a case of breast angiosarcoma. Although B-mode ultrasonography did not indicate a tumor, contrast-enhanced ultrasonography (CEUS) was successfully delineated it. CEUS helped identify the tumor and its extent.

Hepatic sinusoidal obstruction syndrome (SOS)/veno-occlusive disease is a life-threatening complication after hematopoietic stem cell transplantation (HSCT). We previously reported the efficacy of the Hokkaido Ultrasonography (US)-based scoring system (HokUS-10) for US findings. To establish easier-to-use criteria, we retrospectively evaluated US findings from 441 patients, including 30 patients with SOS using the HokUS-10 scoring system. Using logistic regression analysis, we established the novel diagnostic criteria HokUS-6. In the presence of ascites, US diagnosis was made in the presence of two of the following 6 parameters: moderate amount of ascites, the appearance of a paraumbilical vein blood flow signal, gallbladder wall thickening, portal vein dilatation, portal vein velocity decrease, and hepatic artery resistive index increase. The AUC, sensitivity, and specificity of HokUS-6 were 0.974 (95% confidence interval 0.962-0.990), 95.2%, and 96.9%, respectively. The scores were significantly higher in patients with severe SOS than in those with non-severe SOS (p = 0.013). Furthermore, the scores before HSCT were significantly higher in patients who developed SOS than in controls (p = 0.001). The HokUS-6 is an easy and useful way to diagnose and identify the risk of SOS.

Background/Aim: Although computed tomography (CT) is the standard modality for diagnosing lymph node metastasis (LNM), transabdominal ultrasonography (US) can be useful due to its high spatial resolution and use of Doppler signals to precisely analyse lymph nodes. This study aimed to evaluate the accuracy of US for lymph node assessment, establish US-based diagnostic criteria for LNM, and compare the capability of US with that of CT for the diagnosis of LNM. Patients and Methods: This retrospective, single-institution, cohort study included patients who underwent radical surgery for clinical stage 0-III colon cancer, between March 2012 and February 2019. Results: Overall, 34.9% (66/189) of patients had pathological LNM. The optimal US diagnostic criteria were 1) short axis ≥7 mm and short/long ratio ≥0.75 and 2) at least two of the following: the absence of hilar echoes, expansive appearance, or peripheral/mixed vascularity by the colour Doppler and/or contrast-enhanced method. Compared to CT, US showed a higher diagnostic sensitivity (54.5% vs. 43.9%; p=0.296), higher concordance with the number of pathological LNM (correlation coefficient: US, 0.42; CT, 0.27) and pathological N diagnosis (weighted ĸ: US, 0.35; CT, 0.18), and higher sensitivity for advanced LNM, including multiple LNMs (47.4% vs. 18.4%; p=0.014) and N2 stage (27.8% vs. 5.6%; p=0.177). Conclusion: US has higher sensitivity than CT for diagnosing LNM in colon cancer, along with a more accurate preoperative diagnosis of the N stage. Additionally, US may be more helpful than CT alone for preoperatively deciding the appropriateness of neoadjuvant treatment in colon cancer with advanced LNM.

Evaluation of liver stiffness (LS) by magnetic resonance elastography (MRE) is useful for estimating right atrial pressure (RAP) in patients with heart failure (HF). However, its prognostic implications are unclear. We sought to investigate whether LS measured by MRE (LS-MRE) could predict clinical outcomes in patients with HF. We prospectively examined 207 consecutive HF patients between April 2018 and May 2021 after excluding those with organic liver disease. All patients underwent 3.0-T MRE. The primary outcome of interest was the composite of all-cause death and hospitalisation for HF. During a median follow-up period of 720 (interquartile range [IQR] 434–1013) days, the primary outcome occurred in 44 patients (21 • Magnetic resonance elastography (MRE) is an emerging non-invasive imaging technique for evaluating liver stiffness (LS) which can estimate right atrial pressure. • Elevated LS-MRE, which mainly reflects liver congestion, was independently associated with worse clinical outcomes in patients with heart failure. • The assessment of LS-MRE would be useful for stratifying the risk of adverse events in heart failure patients without chronic liver disease.

BACKGROUND:Liver elastography with virtual touch quantification (VTQ) measures the velocity of the shear wave generated by a short-duration acoustic force impulse, with values expressed in units of velocity (m/s). VTQ can evaluate right or left hepatic lobes separately. VTQ might be appropriate for the evaluation of future remnant liver after hepatectomy.METHODS:We analyzed 95 patients underwent liver elastography with VTQ and both future remnant liver and resected side before hepatectomy of more than two sections, except for central bisectionectomy. We divided the patients into a high VTQ group (≥1.52 m/s, n=37, 39%) and a low VTQ group (<1.52 m/s, n=58, 61%) according to the VTQ of future remnant liver. Transient elastography could not be performed in 22 cases due to tumor size. We defined the group with liver stiffness measurement (LSM) ≥7.9 kPa as the high LSM group (n=29, 40%) and those with LSM <7.9 kPa as the low LSM group (n=44, 60%). We investigated the outcome after hepatectomy and the correlations between the VTQ of future remnant liver and other indicators for hepatic fibrosis.RESULTS:The high VTQ group showed significantly higher postoperative ascites (19% vs. 3%; P=0.01), pathological fibrosis (19% vs. 5%; P=0.03), and rates of patients with postoperative T-bil ≥2.0 mg/dL (70% vs. 40%; P<0.01). The high LSM group showed no significant postoperative outcomes compared to the low LSM group. The high VTQ group showed a higher frequency of male gender (78% vs. 57%; P=0.03), higher indocyanine green retention rate at 15 min (ICGR15) (10.5% vs. 6.3%; P<0.01), hyaluronic acid (100 vs. 67 ng/mL; P=0.02), type IV collagen 7S (7.6 vs. 5.1 ng/mL; P<0.01), Mac-2 binding protein glycan isomer (M2BPGi) (1.19 vs. 1.00; P=0.01), Fibrosis-4 (FIB-4) index (2.25 vs. 1.76; P=0.01), and aspartate aminotransferase to platelet ratio index (APRI) score (0.64 vs. 0.41; P<0.01). We also observed an especially strong positive correlation between the high VTQ and hyaluronic acid or type IV collagen 7S.CONCLUSIONS:Elastography with VTQ for future remnant liver before major hepatectomy is an accurate and useful method as a preoperative evaluation.

We previously revealed that Angiopoietin-2 (Ang2) predicts non-regression of liver fibrosis based on liver stiffness measurement (LSM) at 24 weeks after anti-hepatitis C virus (HCV) treatment. In this study, we extended the observational period to 96 weeks to investigate the factors associated with non-regression after treatment with direct-acting-antivirals (DAAs). Patients treated with DAAs who underwent transient elastography at baseline and 24 and 96 weeks after DAA therapy were included. Baseline and post-treatment serum Ang2 levels were measured. Liver fibrosis stages were defined based on LSM. Multivariate regression was used to evaluate factors associated with non-regression of liver fibrosis between various time points. In total, 110 patients were included. Of these, 11% showed non-regression of LSM-based fibrosis stage at 96 weeks after DAA therapy. In multivariate analysis, advanced liver fibrosis stage and high baseline Ang2 levels were significantly associated with non-regression at 96 weeks. In patients with advanced liver fibrosis (F3/4), baseline Ang2 levels were associated with non-regression of liver fibrosis stage. Between SVR24 and SVR96, post-treatment Ang2 levels and controlled attenuation parameter values at SVR24 were significantly associated with non-regression of liver fibrosis stage in patients with F3/4. Thus, serum Ang2 levels are an important target for monitoring and therapy.

Sinusoidal obstruction syndrome (SOS)/hepatic veno-occlusive disease (VOD) is a fatal complication after hematopoietic stem cell transplantation. We previously reported the usefulness of an ultrasonographical (US) scoring system, the Hokkaido US-based scoring system consisting of ten parameters (HokUS-10): (1) hepatomegaly in the left lobe and (2) right lobe, (3) dilatation of the main portal vein (PV), (4) hepatofugal flow in the main PV, (5) decreased velocity of the PV, (6) dilatation of the para-umbilical vein (PUV), (7) appearance of blood flow signal in the PUV, (8) gallbladder (GB) wall thickening, (9) ascites, and (10) increased resistive index of the hepatic artery, for the diagnosis of SOS/VOD. However, the reliability of this system among operators remains elusive. Therefore, we prospectively evaluated the reliability of HokUS-10. Twenty-four healthy volunteers and 40 patients with liver dysfunction were enrolled. Inter- and intra-operator reliabilities were analyzed using three sonographers. The median concordance rate of HokUS-10 among three sonographers and intra-operator in 24 volunteers was 92% (95% CI: 73–98%) and 98% (95% CI: 92–100%), respectively. In all 64 cases, in terms of the reliability between two sonographers for three representative US parameters (amount of ascites, GB wall thickening, and appearance of PUV blood flow signal), the median concordance rate was more than 98% (95% CI: 86–106%). The inter- and intra-reliabilities of HokUS-10 were excellent. Thus, US might be a reliable tool for SOS/VOD diagnosis.

AimFactors associated with improvement of liver fibrosis after successful hepatitis C virus (HCV) eradication by interferon (IFN)‐free direct‐acting antiviral agents (DAAs) have been not clarified well. Angiopoietin‐2 (Ang2) is reported to be associated with vascular leak and inflammation observed in patients with advanced liver fibrosis.MethodsIn this retrospective study, patients treated with IFN‐free DAAs who underwent transient elastography before and at 24‐weeks post‐treatment and achieved sustained viral response were enrolled. Baseline serum Ang2 was measured, and its relationship with other clinical factors was analyzed. Liver fibrosis stage was defined based on liver stiffness according to a previous report. Predictive factors for regression of liver fibrosis stage after DAA therapy were evaluated.ResultsOverall, 116 patients were analyzed. Baseline serum Ang2 levels were significantly associated with liver stiffness, spleen index, and liver stiffness‐based liver fibrosis stage. Moreover, 75% of patients experienced regression of liver fibrosis stage after DAA therapy. Multivariate analysis revealed that advanced liver fibrosis stage and Ang2 levels were significantly associated with regression of liver fibrosis stage after DAA therapy. In patients with advanced liver fibrosis (F3/4), baseline Ang2 level alone could predict regression of liver fibrosis stage. A baseline Ang2 cut‐off value (354 pg/ML) could predict regression of liver fibrosis stage after DAA therapy with high accuracy (sensitivity 0.882, specificity 0.733).ConclusionsEvaluation of serum Ang2 levels before DAA therapy is important. Our results provide a novel mechanistic insight into non‐regression of liver stiffness after DAA therapy.Long‐term and larger studies are required.

50代女性．膵癌術後，直腸カルチノイドで内視鏡的粘膜下層剥離術後の経過観察のCTにて肝S6に低吸収域を指摘された．超音波検査では，肝S6に境界明瞭輪郭不整な低エコー結節でカラードプラでは中心部から辺縁に向かって車輻状に走行する血流信号を認めた．造影超音波検査（Contrast enhanced ultrasonography: CEUS）では，動脈優位相血管像にて背面から内部に流入する蛇行した線状の造影効果を認め，還流像にて結節全体にびまん性の造影効果を呈し，造影効果は周辺肝実質より明らかに強かった．門脈相にて造影効果は比較的遷延しており，早期のwashoutは見られなかった．積算画像では中心部から放射状に広がる車輻状の血管構築を認めた．肝部分切除を施行し，病理組織所見にてNET （G2）と診断された．NETの肝転移腫瘍の典型的なB mode所見は，均一なやや高エコー腫瘤で，CEUSでは動脈優位相での均一な強い増強効果，門脈優位相でwash outされ，後血管相で境界明瞭な造影欠損を示すことが多いと報告されている．しばしば肝細胞癌（Hepatocellular carcinoma: HCC）や限局性結節性過形成（Focal nodular hyperplasia: FNH）との鑑別が問題となる．HCCではwash outが遅いこと， FNHではカラードプラやCEUSにて車輻状の血管構築を示し，多くは後血管相で造影欠損を呈さないことが鑑別点とされる．しかしながらFNHの中には後血管相で造影欠損を呈する報告もあり，慎重な鑑別診断が必要とされる．今回我々は，CEUSで車輻状の血管構築を呈し，鑑別に苦慮したが，生検にてNETの肝転移であった症例を経験したので報告する．

AimUltrasound technology can now be used for liver stiffness measurement (LSM) and for evaluating the amount of hepatic fat quantitatively known as the controlled attenuation parameter (CAP). This study aimed to determine the applicable cut‐off values of LSM and the CAP for primary hepatocellular carcinoma (HCC), and to investigate their clinical usefulness for assessing HCC risk in patients with chronic liver disease.MethodsA total of 1054 patients (88 with primary HCC and 966 without HCC) whose LSM and the CAP were measured by transient elastography with clinically evident hepatitis C virus (419 patients), hepatitis B virus (377 patients), and non‐alcoholic fatty liver disease (258 patients) were enrolled in this study. Subsequently, a total of 966 patients who did not have HCC initially were followed, and the usefulness of the cut‐off values of LSM and CAP for HCC development were evaluated.ResultsIn hepatitis C virus patients, the incidence of HCC development was significantly higher among those with a combination of LSM ≥8.0 kPa and CAP ≤221 dB/m than among those with other values (log–rank test 0.0239, hazard ratio 2.66, 95%CI 1.07–6.47, P = 0.0362). In non‐alcoholic fatty liver disease patients, the incidence of HCC development was significantly higher among those with a combination of LSM ≥5.4 kPa and CAP ≤265 dB/m than among others (log–rank test 0.0040, hazard ratio 8.91, 95% CI 1.47–67.97, P = 0.0192).ConclusionIn the hepatitis C virus and non‐alcoholic fatty liver disease groups, a combination of LSM and the CAP cut‐off values would be useful for screening to identify the high‐risk group for primary HCC development.

Gout, which is characterized by the deposition of monosodium urate monohydrate (MSU) in the synovial fluid and other tissues, is the most common form of inflammatory arthritis. Unlike the easily recognized acute and monoarticular gouty arthritis, advanced gout induces multiple finger joint disorders and may sometimes mimic rheumatoid arthritis (RA) or vice versa. The gold standard for gout diagnosis is the identification of MSU crystals via aspiration in the symptomatic joints or nodules; however, its feasibility and specificity may be inadequate. Recently, there have been important advances in imaging techniques, assisting in the non-invasive diagnosis of gout. Ultrasonography (US) has been known to have the ability to detect deposition of MSU crystals in patients with gout. Herein, we report an evocative case of long-standing gout with precisely detected specific US features indicating MSU crystal deposition and inflammation in multiple joints. Comprehensive US assessment included the bone, hyaline cartilage, soft tissue, subcutaneous nodules and tendon; we also discriminated gouty arthritis from RA.

INTRODUCTION Sinusoidal obstruction syndrome (SOS), also known as hepatic veno-occlusive disease (VOD), is 1 of the lifethreatening complications after hematopoietic stem cell transplantation (HSCT) [1]. Typical clinical presentations of SOS/VOD include body weight gain, painful hepatomegaly, ascites, and jaundice [2,3]. The incidence of SOS/VOD after HSCT varies from 5% to 60% [4-10], depending on types of conditioning regimen and cancer treatments before HSCT. SOS/VOD is induced by damage of the hepatic sinusoidal endothelial cells by cytotoxic agents, such as busulfan, cyclophosphamide, gemtuzumab ozogamicin, and inotuzumab ozogamicin [10]. The sinusoidal endothelial cell damage hinders the outflow of sinusoid by embolization, leading to upstream congestion and portal hypertension. Transabdominal ultrasonography (US) accompanied with Doppler imaging is useful to detect blood flow abnormalities in SOS/VOD [11-17]. Previous studies identified several parameters to be screened by US to detect SOS/VOD [18,19]. In this prospective study we developed a novel US-based scoring system of SOS/VOD.

Liver stiffness (LS) has been reported to be a marker of liver congestion caused by elevated central venous pressure in heart failure (HF) patients. Recent studies demonstrated that LS could be non-invasively measured by virtual touch quantification (VTQ). However, its prognostic implication in patients with acute decompensated heart failure (ADHF) is unclear. This study sought to determine whether LS measured by VTQ could be a determinant of subsequent adverse events in ADHF patients. We prospectively recruited 70 ADHF patients who underwent LS measurement by VTQ on admission in our university hospital between June 2016 and April 2018. The primary outcome of interest was the composite of all-cause mortality and worsening HF. During a median follow-up period of 272 (interquartile range 122–578) days, there were 26 (37%) events, including 5 (7%) deaths and 21 (30%) cases of worsening HF. The c-index of LS for predicting the composite of adverse events was 0.77 (95% CI 0.66–0.88), and the optimal cut-off value of LS was 1.50 m/s. Adverse events were more frequently observed in patients with high LS (≥ 1.50 m/s) compared to those with low LS (< 1.50 m/s). Multivariable Cox regression analyzes revealed that higher LS was independently associated with increased subsequent risk of adverse events after adjustment for confounders. In conclusion, high admission LS was an independent determinant of worse clinical outcomes in patients with ADHF. This finding suggests that LS on admission is useful for risk stratification of patients with ADHF.

Background It has been described that the incidence of testicular microlithiasis is high in several congenital disorders which may be associated with testicular impairment and infertility. Several reports have shown that a prepubertal or pubertal hormonal abnormality in the pituitary-gonadal axis was identified in some patients with hypospadias that is one of the most common disorders of sex development. However, exact prevalence or risk factors of testicular microlithiasis in patients with hypospadias have not reported so far. In the present study, to clarify the prevalence and risk factors of testicular microlithiasis in patients with hypospadias, a retrospective chart review was performed. Methods Children with hypospadias who underwent testicular ultrasonography between January 2010 and April 2016 were enrolled in the present study. Severity of hypospadias was divided into mild and severe. The prevalence and risk factors of testicular microlithiasis or classic testicular microlithiasis were examined. Results Of 121 children, mild and severe hypospadias were identified in 66 and 55, respectively. Sixteen children had undescended testis. Median age at ultrasonography evaluation was 1.7 years old. Testicular microlithiasis and classic testicular microlithiasis were documented in 17 children (14.0%) and 8 (6.6%), respectively. Logistic regression analysis revealed that presence of undescended testis was only a significant factor for testicular microlithiasis and classic testicular microlithiasis. The prevalence of testicular microlithiasis or classic testicular microlithiasis was significantly higher in children with undescended testis compared to those without undescended testis (testicular microlithiasis; 43.8% versus 9.5% ( p = 0.002), classic testicular microlithiasis; 37.5% versus 1.9% ( p < 0.001). Conclusions The current study demonstrated that the presence of undescended testis was only a significant risk factor for testicular microlithiasis or classic testicular microlithiasis in patients with hypospadias. As co-existing undescended testis has been reported as a risk factor for testicular dysfunction among patients with hypospadias, the current findings suggest that testicular microlithiasis in children with hypospadias may be associated with impaired testicular function. Conversely, patients with isolated HS seem to have lower risks for testicular impairment. Further investigation with longer follow-up will be needed to clarify these findings.

Sinusoidal obstruction syndrome (SOS)/hepatic veno-occlusive disease (VOD) is a well-documented complication after hematopoietic stem cell transplantation (HSCT). Transabdominal ultrasonography (US) enables the visualization of blood flow abnormalities and is therefore useful for the diagnosis of SOS/VOD. We herein prospectively evaluated accuracy of a novel US diagnostic scoring system of SOS/VOD based on US findings. We carried out US in 106 patients on day 14 and when SOS/VOD was suspected after allogeneic HSCT. Among 106 patients, 10 patients (9.4%) were diagnosed as SOS/VOD by Baltimore or Seattle criteria. According to univariate analysis of 17 US findings (US-17 screening), we established a novel scoring system (HokUS-10) consisting of 10 parameters, such as gallbladder wall thickening, ascites, and blood flow signal in the paraumbilical vein. The sensitivity and specificity were 100% and 95.8%, respectively. Diagnostic performance of the HokUS-10 was significantly better than US-17 screening. In 4 of 10 patients US detection of SOS/VOD preceded to clinical diagnosis. The HokUS-10 scoring system is useful in the diagnosis of SOS/VOD; however, our results should be validated in other cohorts.