2020 Fiscal Year Final Research Report

Noninvasive diagnostic imaging for liver fibrosis and fatty liver with hepatocellular carcinoma risk prediction based on ultrasonic medicine and morphology

Research Project

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Project/Area Number	18K07985
Research Category	Grant-in-Aid for Scientific Research (C)
Allocation Type	Multi-year Fund
Section	一般
Review Section	Basic Section 53010:Gastroenterology-related
Research Institution	Hyogo Medical University
Principal Investigator	Iijima Hiroko 兵庫医科大学, 医学部, 教授 (80289066)
Co-Investigator(Kenkyū-buntansha)	藤元治朗兵庫医科大学, 医学部, 特別招聘教授 (90199373) 矢野博久久留米大学, 医学部, 教授 (40220206)
Project Period (FY)	2018-04-01 – 2021-03-31
Keywords	線維化 / 肝脂肪化 / 超音波 / 脂肪減衰法 / Elastography / 肝発癌リスク
Outline of Final Research Achievements	Liver stiffness (LS) by shear wave elastography was obtained with 809 patients. The result was compared with histology of fibrosis. The AUROC of transient elastography to predict F2<, F3<, and F4 was 0.809, 0.860 and 0.947; that of virtual touch quantification was 0.793, 0.836 and 0.941, respectively. LS showed significant increase with the progression of fibrosis. Diagnosis of liver fibrosis based on LS measurement was established to avoid invasive diagnosis. Attenuation imaging (ATI) enables to quantitively assess liver steatosis as accurate as controlled attenuation parameter. In 119 steatosis cases, the correlation of ATI with MRI-derived proton density fat fraction (PDFF) was r=0.70. ATI showed a good diagnostic ability as MRI-PDFF. Post-sustained virologic response HCC occurrence is observed more in patients with higher LS and glucose level. A electronic microscopic study showed a higher rate of mitochondrial disorder in HCC recurrence cases.
Free Research Field	消化器内科学
Academic Significance and Societal Importance of the Research Achievements	超音波エラストグラフィは、機種間の差が無く肝線維化診断ができる方法として確立された。異なる方法でも換算式で比較出来る方法を考案した。ゴールドスタンダードである肝生検は入院が必須で出血等の合併症がある。肝臓全体の1/50,000の組織しか採取できずサンプリングエラーが30％前後と報告され、病理医間の読影差もある。エラストグラフィは肝生検に替わる方法として医療に貢献できる。さらに測定値は、線維化と脂肪減衰量を連続変数で定量評価できる。脂肪肝の有病率が上昇し肝線維化脂肪化診断は今後さらに社会的需要が高まる。発癌リスク危険群が同定できたことは極めて大きい。