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LIVER DISEASE
The liver regulates chemical levels in the blood and excretes bile. Bile helps to break down fats, preparing them for further digestion and absorption. All of the blood leaving the stomach and intestines pass through the liver. The liver processes this blood and creates nutrients for the body to use. The body cannot live without a functioning liver. The basic functioning unit in the liver is a “lobule”. Liver function is largely determined by the number of functioning lobules and the blood flow through them. As liver disease progresses, there may be a decrease in the number of functioning lobules, and changes in blood flow to them.
HEPATIQ
HEPATIQ provides six indices of liver disease from a single scan: quantitative liver function, steatosis/steatohepatitis, portal hypertension, alcoholic hepatitis, fibrosis stage and variceal size.[1-28]
It is the only product on the market that precisely and non-invasively quantifies liver functional reserve. Other techniques such as biopsies, elastography and blood tests estimate liver fibrosis but do not quantify function.
Liver Functional Reserve
This is measured by the index PHM (perfused hepatic mass). It can be reduced by infections, alcohol and fat buildup that cause the accumulation of fibrosis or scar tissue (whitish regions in the figure). The liver can regenerate new functioning nodules (e.g. the bumps on the surface in the figure), and blood flow to the liver may increase, providing some mitigation. A large, badly scarred, stiff liver can have normal function (PHM>100) [4] if there are enough functional nodules and adequate blood flow. Once a patient’s PHM drops below 75, they may decompensate, that is, develop clinical problems.[5,6,11,14,19,20,24] If their PHM falls below 60, they may die if not transplanted soon. [10,15,18]
Function Outperforms Fibrosis
Patient outcomes are determined by the liver functional reserve, not the extent of fibrosis. This was established in the 8 year, prospective, multi-center HALT-C trial, which concluded that quantitative liver function may be more accurate than staging fibrosis in predicting clinical outcomes.[5,6] Subsequent clinical research has further confirmed that function outperforms fibrosis in predicting outcomes.[12,13,16,17,21,22,24]
Better diagnosis and prognosis
The HEPATIQ report shows indices: PHM (liver function), fLV (liver volume), fSV (spleen volume), HAI (alcoholic hepatitis), eFS (estimated fibrosis) and eEV (estimated varices). These indices are used for diagnosis, staging, interventions, and monitoring liver disease progression. They help identify those at risk of ascites, variceal bleeding, hepatic encephalopathy and liver-related death.[5,6,10,11,14,15,16,18,19,20,23,24,25,26] Differentials of these indicate steatotic liver disease, steatohepatitis, alcoholic hepatitis, cirrhosis, portal hypertension, varices and infiltrative spleen disease.[5,6,8,11,14,16,21,22,23,25] HEPATIQ also provides the H0-H5 physiological model of liver disease.[27,28]
Comparative Analysis
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Predictive ability of blood test based fibrosis scoring systems to identify persons with advanced fibrosis associated with development of cirrhosis is modest [A]. Fibrosis scores have poor sensitivity for predicting advanced liver disease in diabetic patients [B]. Elastography or a biopsy may be performed for staging liver disease (F0-F4) but they don't provide information on liver functional reserve. It may be beneficial to use HEPATIQ to assess liver functional reserve for patients designated as abnormal (>F0) [12,13,17,22]. Furthermore, before a liver surgery or any liver interventional procedure, use HEPATIQ to assess liver functional reserve [C].