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HEPATIQ is useful to clinicians such as hepatologists, gastroenterologists, and internists. It is also of value to those managing liver cancer such as oncologists, interventionists, and liver surgeons. Scroll down for details about each specialty.
Hepatologists, gastroenterologists and internists
Hepatologists, gastroenterologists and internists manage patients with liver disease. They use blood tests, elastography and biopsies for diagnosis and prognosis. These are all fibrosis based assessments of the liver. However, the liver regenerates and blood flow to the liver increases to compensate for fibrosis.
The liver gets its blood (hepatic flow) from the heart (arterial flow) and from the gut (splanchnic flow). Some of the splanchnic flow does not reach the liver due to collateral shunts. Some of the hepatic flow is effectively lost due to intra-hepatic shunts. These intra-hepatic hemodynamic abnormalities (IHHA) play an important role in tissue perfusion and clearance. Fibrosis measurements entirely miss the IHHA of chronic liver disease.
Thus, an F4 patient may be H0 or H1 and may remain stable for years or decades. On the other hand, an F4 patient may be H2 or H3 and may be at risk of decompensation.
Furthermore, abnormal liver patients (>F0) may be sicker than the fibrosis measurement suggests[A-B]. For better diagnosis and prognosis, HEPATIQ may be used to assess liver functional reserve for abnormal liver patients (>F0) .
Oncologists, interventionists and liver surgeons.
Liver transplantation (LT) has the greatest cure potential for hepatocellular carcinoma (HCC) patients.
Bridge therapies prior to LT include stereotactic body radiation therapy (SBRT), Yttrium-90 radioembolization (Y90), radiofrequency ablation (RFA), transarterial chemoembolization (TACE) and surgical resection.
The figure shows a SPECT image of the liver after Y90 therapy. Notice the dark region in the middle of the liver indicating the large volume of liver tissue (tumor and non-tumor) destroyed by the radiation.
A 2022 publication in The Journal of Hepatology, “The importance of liver functional reserve (LFR) in the non-surgical treatment of hepatocellular carcinoma” by D’Avola et al [C], discusses the role of LFR and efforts to estimate it. The paper concludes that “patients with compensated cirrhosis and large liver functional reserve can always receive the most radical treatment”.
However, “a more detailed and individualized assessment should be carried out in patients with poorer liver functional reserve”. HEPATIQ may be used to assess the patient's liver functional reserve before an intervention or surgery.
patient Case studies
HEPATIQ calculates quantitiative indices of liver disease thus providing a comprehensive view of the health of the liver. Shown below are serial SPECT images of the liver, spleen and bone marrow for 8 patients. Also shown are HEPATIQ differential graphs for the indices PHM, fLV, fSV and HAI.
CASE 1 - Alcoholic Hepatitis (death) 53 year old female presented with PHM 48 (H5). HAI -0.35 indicated marked alcoholic hepatitis activity. fSV of about 4 indicated portal hypertension. Patient died soon after hospital admission.
CASE 2 - Alcoholic Hepatitis (recovery) 60 year old male presented with PHM 67 (H4). HAI -0.3 indicated marked alcoholic hepatitis activity. Patient quit drinking alcohol and recovered to PHM 91 (H3) over 3 years. HAI improved from -0.30 (marked) to -0.12 (moderate).
CASE 3 - Cryptogenic cirrhosis 74 year old female presented as H2 cirrhotic.Over the next 4 years her PHM and fLV both decreased indicating progressive chronic liver disease. There was no indication of alcoholic hepatitis. She developed ascites and died while awaiting a transplant.
CASE 4 - Cirrhosis and HCC. 82 year old female presented as H2 cirrhotic. She was stable H2 for three years. Then she developed Hepatocellular Carcinoma (HCC) and was treated with RFA and Y90. Unfortunately the cancer returned, and after another Y90 she developed ascites and hepatic encephalopathy and then died.
CASE 5 - Liver Transplant 65 year old female with decompensation (H4) received a transplant liver. PHM was near normal (H1) post transplant indicating restoration of liver function. Spleen volume fSV dropped indicating reduction of portal hypertension.
CASE 6 - Autoimmune Hepatitis 65 year old female presented with ascites and jaundice. PHM was 59 (H5). She was diagnosed with Autoimmune Chronic Active Hepatitis and treated with Prednisone/Imuran. PHM improved to 80 (H3) in a few months and eventually to 93 (H2).
CASE 7 - MASH Risk 61 year old female patient presented as normal (H0) with PHM 103 and fLV 7. She was on Prednisone and gaining weight. Liver volume increased from 7 to 11 over six years indicating risk of developing metabolic dysfunction-associated steatohepatitis (MASH). Liver function remained normal.
CASE 8 - F4 with portal hypertension 42 year old female presented as F4 cirrhosis by elastography. PHM was borderline stable for 3 years (H1). In the fourth year PHM dropped rapidly indicating risk of decompensation. Increasing fSV indicated portal hypertension. There was no indication of alcoholic hepatitis.
