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Regression of fibrosis in paediatric autoimmune hepatitis: morphometric assessment of fibrosis versus semiquantiatative methods.

Abdalla AF, Zalata KR, Ismail AF, Shiha G, Attiya M, Abo-Alyazeed A - Fibrogenesis Tissue Repair (2009)

Bottom Line: The median age at presentation was 4 years (range 2 to 12 years).The mean duration of treatment was 22 +/- 7.3 months, and the mean interval between biopsies was 26.2 +/- 6.5 months.Following therapy, there was significant reduction in aspartate aminotransferase, ALT and IgG levels as well as improvement of necroinflammation.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Paediatrics, Hepatology & Gastroenterology Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt. pedgit@mans.edu.eg

ABSTRACT

Background: Regression of hepatic fibrosis in patients with autoimmune hepatitis (AIH) has been described in response to immunosuppressive therapy. These studies, however, besides being few in number, were conducted on adult populations. Our aim was to assess the regression of hepatic fibrosis, using morphometric assessment of fibrosis versus semi-quantitative methods, in children with AIH who achieved clinical and biochemical remission. Thirteen patients who achieved clinical and biochemical remission were included in the study, out of 62 children with AIH. Repeat biopsy was performed after 6 to 12 months of clinical and biochemical remission. Morphometric assessment of fibrosis was performed and correlated with METAVIR and Ishak semi-quantitative scores.

Results: The study group included eight male and five female patients. The median age at presentation was 4 years (range 2 to 12 years). The mean duration of treatment was 22 +/- 7.3 months, and the mean interval between biopsies was 26.2 +/- 6.5 months. Following therapy, there was significant reduction in aspartate aminotransferase, ALT and IgG levels as well as improvement of necroinflammation. The mean fibrosis scores were significantly decreased from 4.5 +/- 1.19 and 2.9 +/- 0.7 before therapy to 2.7 +/- 1.16 and 2 +/- 0.8 after treatment as assessed by Ishak and METAVIR scores, respectively (P = 0.001 and 0.004). The mean morphometric assessment of fibrosis before treatment was 20% +/- 9.7 and following therapy it decreased to 5.6% +/- 3.9 (P = 0.000).

Conclusion: Significant regression of fibrosis in paediatric AIH could occur with current therapeutic regimens. Morphometric assessment of fibrosis is more sensitive than semi-quantitative methods to identify changes in fibrosis.

No MeSH data available.


Related in: MedlinePlus

Morphometric assessment of liver fibrosis in post-treatment biopsy using mosaic picture. a) Post-treatment mosaic picture of 93 microscopic fields (Sirus redx100). b) Delineation of the whole liver core (mosaic picture). c) Computer-assisted marking of fibrosis in binary image. d) Combined marking of fibrosis and the whole core at the same time.
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Figure 1: Morphometric assessment of liver fibrosis in post-treatment biopsy using mosaic picture. a) Post-treatment mosaic picture of 93 microscopic fields (Sirus redx100). b) Delineation of the whole liver core (mosaic picture). c) Computer-assisted marking of fibrosis in binary image. d) Combined marking of fibrosis and the whole core at the same time.

Mentions: The morphometric assessment of liver fibrosis was performed by the fully automated Leica image processor with automated stage and Leica Quin software 2004. The liver biopsy slide, stained with Sirus red, was placed on the x-y motorized stage of Leica microscope. At a magnification of ×10, automated sequential digitalized images were taken and stored, then a mosaic picture was created including all the images with minimal field overlapping. This enables fibrosis assessment of the entire core at the same time. After interactive threshold, the image was converted into a binary image. Artefacts created during slide preparation were eliminated by both automatic and interactive procedures (Figure 1a to 1d). The area of the liver parenchyma was considered the reference area, then the fractional surface occupied by fibrosis was measured within the above-defined area.


Regression of fibrosis in paediatric autoimmune hepatitis: morphometric assessment of fibrosis versus semiquantiatative methods.

Abdalla AF, Zalata KR, Ismail AF, Shiha G, Attiya M, Abo-Alyazeed A - Fibrogenesis Tissue Repair (2009)

Morphometric assessment of liver fibrosis in post-treatment biopsy using mosaic picture. a) Post-treatment mosaic picture of 93 microscopic fields (Sirus redx100). b) Delineation of the whole liver core (mosaic picture). c) Computer-assisted marking of fibrosis in binary image. d) Combined marking of fibrosis and the whole core at the same time.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2682789&req=5

Figure 1: Morphometric assessment of liver fibrosis in post-treatment biopsy using mosaic picture. a) Post-treatment mosaic picture of 93 microscopic fields (Sirus redx100). b) Delineation of the whole liver core (mosaic picture). c) Computer-assisted marking of fibrosis in binary image. d) Combined marking of fibrosis and the whole core at the same time.
Mentions: The morphometric assessment of liver fibrosis was performed by the fully automated Leica image processor with automated stage and Leica Quin software 2004. The liver biopsy slide, stained with Sirus red, was placed on the x-y motorized stage of Leica microscope. At a magnification of ×10, automated sequential digitalized images were taken and stored, then a mosaic picture was created including all the images with minimal field overlapping. This enables fibrosis assessment of the entire core at the same time. After interactive threshold, the image was converted into a binary image. Artefacts created during slide preparation were eliminated by both automatic and interactive procedures (Figure 1a to 1d). The area of the liver parenchyma was considered the reference area, then the fractional surface occupied by fibrosis was measured within the above-defined area.

Bottom Line: The median age at presentation was 4 years (range 2 to 12 years).The mean duration of treatment was 22 +/- 7.3 months, and the mean interval between biopsies was 26.2 +/- 6.5 months.Following therapy, there was significant reduction in aspartate aminotransferase, ALT and IgG levels as well as improvement of necroinflammation.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Paediatrics, Hepatology & Gastroenterology Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt. pedgit@mans.edu.eg

ABSTRACT

Background: Regression of hepatic fibrosis in patients with autoimmune hepatitis (AIH) has been described in response to immunosuppressive therapy. These studies, however, besides being few in number, were conducted on adult populations. Our aim was to assess the regression of hepatic fibrosis, using morphometric assessment of fibrosis versus semi-quantitative methods, in children with AIH who achieved clinical and biochemical remission. Thirteen patients who achieved clinical and biochemical remission were included in the study, out of 62 children with AIH. Repeat biopsy was performed after 6 to 12 months of clinical and biochemical remission. Morphometric assessment of fibrosis was performed and correlated with METAVIR and Ishak semi-quantitative scores.

Results: The study group included eight male and five female patients. The median age at presentation was 4 years (range 2 to 12 years). The mean duration of treatment was 22 +/- 7.3 months, and the mean interval between biopsies was 26.2 +/- 6.5 months. Following therapy, there was significant reduction in aspartate aminotransferase, ALT and IgG levels as well as improvement of necroinflammation. The mean fibrosis scores were significantly decreased from 4.5 +/- 1.19 and 2.9 +/- 0.7 before therapy to 2.7 +/- 1.16 and 2 +/- 0.8 after treatment as assessed by Ishak and METAVIR scores, respectively (P = 0.001 and 0.004). The mean morphometric assessment of fibrosis before treatment was 20% +/- 9.7 and following therapy it decreased to 5.6% +/- 3.9 (P = 0.000).

Conclusion: Significant regression of fibrosis in paediatric AIH could occur with current therapeutic regimens. Morphometric assessment of fibrosis is more sensitive than semi-quantitative methods to identify changes in fibrosis.

No MeSH data available.


Related in: MedlinePlus