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Bao J, Lv Y, Wang K, Wang Q, Chen Y, Dong Y, Zhu Y, Wang W. A Comparative Study of Ultrasound Attenuation Imaging, Controlled Attenuation Parameters, and Magnetic Resonance Spectroscopy for the Detection of Hepatic Steatosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1481-1489. [PMID: 36583414 DOI: 10.1002/jum.16158] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/02/2022] [Accepted: 12/08/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To investigate the methodology and clinical application of ultrasound attenuation imaging (ATI) and comparative analyze the diagnostic performance of ATI and controlled attenuation parameters (CAP) for detecting and grading hepatic steatosis. METHODS A total of 159 patients with NAFLD were prospectively enrolled. CAP and ATI examinations were performed within a week before proton magnetic resonance spectroscopy (1 H-MRS). Ten liver attenuation coefficient (AC) measurements by ATI were obtained in each patient. The interclass correlation coefficients (ICCs) of the intraobserver consistencies and the ICCs between the median of the first two through the first nine measurements and all 10 measurements were calculated. The correlations between 1 H-MRS, CAP, biological data, and ATI were evaluated. The significant factors associated with ATI and the diagnostic performance of ATI and CAP for detecting hepatic steatosis was evaluated. RESULTS The median value of AC for detecting hepatic steatosis was 0.831 dB/cm/MHz. For the intraobserver consistency of ATI, the ICC was 0.931. Compared with 10 measurements, a minimum of four ATI measurements was required. The correlation of AC with hepatic fat fraction (HFF) was significantly higher than that of CAP (0.603 vs 0.326, P = .0015). The HFF and triglyceride (TG) were the significant factors for the ATI. The area under the receiver operating characteristics (ROC) curves of ATI and CAP were 0.939 and 0.788 for detecting ≥10% hepatic steatosis; 0.751 and 0.572 for detecting >33% hepatic steatosis. The cutoff values of ATI and CAP were 0.697 dB/cm/MHz and 310 dB/m for detecting ≥10% hepatic steatosis; 0.793 dB/cm/MHz and 328 dB/m for detecting >33% hepatic steatosis. The sensitivity of ATI and CAP were 85.92% and 52.11% for detecting ≥10% hepatic steatosis; 87.50% and 82.14% for detecting >33% hepatic steatosis. The specificity of ATI and CAP were 94.12% and 100% for detecting ≥10% hepatic steatosis; 54.37% and 43.69% for detecting >33% hepatic steatosis. CONCLUSIONS ATI technology showed excellent intraobserver consistency and the optimal minimum number of ATI measurements was 4. ATI is a promising noninvasive, quantitative and convenient tool for assessing hepatic steatosis.
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Affiliation(s)
- Jingwen Bao
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
- School of Medical Science, Hexi University, Zhangye, China
| | - Yueming Lv
- Department of General Surgery, Zhangye Second People's Hospital, Zhangye, China
| | - Kun Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Quanwen Wang
- School of Medical Science, Hexi University, Zhangye, China
| | - Yanling Chen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuli Zhu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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Kim JW, Lee CH, Yang Z, Kim BH, Lee YS, Kim KA. The spectrum of magnetic resonance imaging proton density fat fraction (MRI-PDFF), magnetic resonance spectroscopy (MRS), and two different histopathologic methods (artificial intelligence vs. pathologist) in quantifying hepatic steatosis. Quant Imaging Med Surg 2022; 12:5251-5262. [PMID: 36330193 PMCID: PMC9622443 DOI: 10.21037/qims-22-393] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/05/2022] [Indexed: 07/26/2023]
Abstract
BACKGROUND The grade of hepatic steatosis is assessed semi-quantitatively and graded as a discrete value. However, the proton density fat fraction (PDFF) measured by magnetic resonance imaging (MRI) and FF measured by MR spectroscopy (FFMRS) are continuous values. Therefore, a quantitative histopathologic method may be needed. This study aimed to (I) provide a spectrum of values of MRI-PDFF, FFMRS, and FFs measured by two different histopathologic methods [artificial intelligence (AI) and pathologist], (II) to evaluate the correlation among them, and (III) to evaluate the diagnostic performance of MRI-PDFF and MRS for grading hepatic steatosis. METHODS Forty-seven patients who underwent liver biopsy and MRI for nonalcoholic steatohepatitis (NASH) evaluation were included. The agreement between MRI-PDFF and MRS was evaluated through Bland-Altman analysis. Correlations among MRI-PDFF, MRS, and two different histopathologic methods were assessed using Pearson correlation coefficient (r). The diagnostic performance of MRI-PDFF and MRS was assessed using receiver operating characteristic curve analyses and the area under the curve (AUC) were obtained. RESULTS The means±standard deviation of MRI-PDFF, FFMRS, FF measured by pathologist (FFpathologist), and FF measured by AI (FFAI) were 12.04±6.37, 14.01±6.16, 34.26±19.69, and 6.79±4.37 (%), respectively. Bland-Altman bias [mean of MRS - (MRI-PDFF) differences] was 2.06%. MRI-PDFF and MRS had a very strong correlation (r=0.983, P<0.001). The two different histopathologic methods also showed a very strong correlation (r=0.872, P<0.001). Both MRI-PDFF and MRS demonstrated a strong correlation with FFpathologist (r=0.701, P<0.001 and r=0.709, P<0.001, respectively) and with FFAI (r=0.700, P<0.001 and r=0.690, P<0.001, respectively). The AUCs of MRI-PDFF for grading ≥S2 and ≥S3 were 0.846 and 0.855, respectively. The AUCs of MRS for grading ≥S2 and ≥S3 were 0.860 and 0.878, respectively. CONCLUSIONS Since MRS and MRI-PDFF demonstrated a strong correlation with each other and with the two different histopathologic methods, they can be used as an alternative noninvasive reference standard in nonalcoholic fatty liver disease (NAFLD) patients. However, these preliminary results should be interpreted with caution until they are validated in further studies.
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Affiliation(s)
- Jeong Woo Kim
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chang Hee Lee
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Zepa Yang
- Biomedical Research Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Baek-Hui Kim
- Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young-Sun Lee
- Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyeong Ah Kim
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Lichtenstein AH, Kris‐Etherton PM, Petersen KS, Matthan NR, Barnes S, Vitolins MZ, Li Z, Sabaté J, Rajaram S, Chowdhury S, Davis KM, Galluccio J, Gilhooly CH, Legro RS, Li J, Lovato L, Perdue LH, Petty G, Rasmussen AM, Segovia‐Siapco G, Sirirat R, Sun A, Reboussin DM. Effect of Incorporating 1 Avocado Per Day Versus Habitual Diet on Visceral Adiposity: A Randomized Trial. J Am Heart Assoc 2022; 11:e025657. [PMID: 35861827 PMCID: PMC9707833 DOI: 10.1161/jaha.122.025657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Excess visceral adiposity is associated with increased risk of cardiometabolic disorders. Short‐term well‐controlled clinical trials suggest that regular avocado consumption favorably affects body weight, visceral adiposity, and satiety.
Methods and Results
The HAT Trial (Habitual Diet and Avocado Trial) was a multicenter, randomized, controlled parallel‐arm trial designed to test whether consuming 1 large avocado per day for 6 months in a diverse group of free‐living individuals (N=1008) with an elevated waist circumference compared with a habitual diet would decrease visceral adiposity as measured by magnetic resonance imaging. Secondary and additional end points related to risk factors associated with cardiometabolic disorders were assessed. The primary outcome, change in visceral adipose tissue volume during the intervention period, was not significantly different between the Avocado Supplemented and Habitual Diet Groups (estimated mean difference (0.017 L [−0.024 L, 0.058 L],
P
=0.405). No significant group differences were observed for the secondary outcomes of hepatic fat fraction, hsCRP (high‐sensitivity C‐reactive protein), and components of the metabolic syndrome. Of the additional outcome measures, modest but nominally significant reductions in total and low‐density lipoprotein cholesterol were observed in the Avocado Supplemented compared with the Habitual Diet Group. Changes in the other additional and post hoc measures (body weight, body mass index, insulin, very low‐density lipoprotein concentrations, and total cholesterol:high‐density lipoprotein cholesterol ratio) were similar between the 2 groups.
Conclusions
Addition of 1 avocado per day to the habitual diet for 6 months in free‐living individuals with elevated waist circumference did not reduce visceral adipose tissue volume and had minimal effect on risk factors associated with cardiometabolic disorders.
Registration
URL:
https://clinicaltrials.gov
; Unique identifier: NCT03528031.
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Affiliation(s)
| | | | | | | | - Samuel Barnes
- Department of Radiology Loma Linda University School of Medicine Loma Linda CA
| | - Mara Z. Vitolins
- Department of Epidemiology and Prevention Wake Forest University School of Medicine Winston‐Salem NC
| | - Zhaoping Li
- Center for Human Nutrition David Geffen School of Medicine at UCLA Los Angeles CA
| | - Joan Sabaté
- Healthy Lifestyles, and Disease Prevention Loma Linda University School of Public Health Center for Nutrition Loma Linda CA
| | - Sujatha Rajaram
- Healthy Lifestyles, and Disease Prevention Loma Linda University School of Public Health Center for Nutrition Loma Linda CA
| | - Shilpy Chowdhury
- Department of Radiology Loma Linda University School of Medicine Loma Linda CA
| | - Kristin M. Davis
- Department of Behavioral Health Pennsylvania State University State College PA
| | - Jean Galluccio
- JM USDA Human Nutrition Center on Aging, Tufts University Boston MA
| | | | | | - Jason Li
- Center for Human Nutrition David Geffen School of Medicine at UCLA Los Angeles CA
| | - Laura Lovato
- Department of Biostatistics Wake Forest University School of Medicine Winston‐Salem NC
| | - Letitia H. Perdue
- Department of Biostatistics Wake Forest University School of Medicine Winston‐Salem NC
| | - Gayle Petty
- JM USDA Human Nutrition Center on Aging, Tufts University Boston MA
| | - Anna M. Rasmussen
- Center for Human Nutrition David Geffen School of Medicine at UCLA Los Angeles CA
| | - Gina Segovia‐Siapco
- Healthy Lifestyles, and Disease Prevention Loma Linda University School of Public Health Center for Nutrition Loma Linda CA
| | - Rawiwan Sirirat
- Healthy Lifestyles, and Disease Prevention Loma Linda University School of Public Health Center for Nutrition Loma Linda CA
| | - April Sun
- Center for Human Nutrition David Geffen School of Medicine at UCLA Los Angeles CA
| | - David M. Reboussin
- Department of Biostatistics Wake Forest University School of Medicine Winston‐Salem NC
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Reboussin DM, Kris-Etherton PM, Lichtenstein AH, Li Z, Sabate J, Matthan NR, Petersen K, Rajaram S, Vitolins M, Ford N. The design and rationale of a multi-center randomized clinical trial comparing one avocado per day to usual diet: The Habitual Diet and Avocado Trial (HAT). Contemp Clin Trials 2021; 110:106565. [PMID: 34496276 DOI: 10.1016/j.cct.2021.106565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/27/2021] [Accepted: 09/03/2021] [Indexed: 11/25/2022]
Abstract
Excess visceral adiposity is associated with increased risk of diabetes and cardiovascular disease. In the U.S. approximately 60% of adults have visceral obesity. Despite high calorie and fat, small, well-controlled clinical studies suggest that avocado consumption has favorable effects on body weight and visceral adiposity. Additionally, short-term studies also suggest that consuming avocados increases satiety, hence, may decrease overall energy intake. The Habitual Diet and Avocado Trial HAT is a multi-center, randomized, controlled trial designed to test whether in a large, diverse cohort providing one avocado per day for consumption for six months compared to a habitual diet essentially devoid of avocados, will result in a decrease in visceral adiposity as measured by magnetic resonance imaging (MRI) in individuals with an increased waist circumference (WC). Additional outcome measures include hepatic lipid content, plasma lipid profiles, blood pressure and high sensitivity C-reactive protein. Inclusion criteria were increased WC and not currently eating more than two avocados per month. Major exclusion criteria were not eating or being allergic to avocados, and not willing or able to undergo MRI scans. From June 27, 2018 to March 4, 2020, 1008 participants were randomized at 4 clinics. The cohort was 72% women, 53% Non-Hispanic White, and had a mean age of 50 years. Follow-up was completed in October 2020 when 936 participants had final MRI scans. HAT will provide information on the effects of avocado consumption on visceral fat adiposity and cardiometabolic disease risk in a diverse sample of participants.
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Affiliation(s)
- David M Reboussin
- Department of Biostatistics, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, N.C. 27157, USA.
| | - Penny M Kris-Etherton
- Department of Nutritional Sciences, Penn State University, 319 Chandlee Laboratory, University Park, PA 16802, USA.
| | - Alice H Lichtenstein
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA 02111, USA,.
| | - Zhaoping Li
- Center for Human Nutrition, David Geffen School of Medicine, UCLA, 200 UCLA Medical Plaza, Suite B365, Los Angeles, CA 90095, USA,.
| | - Joan Sabate
- Center for Nutrition, Lifestyle and Disease Prevention, Loma Linda University School of Public Health, 24951 North Circle Drive, Loma Linda, CA 92350, USA.
| | - Nirupa R Matthan
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA 02111, USA,.
| | - Kristina Petersen
- Department of Nutritional Sciences, Texas Tech University, P.O. Box 41270, Lubbock, TX 79409-1270, USA.
| | - Sujatha Rajaram
- Center for Nutrition, Lifestyle and Disease Prevention, Loma Linda University School of Public Health, 24951 North Circle Drive, Loma Linda, CA 92350, USA.
| | - Mara Vitolins
- Department of Epidemiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, N.C. 27157, USA.
| | - Nikki Ford
- Hass Avocado Board, 25212 Marguerite Parkway, Suite 250, Mission Viejo, CA 92692, USA.
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Makhija N, Vikram NK, Srivastava DN, Madhusudhan KS. Role of Diffusion-Weighted Magnetic Resonance Imaging in the Diagnosis and Grading of Hepatic Steatosis in Patients With Non-alcoholic Fatty Liver Disease: Comparison With Ultrasonography and Magnetic Resonance Spectroscopy. J Clin Exp Hepatol 2021; 11:654-660. [PMID: 34866843 PMCID: PMC8617527 DOI: 10.1016/j.jceh.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 02/20/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is becoming the most common cause of cirrhosis. Although magnetic resonance spectroscopy (MRS) is considered the gold standard, it has a few limitations. The role of diffusion-weighted imaging (DWI), which is a simpler sequence, in the diagnosis and grading of fatty liver is not well studied. The aim of the study was to investigate the value of DWI in the diagnosis and grading of hepatic steatosis in patients with NAFLD. MATERIALS AND METHODS Fifty-one adults (mean age: 38 years; 28 men, 23 women) with NAFLD, diagnosed clinically and by ultrasonography (USG), were included in the study after obtaining informed consent and approval from the institute ethics committee. USG was performed for grading of hepatic steatosis in all patients, followed by magnetic resonance imaging with DWI and MRS, on a 1.5T scanner. The mean apparent diffusion coefficient (ADC) values and proton density fat fraction (PDFF) were calculated, and MRS was used as the gold standard. The mean ADC values were compared with the PDFF and USG grades. RESULTS There was a weak correlation between ADC values and PDFF (r = -0.36; P < 0.05). In addition, there was a weak correlation between the ADC values of the liver and USG grade (r = -0.34; P < 0.05). However, an overall increase in USG grades and PDFF was associated with decrease in the mean ADC value (P < 0.001). CONCLUSION DWI is not accurate in the diagnosis and grading of hepatic steatosis in patients with NAFLD. However, a significant increase in fat deposition in the liver lowers the ADC values.
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Affiliation(s)
- Nikhil Makhija
- Departments of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 10029, India
| | - Naval K. Vikram
- Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 10029, India
| | - Deep N. Srivastava
- Departments of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 10029, India
| | - Kumble S. Madhusudhan
- Departments of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 10029, India,Address for correspondence: Kumble S. Madhusudhan, Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Peng XG, Zhao Z, Chang D, Bai Y, Xu Q, Ju S. Quantification of Fat Concentration and Vascular Response in Brown and White Adipose Tissue of Rats by Spectral CT Imaging. Korean J Radiol 2020; 21:248-256. [PMID: 31997600 PMCID: PMC6992445 DOI: 10.3348/kjr.2019.0111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 09/23/2019] [Indexed: 11/15/2022] Open
Abstract
Objective The purpose of the study was to non-invasively characterize and discriminate brown adipose tissue (BAT) from white adipose tissue (WAT) in rats using spectral computed tomography (CT) with histological validation. Materials and Methods A lipid-containing phantom (lipid fractions from 0% to 100%) was imaged with spectral CT. An in vivo, non-enhanced spectral CT scan was performed on 24 rats, and fat concentrations of BAT and WAT were measured. The rats were randomized to receive intraperitoneal treatment with norepinephrine (NE) (n = 12) or saline (n = 12). Non-enhanced and enhanced spectral CT scans were performed after treatment to measure the elevation of iodine in BAT and WAT. The BAT/aorta and WAT/aorta ratios were calculated and compared, after which isolated BAT and WAT samples were subjected to histological and uncoupling protein 1 (UCP1) analyses. Results The ex-vivo phantom study showed excellent linear fit between measured fat concentration and the known gravimetric reference standard (r2 = 0.996). In vivo, BAT had significantly lower fat concentration than WAT (p < 0.001). Compared to the saline group, the iodine concentration of BAT increased significantly (p < 0.001) after injection of NE, while the iodine concentration of WAT only changed slightly. The BAT/aorta ratio also increased significantly after exposure to NE compared to the saline group (p < 0.001). Histological and UCP1 expression analyses supported the spectral CT imaging results. Conclusion The study consolidates spectral CT as a new approach for non-invasive imaging of BAT and WAT. Quantitative analyses of BAT and WAT by spectral CT revealed different characteristics and pharmacologic activations in the two types of adipose tissue.
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Affiliation(s)
- Xin Gui Peng
- Department of Radiology, Zhongda Hospital, Jiangsu Key Laboratory of Molecular and Functional Imaging, Medical School of Southeast University, Nanjing, China
| | - Zhen Zhao
- Department of Radiology, Zhongda Hospital, Jiangsu Key Laboratory of Molecular and Functional Imaging, Medical School of Southeast University, Nanjing, China
| | - Di Chang
- Department of Radiology, Zhongda Hospital, Jiangsu Key Laboratory of Molecular and Functional Imaging, Medical School of Southeast University, Nanjing, China
| | - Yingying Bai
- Department of Radiology, Zhongda Hospital, Jiangsu Key Laboratory of Molecular and Functional Imaging, Medical School of Southeast University, Nanjing, China
| | - Qiuzhen Xu
- Department of Radiology, Zhongda Hospital, Jiangsu Key Laboratory of Molecular and Functional Imaging, Medical School of Southeast University, Nanjing, China
| | - Shenghong Ju
- Department of Radiology, Zhongda Hospital, Jiangsu Key Laboratory of Molecular and Functional Imaging, Medical School of Southeast University, Nanjing, China.
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Netaji A, Jain V, Gupta AK, Kumar U, Jana M. Utility of MR proton density fat fraction and its correlation with ultrasonography and biochemical markers in nonalcoholic fatty liver disease in overweight adolescents. J Pediatr Endocrinol Metab 2020; 33:473-479. [PMID: 32146441 DOI: 10.1515/jpem-2019-0463] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 01/20/2020] [Indexed: 01/04/2023]
Abstract
Background Clinical or biochemical markers that have good correlation with magnetic resonance proton density fat fraction (MR PDFF) can be used as simple tools for the screening for nonalcoholic fatty liver disease (NAFLD) and in determining the degree of fatty infiltration of the liver. The objective of this study was to determine the degree of relationship between MR PDFF and ultrasonography (USG) grades of fatty liver, and clinical and biochemical parameters of adolescents and to determine the sensitivity and specificity of USG for diagnosis of NAFLD. Methods This prospective study included 34 overweight adolescents (mean age, 12.1 ± 1.5 years; range, 10-15.1 years; 10 girls and 24 boys) who underwent both USG and magnetic resonance imaging (MRI). Correlation analysis was performed between MR fat fraction and USG grades of fatty liver, and clinical and biochemical parameters of fatty liver disease. Results MR fat fraction had a moderate positive correlation with serum alanine transaminase (ALT) and aspartate transaminase (AST) (ρ = 0.634, p < 0.001, ρ = 0.516, p = 0.002, respectively) and had a negligible or weak correlation with body mass index (BMI), BMI standard deviation score (SDS), waist circumference (WC), fasting insulin, homeostatic model assessment of insulin resistance (HOMA-IR), serum triglyceride, low-density lipoprotein (LDL), high-density lipoprotein (HDL) and total cholesterol levels. The sensitivity and specificity of USG in the diagnosis of NAFLD were 81% (95% confidence interval 54%-95%) and 50% (27%-73%), respectively. The MR fat fraction had a moderate positive correlation with ultrasound grades of fatty liver (ρ = 0.487, p = 0.003). Conclusions Serum ALT and AST are potential biochemical markers to assess the degree of hepatic steatosis in NAFLD, which needs validation in further studies. USG can be used as a screening tool for NAFLD, but the diagnosis should be confirmed by estimating the MR fat fraction.
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Affiliation(s)
- Arjunlokesh Netaji
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Vandana Jain
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Arun Kumar Gupta
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Udit Kumar
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Manisha Jana
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
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Multiparametric MR Index for the Diagnosis of Non-Alcoholic Steatohepatitis in Patients with Non-Alcoholic Fatty Liver Disease. Sci Rep 2020; 10:2671. [PMID: 32060386 PMCID: PMC7021895 DOI: 10.1038/s41598-020-59601-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 01/31/2020] [Indexed: 02/06/2023] Open
Abstract
Non-alcoholic steatohepatitis (NASH) is a complex disease consisting of various components including steatosis, lobular inflammation, and ballooning degeneration, with or without fibrosis. Therefore, it is difficult to diagnose NASH with only one imaging modality. This study was aimed to evaluate the feasibility of magnetic resonance imaging (MRI) for predicting NASH and to develop a non-invasive multiparametric MR index for the detection of NASH in non-alcoholic fatty liver disease (NAFLD) patients. This prospective study included 47 NAFLD patients who were scheduled to undergo or underwent ultrasound-guided liver biopsy within 2 months. Biopsy specimens were graded as NASH or non-NASH. All patients underwent non-enhanced MRI including MR spectroscopy (MRS), MR elastography (MRE), and T1 mapping. Diagnostic performances of MRS, MRE, and T1 mapping for grading steatosis, activity, and fibrosis were evaluated. A multiparametric MR index combining fat fraction (FF), liver stiffness (LS) value, and T1 relaxation time was developed using linear regression analysis. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of the newly devised MR index. Twenty NASH patients and 27 non-NASH patients were included. Using MRS, MRE, and T1 mapping, the mean areas under the curve (AUCs) for grading steatosis, fibrosis, and activity were 0.870, 0.951, and 0.664, respectively. The multiparametric MR index was determined as 0.037 × FF (%) + 1.4 × LS value (kPa) + 0.004 × T1 relaxation time (msec) −3.819. ROC curve analysis of the MR index revealed an AUC of 0.883. The cut-off value of 6 had a sensitivity of 80.0% and specificity of 85.2%. The multiparametric MR index combining FF, LS value, and T1 relaxation time showed high diagnostic performance for detecting NASH in NAFLD patients.
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Fu L, Cui H, Lu K, Zou C, Ji G, Li L, Li J, Sheng L, Xie C. [Correlation between serum 25(OH) vitamin D and liver fat content in nonalcoholic fatty liver disease]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2019; 39:1118-1121. [PMID: 31640966 DOI: 10.12122/j.issn.1673-4254.2019.09.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the relationship between serum 25(OH) vitamin D and liver fat content in nonalcoholic fatty liver disease (NAFLD). METHODS A total of 120 patients with NAFLD admitted in our hospital between June and August, 2017 were enrolled and divided into 4 groups with different serum 25 (OH) vitamin D levels: >75 nmol/L (group A, n=25), 50-75 nmol/L (group B, n=35), 25-50 nmol/L (group C, n=32), and < 25 nmol/L (group D, n=28). For all the patients, serum 25 (OH) vitamin D level was measured by ELISA, and liver fat content was determined using in-phase opposed-phase T1WI sequences. The measurement data were compared among the 4 groups to assess the association between serum 25(OH) vitamin D level and liver fat content. RESULTS The liver fat content appeared to be higher in group B (28.66±6.45%) and group C (38.74±11.47%) than in group A (22.79 ± 6.10%), but the difference was not statistically significant (P>0.05); the liver fat content in group D (54.79 ± 5.28%) was significantly higher than that in the other 3 groups (P>0.05). Liver fat content increased significantly as serum 25(OH) vitamin D level decreased, showing an inverse correlation between them in these patients (P < 0.05, r=-0.125). CONCLUSIONS In patients with NAFLD, a decreased serum 25(OH) vitamin D level is associated with an increased liver fat content, suggesting the value of serum 25(OH) vitamin D as a predictor of NAFLD.
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Affiliation(s)
- Likun Fu
- Department of Gastroenterology, First Hospital of Qinhuangdao, Qinhuangdao 066000, China
| | - Hongmei Cui
- Department of Gastroenterology, First Hospital of Qinhuangdao, Qinhuangdao 066000, China
| | - Kunling Lu
- Department of Gastroenterology, First Hospital of Qinhuangdao, Qinhuangdao 066000, China
| | - Chunyan Zou
- Department of Gastroenterology, First Hospital of Qinhuangdao, Qinhuangdao 066000, China
| | - Guixian Ji
- Department of Gastroenterology, First Hospital of Qinhuangdao, Qinhuangdao 066000, China
| | - Li Li
- Department of Gastroenterology, First Hospital of Qinhuangdao, Qinhuangdao 066000, China
| | - Jinglong Li
- Department of Gastroenterology, First Hospital of Qinhuangdao, Qinhuangdao 066000, China
| | - Lina Sheng
- Department of Gastroenterology, First Hospital of Qinhuangdao, Qinhuangdao 066000, China
| | - Changshun Xie
- Department of Gastroenterology, First Hospital of Qinhuangdao, Qinhuangdao 066000, China
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Fukui H, Hori M, Fukuda Y, Onishi H, Nakamoto A, Ota T, Ogawa K, Ninomiya K, Tatsumi M, Osuga K, Yamada D, Eguchi H, Miyoshi E, Tomiyama N. Evaluation of fatty pancreas by proton density fat fraction using 3-T magnetic resonance imaging and its association with pancreatic cancer. Eur J Radiol 2019; 118:25-31. [PMID: 31439250 DOI: 10.1016/j.ejrad.2019.06.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/20/2019] [Accepted: 06/26/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE To evaluate whether pancreatic magnetic resonance imaging-proton density fat fraction (MRI-PDFF) correlates with histological pancreatic fat fraction and its possible usefulness as a biomarker of pancreatic cancer compared with pancreatic index (PI) using computed tomography (CT number of the pancreas divided by that of the spleen). METHOD We included 55 consecutive patients (24 with pancreatic cancer and 31 controls; median age, 72 years) who preoperatively underwent MRI-PDFF using IDEAL-IQ and unenhanced CT and did not receive preoperative therapy. Histologic pancreatic fat fraction was measured in non-tumorous pancreatic tissues at the resection stump. A board-certified radiologist evaluated MRI-PDFF and PI. Correlations were evaluated among MRI-PDFF, PI, and histologic pancreatic fat fraction; the usefulness of MRI-PDFF as a predictor of pancreatic cancer was assessed. RESULTS Histologic pancreatic fat fraction significantly correlated with MRI-PDFF and PI (r = 0.802 and -0.534, respectively; P < 0.01). The absolute correlation coefficient was significantly higher for MRI-PDFF than for PI (P < 0.01). Compared with the control group, the pancreatic cancer group had higher MRI-PDFF and histologic pancreatic fat fraction (P < 0.01) but lower PI (P < 0.01). In multivariate analysis, MRI-PDFF was found to be the sole independent risk factor for pancreatic cancer (odds ratio: 1.19; P < 0.01). CONCLUSIONS Pancreatic fat, which was associated with pancreatic cancer, could be quantified by MRI-PDFF measurement; therefore, MRI-PDFF should be considered as a promising and superior imaging biomarker for estimating the probability of pancreatic cancer than PI.
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Affiliation(s)
- Hideyuki Fukui
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Japan.
| | - Masatoshi Hori
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Japan
| | - Yasunari Fukuda
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Japan
| | - Hiromitsu Onishi
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Japan
| | - Atsushi Nakamoto
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Japan
| | - Takashi Ota
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Japan
| | - Kazuya Ogawa
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Japan
| | - Keisuke Ninomiya
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Japan
| | - Mitsuaki Tatsumi
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Japan
| | - Keigo Osuga
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Japan
| | - Daisaku Yamada
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Japan
| | - Eiji Miyoshi
- Department of Molecular Biochemistry & Clinical Investigation, Osaka University Graduate School of Medicine, Japan
| | - Noriyuki Tomiyama
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Japan
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11
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Li YM, Fan JG. Guidelines of prevention and treatment for alcoholic liver disease (2018, China). J Dig Dis 2019; 20:174-180. [PMID: 30450822 DOI: 10.1111/1751-2980.12687] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 12/11/2022]
Affiliation(s)
- You Ming Li
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Jian Gao Fan
- Department of Gastroenterology, XinHua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Children's Digestion and Nutrition, Shanghai, China
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12
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Zhou JH, Cai JJ, She ZG, Li HL. Noninvasive evaluation of nonalcoholic fatty liver disease: Current evidence and practice. World J Gastroenterol 2019; 25:1307-1326. [PMID: 30918425 PMCID: PMC6429343 DOI: 10.3748/wjg.v25.i11.1307] [Citation(s) in RCA: 126] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/20/2019] [Accepted: 02/23/2019] [Indexed: 02/06/2023] Open
Abstract
With the increasing number of individuals with diabetes and obesity, nonalcoholic fatty liver disease (NAFLD) is becoming increasingly prevalent, affecting one-quarter of adults worldwide. The spectrum of NAFLD ranges from simple steatosis or nonalcoholic fatty liver (NAFL) to nonalcoholic steatohepatitis (NASH). NAFLD, especially NASH, may progress to fibrosis, leading to cirrhosis and hepatocellular carcinoma. NAFLD can impose a severe economic burden, and patients with NAFLD-related terminal or deteriorative liver diseases have become one of the main groups receiving liver transplantation. The increasing prevalence of NAFLD and the severe outcomes of NASH make it necessary to use effective methods to identify NAFLD. Although recognized as the gold standard, biopsy is limited by its sampling bias, poor acceptability, and severe complications, such as mortality, bleeding, and pain. Therefore, noninvasive methods are urgently needed to avoid biopsy for diagnosing NAFLD. This review discusses the current noninvasive methods for assessing NAFLD, including steatosis, NASH, and NAFLD-related fibrosis, and explores the advantages and disadvantages of measurement tools. In addition, we analyze potential noninvasive biomarkers for tracking disease processes and monitoring treatment effects, and explore effective algorithms consisting of imaging and nonimaging biomarkers for diagnosing advanced fibrosis and reducing unnecessary biopsies in clinical practice.
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Affiliation(s)
- Jiang-Hua Zhou
- Department of Cardiology, Renmin Hospital of Wuhan University, Institute of Model Animal of Wuhan University, Wuhan 430071, Hubei Province, China
| | - Jing-Jing Cai
- Department of Cardiology, The 3rd Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
| | - Zhi-Gang She
- Department of Cardiology, Renmin Hospital of Wuhan University, Institute of Model Animal of Wuhan University, Wuhan 430071, Hubei Province, China
| | - Hong-Liang Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Institute of Model Animal of Wuhan University, Wuhan 430071, Hubei Province, China
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13
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Tahtacı M, Algın O, Karakan T, Yürekli ÖT, Alışık M, Köseoğlu H, Metin MR, Bolat AD, Erel Ö, Ersoy O. Can pancreatic steatosis affect exocrine functions of pancreas? TURKISH JOURNAL OF GASTROENTEROLOGY 2019; 29:588-594. [PMID: 30260782 DOI: 10.5152/tjg.2018.17696] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS Pancreatic steatosis (PS) is a generally used term to define accumulation of fat in the pancreas. In theory PS may be able to affect the exocrine function of pancreas. In this study we aimed to determine the effect of PS on exocrine pancreas function. MATERIALS AND METHODS Forty-three patients with PS determined by 3 tesla magnetic resonance imaging (MRI) and 48 patients without PS were included in this study. Patients with PS were classified as group 1 and control patients were classified as group 2. Fecal elastase-1 levels were determined. Fecal elastase-1 levels <200 μg/g were defined as exocrine pancreatic insufficiency (EPI). Patients with PS were further grouped according to severity and anatomic distribution of steatosis based on findings of 3 tesla MRI. RESULTS Fecal elastase-1 levels was significantly lower in group 1 compared to group 2 (319.76±45.7 vs 549.31±69.4, respectively, p=0.003). Proportion of patients with EPI was significantly higher in group 1 than group 2 (35.5% vs 12% p=0.042). There were no significant differences in terms of severity or the anatomic distribution of PS in patients with PS with EPI based on MRI (p=0.052, p=0.198, p=0.405) Conclusion: Current study demonstrates that PS can cause EPI.
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Affiliation(s)
- Mustafa Tahtacı
- Department of Gastroenterology, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Oktay Algın
- Department of Radiology, Atatürk Training and Research Hospital, Ankara, Turkey
| | - Tarkan Karakan
- Department of Gastroenterology, Gazi University School of Medicine, Ankara, Turkey
| | - Öykü Tayfur Yürekli
- Department of Gastroenterology, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Murat Alışık
- Department of Biochemistry, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Hüseyin Köseoğlu
- Department of Gastroenterology, Atatürk Training and Research Hospital, Ankara, Turkey
| | - Melike Ruşen Metin
- Department of Radiology, Atatürk Training and Research Hospital, Ankara, Turkey
| | - Aylin Demirezer Bolat
- Department of Gastroenterology, Atatürk Training and Research Hospital, Ankara, Turkey
| | - Özcan Erel
- Department of Biochemistry, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Osman Ersoy
- Department of Gastroenterology, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
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14
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Bush EC, Gifford A, Coolbaugh CL, Towse TF, Damon BM, Welch EB. Fat-Water Phantoms for Magnetic Resonance Imaging Validation: A Flexible and Scalable Protocol. J Vis Exp 2018. [PMID: 30247483 DOI: 10.3791/57704] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
As new techniques are developed to image adipose tissue, methods to validate such protocols are becoming increasingly important. Phantoms, experimental replicas of a tissue or organ of interest, provide a low cost, flexible solution. However, without access to expensive and specialized equipment, constructing stable phantoms with high fat fractions (e.g., >50% fat fraction levels such as those seen in brown adipose tissue) can be difficult due to the hydrophobic nature of lipids. This work presents a detailed, low cost protocol for creating 5x 100 mL phantoms with fat fractions of 0%, 25%, 50%, 75%, and 100% using basic lab supplies (hotplate, beakers, etc.) and easily accessible components (distilled water, agar, water-soluble surfactant, sodium benzoate, gadolinium-diethylenetriaminepentacetate (DTPA) contrast agent, peanut oil, and oil-soluble surfactant). The protocol was designed to be flexible; it can be used to create phantoms with different fat fractions and a wide range of volumes. Phantoms created with this technique were evaluated in the feasibility study that compared the fat fraction values from fat-water magnetic resonance imaging to the target values in the constructed phantoms. This study yielded a concordance correlation coefficient of 0.998 (95% confidence interval: 0.972-1.00). In summary, these studies demonstrate the utility of fat phantoms for validating adipose tissue imaging techniques across a range of clinically relevant tissues and organs.
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Affiliation(s)
- Emily C Bush
- Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University Medical Center
| | - Aliya Gifford
- Department of Biomedical Informatics, Vanderbilt University Medical Center
| | - Crystal L Coolbaugh
- Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University Medical Center
| | - Theodore F Towse
- Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University Medical Center; Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center; Department of Biomedical Sciences, Grand Valley State University
| | - Bruce M Damon
- Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University Medical Center; Department of Radiology & Radiological Sciences, Vanderbilt University Medical Center; Department of Biomedical Engineering, Vanderbilt University; Department of Molecular Physiology and Biophysics, Vanderbilt University;
| | - E Brian Welch
- Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University Medical Center; Department of Radiology & Radiological Sciences, Vanderbilt University Medical Center
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15
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Wang XM, Zhang XJ, Ma L. Diagnostic performance of magnetic resonance technology in detecting steatosis or fibrosis in patients with nonalcoholic fatty liver disease: A meta-analysis. Medicine (Baltimore) 2018; 97:e10605. [PMID: 29794735 PMCID: PMC6392510 DOI: 10.1097/md.0000000000010605] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the diagnostic accuracy of magnetic resonance (MR) imaging-based methods for detecting steatosis and fibrosis in nonalcoholic fatty liver disease (NAFLD). METHODS Data were extracted from research articles obtained after a literature search from multiple electronic databases. Random-effects meta-analyses were performed to obtain overall effect size of the area of operator receiver curve (AUROC), sensitivity and specificity of MR imaging, MR elastography, and MR spectroscopy in detecting or grading steatosis/fibrosis. Meta-analysis of correlation coefficients was performed to have an overall effect size of correlation between MR-based diagnosis and histological diagnosis. RESULTS Twenty-one studies (1658 subjects; 45.32 years [95% CI: 35.94, 54.71] of age, 53.67% [45.39, 61.95] males, and 29.98 kg/m [21.93, 38.04] BMI) were included in the meta-analysis. Pooled analyses of the AUROC, specificity, and sensitivity values reported in the individual studies revealed an overall effect sizes of 0.90 (0.88, 0.92), 82.27% (77.74, 86.80), and 86.94% (84.18, 95.28) in the use of any MR-based technique for the diagnosis of NAFLD or its severity. The correlation coefficient between MR-based detection of liver steatosis and histologically measured steatosis was 0.748 (0.706, 0.789) (P < .00001). CONCLUSION MRI-based diagnostic methods are valuable additions in detecting NAFLD or determining the severity of the NAFLD.
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Affiliation(s)
- Xiao-min Wang
- Department of Radiology, Chinese PLA General Hospital, Beijing
- School of Medical Imaging, Tianjin Medical University, Tianjin, China
| | - Xiao-jing Zhang
- Department of Radiology, Chinese PLA General Hospital, Beijing
| | - Lin Ma
- Department of Radiology, Chinese PLA General Hospital, Beijing
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16
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Alcohol consumption, but not smoking is associated with higher MR-derived liver fat in an asymptomatic study population. PLoS One 2018; 13:e0192448. [PMID: 29401483 PMCID: PMC5798849 DOI: 10.1371/journal.pone.0192448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 01/23/2018] [Indexed: 01/01/2023] Open
Abstract
Background The aim of our study was to determine the relation of alcohol consumption and cigarette smoking on continuous-measured hepatic fat fraction (HFF) in a population free of cardiovascular disease. We suggested a direct correlation of alcohol consumption with HFF and increased HFF in former smokers compared to current smokers. Methods Data from 384 subjects (mean age: 56 years, 58% men) of a population-based cohort study (KORA) were included in a cross-sectional design. Liver fat was assessed by 3 Tesla magnetic resonance imaging (MRI) using a multi-echo Dixon sequence and T2-corrected single voxel multi-echo spectroscopy (1H-MRS). Smoking status was classified as never, former or current smoker and alcohol consumption as non-, moderate (0.1–39.9 g/day for men and 0.1–19.9 g/day for women), or heavy drinker (≥ 40 g/day for men and ≥ 20 g/day for women). Fatty liver disease was defined as HFF≥5.56%. Results Average HFF was 8.8% by 1H-MRS and 8.5% by MRI. Former smokers showed a higher HFF (MRI: β = 2.64; p = 0.006) and a higher FLD prevalence (MRI: OR = 1.91; p = 0.006) compared to never smokers. Current smokers showed decreased odds for FLD measured by 1H-MRS after multivariable adjustment (OR = 0.37; p = 0.007) with never smoker as reference. Heavy drinking was positively associated with HFF (1H-MRS: β = 2.99; p = 0.003) and showed highest odds for FLD (1H-MRS: OR = 3.05; p = 0.008) with non-drinker as reference. Moderate drinking showed a positive association with HFF (1H-MRS: β = 1.54; p = 0.061 and MRI: β = 1.75; p = 0.050). Conclusions Our data revealed lowest odds for FLD in current smokers, moderate drinkers showing higher HFF than non-drinkers and heavy drinkers showing highest HFF and odds for FLD. These findings partly conflict with former literature and underline the importance of further studies to investigate the complex effects on liver metabolism.
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17
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Esterson YB, Grimaldi GM. Radiologic Imaging in Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis. Clin Liver Dis 2018; 22:93-108. [PMID: 29128063 DOI: 10.1016/j.cld.2017.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The article reviews the multimodality (ultrasound, computed tomography, and magnetic resonance [MR]) imaging appearance of nonalcoholic fatty liver disease (NAFLD) and discusses the radiologic diagnostic criteria as well as the sensitivity and specificity of these imaging methods. The authors review the role of both ultrasound and MR elastography for the diagnosis of fibrosis and for the longitudinal evaluation of patients following therapeutic intervention. Lastly, the authors briefly discuss the screening and diagnosis of hepatocellular carcinoma in patients with NAFLD, as there are special considerations in this population.
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Affiliation(s)
- Yonah B Esterson
- Department of Radiology, Northwell Health System, Hofstra Northwell School of Medicine, 300 Community Drive, Manhasset, NY 11030, USA.
| | - Gregory M Grimaldi
- Department of Radiology, Northwell Health System, Hofstra Northwell School of Medicine, 300 Community Drive, Manhasset, NY 11030, USA
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18
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Liver Adiposity and Metabolic Profile in Individuals with Chronic Spinal Cord Injury. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1364818. [PMID: 28948164 PMCID: PMC5602482 DOI: 10.1155/2017/1364818] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/22/2017] [Accepted: 07/09/2017] [Indexed: 01/14/2023]
Abstract
PURPOSE To quantify liver adiposity using magnetic resonance imaging (MRI) and to determine its association with metabolic profile in men with spinal cord injury (SCI). MATERIALS AND METHODS MRI analysis of liver adiposity by fat signal fraction (FSF) and visceral adipose tissue (VAT) was completed on twenty participants. Intravenous glucose tolerance test was conducted to measure glucose effectiveness (Sg) and insulin sensitivity (Si). Lipid panel, fasting glucose, glycated hemoglobin (HbA1c), and inflammatory cytokines were also analyzed. RESULTS Average hepatic FSF was 3.7% ± 2.1. FSF was positively related to TG, non-HDL-C, fasting glucose, HbA1c, VAT, and tumor necrosis factor alpha (TNF-α). FSF was negatively related to Si and testosterone. FSF was positively related to VAT (r = 0.48, p = 0.032) and TNF-α (r = 0.51, p = 0.016) independent of age, level of injury (LOI), and time since injury (TSI). The associations between FSF and metabolic profile were independent of VAT. CONCLUSIONS MRI noninvasively estimated hepatic adiposity in men with chronic SCI. FSF was associated with dysfunction in metabolic profile, central adiposity, and inflammation. Importantly, liver adiposity influenced metabolic profile independently of VAT. These findings highlight the significance of quantifying liver adiposity after SCI to attenuate the development of metabolic disorders.
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Manning P, Murphy P, Wang K, Hooker J, Wolfson T, Middleton MS, Newton KP, Behling C, Awai HI, Durelle J, Paiz MN, Angeles JE, De La Pena D, McCutchan JA, Schwimmer JB, Sirlin CB. Liver histology and diffusion-weighted MRI in children with nonalcoholic fatty liver disease: A MAGNET study. J Magn Reson Imaging 2017; 46:1149-1158. [PMID: 28225568 DOI: 10.1002/jmri.25663] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 01/25/2017] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To determine potential associations between histologic features of pediatric nonalcoholic fatty liver disease (NAFLD) and estimated quantitative magnetic resonance diffusion-weighted imaging (DWI) parameters. MATERIALS AND METHODS This prospective, cross-sectional study was performed as part of the Magnetic Resonance Assessment Guiding NAFLD Evaluation and Treatment (MAGNET) ancillary study to the Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN). Sixty-four children underwent a 3T DWI scan (b-values: 0, 100, and 500 s/mm2 ) within 180 days of a clinical liver biopsy of the right hepatic lobe. Three parameters were estimated in the right hepatic lobe: apparent diffusion coefficient (ADC), diffusivity (D), and perfusion fraction (F); the first assuming exponential decay and the latter two assuming biexponential intravoxel incoherent motion. Grading and staging of liver histology were done using the NASH CRN scoring system. Associations between histologic scores and DWI-estimated parameters were tested using multivariate linear regression. RESULTS Estimated means ± standard deviations were: ADC: 1.3 (0.94-1.8) × 10-3 mm2 /s; D: 0.82 (0.56-1.0) × 10-3 mm2 /s; and F: 17 (6.0-28)%. Multivariate analyses showed ADC and D decreased with steatosis and F decreased with fibrosis (P < 0.05). Associations between DWI-estimated parameters and other histologic features were not significant: ADC: fibrosis (P = 0.12), lobular inflammation (P = 0.20), portal inflammation (P = 0.27), hepatocellular inflammation (P = 0.29), NASH (P = 0.30); D: fibrosis (P = 0.34), lobular inflammation (P = 0.84), portal inflammation (P = 0.76), hepatocellular inflammation (P = 0.38), NASH (P = 0.81); F: steatosis (P = 0.57), lobular inflammation (P = 0.22), portal inflammation (P = 0.42), hepatocellular inflammation (P = 0.59), NASH (P = 0.07). CONCLUSION In children with NAFLD, steatosis and fibrosis have independent effects on DWI-estimated parameters ADC, D, and F. Further research is needed to determine the underlying mechanisms and clinical implications of these effects. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1149-1158.
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Affiliation(s)
- Paul Manning
- Liver Imaging Group, Department of Radiology, University of California, San Diego, School of Medicine, San Diego, California, USA
| | - Paul Murphy
- Liver Imaging Group, Department of Radiology, University of California, San Diego, School of Medicine, San Diego, California, USA
| | - Kang Wang
- Liver Imaging Group, Department of Radiology, University of California, San Diego, School of Medicine, San Diego, California, USA
| | - Jonathan Hooker
- Liver Imaging Group, Department of Radiology, University of California, San Diego, School of Medicine, San Diego, California, USA
| | - Tanya Wolfson
- Computational and Applied Statistics Laboratory (CASL), SDSC, University of California, San Diego, La Jolla, California, USA
| | - Michael S Middleton
- Liver Imaging Group, Department of Radiology, University of California, San Diego, School of Medicine, San Diego, California, USA
| | - Kimberly P Newton
- Department of Pediatrics, UCSD and Department of Gastroenterology, Rady Children's Hospital, San Diego, California, USA
| | - Cynthia Behling
- Department of Pediatrics, UCSD and Department of Gastroenterology, Rady Children's Hospital, San Diego, California, USA
| | - Hannah I Awai
- Department of Pediatrics, UCSD and Department of Gastroenterology, Rady Children's Hospital, San Diego, California, USA
| | - Janis Durelle
- Department of Pediatrics, UCSD and Department of Gastroenterology, Rady Children's Hospital, San Diego, California, USA
| | - Melissa N Paiz
- Department of Pediatrics, UCSD and Department of Gastroenterology, Rady Children's Hospital, San Diego, California, USA
| | - Jorge E Angeles
- Department of Pediatrics, UCSD and Department of Gastroenterology, Rady Children's Hospital, San Diego, California, USA
| | - Diana De La Pena
- Department of Pediatrics, UCSD and Department of Gastroenterology, Rady Children's Hospital, San Diego, California, USA
| | | | - Jeffrey B Schwimmer
- Department of Pediatrics, UCSD and Department of Gastroenterology, Rady Children's Hospital, San Diego, California, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California, San Diego, School of Medicine, San Diego, California, USA
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Keese D, Korkusuz H, Huebner F, Namgaladze D, Raschidi B, Vogl TJ. In vivo and ex vivo measurements: noninvasive assessment of alcoholic fatty liver using 1H-MR spectroscopy. Diagn Interv Radiol 2017; 22:13-21. [PMID: 26627137 DOI: 10.5152/dir.2015.14331] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE We aimed to evaluate the ability of 1H-magnetic resonance spectroscopy (1H-MRS) to detect and quantify hepatic fat content in vivo and ex vivo in an experimental rat model of alcoholic fatty liver using histopathology, biochemistry, and laboratory analyses as reference. METHODS Alcoholic fatty liver was induced within 48 hours in 20 Lewis rats; 10 rats served as control. Intrahepatic fat content determined by 1H-MRS was expressed as the percent ratio of the lipid and water peaks and was correlated with intrahepatic fat content determined histologically and biochemically. Liver enzymes were measured in serum. RESULTS Fatty liver could be detected in vivo as well as ex vivo using 1H-MRS, in all 20 animals. Histologic analysis showed a fatty liver in 16 of 20 animals. Histology and 1H-MRS results were highly correlated (in vivo, r=0.93, P = 0.0005; ex vivo, r=0.92, P = 0.0006). Also a strong correlation was noted between in vivo 1H-MRS measurements and the fat content determined biochemically (r=0.96, P = 0.0003). Ex vivo results showed a similarly strong correlation between 1H-MRS and biochemistry (r=0.89, P = 0.0011). CONCLUSION 1H-MRS can be carried out in ex vivo models, as well as in vivo, to detect and quantify intrahepatic fat content in the acute fatty liver.
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Affiliation(s)
- Daniel Keese
- Department of Diagnostic and Interventional Radiology , Johannes Wolfgang Goethe University Frankfurt, Frankfurt, Germany; These authors contributed equally to this work.
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St. Pierre TG, House MJ, Bangma SJ, Pang W, Bathgate A, Gan EK, Ayonrinde OT, Bhathal PS, Clouston A, Olynyk JK, Adams LA. Stereological Analysis of Liver Biopsy Histology Sections as a Reference Standard for Validating Non-Invasive Liver Fat Fraction Measurements by MRI. PLoS One 2016; 11:e0160789. [PMID: 27501242 PMCID: PMC4976876 DOI: 10.1371/journal.pone.0160789] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/25/2016] [Indexed: 12/12/2022] Open
Abstract
Background and Aims Validation of non-invasive methods of liver fat quantification requires a reference standard. However, using standard histopathology assessment of liver biopsies is problematical because of poor repeatability. We aimed to assess a stereological method of measuring volumetric liver fat fraction (VLFF) in liver biopsies and to use the method to validate a magnetic resonance imaging method for measurement of VLFF. Methods VLFFs were measured in 59 subjects (1) by three independent analysts using a stereological point counting technique combined with the Delesse principle on liver biopsy histological sections and (2) by three independent analysts using the HepaFat-Scan® technique on magnetic resonance images of the liver. Bland Altman statistics and intraclass correlation (IC) were used to assess the repeatability of each method and the bias between the methods of liver fat fraction measurement. Results Inter-analyst repeatability coefficients for the stereology and HepaFat-Scan® methods were 8.2 (95% CI 7.7–8.8)% and 2.4 (95% CI 2.2–2.5)% VLFF respectively. IC coefficients were 0.86 (95% CI 0.69–0.93) and 0.990 (95% CI 0.985–0.994) respectively. Small biases (≤3.4%) were observable between two pairs of analysts using stereology while no significant biases were observable between any of the three pairs of analysts using HepaFat-Scan®. A bias of 1.4±0.5% VLFF was observed between the HepaFat-Scan® method and the stereological method. Conclusions Repeatability of the stereological method is superior to the previously reported performance of assessment of hepatic steatosis by histopathologists and is a suitable reference standard for validating non-invasive methods of measurement of VLFF.
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Affiliation(s)
- Tim G. St. Pierre
- School of Physics, The University of Western Australia, Crawley, Western Australia, Australia
- * E-mail:
| | - Michael J. House
- School of Physics, The University of Western Australia, Crawley, Western Australia, Australia
- Resonance Health Ltd, Claremont, Western Australia, Australia
| | | | - Wenjie Pang
- Resonance Health Ltd, Claremont, Western Australia, Australia
| | - Andrew Bathgate
- Resonance Health Ltd, Claremont, Western Australia, Australia
| | - Eng K. Gan
- School of Medicine and Pharmacology, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Gastroenterology, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Oyekoya T. Ayonrinde
- School of Medicine and Pharmacology, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Gastroenterology, Fremantle Hospital, Fremantle, Western Australia, Australia
- Faculty of Health Sciences, Curtin University of Technology, Bentley, Western Australia, Australia
| | - Prithi S. Bhathal
- Department of Pathology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Clouston
- Centre for Liver Disease Research, School of Medicine Translational Research Institute, The University of Queensland, Woolloongabba, Queensland, Australia
| | - John K. Olynyk
- School of Medicine and Pharmacology, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Gastroenterology, Fremantle Hospital, Fremantle, Western Australia, Australia
- Faculty of Health Sciences, Curtin University of Technology, Bentley, Western Australia, Australia
- Institute for Immunology & Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
| | - Leon A. Adams
- School of Medicine and Pharmacology, The University of Western Australia, Crawley, Western Australia, Australia
- Liver Transplant Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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Abstract
Alcoholic liver disease is a spectrum of conditions that include alcoholic fatty liver disease, alcoholic hepatitis, and chronic alcoholic liver disease. The diagnosis of alcoholic liver disease remains founded in an accurate patient history and detailed physical examination. Concurrent with the physical examination, objective data from laboratory, imaging, and histologic studies are helpful to confirm a diagnosis of alcoholic liver disease. Novel biomarkers, scoring systems, and imaging modalities are improving the ability to diagnose and manage alcoholic liver disease, but for most practicing clinicians, these have not been adopted widely because of their cost, but also because of limitations and uncertainty in their performance characteristics.
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Dong Z, Luo Y, Cai H, Zhang Z, Peng Z, Jiang M, Li Y, Li C, Li ZP, Feng ST. Noninvasive fat quantification of the liver and pancreas may provide potential biomarkers of impaired glucose tolerance and type 2 diabetes. Medicine (Baltimore) 2016; 95:e3858. [PMID: 27281097 PMCID: PMC4907675 DOI: 10.1097/md.0000000000003858] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The aim of the study is to investigate if the fat content of the liver and pancreas may indicate impaired glucose tolerance (IGT) or type 2 diabetes mellitus (T2DM). A total of 83 subjects (34 men; aged 46.5 ± 13.5 years) were characterized as T2DM, IGT, or normal glucose tolerant (NGT). NGT individuals were stratified as <40 or ≥40 years. Standard laboratory tests were conducted for insulin resistance and β-cell dysfunction. The magnetic resonance imaging Dixon technique was used to determine fat distribution in the liver and pancreas. Correlations among liver and pancreatic fat volume fractions (LFVFs and PFVFs, respectively) and laboratory parameters were analyzed. Among the groups, fat distribution was consistent throughout sections of the liver and pancreas, and LFVFs closely correlated with PFVFs. LFVFs correlated more closely than PFVFs with insulin resistance and β-cell function. Both the LFVFs and PFVFs were the highest in the T2DM patients, less in the IGT, and least in the NGT; all differences were significant. The PFVFs of the NGT subjects ≥40 years were significantly higher than that of those <40 years. The fat content of the liver and pancreas, particularly the liver, may be a biomarker for IGT and T2DM.
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Affiliation(s)
- Zhi Dong
- Department of Radiology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China,
| | - Yanji Luo
- Department of Radiology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China,
| | - Huasong Cai
- Department of Radiology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China,
| | - Zhongwei Zhang
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX,
| | - Zhenpeng Peng
- Department of Radiology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China,
| | - Mengjie Jiang
- Department of Radiology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China,
| | - Yanbing Li
- Department of Endocrinology and Diabetes Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chang Li
- Department of Radiology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China,
| | - Zi-Ping Li
- Department of Radiology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China,
| | - Shi-Ting Feng
- Department of Radiology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China,
- ∗Correspondence: Shi-Ting Feng, Department of Radiology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China (e-mail: ); Zi-Ping Li, Department of Radiology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China (e-mail: )
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Dioguardi Burgio M, Bruno O, Agnello F, Torrisi C, Vernuccio F, Cabibbo G, Soresi M, Petta S, Calamia M, Papia G, Gambino A, Ricceri V, Midiri M, Lagalla R, Brancatelli G. The cheating liver: imaging of focal steatosis and fatty sparing. Expert Rev Gastroenterol Hepatol 2016; 10:671-8. [PMID: 27027652 DOI: 10.1586/17474124.2016.1169919] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Focal steatosis and fatty sparing are a frequent finding in liver imaging, and can mimic solid lesions. Liver regional variations in the degree of fat accumulation can be related to vascular anomalies, metabolic disorders, use of certain drugs or coexistence of hepatic masses. CT and MRI are the modalities of choice for the noninvasive diagnosis of hepatic steatosis. Knowledge of CT and MRI appearance of focal steatosis and fatty sparing is crucial for an accurate diagnosis, and to rule-out other pathologic processes. This paper will review the CT and MRI techniques for the diagnosis of hepatic steatosis and the CT and MRI features of common and uncommon causes of focal steatosis and fatty sparing.
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Affiliation(s)
| | - Onorina Bruno
- b Department of Radiology , Hospital Beaujon , Clichy , France
| | - Francesco Agnello
- a Section of Radiology, Di.Bi.Med. , University of Palermo , Palermo , Italy
| | - Chiara Torrisi
- a Section of Radiology, Di.Bi.Med. , University of Palermo , Palermo , Italy
| | - Federica Vernuccio
- a Section of Radiology, Di.Bi.Med. , University of Palermo , Palermo , Italy
| | - Giuseppe Cabibbo
- c Section of Gastroenterology, Di.Bi.M.I.S ., University of Palermo , Palermo , Italy
| | - Maurizio Soresi
- d Unit of Internal Medicine, Di.Bi.M.I.S ., University of Palermo , Palermo , Italy
| | - Salvatore Petta
- c Section of Gastroenterology, Di.Bi.M.I.S ., University of Palermo , Palermo , Italy
| | - Mauro Calamia
- a Section of Radiology, Di.Bi.Med. , University of Palermo , Palermo , Italy
| | - Giovanni Papia
- a Section of Radiology, Di.Bi.Med. , University of Palermo , Palermo , Italy
| | - Angelo Gambino
- a Section of Radiology, Di.Bi.Med. , University of Palermo , Palermo , Italy
| | - Viola Ricceri
- a Section of Radiology, Di.Bi.Med. , University of Palermo , Palermo , Italy
| | - Massimo Midiri
- a Section of Radiology, Di.Bi.Med. , University of Palermo , Palermo , Italy
| | - Roberto Lagalla
- a Section of Radiology, Di.Bi.Med. , University of Palermo , Palermo , Italy
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Liver steatosis assessed by preoperative MRI: An independent risk factor for severe complications after major hepatic resection. Surgery 2016; 159:1050-7. [DOI: 10.1016/j.surg.2015.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 09/20/2015] [Accepted: 10/06/2015] [Indexed: 02/06/2023]
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26
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Loffroy R, Terriat B, Jooste V, Robin I, Brindisi MC, Hillon P, Vergès B, Cercueil JP, Petit JM. Liver fat content is negatively associated with atherosclerotic carotid plaque in type 2 diabetic patients. Quant Imaging Med Surg 2016; 5:792-8. [PMID: 26807360 DOI: 10.3978/j.issn.2223-4292.2015.12.03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is independently associated with atherosclerosis in nondiabetic individuals. In type 2 diabetic patients, the link between fatty liver and atherosclerosis is less clear. Here, we assessed whether liver fat content evaluated using (1)H-magnetic resonance spectroscopy ((1)H-MRS) was independently associated with prevalent carotid plaque as a marker of atherosclerosis in type 2 diabetic patients. METHODS One hundred and forty-four prospectively enrolled patients with type 2 diabetes underwent liver fat content measurement using (1)H-MRS and carotid plaque assessment using ultrasound. Multiple logistic regressions were used to identify factors associated with carotid plaque. RESULTS Mean ± SD liver fat content was 9.86±8.12%. Carotid plaque prevalence was 52.1% (75/144). Patients without plaque were younger (P=0.006) and had a smaller visceral fat area (P=0.015), lower reported prevalence of previous cardiovascular events or current statin therapy (P=0.002), and higher liver fat content than those with plaque (P=0.009). By multivariable logistic regression, increased liver fat content independently predicted the absence of carotid plaque [odds ratios (ORs), 0.94; 95% confidence intervals (CIs), 0.89-0.99; P=0.017]. CONCLUSIONS Liver fat content measured by (1)H-MRS is higher in type 2 diabetic patients without carotid plaque compared to those with plaque. This study suggests that increased liver fat content could be associated with a relative protection against carotid atherosclerosis in patients with type 2 diabetes mellitus.
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Affiliation(s)
- Romaric Loffroy
- 1 Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France ; 2 LE2I, UMR CNRS 6306, University of Burgundy, Dijon, France ; 3 Department of Angiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France ; 4 Inserm U866, University of Burgundy, Dijon, France ; 5 Department of Endocrinology, Diabetes and Nutrition, 6 Department of Hepatology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France
| | - Béatrice Terriat
- 1 Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France ; 2 LE2I, UMR CNRS 6306, University of Burgundy, Dijon, France ; 3 Department of Angiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France ; 4 Inserm U866, University of Burgundy, Dijon, France ; 5 Department of Endocrinology, Diabetes and Nutrition, 6 Department of Hepatology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France
| | - Valérie Jooste
- 1 Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France ; 2 LE2I, UMR CNRS 6306, University of Burgundy, Dijon, France ; 3 Department of Angiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France ; 4 Inserm U866, University of Burgundy, Dijon, France ; 5 Department of Endocrinology, Diabetes and Nutrition, 6 Department of Hepatology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France
| | - Isabelle Robin
- 1 Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France ; 2 LE2I, UMR CNRS 6306, University of Burgundy, Dijon, France ; 3 Department of Angiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France ; 4 Inserm U866, University of Burgundy, Dijon, France ; 5 Department of Endocrinology, Diabetes and Nutrition, 6 Department of Hepatology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France
| | - Marie-Claude Brindisi
- 1 Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France ; 2 LE2I, UMR CNRS 6306, University of Burgundy, Dijon, France ; 3 Department of Angiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France ; 4 Inserm U866, University of Burgundy, Dijon, France ; 5 Department of Endocrinology, Diabetes and Nutrition, 6 Department of Hepatology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France
| | - Patrick Hillon
- 1 Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France ; 2 LE2I, UMR CNRS 6306, University of Burgundy, Dijon, France ; 3 Department of Angiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France ; 4 Inserm U866, University of Burgundy, Dijon, France ; 5 Department of Endocrinology, Diabetes and Nutrition, 6 Department of Hepatology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France
| | - Bruno Vergès
- 1 Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France ; 2 LE2I, UMR CNRS 6306, University of Burgundy, Dijon, France ; 3 Department of Angiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France ; 4 Inserm U866, University of Burgundy, Dijon, France ; 5 Department of Endocrinology, Diabetes and Nutrition, 6 Department of Hepatology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France
| | - Jean-Pierre Cercueil
- 1 Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France ; 2 LE2I, UMR CNRS 6306, University of Burgundy, Dijon, France ; 3 Department of Angiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France ; 4 Inserm U866, University of Burgundy, Dijon, France ; 5 Department of Endocrinology, Diabetes and Nutrition, 6 Department of Hepatology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France
| | - Jean-Michel Petit
- 1 Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France ; 2 LE2I, UMR CNRS 6306, University of Burgundy, Dijon, France ; 3 Department of Angiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France ; 4 Inserm U866, University of Burgundy, Dijon, France ; 5 Department of Endocrinology, Diabetes and Nutrition, 6 Department of Hepatology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France
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Krishan S, Jain D, Bathina Y, Kale A, Saraf N, Saigal S, Choudhary N, Baijal S, Soin A. Non-invasive quantification of hepatic steatosis in living, related liver donors using dual-echo Dixon imaging and single-voxel proton spectroscopy. Clin Radiol 2016; 71:58-63. [DOI: 10.1016/j.crad.2015.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 09/30/2015] [Accepted: 10/05/2015] [Indexed: 01/01/2023]
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Ulbrich EJ, Fischer MA, Manoliu A, Marcon M, Luechinger R, Nanz D, Reiner CS. Age- and Gender Dependent Liver Fat Content in a Healthy Normal BMI Population as Quantified by Fat-Water Separating DIXON MR Imaging. PLoS One 2015; 10:e0141691. [PMID: 26554709 PMCID: PMC4640707 DOI: 10.1371/journal.pone.0141691] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 10/09/2015] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To establish age- and sex-dependent values of magnetic resonance (MR) liver fat-signal fraction (FSF) in healthy volunteers with normal body-mass index (BMI). METHODS 2-point mDIXON sequences (repetition time/echo time, 4.2msec/1.2msec, 3.1msec) at 3.0 Tesla MR were acquired in 80 healthy volunteers with normal BMI (18.2 to 25.7 kg/m2) between 20 and 62 years (10 men/10 women per decade). FSF was measured in 5 liver segments (segment II, III, VI, VII, VIII) based on mean signal intensities in regions of interest placed on mDIXON-based water and fat images. Multivariate general linear models were used to test for significant differences between BMI-corrected FSF among age subgroups. Pearson and Spearman correlations between FSF and several body measures were calculated. RESULTS Mean FSF (%) ± standard deviations significantly differed between women (3.91 ± 1.10) and men (4.69 ± 1.38) and varied with age for women/men (p-value: 0.002/0.027): 3.05 ± 0.49/3.74 ± 0.60 (age group 20-29), 3.75 ± 0.66/4.99 ± 1.30 (30-39), 4.76 ± 1.16/5.25 ± 1.97 (40-49) and 4.09 ± 1.26/4.79 ± 0.93 (50-62). FSF differences among age subgroups were significant for women only (p = 0.003). CONCLUSIONS MR-based liver fat content is higher in men and peaks in the fifth decade for both genders.
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Affiliation(s)
- Erika J. Ulbrich
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Michael A. Fischer
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Andrei Manoliu
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Magda Marcon
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Roger Luechinger
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Daniel Nanz
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Caecilia S. Reiner
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
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Satkunasingham J, Besa C, Bane O, Shah A, de Oliveira A, Gilson WD, Kannengiesser S, Taouli B. Liver fat quantification: Comparison of dual-echo and triple-echo chemical shift MRI to MR spectroscopy. Eur J Radiol 2015; 84:1452-1458. [PMID: 26047820 DOI: 10.1016/j.ejrad.2015.05.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 04/29/2015] [Accepted: 05/02/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE To assess the diagnostic value of MRI using dual-echo (2PD) and triple-echo (3PD) chemical shift imaging for liver fat quantification against multi-echo T2 corrected MR spectroscopy (MRS) used as the reference standard, and examine the effect of T2(*) imaging on accuracy of MRI for fat quantification. MATERIALS AND METHODS Patients who underwent 1.5T liver MRI that incorporated 2PD, 3PD, multi-echo T2(*) and MRS were included in this IRB approved prospective study. Regions of interest were placed in the liver to measure fat fraction (FF) with 2PD and 3PD and compared with MRS-FF. A random subset of 25 patients with a wide range of MRS-FF was analyzed with an advanced FF calculation method, to prove concordance with the 3PD. The statistical analysis included correlation stratified according to T2(*), Bland-Altman analysis, and calculation of diagnostic accuracy for detection of MRS-FF>6.25%. RESULTS 220 MRI studies were identified in 217 patients (mean BMI 28.0±5.6). 57/217 (26.2%) patients demonstrated liver steatosis (MRS-FF>6.25%). Bland-Altman analysis revealed strong agreement between 3PD and MRS (mean±1.96 SD: -0.5%±4.6%) and weaker agreement between 2PD and MRS (4.7%±16.0%). Sensitivity of 3PD for diagnosing FF> 6.25% was higher than that of 2PD. 3PD-FF showed minor discrepancies (coefficient of variation <10%) from FF measured with the advanced method. CONCLUSION Our large series study validates the use of 3PD chemical shift sequence for detection of liver fat in the clinical environment, even in the presence of T2(*) shortening.
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Affiliation(s)
- Janakan Satkunasingham
- Department of Radiology, Body MRI, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, United States; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, United States
| | - Cecilia Besa
- Department of Radiology, Body MRI, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, United States; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, United States
| | - Octavia Bane
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, United States
| | - Ami Shah
- Department of Radiology, Body MRI, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, United States
| | | | | | | | - Bachir Taouli
- Department of Radiology, Body MRI, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, United States; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, United States.
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30
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Adams LA, Crawford DH, Stuart K, House MJ, St Pierre TG, Webb M, Ching HLI, Kava J, Bynevelt M, MacQuillan GC, Garas G, Ayonrinde OT, Mori TA, Croft KD, Niu X, Jeffrey GP, Olynyk JK. The impact of phlebotomy in nonalcoholic fatty liver disease: A prospective, randomized, controlled trial. Hepatology 2015; 61:1555-64. [PMID: 25524401 DOI: 10.1002/hep.27662] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 12/12/2014] [Indexed: 02/06/2023]
Abstract
UNLABELLED Iron is implicated in the pathogenesis of liver injury and insulin resistance (IR) and thus phlebotomy has been proposed as a treatment for nonalcoholic fatty liver disease (NAFLD). We performed a prospective 6-month randomized, controlled trial examining the impact of phlebotomy on the background of lifestyle advice in patients with NAFLD. Primary endpoints were hepatic steatosis (HS; quantified by magnetic resonance imaging) and liver injury (determined by alanine aminotransaminase [ALT] and cytokeratin-18 [CK-18]). Secondary endpoints included insulin resistance measured by the insulin sensitivity index (ISI) and homeostasis model of assessment (HOMA), and systemic lipid peroxidation determined by plasma F2-isoprostane levels. A total of 74 subjects were randomized (33 phlebotomy and 41 control). The phlebotomy group underwent a median (range) of 7 (1-19) venesection sessions and had a significantly greater reduction in ferritin levels over 6 months, compared to controls (-148 ± 114 vs. -38 ± 89 ng/mL; P < 0.001). At 6 months, there was no difference between phlebotomy and control groups in HS (17.7% vs. 15.5%; P = 0.4), serum ALT (36 vs. 46 IU/L; P = 0.4), or CK-18 levels (175 vs. 196 U/L; P = 0.9). Similarly, there was no difference in end-of-study ISI (2.5 vs. 2.7; P = 0.9), HOMA (3.2 vs. 3.2; P = 0.6), or F2-isoprostane levels (1,332 vs. 1,190 pmmol/L; P = 0.6) between phlebotomy and control groups. No differences in any endpoint were noted in patients with hyperferritinemia at baseline. Among patients undergoing phlebotomy, there was no correlation between number of phlebotomy sessions and change in HS, liver injury, or IR from baseline to end of study. CONCLUSION Reduction in ferritin by phlebotomy does not improve liver enzymes, hepatic fat, or IR in subjects with NAFLD.
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Affiliation(s)
- Leon A Adams
- School of Medicine & Pharmacology, University of Western Australia, Crawley, Australia; Department of Gastroenterology & Hepatology, Sir Charles Gairdner Hospital, Perth, Australia
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Galimberti S, Trombini P, Bernasconi DP, Redaelli I, Pelucchi S, Bovo G, Di Gennaro F, Zucchini N, Paruccini N, Piperno A. Simultaneous liver iron and fat measures by magnetic resonance imaging in patients with hyperferritinemia. Scand J Gastroenterol 2015; 50:429-38. [PMID: 25633726 DOI: 10.3109/00365521.2014.940380] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Hyperferritinemia is frequent in chronic liver diseases of any cause, but the extent to which ferritin truly reflects iron stores is variable. In these patients, both liver iron and fat are found in variable amount and association. Liver biopsy is often required to quantify liver fat and iron, but sampling variability and invasiveness limit its use. We aimed to assess single breath-hold multiecho magnetic resonance imaging (MRI) for the simultaneous lipid and iron quantification in patients with hyperferritinemia. MATERIAL AND METHODS We compared MRI results for both iron and fat with their respective gold standards - liver iron concentration and computer-assisted image analysis for steatosis on biopsy. We prospectively studied 67 patients with hyperferritinemia and other 10 consecutive patients were used for validation. We estimated two linear calibration equations for the prediction of iron and fat based on MRI. The agreement between MRI and biopsy was evaluated. RESULTS MRI showed good performances in both the training and validation samples. MRI information was almost completely in line with that obtained from liver biopsy. CONCLUSION Single breath-hold multiecho MRI is an accurate method to obtain a valuable measure of both liver iron and steatosis in patients with hyperferritinemia.
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Affiliation(s)
- Stefania Galimberti
- Department of Health Sciences, Centre of Biostatistics for Clinical Epidemiology, University of Milano-Bicocca , Monza , Italy
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Abstract
PURPOSE Fatty liver disease is the most common cause of chronic liver disease in the western world. The aim of this study was to analyze steatotic liver characteristics using multidetector row computed tomography (CT) to identify reliable criteria to identify the steatosis and quantify its severity. PATIENTS AND METHODS Multiphasic CT scans of 51 consecutive adults (36 men, mean age 57.1±9.9 years), who underwent ultrasound-guided liver biopsy, were analyzed. In all patients, the Hounsfield units (HU) value was determined for each hepatic segment and for each contrast phase. Also, the splenic attenuation was quantified and the differences in the liver-spleen (DLS). Steatosis was graded according its severity into four grades. Receiver operating characteristic (ROC) curve analysis was carried out to calculate the sensitivity and specificity for the specific HU threshold. Pearson's ρ correlation was also calculated. A P value of 0.05 was considered statistically significant. RESULTS We found that 14 individuals (10 men, mean age 56±9.8 years) did not have hepatic steatosis. Only the nonenhanced CT scans showed a statistically significant association with liver steatosis (with the only exception of region-of-interest selected in the Couinaud segment VII, where a P value of 0.0513 was obtained). For grades 1, 2, 3, and 4, we identified 50, 45, 35, and 20 HU as thresholds. A statistically significant association was found between steatosis and DLS in the nonenhanced and the arterial phase (P=0.0192 and 0.001, respectively). CONCLUSION The result of our study indicates that the nonenhanced value of the liver can be used to identify steatosis of the liver and to grade its severity. Moreover, the DLS in the arterial phase represents another reliable parameter.
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Shin HJ, Kim HG, Kim MJ, Koh H, Kim HY, Roh YH, Lee MJ. Normal range of hepatic fat fraction on dual- and triple-echo fat quantification MR in children. PLoS One 2015; 10:e0117480. [PMID: 25659155 PMCID: PMC4319769 DOI: 10.1371/journal.pone.0117480] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 12/23/2014] [Indexed: 12/22/2022] Open
Abstract
Objectives To evaluate hepatic fat fraction on dual- and triple-echo gradient-recalled echo MRI sequences in healthy children. Materials and Methods We retrospectively reviewed the records of children in a medical check-up clinic from May 2012 to November 2013. We excluded children with abnormal laboratory findings or those who were overweight. Hepatic fat fraction was measured on dual- and triple-echo sequences using 3T MRI. We compared fat fractions using the Wilcoxon signed rank test and the Bland-Altman 95% limits of agreement. The correlation between fat fractions and clinical and laboratory findings was evaluated using Spearman’s correlation test, and the cut-off values of fat fractions for diagnosing fatty liver were obtained from reference intervals. Results In 54 children (M:F = 26:28; 5–15 years; mean 9 years), the dual fat fraction (0.1–8.0%; median 1.6%) was not different from the triple fat fraction (0.4–6.5%; median 2.7%) (p = 0.010). The dual- and triple-echo fat fractions showed good agreement using a Bland-Altman plot (-0.6 ± 2.8%). Eight children (14.8%) on dual-echo sequences and six (11.1%) on triple-echo sequences had greater than 5% fat fraction. From these children, six out of eight children on dual-echo sequences and four out of six children on triple-echo sequences had a 5–6% hepatic fat fraction. When using a cut-off value of a 6% fat fraction derived from a reference interval, only 3.7% of children were diagnosed with fatty liver. There was no significant correlation between clinical and laboratory findings with dual and triple-echo fat fractions. Conclusions Dual fat fraction was not different from triple fat fraction. We suggest a cut-off value of a 6% fat fraction is more appropriate for diagnosing fatty liver on both dual- and triple-echo sequences in children.
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Affiliation(s)
- Hyun Joo Shin
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Gi Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myung-Joon Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hong Koh
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ha Yan Kim
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Yun Ho Roh
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Mi-Jung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
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Marcon M, Ciritsis B, Laux C, Nanz D, Fischer MA, Andreisek G, Ulbrich EJ. Quantitative and qualitative MR-imaging assessment of vastus medialis muscle volume loss in asymptomatic patients after anterior cruciate ligament reconstruction. J Magn Reson Imaging 2014; 42:515-25. [PMID: 25446958 DOI: 10.1002/jmri.24777] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 09/27/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND To quantitatively and qualitatively assess vastus medialis muscle atrophy in asymptomatic patients with anterior cruciate ligament reconstruction, using the nonoperated leg as control. METHODS Prospective Institutional Review Board approved study with written informed patient consent. Thirty-three asymptomatic patients (men, 21; women,12) with ACL-reconstruction underwent MR imaging of both legs (axial T1-weighted spin-echo and 3D spoiled dual gradient-echo sequences). Muscle volume and average fat-signal fraction (FSF) of the vastus medialis muscles were measured. Additionally, Goutallier classification was used to classify fatty muscle degeneration. Significant side differences were evaluated using the Wilcoxon test and, between volumes and FSF, using student t-tests with P-value < 0.05 and < 0.025, respectively. RESULTS The muscle volume was significantly smaller in the operated (mean ± SD, 430.6 ± 119.6 cm(3) ; range, 197.3 to 641.7 cm(3) ) than in the nonoperated leg (479.5 ± 124.8 cm(3) ; 261.4 to 658.9 cm(3) ) (P < 0.001). Corresponding FSF was 6.3 ± 1.5% (3.9 to 9.2%) and 5.8 ± 0.9% (4.0 to 7.4%), respectively, with a nonsignificant (P > 0.025) difference. The relative muscle-volume and FSF differences were -10.1 ± 8.6% (7.1 to -30.1%) and 10.9 ± 29.4% (39.7 to 40.1%). The qualitative assessment revealed no significant differences (P > 0.1). CONCLUSION A significant muscle volume loss of the vastus medialis muscle does exist in asymptomatic patients with ACL-reconstruction, but without fatty degeneration.
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Affiliation(s)
- Magda Marcon
- Department of Radiology, University Hospital Zurich, Zurich, Switzerland.,Department of Radiology, University Hospital Udine, P.le S. Maria della Misericordia Udine, Italy
| | - Bernhard Ciritsis
- Department of Traumatology, University Hospital Zurich, Zurich, Switzerland
| | - Christoph Laux
- Department of Traumatology, University Hospital Zurich, Zurich, Switzerland
| | - Daniel Nanz
- Department of Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Michael A Fischer
- Department of Radiology, University Hospital Zurich, Zurich, Switzerland.,Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Gustav Andreisek
- Department of Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Erika J Ulbrich
- Department of Radiology, University Hospital Zurich, Zurich, Switzerland
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Parente DB, Rodrigues RS, Paiva FF, Oliveira Neto JA, Machado-Silva L, Lanzoni V, Campos CFF, Eiras-Araujo AL, do Brasil PEAA, Garteiser P, de Brito Gomes M, de Mello Perez R. Is MR spectroscopy really the best MR-based method for the evaluation of fatty liver in diabetic patients in clinical practice? PLoS One 2014; 9:e112574. [PMID: 25426708 PMCID: PMC4245094 DOI: 10.1371/journal.pone.0112574] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 10/08/2014] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To investigate if magnetic resonance spectroscopy (MRS) is the best Magnetic Resonance (MR)-based method when compared to gradient-echo magnetic resonance imaging (MRI) for the detection and quantification of liver steatosis in diabetic patients in the clinical practice using liver biopsy as the reference standard, and to assess the influence of steatohepatitis and fibrosis on liver fat quantification. METHODS Institutional approval and patient consent were obtained for this prospective study. Seventy-three patients with type 2 diabetes (60 women and 13 men; mean age, 54 ± 9 years) underwent MRI and MRS at 3.0 T. The liver fat fraction was calculated from triple- and multi-echo gradient-echo sequences, and MRS data. Liver specimens were obtained in all patients. The accuracy for liver fat detection was estimated by receiver operator characteristic (ROC) analysis, and the correlation between fat quantification by imaging and histolopathology was analyzed by Spearman's correlation coefficients. RESULTS The prevalence of hepatic steatosis was 92%. All gradient-echo MRI and MRS findings strongly correlated with biopsy findings (triple-echo, rho = 0.819; multi-echo, rho = 0.773; MRS, rho = 0.767). Areas under the ROC curves to detect mild, moderate, and severe steatosis were: triple-echo sequences, 0.961, 0.975, and 0.962; multi-echo sequences, 0.878, 0.979, and 0.961; and MRS, 0.981, 0.980, and 0.954. The thresholds for mild, moderate, and severe steatosis were: triple-echo sequences, 4.09, 9.34, and 12.34, multi-echo sequences, 7.53, 11.75, and 15.08, and MRS, 1.71, 11.69, and 14.91. Quantification was not significantly influenced by steatohepatitis or fibrosis. CONCLUSIONS Liver fat quantification by MR methods strongly correlates with histopathology. Due to the wide availability and easier post-processing, gradient-echo sequences may represent the best imaging method for the detection and quantification of liver fat fraction in diabetic patients in the clinical practice.
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Affiliation(s)
- Daniella Braz Parente
- D′Or Institute for Research and Education, Rio de Janeiro, Brazil
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail:
| | - Rosana Souza Rodrigues
- D′Or Institute for Research and Education, Rio de Janeiro, Brazil
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernando Fernandes Paiva
- D′Or Institute for Research and Education, Rio de Janeiro, Brazil
- Institute of Physics of São Carlos, University of São Paulo, São Carlos, Brazil
| | | | | | | | | | - Antonio Luis Eiras-Araujo
- D′Or Institute for Research and Education, Rio de Janeiro, Brazil
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | - Renata de Mello Perez
- D′Or Institute for Research and Education, Rio de Janeiro, Brazil
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
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Runge JH, Bakker P, Gaemers I, Verheij J, Hakvoort TB, Ottenhoff R, Stoker J, Nederveen AJ. Quantitative determination of liver triglyceride levels with 3T ¹H-MR spectroscopy in mice with moderately elevated liver fat content. Acad Radiol 2014; 21:1446-54. [PMID: 25300722 DOI: 10.1016/j.acra.2014.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/23/2014] [Accepted: 06/23/2014] [Indexed: 01/01/2023]
Abstract
RATIONALE AND OBJECTIVES To diagnose hepatic steatosis with noninvasive magnetic resonance (MR)-based measurements, threshold values of liver fat percentages are used. However, these differ between studies. Consequently, the choice of threshold values influences diagnostic accuracy, especially in subjects with borderline hepatic steatosis. In this study, we compared (1)H-MR spectroscopy (MRS) and biochemically determined liver fat content in mice with moderately elevated fat content and studied the diagnostic accuracy of (1)H-MRS using two literature-based threshold values. MATERIALS AND METHODS Fifty mice were divided into three groups: 21 C57Bl/6OlaHSD (B6) mice on a high-fat diet, 20 B6 mice on a control diet, and 9 LDLr-/- mice on a high-fat high-cholesterol diet. (1)H-MRS was performed using multi-echo STEAM at 3T to derive a fat mass fraction ((1)H-MRS fat content). Biochemical fat content was determined from liver homogenates. Correlation and agreement were assessed with the Pearson correlation coefficient and the Bland-Altman analysis and diagnostic accuracy by calculating sensitivity, specificity, and positive and negative predictive values. RESULTS All mice were pooled to form a single cohort. Mean (±standard deviation) biochemical fat content was 32.2 (±13.9) mg/g. Mean (1)H-MRS fat content did not differ at 30.2 (±12.0) mg/g (P = .13). Correlation r was 0.74 (P < .0001). Bland-Altman analysis indicated that (1)H-MRS fat content underestimated biochemical fat content by 2.1 mg/g. The diagnostic accuracy of (1)H-MRS depended to a great extent on the chosen reference threshold value. CONCLUSIONS (1)H-MRS measurement of moderately elevated liver fat content in mice correlated substantially with biochemical fat content measurement. Contrary to earlier studies, diagnostic accuracy of (1)H-MRS fat content in borderline liver fat content appears limited.
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Cross-sectional area measurements versus volumetric assessment of the quadriceps femoris muscle in patients with anterior cruciate ligament reconstructions. Eur Radiol 2014; 25:290-8. [PMID: 25358592 DOI: 10.1007/s00330-014-3424-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/15/2014] [Accepted: 08/29/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Our aim was to validate the use of cross-sectional area (CSA) measurements at multiple quadriceps muscle levels for estimating the total muscle volume (TMV), and to define the best correlating measurement level. METHODS Prospective institutional review board (IRB)-approved study with written informed patient consent. Thighs of thirty-four consecutive patients with ACL-reconstructions (men, 22; women, 12) were imaged at 1.5-T using three-dimensional (3D) spoiled dual gradient-echo sequences. CSA was measured at three levels: 15, 20, and 25 cm above the knee joint line. TMV was determined using dedicated volumetry software with semiautomatic segmentation. Pearson's correlation and regression analysis (including standard error of the estimate, SEE) was used to compare CSA and TMV. RESULTS The mean ± standard deviation (SD) for the CSA was 60.6 ± 12.8 cm(2) (range, 35.6-93.4 cm(2)), 71.1 ± 15.1 cm(2) (range, 42.5-108.9 cm(2)) and 74.2 ± 17.1 cm(2) (range, 40.9-115.9 cm(2)) for CSA-15, CSA-20 and CSA-25, respectively. The mean ± SD quadriceps' TMV was 1949 ± 533.7 cm(3) (range, 964.0-3283.0 cm(3)). Pearson correlation coefficient was r = 0.835 (p < 0.01), r = 0.906 (p < 0.01), and r = 0.956 (p < 0.01) for CSA-15, CSA-20 and CSA-25, respectively. Corresponding SEE, expressed as percentage of the TMV, were 15.2%, 11.6% and 8.1%, respectively. CONCLUSION The best correlation coefficient between quadriceps CSA and TMV was found for CSA-25, but its clinical application to estimate the TMV is limited by a relatively large SEE. KEY POINTS • Cross-sectional area was used to estimate QFM size in patients with ACL-reconstruction • A high correlation coefficient exists between quadriceps CSA and volume • Best correlation was seen 25 cm above the knee joint line • A relatively large standard error of the estimate limits CSA application.
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Mueller S, Seitz HK, Rausch V. Non-invasive diagnosis of alcoholic liver disease. World J Gastroenterol 2014; 20:14626-41. [PMID: 25356026 PMCID: PMC4209529 DOI: 10.3748/wjg.v20.i40.14626] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 04/30/2014] [Accepted: 07/22/2014] [Indexed: 02/06/2023] Open
Abstract
Alcoholic liver disease (ALD) is the most common liver disease in the Western world. For many reasons, it is underestimated and underdiagnosed. An early diagnosis is absolutely essential since it (1) helps to identify patients at genetic risk for ALD; (2) can trigger efficient abstinence namely in non-addicted patients; and (3) initiate screening programs to prevent life-threatening complications such as bleeding from varices, spontaneous bacterial peritonitis or hepatocellular cancer. The two major end points of ALD are alcoholic liver cirrhosis and the rare and clinically-defined alcoholic hepatitis (AH). The prediction and early diagnosis of both entities is still insufficiently solved and usually relies on a combination of laboratory, clinical and imaging findings. It is not widely conceived that conventional screening tools for ALD such as ultrasound imaging or routine laboratory testing can easily overlook ca. 40% of manifest alcoholic liver cirrhosis. Non-invasive methods such as transient elastography (Fibroscan), acoustic radiation force impulse imaging or shear wave elastography have significantly improved the early diagnosis of alcoholic cirrhosis. Present algorithms allow either the exclusion or the exact definition of advanced fibrosis stages in ca. 95% of patients. The correct interpretation of liver stiffness requires a timely abdominal ultrasound and actual transaminase levels. Other non-invasive methods such as controlled attenuation parameter, serum levels of M30 or M65, susceptometry or breath tests are under current evaluation to assess the degree of steatosis, apoptosis and iron overload in these patients. Liver biopsy still remains an important option to rule out comorbidities and to confirm the prognosis namely for patients with AH.
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Dong Z, Luo Y, Zhang Z, Cai H, Li Y, Chan T, Wu L, Li ZP, Feng ST. MR quantification of total liver fat in patients with impaired glucose tolerance and healthy subjects. PLoS One 2014; 9:e111283. [PMID: 25343445 PMCID: PMC4208854 DOI: 10.1371/journal.pone.0111283] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 09/29/2014] [Indexed: 12/19/2022] Open
Abstract
Objective To explore the correlations between liver fat content and clinical index in patients with impaired glucose tolerance (IGT) and healthy subjects. Materials and Methods 56 subjects were enrolled and each of them underwent upper-abdominal MRI examination that involved a T1 VIBE Dixon sequence. 14 was clinically diagnosed with IGT (collectively as IGT group ) while 42 showed normal glucose tolerance,(collectively as NGT group). NGT group was further divided into NGTFat (BMI≥25, 18 subjects) and NGTLean (BMI<25, 24 subjects). The total liver fat contents was measured and compared with clinical findings and laboratory results in order to determine statistical correlations between these parameters. Differences among IGT, NGTFat and NGTLean groups were evaluated. Results For all the subjects, fat volume fractions (FVFs) ranged from 4.2% to 24.2%, positive correlations was observed with BMI, waist hip ratio(WHR), low density lipoprotein(LDL), fasting plasma insulin(FPI), homeostasis model assessment insulin resistance (HOMA-IR) and homeostasis model assessment β(HOMAβ). FVFs of IGT group (p = 0.004) and NGTFat group (p = 0.006) were significantly higher than those of NGTLean group. Conclusions People with higher BMI, WHR and LDL levels tend to have higher liver fat content. Patients with BMI≥25 are more likely to develop IGT. Patients with higher FVF showed higher resistance to insulin, thus obtained a higher risk of developing type 2 diabetes mellitus.
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Affiliation(s)
- Zhi Dong
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yanji Luo
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhongwei Zhang
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Huasong Cai
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yanbing Li
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tao Chan
- Medical Imaging Department, Union Hospital, Hong Kong
| | - Ling Wu
- Department of Radiology, Kiang Wu Hospital, Macao
| | - Zi-Ping Li
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Shi-Ting Feng
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Park YS, Lee CH, Kim JH, Kim BH, Kim JH, Kim KA, Park CM. Effect of Gd-EOB-DTPA on hepatic fat quantification using high-speed T2-corrected multi-echo acquisition in 1H MR spectroscopy. Magn Reson Imaging 2014; 32:886-90. [DOI: 10.1016/j.mri.2014.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 02/20/2014] [Accepted: 04/15/2014] [Indexed: 11/30/2022]
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Pokhrel B, Choi EK, Khalid O, Sandrasegaran K, Fogel EL, McHenry L, Sherman S, Watkins J, Cote GA, Pitt HA, Zyromski NJ, Juliar B, Lehman GA. Increased fat in pancreas not associated with risk of pancreatitis post-endoscopic retrograde cholangiopancreatography. Clin Exp Gastroenterol 2014; 7:199-204. [PMID: 24959090 PMCID: PMC4061141 DOI: 10.2147/ceg.s31333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background A preliminary study has shown increased pancreatic fat in patients with idiopathic pancreatitis and sphincter of Oddi dysfunction. In this study, we aimed to determine if an increased quantity of pancreatic fat is an independent risk factor for pancreatitis post-endoscopic retrograde cholangiopancreatography (ERCP). Methods In this case control study, we retrospectively reviewed a local radiological and ERCP database to identify patients who had had abdominal magnetic resonance imaging (MRI) followed by ERCP no more than 60 days later between September 2003 and January 2011. Percentage of fat was determined by recording signal intensity in the in-phase (Sin) and out-of-phase (Sout) T1-weighted gradient sequences, and calculation of the fat fraction as (Sin − Sout)/(Sin) × 2 by an abdominal radiologist blinded to clinical history. Controls matched for age, gender, and other pancreatobiliary disease were selected from a group with no post-ERCP pancreatitis (before fat content of the pancreas was analyzed). Results Forty-seven patients were enrolled. Compared with controls, subjects with post-ERCP pancreatitis were similar in terms of age (41.4 years versus 41.1 years), gender (21.2% versus 20.2% males), pancreatobiliary disease characteristics, and most ERCP techniques. Measurements of pancreatic head, body, and tail fat and body mass index were similar in patients and controls. Conclusion Increased pancreatic fat on MRI criteria is not an independent predictor of post-ERCP pancreatitis.
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Affiliation(s)
- Bhupesh Pokhrel
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Eun Kwang Choi
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Omer Khalid
- Department of Gastroenterology, St Louis University School of Medicine, St Louis, MO
| | - Kumar Sandrasegaran
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Evan L Fogel
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Lee McHenry
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Stuart Sherman
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - James Watkins
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Gregory A Cote
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Henry A Pitt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nicholas J Zyromski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Beth Juliar
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Glen A Lehman
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
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Abstract
Liver fibrosis is the final common pathway for almost all causes of chronic liver injury. Liver fibrosis is now known to be a dynamic process having significant potential for resolution. Therefore, fibrosis prediction is an essential part of the assessment and management of patients with chronic liver disease. As such, there is strong demand for reliable liver biomarkers that provide insight into disease etiology, diagnosis, therapy, and prognosis in lieu of more invasive approaches such as liver biopsy. Current diagnostic strategies range from use of serum biomarkers to more advanced imaging techniques including transient elastography and magnetic resonance imaging. In addition to these modalities, there are other approaches including the use of novel, but yet to be validated, biomarkers. In this chapter, we discuss the biomarkers of liver fibrosis including the use of invasive and noninvasive biomarkers and disease-specific biomarkers in various chronic liver diseases.
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Lee Y, Kim H. Assessment of diffusion tensor MR imaging (DTI) in liver fibrosis with minimal confounding effect of hepatic steatosis. Magn Reson Med 2014; 73:1602-8. [PMID: 24733754 DOI: 10.1002/mrm.25253] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 03/10/2014] [Accepted: 03/25/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE Given the potential confounding effect of fat on apparent diffusion coefficient (ADC) in the liver, we have assessed diffusion tensor imaging in liver fibrosis with minimal effect of fat on ADC and fractional anisotropy (FA). METHODS Thirty-six mice were used, among which 20 mice were CCl4 treated for fibrosis induction. Diffusion tensor imaging was performed at 9.4T using a spin-echo diffusion tensor imaging sequence with six gradient directions. Hepatic fat fraction obtained by MR spectroscopy was used as hepatic fat content. Fibrosis scores were obtained from histopathology. RESULTS The hepatic fat fractions of the two animal groups were below 5.5% and not different (5.3 ± 1.5 vs. 4.6 ± 1.1%; P = 0.115). Fibrosis scores were higher in CCl4 -treated mice (0.0 ± 0.0 vs. 2.1 ± 0.7; P < 0.001). Nonetheless, there was no difference in ADC between the two groups (0.711 ± 0.068 × 10(-3) vs. 0.718 ± 0.095 × 10(-3) mm(2) s(-1) ; P = 0.911). The treated group had a lower FA than control (0.552 ± 0.050 vs. 0.586 ± 0.013; P = 0.023). ADC was not correlated with hepatic fat fraction and fibrosis. FA was correlated with hepatic fat fraction (r = 0.418, P = 0.011) and fibrosis (r = -0.411, P = 0.012). CONCLUSION FA may be more sensitive to mild-to-moderate liver fibrosis than ADC. In addition to ADC, FA may also be sensitive to hepatic fat content, and therefore need careful interpretation in liver fibrosis with concomitant fatty liver.
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Affiliation(s)
- Yunjung Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
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Kim SY, Kim H, Cho JY, Lim S, Cha K, Lee KH, Kim YH, Kim JH, Yoon YS, Han HS, Kang HS. Quantitative assessment of pancreatic fat by using unenhanced CT: pathologic correlation and clinical implications. Radiology 2014; 271:104-12. [PMID: 24475851 DOI: 10.1148/radiol.13122883] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To assess the relationship between computed tomographic (CT) indexes and histologically measured pancreatic fat in surgical specimens and to evaluate patients with impaired glucose metabolism in a clinical setting. MATERIALS AND METHODS This retrospective study was institutional review board approved and informed consent was waived. The hospital database was searched for records from November 2008 to April 2009, and 62 patients (42 men and 20 women; mean age, 61.4 years; age range, 21-81 years) who underwent CT within 1 month before pancreatectomy were identified. The histologic pancreatic fat fraction (area ratio of fat to total tissue times 100%) was measured in nontumorous pancreatic tissue. Attenuation was measured in three regions of interest in the pancreas and the spleen on nonenhanced CT images. The difference between pancreatic and splenic attenuation and the pancreas-to-spleen attenuation ratio were calculated. Visceral fat area at the level of the umbilicus was measured on the CT images. Spearman correlation coefficients (ρ) were calculated to examine the correlation between the CT indexes or visceral fat area and the histologic pancreatic fat fraction. A multivariate logistic regression model was used to determine whether CT attenuation indexes and patient age, sex, and visceral fat correlated with impaired glucose metabolism (ie, impaired glucose tolerance, impaired fasting glucose, or presence of diabetes). RESULTS The histologic pancreatic fat fraction ranged from 0% to 65.3% and was significantly correlated with the difference between pancreatic and splenic attenuation (ρ = -0.622, P < .01) and the pancreas-to-spleen attenuation ratio (ρ = -0.616, P < .01). The visceral fat area was not correlated with the histologic pancreatic fat fraction (ρ = 0.09, P = .50). The CT attenuation indexes were significant and independent variables predictive of impaired glucose metabolism after adjusting for age, sex, and visceral fat. CONCLUSION Pancreatic fat can be quantified by using CT, and CT attenuation indexes that are applied to the quantification of pancreatic fat are significantly associated with clinical assessment of impaired glucose metabolism.
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Affiliation(s)
- So Yeon Kim
- From the Departments of Radiology (S.Y.K., K.H.L., Y.H.K., H.S.K.), Pathology (H.K.), Surgery (J.Y.C., J.H.K., Y.S.Y., H.S.H.), and Internal Medicine (S.L.), Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Korea; and Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pa (K.C.)
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Quantification of the Fat Fraction in the Liver Using Dual-Energy Computed Tomography and Multimaterial Decomposition. J Comput Assist Tomogr 2014; 38:845-52. [DOI: 10.1097/rct.0000000000000142] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Barry B, Buch K, Soto JA, Jara H, Nakhmani A, Anderson SW. Quantifying liver fibrosis through the application of texture analysis to diffusion weighted imaging. Magn Reson Imaging 2014; 32:84-90. [DOI: 10.1016/j.mri.2013.04.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 04/09/2013] [Accepted: 04/09/2013] [Indexed: 11/27/2022]
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d'Assignies G, Fontés G, Kauffmann C, Latour M, Gaboury L, Boulanger Y, Van Beers BE, Soulez G, Poitout V, Tang A. Early detection of liver steatosis by magnetic resonance imaging in rats infused with glucose and intralipid solutions and correlation to insulin levels. Metabolism 2013; 62:1850-7. [PMID: 24035445 PMCID: PMC3914148 DOI: 10.1016/j.metabol.2013.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 07/25/2013] [Accepted: 08/09/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Magnetic resonance (MR) techniques allow noninvasive fat quantification. We aimed to investigate the accuracy of MR imaging (MRI), MR spectroscopy (MRS) and histological techniques to detect early-onset liver steatosis in three rat phenotypes assigned to an experimental glucolipotoxic model or a control group. MATERIALS AND METHODS This study was approved by the institutional committee for the protection of animals. Thirty-two rats (13 young Wistar, 6 old Wistar and 13 diabetic Goto-Kakizaki rats) fed a standard diet were assigned to a 72h intravenous infusion of glucose and Intralipid fat emulsion or a saline infusion. Plasma insulin levels were measured. Steatosis was quantified in ex vivo livers with gradient-recalled multi-echo MRI, MRS and histology as fat fractions (FF). RESULTS A significant correlation was found between multi-echo MRI-FF and MRS-FF (r=0.81, p<0.01) and a weaker correlation was found between histology and MRS-FF (r=0.60, p<0.01). MRS and MRI accurately distinguished young Wistar and Goto-Kakizaki rats receiving the glucose+Intralipid infusion from those receiving the saline control whereas histology did not. Significant correlations were found between MRI or MRS and insulin plasma level (r=0.63, p<0.01; r=0.57, p<0.01), and between MRI or MRS and C-peptide concentration (r=0.54, p<0.01; r=0.44, p<0.02). CONCLUSIONS Multi-echo MRI and MRS may be more sensitive to measure early-onset liver steatosis than histology in an experimental glucolipotoxic rat model.
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Affiliation(s)
- Gaspard d'Assignies
- Department of Radiology, University of Montreal, Hôpital Saint-Luc, 1058 rue Saint-Denis, Montreal, Quebec, Canada, H2X 3J4
- Research Center CHUM, Hôpital Saint-Luc, 264, René-Lévesque Blvd. East, Montreal, Quebec, Canada, H2X 1P1
- Department of Radiology, Beaujon Hospital, Université Paris VII, 100 Bd du Général Leclerc, 92118 Clichy, France
| | - Ghislaine Fontés
- Research Center CHUM, Hôpital Saint-Luc, 264, René-Lévesque Blvd. East, Montreal, Quebec, Canada, H2X 1P1
- Montreal Diabetes Research Center, CRCHUM, Technopôle Angus, 2901, Rachel Street East – Room 303, Montreal, Quebec, Canada, H1W 4A4
- Department of Medicine, University of Montreal, Qc, Canada, PO Box 6128, Station Centre-ville, Montreal, Quebec, Canada, H3C 3J7
| | - Claude Kauffmann
- Department of Radiology, University of Montreal, Hôpital Saint-Luc, 1058 rue Saint-Denis, Montreal, Quebec, Canada, H2X 3J4
- Research Center CHUM, Hôpital Saint-Luc, 264, René-Lévesque Blvd. East, Montreal, Quebec, Canada, H2X 1P1
| | - Martin Latour
- Research Center CHUM, Hôpital Saint-Luc, 264, René-Lévesque Blvd. East, Montreal, Quebec, Canada, H2X 1P1
- Montreal Diabetes Research Center, CRCHUM, Technopôle Angus, 2901, Rachel Street East – Room 303, Montreal, Quebec, Canada, H1W 4A4
| | - Louis Gaboury
- Department of anatomo-pathology, Centre hospitalier de l'Université de Montréal (CHUM), 3840 rue St-Urbain, Montreal, Quebec, Canada, H2W 1T8
| | - Yvan Boulanger
- Department of Radiology, University of Montreal, Hôpital Saint-Luc, 1058 rue Saint-Denis, Montreal, Quebec, Canada, H2X 3J4
- Research Center CHUM, Hôpital Saint-Luc, 264, René-Lévesque Blvd. East, Montreal, Quebec, Canada, H2X 1P1
| | - Bernard E. Van Beers
- Department of Radiology, Beaujon Hospital, Université Paris VII, 100 Bd du Général Leclerc, 92118 Clichy, France
| | - Gilles Soulez
- Department of Radiology, University of Montreal, Hôpital Notre-Dame, 1560 rue Sherbrooke Est, Montreal, Quebec, Canada, H2L 4M1
| | - Vincent Poitout
- Research Center CHUM, Hôpital Saint-Luc, 264, René-Lévesque Blvd. East, Montreal, Quebec, Canada, H2X 1P1
- Montreal Diabetes Research Center, CRCHUM, Technopôle Angus, 2901, Rachel Street East – Room 303, Montreal, Quebec, Canada, H1W 4A4
- Department of Medicine, University of Montreal, Qc, Canada, PO Box 6128, Station Centre-ville, Montreal, Quebec, Canada, H3C 3J7
- Department of Nutrition, University of Montreal, Qc, Canada, PO Box 6128, Station Centre-ville, Montreal, Quebec, Canada, H3C 3J7
- Department of Biochemistry, University of Montreal, Qc, Canada, PO Box 6128, Station Centre-ville, Montreal, Quebec, Canada, H3C 3J7
| | - An Tang
- Department of Radiology, University of Montreal, Hôpital Saint-Luc, 1058 rue Saint-Denis, Montreal, Quebec, Canada, H2X 3J4
- Research Center CHUM, Hôpital Saint-Luc, 264, René-Lévesque Blvd. East, Montreal, Quebec, Canada, H2X 1P1
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(1)H MRS assessment of hepatic steatosis in overweight children and adolescents: comparison between 3T and open 1T MR-systems. ACTA ACUST UNITED AC 2013; 38:315-9. [PMID: 22736224 DOI: 10.1007/s00261-012-9930-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE In recent years, proton magnetic resonance spectroscopy (MRS) has emerged as a non-invasive technique for measurement of fat content in the liver. The technique is often applied for overweight and obese patients. However, excessively obese patients cannot be examined in most conventional magnetic resonance systems due to limited space. The purpose of this study was to examine the ability of open 1T system to monitor liver fat with proton MRS and to compare hepatic fat fractions (HFFs) obtained using an open 1T system with assessment with 3T proton MRS. METHODS The study included 23 children and adolescents up to 20 years of age with a body mass index above the 97th percentile according to age and gender. Proton MRS for each patient was performed in both 1T and 3T using point resolved spectroscopy sequence in a single volume positioned in the right liver lobe. RESULTS Average T2 relaxation times obtained for an open 1T system (55 ± 7 ms for water and 85 ± 11 ms for fat) were higher than average T2 relaxation times obtained for a 3T system (31 ± 4 ms for water and 66 ± 10 ms for fat). HFFs measured using an open 1T system showed strong correlation with HFFs measured using a 3T system (r = 0.99, P < 0.0001). CONCLUSIONS Proton MRS measurements of HFF with an open 1T system are feasible. Open 1T system may reliably replace 3T magnetic resonance system for the assessment of liver fat.
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Leitão HS, Paulino C, Rodrigues D, Gonçalves SI, Marques C, Carvalheiro M, Geraldes CF, Caseiro-Alves F. MR fat fraction mapping: a simple biomarker for liver steatosis quantification in nonalcoholic fatty liver disease patients. Acad Radiol 2013; 20:957-61. [PMID: 23830602 DOI: 10.1016/j.acra.2013.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 04/27/2013] [Accepted: 05/07/2013] [Indexed: 01/06/2023]
Abstract
RATIONALE AND OBJECTIVES To assess the performance, postprocessing time, and intra- and interobserver agreement of a simple magnetic resonance-based mapping technique to quantify liver fat. MATERIALS AND METHODS This prospective, single-center study included 26 patients who were overweight with type 2 diabetes and at risk for nonalcoholic fatty liver disease. Mapping of the liver was based on a triple echo gradient-echo sequence, and (1)H magnetic resonance spectroscopy was used as the reference standard. The nonparametric Spearman correlation coefficient and the Wilcoxon test were used for comparisons between mapping and spectroscopy. The mapping was assessed for its predictive performance using the area under the curve of a receiver operating characteristic curve. Intraclass correlation coefficients were used to calculate intra- and interobserver's agreement for mapping measurements. RESULTS Patients had a mean fat percentage of 11.7% (range, 2-35.4%). A strong correlation was seen between mapping and spectroscopy (r = 0.89, P < .0001). A cutoff of 6.9% for fat fraction mapping was found to diagnose steatosis with 93% sensitivity and 100% specificity with an area under the curve of 0.99. Mapping of the liver had shorter acquisition and post-processing times than spectroscopy (5 min vs. 38 min; P < .0001). Mapping measurements had an intra- and interobserver agreement of 0.98 and 0.99, respectively. CONCLUSIONS The magnetic resonance-based liver mapping can accurately quantify liver fat with a cutoff value of 6.9% and excellent intra- and interobserver agreement. This mapping technique, with its simple methodology and short postprocessing time, has the potential to be included in routine abdominal protocols.
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