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Orcel T, Chau HT, Turlin B, Chaigneau J, Bannier E, Otal P, Frampas E, Leguen A, Boulic A, Saint-Jalmes H, Aubé C, Boursier J, Bardou-Jacquet E, Gandon Y. Evaluation of proton density fat fraction (PDFF) obtained from a vendor-neutral MRI sequence and MRQuantif software. Eur Radiol 2023; 33:8999-9009. [PMID: 37402003 DOI: 10.1007/s00330-023-09798-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 03/29/2023] [Accepted: 04/21/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To validate the proton density fat fraction (PDFF) obtained by the MRQuantif software from 2D chemical shift encoded MR (CSE-MR) data in comparison with the histological steatosis data. METHODS This study, pooling data from 3 prospective studies spread over time between January 2007 and July 2020, analyzed 445 patients who underwent 2D CSE-MR and liver biopsy. MR derived liver iron concentration (MR-LIC) and PDFF was calculated using the MRQuantif software. The histological standard steatosis score (SS) served as reference. In order to get a value more comparable to PDFF, histomorphometry fat fraction (HFF) were centrally determined for 281 patients. Spearman correlation and the Bland and Altman method were used for comparison. RESULTS Strong correlations were found between PDFF and SS (rs = 0.84, p < 0.001) or HFF (rs = 0.87, p < 0.001). Spearman's coefficients increased to 0.88 (n = 324) and 0.94 (n = 202) when selecting only the patients without liver iron overload. The Bland and Altman analysis between PDFF and HFF found a mean bias of 5.4% ± 5.7 [95% CI 4.7, 6.1]. The mean bias was 4.7% ± 3.7 [95% CI 4.2, 5.3] and 7.1% ± 8.8 [95% CI 5.2, 9.0] for the patients without and with liver iron overload, respectively. CONCLUSION The PDFF obtained by MRQuantif from a 2D CSE-MR sequence is highly correlated with the steatosis score and very close to the fat fraction estimated by histomorphometry. Liver iron overload reduced the performance of steatosis quantification and joint quantification is recommended. This device-independent method can be particularly useful for multicenter studies. CLINICAL RELEVANCE STATEMENT The quantification of liver steatosis using a vendor-neutral 2D chemical-shift MR sequence, processed by MRQuantif, is well correlated to steatosis score and histomorphometric fat fraction obtained from biopsy, whatever the magnetic field and the MR device used. KEY POINTS • The PDFF measured by MRQuantif from 2D CSE-MR sequence data is highly correlated to hepatic steatosis. • Steatosis quantification performance is reduced in case of significant hepatic iron overload. • This vendor-neutral method may allow consistent estimation of PDFF in multicenter studies.
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Affiliation(s)
- T Orcel
- Department of Radiology, Rennes University Hospital, 2 Rue H. Le Guilloux, 35033, Rennes, France
| | - H T Chau
- Department of Radiology, Rennes University Hospital, 2 Rue H. Le Guilloux, 35033, Rennes, France
- NUMECAN, INSERM U1099, Rennes University Hospital, 2 Rue H. Le Guilloux, 35033, Rennes, France
| | - B Turlin
- NUMECAN, INSERM U1099, Rennes University Hospital, 2 Rue H. Le Guilloux, 35033, Rennes, France
- Department of Pathology, Rennes University Hospital, 2 Rue H. Le Guilloux, 35033, Rennes, France
| | - J Chaigneau
- HIFIH, UPRES EA3859, Angers University Hospital, 4 Rue Larrey, 49993, Angers, France
| | - E Bannier
- Department of Radiology, Rennes University Hospital, 2 Rue H. Le Guilloux, 35033, Rennes, France
- EMPENN U746 Unit/Project, INSERM/INRIA, IRISA, University of Rennes, Beaulieu Campus, UMR CNRS 6074, 35042, Rennes, France
| | - P Otal
- Department of Radiology, Toulouse University Hospital, 1 Av Pr J. Poulhes, 31059, Toulouse, France
| | - E Frampas
- Department of Radiology, Nantes University Hospital, 1 Pl. Alexis-Ricordeau, 44000, Nantes, France
| | - A Leguen
- Department of Radiology, Bretagne-Atlantique Hospital, 20 Bd Général Maurice Guillaudot, 56000, Vannes, France
| | - A Boulic
- Department of Radiology, Bretagne Sud Hospital, 5 Avenue de Choiseul, 56322, Lorient, France
| | - H Saint-Jalmes
- INSERM U1099, LTSI, University of Rennes, Beaulieu Campus, 35042, Rennes, France
| | - C Aubé
- HIFIH, UPRES EA3859, Angers University Hospital, 4 Rue Larrey, 49993, Angers, France
- Department of Radiology, Angers University Hospital, 4 Rue Larrey, 49993, Angers, France
| | - J Boursier
- HIFIH, UPRES EA3859, Angers University Hospital, 4 Rue Larrey, 49993, Angers, France
- Department of Hepatology-GastoeEnterology, Angers University Hospital, 4 Rue Larrey, 49993, Angers, France
| | - E Bardou-Jacquet
- NUMECAN, INSERM U1099, Rennes University Hospital, 2 Rue H. Le Guilloux, 35033, Rennes, France
- Department of Hepatology, Rennes University Hospital, 2 Rue H. Le Guilloux, 35033, Rennes, France
| | - Y Gandon
- Department of Radiology, Rennes University Hospital, 2 Rue H. Le Guilloux, 35033, Rennes, France.
- NUMECAN, INSERM U1099, Rennes University Hospital, 2 Rue H. Le Guilloux, 35033, Rennes, France.
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Bilak JM, Yeo JL, Gulsin GS, Marsh AM, Sian M, Dattani A, Ayton SL, Parke KS, Bain M, Pang W, Boulos S, Pierre TGS, Davies MJ, Yates T, McCann GP, Brady EM. Impact of the Remission of Type 2 Diabetes on Cardiovascular Structure and Function, Exercise Capacity and Risk Profile: A Propensity Matched Analysis. J Cardiovasc Dev Dis 2023; 10:191. [PMID: 37233158 PMCID: PMC10219263 DOI: 10.3390/jcdd10050191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/14/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
Type 2 diabetes (T2D) confers a high risk of heart failure frequently with evidence of cardiovascular structural and functional abnormalities before symptom onset. The effects of remission of T2D on cardiovascular structure and function are unknown. The impact of the remission of T2D, beyond weight loss and glycaemia, on cardiovascular structure and function and exercise capacity is described. Adults with T2D without cardiovascular disease underwent multimodality cardiovascular imaging, cardiopulmonary exercise testing and cardiometabolic profiling. T2D remission cases (Glycated hemoglobin (HbA1c) < 6.5% without glucose-lowering therapy, ≥3 months) were propensity score matched 1:4 based on age, sex, ethnicity and time of exposure to those with active T2D (n = 100) with the nearest-neighbour method and 1:1 with non-T2D controls (n = 25). T2D remission was associated with a lower leptin-adiponectin ratio, hepatic steatosis and triglycerides, a trend towards greater exercise capacity and significantly lower minute ventilation/carbon dioxide production (VE/VCO2 slope) vs. active T2D (27.74 ± 3.95 vs. 30.52 ± 5.46, p < 0.0025). Evidence of concentric remodeling remained in T2D remission vs. controls (left ventricular mass/volume ratio 0.88 ± 0.10 vs. 0.80 ± 0.10, p < 0.025). T2D remission is associated with an improved metabolic risk profile and ventilatory response to exercise without concomitant improvements in cardiovascular structure or function. There is a requirement for continued attention to risk factor control for this important patient population.
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Affiliation(s)
- Joanna M. Bilak
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (J.M.B.); (J.L.Y.); (G.S.G.); (A.-M.M.); (A.D.); (S.L.A.)
| | - Jian L. Yeo
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (J.M.B.); (J.L.Y.); (G.S.G.); (A.-M.M.); (A.D.); (S.L.A.)
| | - Gaurav S. Gulsin
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (J.M.B.); (J.L.Y.); (G.S.G.); (A.-M.M.); (A.D.); (S.L.A.)
| | - Anna-Marie Marsh
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (J.M.B.); (J.L.Y.); (G.S.G.); (A.-M.M.); (A.D.); (S.L.A.)
| | - Manjit Sian
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (J.M.B.); (J.L.Y.); (G.S.G.); (A.-M.M.); (A.D.); (S.L.A.)
| | - Abhishek Dattani
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (J.M.B.); (J.L.Y.); (G.S.G.); (A.-M.M.); (A.D.); (S.L.A.)
| | - Sarah L. Ayton
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (J.M.B.); (J.L.Y.); (G.S.G.); (A.-M.M.); (A.D.); (S.L.A.)
| | - Kelly S. Parke
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (J.M.B.); (J.L.Y.); (G.S.G.); (A.-M.M.); (A.D.); (S.L.A.)
| | - Moira Bain
- Public and Patient Involvement Representative for National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK
| | - Wenjie Pang
- Resonance Health Ltd., Burswood, WA 6100, Australia
| | | | - Tim G. St Pierre
- School of Physics, The University of Western Australia, Perth, WA 6009, Australia
| | - Melanie J. Davies
- Diabetes Research Centre, NIHR Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (M.J.D.)
| | - Thomas Yates
- Diabetes Research Centre, NIHR Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (M.J.D.)
| | - Gerry P. McCann
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (J.M.B.); (J.L.Y.); (G.S.G.); (A.-M.M.); (A.D.); (S.L.A.)
| | - Emer M. Brady
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (J.M.B.); (J.L.Y.); (G.S.G.); (A.-M.M.); (A.D.); (S.L.A.)
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Chen P, Yang Z, Guo L, Huang Y, Li J, Chen X. Effects of homocysteine on nonalcoholic fatty liver related disease: A mendelian randomization study. Front Mol Biosci 2022; 9:1083855. [PMID: 36561351 PMCID: PMC9763576 DOI: 10.3389/fmolb.2022.1083855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Since the association of homocysteine and clinical results of observational studies are controversial on non-alcoholic fatty liver related disease, we compute the two-sample Mendelian Randomization (MR) study. Objective: To evaluate whether the plasma level of homocysteine has an effect on the risk of Non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH), and Cirrhosis after its progress, we investigated the causal relationships between plasma homocysteine and the three non-alcoholic fatty liver related diseases mentioned above. Design and methods: Summary estimates were elicited from the inverse-variance weighted (IVW) method through 12 single nucleotide polymorphisms (SNPs) which related to the plasma homocysteine, the SNPs were obtained from a large genome-wide association studies (GWAS) of 44,147 European participants. And the summary statistics for the latest and largest GWAS datasets for NAFLD (307576 in total and 1,578 cases), NASH (309055 in total and 99 cases) and Cirrhosis (306145 in total and 826 cases) were collected from Ristey FinnGen website where the association of genetic variations with blood metabolite levels was conducted using comprehensive metabolite profiling. The study was performed through two-sample MR method. Results: The result indicated that the plasma homocysteine is not significantly associated with NAFLD, and its progression, NASH and Cirrhosis. Conclusion: The evidence in this study is quite deficient to support the causal association of the individual plasma homocysteine with NAFLD, NASH and Cirrhosis, the putative of associations is not exist.
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Affiliation(s)
- Pengcheng Chen
- School of Electronics and Information Engineering, Institute of Big Data and Artificial Intelligence in Medicine, Taizhou University, Taizhou, China
| | - Ze Yang
- Department of Biochemistry and Molecular Biology, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China,Department of Biochemistry and Cancer Medicine, International Institutes of Medicine, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Lingyun Guo
- Department of Biochemistry and Molecular Biology, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China,Department of Biochemistry and Cancer Medicine, International Institutes of Medicine, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Yingfei Huang
- Department of Biochemistry and Molecular Biology, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China,Department of Biochemistry and Cancer Medicine, International Institutes of Medicine, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Jingjia Li
- Human Phenome Institute, Zhangjiang Fudan International Innovation Center, Fudan University, Shanghai, China
| | - Xin Chen
- School of Electronics and Information Engineering, Institute of Big Data and Artificial Intelligence in Medicine, Taizhou University, Taizhou, China,School of Medicine, Institute of Pharmaceutical Biotechnology, Zhejiang University, Hangzhou, China,Joint Institute for Genetics and Genome Medicine, Zhejiang University and University of Toronto, Zhejiang University, Hangzhou, China,*Correspondence: Xin Chen,
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Stahlschmidt FL, Weber IL, Ludwig MVD, Feuerschuette LM. Steatosis Grading Comparison Between Qualitative Ultrasonography and Magnetic Resonance Spectroscopy in Patients With Nonalcoholic Fatty Liver Disease. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2022. [DOI: 10.1177/87564793221112107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Assess the correlation between the qualitative sonographic score for detecting hepatic steatosis (HS) and liver fat quantification, using proton magnetic resonance spectroscopy (MRS). Materials and Methods: Sixty-six patients with known or suspected nonalcoholic fatty liver disease (NAFLD) underwent ultrasonography (US) and magnetic resonance imaging (MRI). The qualitative sonographic score and fat quantification, measured by MRS, were the techniques used. A Kappa coefficient was used for agreement calculation, and a Fisher test was used to assess the normality of the variables. The MRS results were the gold standard for US quality assessment. Results: The agreement between MRS and US was 50% (Kappa 0.35). Ultrasonography results were more severe in 42.4% of the cases, and 66.7% of the patients had a body mass index greater than 30 ( P = .017). For diagnosis of HS, US presented 100% sensitivity, 30.8% to 60% specificity, 61.7% to 72.7% accuracy, 40% to 69.2% false-positive rate, 0% false-negative rate, 53.8% positive predictive value, and 100% negative predictive value. Conclusion: Ultrasonography is a reliable exam for detecting HS, although not for grading purposes. Therefore, US is not a good predictor of HS severity for the management and follow-up of NAFLD.
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Affiliation(s)
- Fábio L. Stahlschmidt
- School of Medicine, Pontifical Catholic University of Paraná, Curitiba, Brazil
- Cajuru University Hospital, Curitiba, Brazil
| | - Isabela L. Weber
- School of Medicine, Pontifical Catholic University of Paraná, Curitiba, Brazil
- Cajuru University Hospital, Curitiba, Brazil
| | - Maria V. D. Ludwig
- School of Medicine, Pontifical Catholic University of Paraná, Curitiba, Brazil
- Cajuru University Hospital, Curitiba, Brazil
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Li B, Tai DI, Yan K, Chen YC, Chen CJ, Huang SF, Hsu TH, Yu WT, Xiao J, Le L, Harrison AP. Accurate and generalizable quantitative scoring of liver steatosis from ultrasound images via scalable deep learning. World J Gastroenterol 2022; 28:2494-2508. [PMID: 35979264 PMCID: PMC9258285 DOI: 10.3748/wjg.v28.i22.2494] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/03/2022] [Accepted: 04/25/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatic steatosis is a major cause of chronic liver disease. Two-dimensional (2D) ultrasound is the most widely used non-invasive tool for screening and monitoring, but associated diagnoses are highly subjective.
AIM To develop a scalable deep learning (DL) algorithm for quantitative scoring of liver steatosis from 2D ultrasound images.
METHODS Using multi-view ultrasound data from 3310 patients, 19513 studies, and 228075 images from a retrospective cohort of patients received elastography, we trained a DL algorithm to diagnose steatosis stages (healthy, mild, moderate, or severe) from clinical ultrasound diagnoses. Performance was validated on two multi-scanner unblinded and blinded (initially to DL developer) histology-proven cohorts (147 and 112 patients) with histopathology fatty cell percentage diagnoses and a subset with FibroScan diagnoses. We also quantified reliability across scanners and viewpoints. Results were evaluated using Bland-Altman and receiver operating characteristic (ROC) analysis.
RESULTS The DL algorithm demonstrated repeatable measurements with a moderate number of images (three for each viewpoint) and high agreement across three premium ultrasound scanners. High diagnostic performance was observed across all viewpoints: Areas under the curve of the ROC to classify mild, moderate, and severe steatosis grades were 0.85, 0.91, and 0.93, respectively. The DL algorithm outperformed or performed at least comparably to FibroScan control attenuation parameter (CAP) with statistically significant improvements for all levels on the unblinded histology-proven cohort and for “= severe” steatosis on the blinded histology-proven cohort.
CONCLUSION The DL algorithm provides a reliable quantitative steatosis assessment across view and scanners on two multi-scanner cohorts. Diagnostic performance was high with comparable or better performance than the CAP.
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Affiliation(s)
- Bowen Li
- Research and Development, PAII Inc., Bethesda, MD 20817, United States
| | - Dar-In Tai
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 33305, Taiwan
| | - Ke Yan
- Research and Development, PAII Inc., Bethesda, MD 20817, United States
| | - Yi-Cheng Chen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 33305, Taiwan
| | - Cheng-Jen Chen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 33305, Taiwan
| | - Shiu-Feng Huang
- Division of Molecular and Genomic Medicine, National Health Research Institute, Taoyuan 33305, Taiwan
| | - Tse-Hwa Hsu
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 33305, Taiwan
| | - Wan-Ting Yu
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 33305, Taiwan
| | - Jing Xiao
- Research and Development, Ping An Insurance Group, Shenzhen 518001, Guangdong, China
| | - Lu Le
- Research and Development, PAII Inc., Bethesda, MD 20817, United States
| | - Adam P Harrison
- Research and Development, PAII Inc., Bethesda, MD 20817, United States
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Xu JJ, Boesen MR, Hansen SL, Ulriksen PS, Holm S, Lönn L, Hansen KL. Assessment of Liver Fat: Dual-Energy CT versus Conventional CT with and without Contrast. Diagnostics (Basel) 2022; 12:diagnostics12030708. [PMID: 35328261 PMCID: PMC8946969 DOI: 10.3390/diagnostics12030708] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/26/2022] [Accepted: 03/10/2022] [Indexed: 12/04/2022] Open
Abstract
We assessed the correlation between liver fat percentage using dual-energy CT (DECT) and Hounsfield unit (HU) measurements in contrast and non-contrast CT. This study included 177 patients in two patient groups: Group A (n = 125) underwent whole body non-contrast DECT and group B (n = 52) had a multiphasic DECT including a conventional non-contrast CT. Three regions of interest were placed on each image series, one in the left liver lobe and two in the right to measure Hounsfield Units (HU) as well as liver fat percentage. Linear regression analysis was performed for each group as well as combined. Receiver operating characteristic (ROC) curve was generated to establish the optimal fat percentage threshold value in DECT for predicting a non-contrast threshold of 40 HU correlating to moderate-severe liver steatosis. We found a strong correlation between fat percentage found with DECT and HU measured in non-contrast CT in group A and B individually (R2 = 0.81 and 0.86, respectively) as well as combined (R2 = 0.85). No significant difference was found when comparing venous and arterial phase DECT fat percentage measurements in group B (p = 0.67). A threshold of 10% liver fat found with DECT had 95% sensitivity and 95% specificity for the prediction of a 40 HU threshold using non-contrast CT. In conclusion, liver fat quantification using DECT shows high correlation with HU measurements independent of scan phase.
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Affiliation(s)
- Jack Junchi Xu
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (P.S.U.); (L.L.); (K.L.H.)
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
- Correspondence:
| | - Mikkel Ranum Boesen
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.R.B.); (S.L.H.); (S.H.)
| | - Sofie Lindskov Hansen
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.R.B.); (S.L.H.); (S.H.)
| | - Peter Sommer Ulriksen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (P.S.U.); (L.L.); (K.L.H.)
| | - Søren Holm
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.R.B.); (S.L.H.); (S.H.)
| | - Lars Lönn
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (P.S.U.); (L.L.); (K.L.H.)
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Kristoffer Lindskov Hansen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (P.S.U.); (L.L.); (K.L.H.)
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
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7
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Ballard DH, Ludwig DR, Fraum TJ, Salter A, Narra VR, Shetty AS. Quality Control of Magnetic Resonance Elastography Using Percent Measurable Liver Volume Estimation. J Magn Reson Imaging 2021; 55:1890-1899. [PMID: 34704644 DOI: 10.1002/jmri.27976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although studies have described factors associated with failed magnetic resonance elastography (MRE), little is known about what factors influence usable elastography data. PURPOSE To identify factors that have a negative impact on percent measurable liver volume (pMLV), defined as the proportion of usable liver elastography data relative to the volume of imaged liver in patients undergoing MRE. STUDY TYPE Retrospective. SUBJECTS A total of 264 patients (n = 132 males, n = 132 females; mean age = 57 years) with suspected or known chronic liver disease underwent MRE paired with a liver protocol MRI. FIELD STRENGTH/SEQUENCE MRE was performed on a single 1.5 T scanner using a two-dimensional gradient-recalled echo phase-contrast sequence with a passive acoustic driver overlying the right hemiliver. ASSESSMENT Stiffness maps (usable data at 95% confidence) and liver contours on magnitude images of the MRE acquisition were manually traced and used to assess mean stiffness and pMLV. Hepatic fat fraction and R2 * values were also calculated. The distance from the acoustic wave generator on the skin surface to the liver edge was measured. Two radiologists performed the MR analyses with 50 overlapping cases for inter-reader analysis. STATISTICAL TESTS Linear regression was performed to identify factors significantly associated with pMLV. Intraclass correlation was performed for inter-reader reliability. RESULTS pMLV was 31% ± 20% (range 0%-86%). Complete MRE failure (i.e. pMLV = 0%) occurred in 10 patients (4%). Multivariate linear regression identified higher hepatic fat fraction, R2 *, BMI, and driver-to-liver surface distance; male sex; and lower mean liver stiffness was significantly independently associated with lower pMLV. Intraclass correlation for pMLV was 0.96, suggestive of excellent reliability. DATA CONCLUSION Higher fat fraction, R2 *, BMI, driver-to-liver surface distance, male sex, and lower mean liver stiffness were associated with lower pMLV. Optimization of image acquisition parameters and driver placement may improve MRE quality, and pMLV likely serves as a diagnostic utility quality control metric. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Tyler J Fraum
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Amber Salter
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Vamsi R Narra
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anup S Shetty
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
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8
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Athithan L, Gulsin GS, House MJ, Pang W, Brady EM, Wormleighton J, Parke KS, Graham-Brown M, St. Pierre TG, Levelt E, McCann GP. A comparison of liver fat fraction measurement on MRI at 3T and 1.5T. PLoS One 2021; 16:e0252928. [PMID: 34255778 PMCID: PMC8277031 DOI: 10.1371/journal.pone.0252928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 05/26/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Volumetric liver fat fraction (VLFF) measurements were made using the HepaFat-Scan® technique at 1.5T and 3T to determine the agreement between the measurements obtained at the two fields. METHODS Sixty patients with type 2 diabetes (67% male, mean age 50.92 ± 6.56yrs) and thirty healthy volunteers (50% male, mean age 48.63 ± 6.32yrs) were scanned on 1.5T Aera and 3T Skyra (Siemens, Erlangen, Germany) MRI scanners on the same day using the HepaFat-Scan® gradient echo protocol with modification of echo times for 3T (TEs 2.38, 4.76, 7.14 ms at 1.5T and 1.2, 2.4, 3.6 ms at 3T). The 3T analyses were performed independently of the 1.5T analyses by a different analyst, blinded from the 1.5T results. Data were analysed for agreement and bias using Bland-Altman methods and intraclass correlation coefficients (ICC). A second cohort of 17 participants underwent interstudy repeatability assessment of VLFF measured by HepaFat-Scan® at 3T. RESULTS A small, but statistically significant mean bias of 0.48% was observed between 3T and 1.5T with 95% limits of agreement -2.2% to 3.2% VLFF. The ICC for agreement between field strengths was 0.983 (95% CI 0.972-0.989). In the repeatability cohort studied at 3T the repeatability coefficient was 4.2%. The ICC for agreement was 0.971 (95% CI 0.921-0.989). CONCLUSION There is minimal bias and excellent agreement between the measures of VLFF using the HepaFat-Scan® at 1.5 and 3T. The test retest repeatability coefficient at 3T is comparable to the 95% limits of agreement between 1.5T and 3T suggesting that measurements can be made interchangeably between field strengths.
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Affiliation(s)
- Lavanya Athithan
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Gaurav S. Gulsin
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Michael J. House
- Department of Physics, The University of Western Australia, Crawley, Western Australia, Australia
- Resonance Health Ltd, Burswood, Western Australia, Australia
| | - Wenjie Pang
- Resonance Health Ltd, Burswood, Western Australia, Australia
| | - Emer M. Brady
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Joanne Wormleighton
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Kelly S. Parke
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Matthew Graham-Brown
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Tim G. St. Pierre
- Department of Physics, The University of Western Australia, Crawley, Western Australia, Australia
| | - Eylem Levelt
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Gerry P. McCann
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
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Harry S, Lai LL, Nik Mustapha NR, Abdul Aziz YF, Vijayananthan A, Rahmat K, Mahadeva S, Chan WK. Volumetric Liver Fat Fraction Determines Grade of Steatosis More Accurately Than Controlled Attenuation Parameter in Patients With Nonalcoholic Fatty Liver Disease. Clin Gastroenterol Hepatol 2020; 18:945-953.e2. [PMID: 31442603 DOI: 10.1016/j.cgh.2019.08.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/29/2019] [Accepted: 08/09/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS HepaFat-Scan is a magnetic resonance imaging-based method for quantification of hepatic steatosis by volumetric liver fat fraction (VLFF) measurement. We aimed to validate VLFF and to compare it with controlled attenuation parameter (CAP) for determination of hepatic steatosis grade in patients with NAFLD, using histopathology and stereologic analyses of biopsies as the reference standard. METHODS We performed a prospective study of consecutive adults with NAFLD who were scheduled for a liver biopsy at a tertiary hospital in Malaysia. Patients underwent VLFF and CAP measurements on the same day as their liver biopsy. Histopathology analyses of liver biopsy specimens were reported according to the Nonalcoholic Steatohepatitis Clinical Research Network scoring system. Stereologic analysis was performed using grid-point counting method combined with the Delesse principle. RESULTS We analyzed data from 97 patients (mean age 57.0 ± 10.1 years; 44.33% male; 91.8% obese; 95.9% centrally obese). Based on histopathology analysis, the area under receiver operating characteristic curve (AUROC) for VLFF in detection of steatosis grade ≥S2 was 0.92 and for CAP the AUROC was 0.65 (P < .001). Based on stereological analysis, the AUROC for VLFF for detection of steatosis grade ≥S2 was 0.92 and for CAP the AUROC was 0.63, (P = .002); for identification of steatosis grade S3, the AUROC for VLFF was 0.92 and for CAP the AUROC was 0.68 (P < .001). CONCLUSIONS In a prospective study of patients with NAFLD undergoing liver biopsy analysis, we found VLFF to more accurately determine grade of hepatic steatosis than CAP.
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Affiliation(s)
- Syaman Harry
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lee Lee Lai
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Yang Faridah Abdul Aziz
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Anushya Vijayananthan
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kartini Rahmat
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sanjiv Mahadeva
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wah Kheong Chan
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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10
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Lai LL, Vethakkan SR, Nik Mustapha NR, Mahadeva S, Chan WK. Empagliflozin for the Treatment of Nonalcoholic Steatohepatitis in Patients with Type 2 Diabetes Mellitus. Dig Dis Sci 2020; 65:623-631. [PMID: 30684076 DOI: 10.1007/s10620-019-5477-1] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 01/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a novel class of drugs that lower glucose by inducing renal glycosuria. We aimed to explore whether SGLT2 inhibitor added to the usual care for patients with type 2 diabetes mellitus (T2DM) and biopsy-proven nonalcoholic steatohepatitis (NASH) will benefit NASH histology. METHODS In this investigator-initiated, single-arm, open-label, pilot study, nine biopsy-proven NASH patients with T2DM were given empagliflozin 25 mg daily for 24 weeks. Liver biopsy was repeated at the end of treatment. The histological outcomes were compared with the placebo group of a previous 48-week clinical trial. RESULTS There was a significant reduction in body mass index (median change, Δ = -0.7 kg per m2, p = 0.011), waist circumference (Δ = -3 cm, p = 0.033), systolic blood pressure (Δ = -9 mmHg, p = 0.024), diastolic blood pressure (Δ = -6 mmHg, p = 0.033), fasting blood glucose (Δ = -1.7 mmol/L, p = 0.008), total cholesterol (Δ = -0.5 mmol/L, p = 0.011), gamma glutamyl transpeptidase (Δ = -19 U/L, p = 0.013), volumetric liver fat fraction (Δ = -7.8%, p = 0.017), steatosis (Δ = -1, p = 0.014), ballooning (Δ = -1, p = 0.034), and fibrosis (Δ = 0, p = 0.046). All histological components either remained unchanged or improved, except in one patient who had worsening ballooning. Empagliflozin resulted in significantly greater improvements in steatosis (67% vs. 26%, p = 0.025), ballooning (78% vs. 34%, p = 0.024), and fibrosis (44% vs. 6%, p = 0.008) compared with historical placebo. CONCLUSION This pilot study provides primary histological evidence that empagliflozin may be useful for the treatment of NASH. This preliminary finding should prompt larger clinical trials to assess the effectiveness of empagliflozin and other SGLT2 inhibitors for the treatment of NASH in T2DM patients. Trial registry number ClincialTrials.gov number, NCT02964715.
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Affiliation(s)
- Lee-Lee Lai
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Shireene Ratna Vethakkan
- Endocrine Unit, Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | | | - Sanjiv Mahadeva
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Wah-Kheong Chan
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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11
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Chuah KH, Chan WK. Quantification of Liver Fat in NAFLD: Available Modalities and Clinical Significance. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s11901-019-00493-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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12
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Munsterman ID, van Erp M, Weijers G, Bronkhorst C, de Korte CL, Drenth JPH, van der Laak JAWM, Tjwa ETTL. A Novel Automatic Digital Algorithm that Accurately Quantifies Steatosis in NAFLD on Histopathological Whole-Slide Images. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019; 96:521-528. [PMID: 31173462 PMCID: PMC6899563 DOI: 10.1002/cyto.b.21790] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/21/2019] [Accepted: 05/17/2019] [Indexed: 12/14/2022]
Abstract
Background Accurate assessment of hepatic steatosis is a key to grade disease severity in non‐alcoholic fatty liver disease (NAFLD). Methods We developed a digital automated quantification of steatosis on whole‐slide images (WSIs) of liver tissue and performed a validation study. Hematoxylin–eosin stained liver tissue slides were digitally scanned, and steatotic areas were manually annotated. We identified thresholds for size and roundness parameters by logistic regression to discriminate steatosis from surrounding liver tissue. The resulting algorithm produces a steatosis proportionate area (SPA; ratio of steatotic area to total tissue area described as percentage). The software can be implemented as a Java plug‐in in FIJI, in which digital WSI can be processed automatically using the Pathomation extension. Results We obtained liver tissue specimens from 61 NAFLD patients and 18 controls. The area under the curve of correctly classified steatosis by the algorithm was 0.970 (95% CI 0.968–0.973), P < 0.001. Accuracy of the algorithm was 91.9%, with a classification error of 8.1%. SPA correlated significantly with steatosis grade (Rs = 0.845, CI: 0.749–0.902, P < 0.001) and increased significantly with each individual steatosis grade, except between Grade 2 and 3. Conclusions We have developed a novel digital analysis algorithm that accurately quantifies steatosis on WSIs of liver tissue. This algorithm can be incorporated when quantification of steatosis is warranted, such as in clinical trials studying efficacy of new therapeutic interventions in NAFLD. © 2019 The Authors. Cytometry Part B: Clinical Cytometry published by Wiley Periodicals, Inc. on behalf of International Clinical Cytometry Society.
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Affiliation(s)
- Isabelle D Munsterman
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Merijn van Erp
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands.,Microscopic Imaging Centre, Radboud Institute for Molecular Life Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Gert Weijers
- Medical UltraSound Imaging Centre (MUSIC), Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Carolien Bronkhorst
- Department of Pathology, Jeroen Bosch Ziekenhuis's-Hertogenbosch, The Netherlands
| | - Chris L de Korte
- Medical UltraSound Imaging Centre (MUSIC), Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Eric T T L Tjwa
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
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13
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Wang T, Chen P, Bian D, Xiao E, Li D. Correlations of PPARα and PPARγ expressions with 1H-MRS quantified hepatic fat content in pups of rats that experienced intrauterine growth restriction. J Matern Fetal Neonatal Med 2019; 34:606-613. [PMID: 31068026 DOI: 10.1080/14767058.2019.1611766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Proton magnetic resonance spectroscopy (1H-MRS) measurement of hepatic fat content in intrauterine growth restriction rats has rarely been reported. This study was to explore the association of peroxisome proliferator-activated receptor alpha and gamma (PPARα and PPARγ) expression with 1H-MRS quantified hepatic fat content in offspring of rats that experienced intrauterine growth restriction (IUGR).Methods and findings: IUGR was established by feeding a low-protein diet to female rats during pregnancy. Male pups of IUGR rats were weighed, liver tissues were collected at the ages of 1 day and 1, 3, 8 and 12 weeks post birth. Visceral adipose tissues (VATs) were collected at 3, 8, and 12 weeks post birth. Male pups also received conventional magnetic resonance imaging and 1H-MRS using a 3.0 T whole-body MR scanner at 3, 8, and 12 weeks post birth. The peak area ratios in the MR spectra were calculated to determine hepatic lipid content. The expression of PPARα protein was detected by Western blot. The expression of PPARα mRNA was measured by real-time quantitative PCR. Significantly lower PPARα protein and mRNA expression were observed in liver tissues of male pups of IUGR rats at 1 day and 1, 3, 8, and 12 weeks post birth compared to male pups of control rats. In contrast, significantly higher PPARγ protein and mRNA expression were observed in VATs of male pups of IUGR rats at 3, 8, and 12 weeks post birth compared to male pups of control rats. PPARα protein and mRNA expression in the liver negatively correlated with the hepatic fat content (r = -0.611, -0.607, respectively), whereas PPARγ protein and mRNA expression in VATs positively correlated with the hepatic fat content (r = 0.659, 0.668, respectively).Conclusion: 1H-MRS allows noninvasive assessment of hepatic fat content in rats. PPARα protein and mRNA expression were significantly decreased in the livers of rats, whereas PPARγ protein and mRNA expression was significantly increased in VATs in pups of IUGR rats.
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Affiliation(s)
- Tao Wang
- Division of Neonatology, Department of Pediatrics, Children's Medical Center, Second Xiangya Hospital, Central South University, Changsha, P. R. China
| | - Pingyang Chen
- Division of Neonatology, Department of Pediatrics, Children's Medical Center, Second Xiangya Hospital, Central South University, Changsha, P. R. China
| | - Dujun Bian
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Enhua Xiao
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Dan Li
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, People's Republic of China
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14
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Mouillot T, Beylot M, Drai J, Hillon P, Gelas P, Lauverjat M, Brondel L, Chambrier C. Effect of bile acid supplementation on endogenous lipid synthesis in patients with short bowel syndrome: A pilot study. Clin Nutr 2019; 39:928-934. [PMID: 31000340 DOI: 10.1016/j.clnu.2019.03.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 01/18/2019] [Accepted: 03/26/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND & AIMS Short bowel syndrome patients (SBS) receiving parenteral nutrition (PN) often have dyslipidaemia and can develop intestinal failure-associated liver disease (IFALD). These patients demonstrate increased cholesterol synthesis and hepatic lipogenesis. These lipid disturbances may be due to a decreased concentration of the bile acid pool or malabsorption. The aim of this pilot study was to evaluate the effect of bile acid administration on lipid synthesis in patients with SBS. METHODS The 24 h fractional synthesis rate (FSR) of cholesterol and triglycerides was measured by the isotopic method (deuterated water) before and after 4 months of ursodeoxycholic acid (UDCA) treatment (20 mg/kg/day). Five short bowel patients (age: 53.4 ± 19.2 years) who had normal liver function and lipid plasmatic profiles received 1920 ± 300 ml of PN for 151 ± 74 days (mean PN energy intake was 27.0 ± 6.0 kcal/kg body weight, composed with 3.87 ± 1.38 g/kg of carbohydrate, 0.72 ± 0.25 g/kg of fat and 1.10 ± 0.23 g/kg of amino acids). Plasma metabolites, liver enzymes, 7-α-OH-cholesterol and steatosis levels were also evaluated before and after treatment. Student's t-tests were performed, and the results were expressed in means (±SD). RESULTS After treatment, decreases in the absolute values of cholesterol synthesis (0.31 ± 0.12 mmol L-1 to 0.24 ± 0.11 mmol L-1; p < 0.05), FSR of cholesterol (31.6 ± 4.7% to 26.4 ± 4.7%; p = 0.06) and FSR of triglycerides (12.8 ± 5.8% to 9.2 ± 5.5%; p < 0.01) were observed. Cholesterol and alanine aminotransferase concentrations also decreased (ALT) (p < 0.05). The absolute values of triglyceride synthesis and triglyceride concentrations remained unchanged. CONCLUSIONS In SBS patients, UDCA decreases the hepatic synthesis of triglycerides and cholesterol. These results suggest that UDCA could prevent the onset of the IFALD.
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Affiliation(s)
- Thomas Mouillot
- Hepatology and Gastroenterology Department, University Hospital F. Mitterrand, F-21000, Dijon, France; Centre for Taste and Feeding Behaviour, CNRS, INRA, University of Bourgogne Franche-Comté, F-21000, Dijon, France
| | - Michel Beylot
- Neurocardiology Unit - EA 4612, Institute of Pharmaceutical and Biological Sciences, University Claude Bernard Lyon 1, Lyon, France
| | - Jocelyne Drai
- Biochemistry and Molecular Biology Unit, Hospices Civil de Lyon, F-69495, Pierre Benite Cedex, France
| | - Patrick Hillon
- Hepatology and Gastroenterology Department, University Hospital F. Mitterrand, F-21000, Dijon, France
| | - Patrick Gelas
- Nutrition Intensive Care Unit, Hospices Civil de Lyon, F-69495, Pierre Benite Cedex, France
| | - Madeleine Lauverjat
- Nutrition Intensive Care Unit, Hospices Civil de Lyon, F-69495, Pierre Benite Cedex, France
| | - Laurent Brondel
- Hepatology and Gastroenterology Department, University Hospital F. Mitterrand, F-21000, Dijon, France; Centre for Taste and Feeding Behaviour, CNRS, INRA, University of Bourgogne Franche-Comté, F-21000, Dijon, France
| | - Cécile Chambrier
- Nutrition Intensive Care Unit, Hospices Civil de Lyon, F-69495, Pierre Benite Cedex, France.
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15
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Gulsin GS, Brady EM, Swarbrick DJ, Athithan L, Henson J, Baldry E, McAdam J, Marsh AM, Parke KS, Wormleighton JV, Levelt E, Yates T, Bodicoat D, Khunti K, Davies MJ, McCann GP. Rationale, design and study protocol of the randomised controlled trial: Diabetes Interventional Assessment of Slimming or Training tO Lessen Inconspicuous Cardiovascular Dysfunction (the DIASTOLIC study). BMJ Open 2019; 9:e023207. [PMID: 30928925 PMCID: PMC6475184 DOI: 10.1136/bmjopen-2018-023207] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Despite their young age and relatively short duration of disease, younger adults with type 2 diabetes (T2D) already have diastolic dysfunction and may be at risk of incipient heart failure. Whether weight loss or exercise training improve cardiac dysfunction in people with T2D remains to be established. METHODS AND ANALYSIS Prospective, randomised, open-label, blind endpoint trial. The primary aim of the study is to determine if diastolic function can be improved by either a meal replacement plan or a supervised exercise programme, compared with guideline-directed care. A total of 90 obese participants with T2D (aged 18-65 years), diabetes duration <12 years and not on insulin treatment will be randomised to either guideline-directed clinical care with lifestyle coaching, a low-energy meal replacement diet (average ≈810 kcal/day) or a supervised exercise programme for 12 weeks. Participants undergo glycometabolic profiling, cardiopulmonary exercise testing, echocardiography and MRI scanning to assesses cardiac structure and function and dual-energy X-ray absorptiometry scanning for body composition. Key secondary aims are to assess the effects of the interventions on glycaemic control and insulin resistance, exercise capacity, blood pressure, changes in body composition and association of favourable cardiac remodelling with improvements in weight loss, exercise capacity and glycometabolic control. ETHICS AND DISSEMINATION The study has full ethical approval, and data collection was completed in August 2018. The study results will be submitted for publication within 6 months of completion. TRIAL REGISTRATION NUMBER NCT02590822; Pre-results.
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Affiliation(s)
- Gaurav Singh Gulsin
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Emer M Brady
- Diabetes Research Centre, University of Leicester and the Leicester NIHR Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Daniel J Swarbrick
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Lavanya Athithan
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Joseph Henson
- National College of Sport and Exercise Medicine, University of Loughborough, Loughborough, UK
| | - Emma Baldry
- Diabetes Research Centre, University of Leicester and the Leicester NIHR Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - John McAdam
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Anna-Marie Marsh
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Kelly S Parke
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Joanne V Wormleighton
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Eylem Levelt
- University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester and the Leicester NIHR Biomedical Research Centre, Leicester General Hospital, Leicester, UK
- National College of Sport and Exercise Medicine, University of Loughborough, Loughborough, UK
| | - Danielle Bodicoat
- Diabetes Research Centre, University of Leicester and the Leicester NIHR Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester and the Leicester NIHR Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester and the Leicester NIHR Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, UK
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Braun HA, Faasse SA, Vos MB. Advances in Pediatric Fatty Liver Disease: Pathogenesis, Diagnosis, and Treatment. Gastroenterol Clin North Am 2018; 47:949-968. [PMID: 30337043 DOI: 10.1016/j.gtc.2018.07.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Pediatric nonalcoholic fatty liver disease is an increasingly prevalent disease, but its pathophysiology is not fully elucidated, diagnosis is difficult and invasive, and therapeutic options are limited. This article addresses the recent advancements made in understanding the pathophysiology of nonalcoholic fatty liver disease, the development of less invasive diagnostic modalities, and emerging therapeutic options, including ongoing clinical trials in children.
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Affiliation(s)
- Hayley A Braun
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Emory University School of Medicine, 1760 Haygood Drive North East, Atlanta, GA 30322, USA.
| | - Sarah A Faasse
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Emory University School of Medicine, 1760 Haygood Drive North East, Atlanta, GA 30322, USA; Division of Gastroenterology, Hepatology, and Nutrition, Children's Healthcare of Atlanta, 1405 Clifton Road, Atlanta, GA 30329, USA
| | - Miriam B Vos
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Emory University School of Medicine, 1760 Haygood Drive North East, Atlanta, GA 30322, USA; Division of Gastroenterology, Hepatology, and Nutrition, Children's Healthcare of Atlanta, 1405 Clifton Road, Atlanta, GA 30329, USA
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17
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Fraum TJ, Ludwig DR, Kilian S, Curtis WA, Pilgram TK, Sirlin CB, Fowler KJ. Epidemiology of Hepatic Steatosis at a Tertiary Care Center: An MRI-based Analysis. Acad Radiol 2018; 25:317-327. [PMID: 29199057 DOI: 10.1016/j.acra.2017.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/16/2017] [Accepted: 10/16/2017] [Indexed: 02/08/2023]
Abstract
RATIONALE AND OBJECTIVES Little is known about the frequency and risk factors of hepatic steatosis in the tertiary care setting. Such knowledge is essential to clinicians making decisions about testing for this condition. Thus, our aim was to describe the epidemiology of hepatic steatosis, as captured by magnetic resonance imaging (MRI), at a tertiary care center. MATERIALS AND METHODS A near-consecutive cohort of 1006 adult patients underwent standard-of-care liver MRIs. Images were retrospectively processed to derive proton density fat fraction (PDFF) maps. Data from three spatially distinct regions of interest (ROIs) were aggregated to derive overall hepatic PDFF values. Demographic, anthropometric, clinical, and laboratory variables were included in a multivariate analysis to determine predictors of hepatic steatosis grades (based on established PDFF cutoffs). Hepatic steatosis grades derived from single vs aggregated ROIs were compared. RESULTS Hepatic steatosis was observed in 25% of patients (19% grade 1; 3% grade 2; 3% grade 3). Controlling for all other variables, the odds of hepatic steatosis increased by 7%-9% (P <.001) for each whole point increase in body mass index (BMI), whereas elevated serum bilirubin was associated with lower odds of hepatic steatosis (P = .002). Race, diabetes mellitus, dyslipidemia, and metabolic syndrome were not independently predictive of hepatic steatosis when controlling for other variables (eg, BMI). Employing single ROIs (rather than three aggregated ROIs) resulted in incorrect steatosis grading in up to 8.0% of patients. CONCLUSION Many adult patients undergoing liver MRI at a tertiary care center have hepatic steatosis, with larger BMIs as the only independent predictor of higher grades. This information can be used by clinicians at such centers to make evidence-based decisions about when to test for hepatic steatosis in their patients.
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Cheng X, Blake GM, Brown JK, Guo Z, Zhou J, Wang F, Yang L, Wang X, Xu L. The measurement of liver fat from single-energy quantitative computed tomography scans. Quant Imaging Med Surg 2017; 7:281-291. [PMID: 28811994 DOI: 10.21037/qims.2017.05.06] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Studies of soft tissue composition using computed tomography (CT) scans are often semi-quantitative and based on Hounsfield units (HU) measurements that have not been calibrated with a quantitative CT (QCT) phantom. We describe a study to establish the water (H2O) and dipotassium hydrogen phosphate (K2HPO4) basis set equivalent densities of fat and fat-free liver tissue. With this information liver fat can be accurately measured from any abdominal CT scan calibrated with a suitable phantom. METHODS Liver fat content was measured by comparing single-energy QCT (SEQCT) HU measurements of the liver with predicted HU values for fat and fat-free liver tissue calculated from their H2O and K2HPO4 equivalent densities and calibration data from a QCT phantom. The equivalent densities of fat were derived from a listing of its constituent fatty acids, and those of fat-free liver tissue from a dual-energy QCT (DEQCT) study performed in 14 healthy Chinese subjects. This information was used to calculate liver fat from abdominal SEQCT scans performed in a further 541 healthy Chinese subjects (mean age 62 years; range, 31-95 years) enrolled in the Prospective Urban Rural Epidemiology (PURE) Study. RESULTS The equivalent densities of fat were 941.75 mg/cm3 H2O and -43.72 mg/cm3 K2HPO4, and for fat-free liver tissue 1,040.13 mg/cm3 H2O and 21.34 mg/cm3 K2HPO4. Liver fat in the 14 subjects in the DEQCT study varied from 0-17.9% [median: 4.5%; interquartile range (IQR): 3.0-7.9%]. Liver fat in the 541 PURE study subjects varied from -0.3-29.9% (median: 4.9%; IQR: 3.4-6.9%). CONCLUSIONS We have established H2O and K2HPO4 equivalent densities for fat and fat-free liver tissue that allow a measurement of liver fat to be obtained from any abdominal CT scan acquired with a QCT phantom. Although radiation dose considerations preclude the routine use of QCT to measure liver fat, the method described here facilitates its measurement in patients having CT scans performed for other purposes. Further studies comparing the results with magnetic resonance (MR) measurements of liver fat are required to validate the method as a useful clinical tool.
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Affiliation(s)
- Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Glen M Blake
- Biomedical Engineering Department, King's College London, Strand, London WC2R 2LS, UK
| | | | - Zhe Guo
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Jun Zhou
- Department of Radiology, Shenyang No.4 Hospital, Shenyang 110082, China
| | - Fengzhe Wang
- Department of Radiology, Shenyang No.4 Hospital, Shenyang 110082, China
| | - Liqiang Yang
- Department of Radiology, the General Hospital of CNPC in Jilin City, Jilin 132021, China
| | - Xiaohong Wang
- Department of Radiology, the General Hospital of CNPC in Jilin City, Jilin 132021, China
| | - Li Xu
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
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