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Brennan PN, MacMillan M, Manship T, Moroni F, Glover A, Graham C, Semple S, Morris DM, Fraser AR, Pass C, McGowan NWA, Turner ML, Lachlan N, Dillon JF, Campbell JDM, Fallowfield JA, Forbes SJ. Study protocol: a multicentre, open-label, parallel-group, phase 2, randomised controlled trial of autologous macrophage therapy for liver cirrhosis (MATCH). BMJ Open 2021; 11:e053190. [PMID: 34750149 PMCID: PMC8576470 DOI: 10.1136/bmjopen-2021-053190] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Liver cirrhosis is a growing global healthcare challenge. Cirrhosis is characterised by severe liver fibrosis, organ dysfunction and complications related to portal hypertension. There are no licensed antifibrotic or proregenerative medicines and liver transplantation is a scarce resource. Hepatic macrophages can promote both liver fibrogenesis and fibrosis regression. The safety and feasibility of peripheral infusion of ex vivo matured autologous monocyte-derived macrophages in patients with compensated cirrhosis has been demonstrated. METHODS AND ANALYSIS The efficacy of autologous macrophage therapy, compared with standard medical care, will be investigated in a cohort of adult patients with compensated cirrhosis in a multicentre, open-label, parallel-group, phase 2, randomised controlled trial. The primary outcome is the change in Model for End-Stage Liver Disease score at 90 days. The trial will provide the first high-quality examination of the efficacy of autologous macrophage therapy in improving liver function, non-invasive fibrosis markers and other clinical outcomes in patients with compensated cirrhosis. ETHICS AND DISSEMINATION The trial will be conducted according to the ethical principles of the Declaration of Helsinki 2013 and has been approved by Scotland A Research Ethics Committee (reference 15/SS/0121), National Health Service Lothian Research and Development department and the Medicine and Health Care Regulatory Agency-UK. Final results will be presented in peer-reviewed journals and at relevant conferences. TRIAL REGISTRATION NUMBERS ISRCTN10368050 and EudraCT; reference 2015-000963-15.
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Affiliation(s)
- Paul Noel Brennan
- Centre for Regenerative Medicine, The University of Edinburgh Medical School, Edinburgh, UK
| | - Mark MacMillan
- Centre for Regenerative Medicine, The University of Edinburgh Medical School, Edinburgh, UK
| | | | | | - Alison Glover
- Scottish National Blood Transfusion Service, Edinburgh, UK
| | - Catriona Graham
- Deanery of Clinical Sciences, The University of Edinburgh, Edinburgh, UK
| | - Scott Semple
- Centre for Cardiovascular Science, The University of Edinburgh Deanery of Clinical Sciences, Edinburgh, UK
| | - David M Morris
- Centre for Cardiovascular Science, The University of Edinburgh Deanery of Clinical Sciences, Edinburgh, UK
| | | | - Chloe Pass
- Tissues, Cells and Advanced Therapeutics, SNBTS, Edinburgh, UK
| | | | - Marc L Turner
- Tissues, Cells and Advanced Therapeutics, SNBTS, Edinburgh, UK
| | - Neil Lachlan
- Department of Gastroenterology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - John F Dillon
- Liver Group, University of Dundee Division of Cardiovascular and Diabetes Medicine, Dundee, UK
| | | | - Jonathan Andrew Fallowfield
- Queen's Medical Research Institute, University of Edinburgh MRC Centre for Inflammation Research, Edinburgh, UK
| | - Stuart J Forbes
- Centre for Regenerative Medicine, The University of Edinburgh Deanery of Clinical Sciences, Edinburgh, UK
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Liu JY, Cai YY, Ding ZY, Zhou ZY, Lv M, Liu H, Zheng LY, Li L, Luo YH, Xiao EH. Characterizing Fibrosis and Inflammation in a Partial Bile Duct Ligation Mouse Model by Multiparametric Magnetic Resonance Imaging. J Magn Reson Imaging 2021; 55:1864-1874. [PMID: 34545977 PMCID: PMC9290705 DOI: 10.1002/jmri.27925] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 12/19/2022] Open
Abstract
Background Partial bile duct ligation (PBDL) model is a reliable cholestatic fibrosis experimental model that showed complex histopathological changes. Magnetic resonance imaging (MRI) features of PBDL have not been well characterized. Purpose To investigate the potential of MRI parameters in assessing fibrosis in PBDL and explore the relationships between MRI and pathological features. Animal Model Established PBDL models. Population Fifty‐four mice were randomly divided into four timepoints PBDL groups and one sham group. Field Strength/Sequence 3.0 T; MRI sequences included T1‐weighted fast spin‐echo (FSE), T2‐weighted single shot FSE, variable flip angle T1 mapping, multi‐echo SE T2 mapping, multi‐echo gradient‐echo T2* mapping, and multi‐b‐value diffusion‐weighted imaging. Assessment MRI examination was performed at the corresponding timepoints after surgery. Native T1, ΔT1 (T1native‐T1post), T2, T2*, apparent diffusion coefficient (ADC) values, histogram parameters (skewness and kurtosis), intravoxel incoherent motion parameters (f, D, and D*) within the entire ligated (PBDL), non‐ligated liver (PBDL), and whole liver (sham) were obtained. Fibrosis and inflammation were assessed in Masson and H&E staining slices using the Metavir and activity scoring system. Statistical Tests One‐way ANOVA, Spearman's rank correlation, and receiver operating characteristic curves were performed. P < 0.05 was considered statistically significant. Results Fibrosis and inflammation were finally staged as F3 and A3 in ligated livers but were not observed in non‐ligated or sham livers. Ligated livers displayed significantly elevated native T1, ΔT1, T2, and reduced ADC and T2* than other livers. Spearman's correlation showed better correlation with inflammation (r = 0.809) than fibrosis (r = 0.635) in T2 and both ΔT1 and ADC showed stronger correlation with fibrosis (r = 0.704 and r = −0.718) than inflammation (r = 0.564 and r = −0.550). Area under the curve (AUC) for ΔT1 performed the highest (0.896). When combined with all relative parameters, AUC increased to 0.956. Data Conclusion Multiparametric MRI can evaluate and differentiate pathological changes in PBDL. ΔT1 and ADC better correlated with fibrosis while T2 stronger with inflammation. Level of Evidence 1 Technical Efficacy Stage 2
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Affiliation(s)
- Jia-Yi Liu
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ye-Yu Cai
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhu-Yuan Ding
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zi-Yi Zhou
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Min Lv
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Huan Liu
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Li-Yun Zheng
- MR Collaboration, Central Research Institute, United Imaging Healthcare, Shanghai, China
| | - Lan Li
- Department of Pathology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yong-Heng Luo
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - En-Hua Xiao
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China.,Medical Imaging Research Center, Central South University, Changsha, 410008, China
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Rebelos E, Iozzo P, Guzzardi MA, Brunetto MR, Bonino F. Brain-gut-liver interactions across the spectrum of insulin resistance in metabolic fatty liver disease. World J Gastroenterol 2021; 27:4999-5018. [PMID: 34497431 PMCID: PMC8384743 DOI: 10.3748/wjg.v27.i30.4999] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/29/2021] [Accepted: 07/13/2021] [Indexed: 02/06/2023] Open
Abstract
Metabolic associated fatty liver disease (MAFLD), formerly named "nonalcoholic fatty liver disease" occurs in about one-third of the general population of developed countries worldwide and behaves as a major morbidity and mortality risk factor for major causes of death, such as cardiovascular, digestive, metabolic, neoplastic and neuro-degenerative diseases. However, progression of MAFLD and its associated systemic complications occur almost invariably in patients who experience the additional burden of intrahepatic and/or systemic inflammation, which acts as disease accelerator. Our review is focused on the new knowledge about the brain-gut-liver axis in the context of metabolic dysregulations associated with fatty liver, where insulin resistance has been assumed to play an important role. Special emphasis has been given to digital imaging studies and in particular to positron emission tomography, as it represents a unique opportunity for the noninvasive in vivo study of tissue metabolism. An exhaustive revision of targeted animal models is also provided in order to clarify what the available preclinical evidence suggests for the causal interactions between fatty liver, dysregulated endogenous glucose production and insulin resistance.
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Affiliation(s)
- Eleni Rebelos
- Turku PET Centre, University of Turku, Turku 20500, Finland
| | - Patricia Iozzo
- Institute of Clinical Physiology, National Research Council, Pisa 56124, Italy
| | | | - Maurizia Rossana Brunetto
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis, Pisa University Hospital, Pisa 56121, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56121, Italy
- Institute of Biostructure and Bioimaging, National Research Council, Napoli 80145, Italy
| | - Ferruccio Bonino
- Institute of Biostructure and Bioimaging, National Research Council, Napoli 80145, Italy
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Hydes T, Brown E, Hamid A, Bateman AC, Cuthbertson DJ. Current and Emerging Biomarkers and Imaging Modalities for Nonalcoholic Fatty Liver Disease: Clinical and Research Applications. Clin Ther 2021; 43:1505-1522. [PMID: 34400007 DOI: 10.1016/j.clinthera.2021.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Nonalcoholic fatty liver disease (NAFLD) is a metabolic disorder that frequently coexists with obesity, metabolic syndrome, and type 2 diabetes. The NAFLD spectrum, ranging from hepatic steatosis to nonalcoholic steatohepatitis, fibrosis, and cirrhosis, can be associated with long-term hepatic (hepatic decompensation and hepatocellular carcinoma) and extrahepatic complications. Diagnosis of NAFLD requires detection of liver steatosis with exclusion of other causes of chronic liver disease. Screening for NAFLD and identification of individuals at risk of end-stage liver disease represent substantial challenges that have yet to be met. NAFLD affects up to 25% of adults, yet only a small proportion will progress beyond steatosis to develop advanced disease (steatohepatitis and fibrosis) associated with increased morbidity and mortality. Identification of this cohort has required the gold standard liver biopsy, which is both invasive and expensive. The use of serum biomarkers and noninvasive imaging techniques is an area of significant clinical relevance. This narrative review outlines current and emerging technologies for the diagnosis of NAFLD, nonalcoholic steatohepatitis, and hepatic fibrosis. METHODS We reviewed the literature using PubMed and reviewed national and international guidelines and conference proceedings to provide a comprehensive overview of the evidence. FINDINGS Significant advances have been made during the past 2 decades that have enhanced noninvasive assessment of NAFLD without the need for liver biopsy. For the detection of steatosis, abdominal ultrasonography remains the first-line investigation, although a controlled attenuation parameter using transient elastography is more sensitive. For detecting fibrosis, noninvasive serum markers of fibrosis and algorithms based on routine biochemistry are available, in addition to transient elastography. These techniques are well validated and have been incorporated into national and international screening guidelines. These approaches have facilitated more judicious use of liver biopsy but are yet to entirely replace it. Although serum biomarkers present a pragmatic and widely available screening approach for NAFLD in large population-based studies, magnetic resonance imaging techniques offer the benefit of achieving high degrees of accuracy in disease grading, tumor staging, and assessing therapeutic response. IMPLICATIONS This diagnostic clinical and research field is rapidly evolving; increasingly combined applications of biomarkers and transient elastography or imaging of selective (intermediate or high risk) cases are being used for clinical and research purposes. Liver biopsy remains the gold standard investigation, particularly in the context of clinical trials, but noninvasive options are emerging, using multimodality assessment, that are quicker, more tolerable, more widely available and have greater patient acceptability.
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Affiliation(s)
- T Hydes
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom; Liverpool University Hospitals National Health Service Foundation Trust, Liverpool, United Kingdom.
| | - E Brown
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom; Liverpool University Hospitals National Health Service Foundation Trust, Liverpool, United Kingdom
| | - A Hamid
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom; Liverpool University Hospitals National Health Service Foundation Trust, Liverpool, United Kingdom
| | - A C Bateman
- Department of Cellular Pathology, Southampton General Hospital, Southampton, United Kingdom
| | - D J Cuthbertson
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom; Liverpool University Hospitals National Health Service Foundation Trust, Liverpool, United Kingdom
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Prospective evaluation of the prevalence of non-alcoholic fatty liver disease and steatohepatitis in a large middle-aged US cohort. J Hepatol 2021; 75:284-291. [PMID: 33746083 DOI: 10.1016/j.jhep.2021.02.034] [Citation(s) in RCA: 124] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Large prospective studies to establish the prevalence of non-alcoholic fatty liver disease (NAFLD) and steatohepatitis (NASH), are lacking. We prospectively assessed the prevalence and severity of NAFLD/NASH in a cohort of asymptomatic middle-aged Americans attending a colonoscopy class at a gastroenterology clinic. METHODS Screening for NAFLD was performed using magnetic resonance (MR)-based LiverMultiScan® proton density fat fraction (LMS-PDFF). MR exams also included corrected T1 and elastography for liver stiffness measurement (LSM). FibroScan® was also used to measure LSM. Participants with predetermined abnormal imaging parameters were offered a liver biopsy. Biopsies were read in a blinded fashion with results based on the consensus by 2 expert pathologists. The prevalence of NAFLD was determined by PDFF ≥5% or by histological diagnosis of NAFLD (if biopsy data were available). The prevalence of NASH was defined by biopsy. RESULTS Of 835 participants, 664 met the inclusion and exclusion criteria. The mean age was 56 ± 6.4 years, 50% were male, the mean BMI was 30.48 ± 5.46 kg/m2, and 52% were obese. The prevalence of NAFLD was 38% (95% CI 34-41%) and the prevalence of NASH was 14% (95% CI 12-17%). While no patient had cirrhosis on biopsy, significant fibrosis (F ≥2) was present in 5.9% (95% CI 4-8%) and bridging fibrosis in 1.6% (95% CI 1-3%). In a multivariable analysis, factors associated with the presence of NASH were race, obesity, and diabetes. CONCLUSION Using state-of-the-art liver imaging modalities and reference biopsy, this study establishes an overall prevalence of NAFLD of 38% and NASH by biopsy of 14% in this cohort of asymptomatic middle-aged US adults. LAY SUMMARY There are no prospective studies to determine how common is nonalcoholic steatohepatitis (NASH), the severe form of non-alcoholic fatty liver disease (NAFLD). In a large number of asymptomatic middle-aged Americans, we used a combination of state-of-the-art liver imaging methods and liver biopsy to prospectively determine the prevalence of NAFLD and NASH. NAFLD was diagnosed in 38%, NASH in 14%, and significant liver fibrosis in 6% of asymptomatic middle-aged Americans.
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Sofias AM, De Lorenzi F, Peña Q, Azadkhah Shalmani A, Vucur M, Wang JW, Kiessling F, Shi Y, Consolino L, Storm G, Lammers T. Therapeutic and diagnostic targeting of fibrosis in metabolic, proliferative and viral disorders. Adv Drug Deliv Rev 2021; 175:113831. [PMID: 34139255 PMCID: PMC7611899 DOI: 10.1016/j.addr.2021.113831] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/30/2021] [Accepted: 06/10/2021] [Indexed: 02/07/2023]
Abstract
Fibrosis is a common denominator in many pathologies and crucially affects disease progression, drug delivery efficiency and therapy outcome. We here summarize therapeutic and diagnostic strategies for fibrosis targeting in atherosclerosis and cardiac disease, cancer, diabetes, liver diseases and viral infections. We address various anti-fibrotic targets, ranging from cells and genes to metabolites and proteins, primarily focusing on fibrosis-promoting features that are conserved among the different diseases. We discuss how anti-fibrotic therapies have progressed over the years, and how nanomedicine formulations can potentiate anti-fibrotic treatment efficacy. From a diagnostic point of view, we discuss how medical imaging can be employed to facilitate the diagnosis, staging and treatment monitoring of fibrotic disorders. Altogether, this comprehensive overview serves as a basis for developing individualized and improved treatment strategies for patients suffering from fibrosis-associated pathologies.
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Affiliation(s)
- Alexandros Marios Sofias
- Department of Nanomedicine and Theranostics, Institute for Experimental Molecular Imaging, Faculty of Medicine, RWTH Aachen University, Aachen, Germany; Mildred Scheel School of Oncology (MSSO), Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO(ABCD)), University Hospital Aachen, Aachen, Germany; Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Federica De Lorenzi
- Department of Nanomedicine and Theranostics, Institute for Experimental Molecular Imaging, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Quim Peña
- Department of Nanomedicine and Theranostics, Institute for Experimental Molecular Imaging, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Armin Azadkhah Shalmani
- Department of Nanomedicine and Theranostics, Institute for Experimental Molecular Imaging, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Mihael Vucur
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty at Heinrich-Heine-University, Duesseldorf, Germany
| | - Jiong-Wei Wang
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Cardiovascular Research Institute, National University Heart Centre Singapore, Singapore, Singapore; Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Nanomedicine Translational Research Programme, Centre for NanoMedicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Fabian Kiessling
- Department of Nanomedicine and Theranostics, Institute for Experimental Molecular Imaging, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Yang Shi
- Department of Nanomedicine and Theranostics, Institute for Experimental Molecular Imaging, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Lorena Consolino
- Department of Nanomedicine and Theranostics, Institute for Experimental Molecular Imaging, Faculty of Medicine, RWTH Aachen University, Aachen, Germany.
| | - Gert Storm
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Nanomedicine Translational Research Programme, Centre for NanoMedicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands; Department of Targeted Therapeutics, University of Twente, Enschede, the Netherlands.
| | - Twan Lammers
- Department of Nanomedicine and Theranostics, Institute for Experimental Molecular Imaging, Faculty of Medicine, RWTH Aachen University, Aachen, Germany; Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands; Department of Targeted Therapeutics, University of Twente, Enschede, the Netherlands.
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Iwakiri Y, Trebicka J. Portal hypertension in cirrhosis: Pathophysiological mechanisms and therapy. JHEP Rep 2021; 3:100316. [PMID: 34337369 PMCID: PMC8318926 DOI: 10.1016/j.jhepr.2021.100316] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 04/19/2021] [Accepted: 05/12/2021] [Indexed: 12/14/2022] Open
Abstract
Portal hypertension, defined as increased pressure in the portal vein, develops as a consequence of increased intrahepatic vascular resistance due to the dysregulation of liver sinusoidal endothelial cells (LSECs) and hepatic stellate cells (HSCs), frequently arising from chronic liver diseases. Extrahepatic haemodynamic changes contribute to the aggravation of portal hypertension. The pathogenic complexity of portal hypertension and the unsuccessful translation of preclinical studies have impeded the development of effective therapeutics for patients with cirrhosis, while counteracting hepatic and extrahepatic mechanisms also pose a major obstacle to effective treatment. In this review article, we will discuss the following topics: i) cellular and molecular mechanisms of portal hypertension, focusing on dysregulation of LSECs, HSCs and hepatic microvascular thrombosis, as well as changes in the extrahepatic vasculature, since these are the major contributors to portal hypertension; ii) translational/clinical advances in our knowledge of portal hypertension; and iii) future directions.
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Key Words
- ACE2, angiogenesis-converting enzyme 2
- ACLF, acute-on-chronic liver failure
- AT1R, angiotensin II type I receptor
- CCL2, chemokine (C-C motif) ligand 2
- CCl4, carbon tetrachloride
- CLD, chronic liver disease
- CSPH, clinically significant portal hypertension
- Dll4, delta like canonical Notch ligand 4
- ECM, extracellular matrix
- EUS, endoscopic ultrasound
- FXR
- FXR, farnesoid X receptor
- HCC, hepatocellular carcinoma
- HRS, hepatorenal syndrome
- HSC
- HSCs, hepatic stellate cells
- HVPG, hepatic venous pressure gradient
- Hsp90, heat shock protein 90
- JAK2, Janus kinase 2
- KO, knockout
- LSEC
- LSEC, liver sinusoidal endothelial cells
- MLCP, myosin light-chain phosphatase
- NET, neutrophil extracellular trap
- NO
- NO, nitric oxide
- NSBB
- NSBBs, non-selective beta blockers
- PDE, phosphodiesterase
- PDGF, platelet-derived growth factor
- PIGF, placental growth factor
- PKG, cGMP-dependent protein kinase
- Rho-kinase
- TIPS
- TIPS, transjugular intrahepatic portosystemic shunt
- VCAM1, vascular cell adhesion molecule 1
- VEGF
- VEGF, vascular endothelial growth factor
- angiogenesis
- eNOS, endothelial nitric oxide synthase
- fibrosis
- liver stiffness
- statins
- β-Arr2, β-arrestin 2
- β1-AR, β1-adrenergic receptor
- β2-AR, β2-adrenergic receptor
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Affiliation(s)
- Yasuko Iwakiri
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jonel Trebicka
- Translational Hepatology, Department of Internal Medicine I, University Clinic Frankfurt, Frankfurt, Germany
- European Foundation for the Study of Chronic Liver Failure-EF Clif, Barcelona, Spain
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Ward LD, Tu HC, Quenneville CB, Tsour S, Flynn-Carroll AO, Parker MM, Deaton AM, Haslett PAJ, Lotta LA, Verweij N, Ferreira MAR, Baras A, Hinkle G, Nioi P. GWAS of serum ALT and AST reveals an association of SLC30A10 Thr95Ile with hypermanganesemia symptoms. Nat Commun 2021; 12:4571. [PMID: 34315874 PMCID: PMC8316433 DOI: 10.1038/s41467-021-24563-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/23/2021] [Indexed: 02/07/2023] Open
Abstract
Understanding mechanisms of hepatocellular damage may lead to new treatments for liver disease, and genome-wide association studies (GWAS) of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) serum activities have proven useful for investigating liver biology. Here we report 100 loci associating with both enzymes, using GWAS across 411,048 subjects in the UK Biobank. The rare missense variant SLC30A10 Thr95Ile (rs188273166) associates with the largest elevation of both enzymes, and this association replicates in the DiscovEHR study. SLC30A10 excretes manganese from the liver to the bile duct, and rare homozygous loss of function causes the syndrome hypermanganesemia with dystonia-1 (HMNDYT1) which involves cirrhosis. Consistent with hematological symptoms of hypermanganesemia, SLC30A10 Thr95Ile carriers have increased hematocrit and risk of iron deficiency anemia. Carriers also have increased risk of extrahepatic bile duct cancer. These results suggest that genetic variation in SLC30A10 adversely affects more individuals than patients with diagnosed HMNDYT1.
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Affiliation(s)
- Lucas D. Ward
- grid.417897.40000 0004 0506 3000Alnylam Pharmaceuticals, Cambridge, MA USA
| | - Ho-Chou Tu
- grid.417897.40000 0004 0506 3000Alnylam Pharmaceuticals, Cambridge, MA USA
| | | | - Shira Tsour
- grid.417897.40000 0004 0506 3000Alnylam Pharmaceuticals, Cambridge, MA USA
| | | | - Margaret M. Parker
- grid.417897.40000 0004 0506 3000Alnylam Pharmaceuticals, Cambridge, MA USA
| | - Aimee M. Deaton
- grid.417897.40000 0004 0506 3000Alnylam Pharmaceuticals, Cambridge, MA USA
| | | | - Luca A. Lotta
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Tarrytown, NY USA
| | - Niek Verweij
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Tarrytown, NY USA
| | | | | | | | - Aris Baras
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Tarrytown, NY USA
| | - Gregory Hinkle
- grid.417897.40000 0004 0506 3000Alnylam Pharmaceuticals, Cambridge, MA USA
| | - Paul Nioi
- grid.417897.40000 0004 0506 3000Alnylam Pharmaceuticals, Cambridge, MA USA
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Mózes FE, Valkovič L, Pavlides M, Robson MD, Tunnicliffe EM. Hydration and glycogen affect T 1 relaxation times of liver tissue. NMR IN BIOMEDICINE 2021; 34:e4530. [PMID: 33951228 DOI: 10.1002/nbm.4530] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 04/05/2021] [Indexed: 06/12/2023]
Abstract
T1 mapping is a useful tool for the assessment of patients with nonalcoholic fatty liver disease but still suffers from a large unexplained variance in healthy subjects. This study aims to characterize the potential effects of liver glycogen concentration and body hydration status on liver shortened modified Look-Locker inversion recovery (shMOLLI) T1 measurements. Eleven glycogen phantoms and 12 healthy volunteers (mean age: 31 years, three females) were scanned at 3 T using inversion recovery spin echo, multiple contrast spin echo (in phantoms), shMOLLI T1 mapping, multiple-echo spoiled gradient recalled echo and 13 C spectroscopy (in healthy volunteers). Phantom r1 and r2 relaxivities were determined from measured T1 and T2 values. Participants underwent a series of five metabolic experiments to vary their glycogen concentration and hydration levels: feeding, food fasting, exercising, underhydration, and rehydration. Descriptive statistics were calculated for shMOLLI T1 , inferior vena cava to aorta cross-sectional area ratio (IVC/Ao) as a marker of body hydration status, glycogen concentration, T2 * and proton density fat fraction values. A linear mixed model for shMOLLI R1 was constructed to determine the effects of glycogen concentration and IVC/Ao ratio. The mean shMOLLI T1 after fasting was 737 ± 67 ms. The mean within-subject change was 80 ± 45 ms. The linear mixed model revealed a glycogen r1 relaxivity in volunteers (0.18 M-1 s-1 , p = 0.03) close to that determined in phantoms (0.28 M-1 s-1 ). A unit change in IVC/Ao ratio was associated with a drop of -0.113 s-1 in R1 (p < 0.001). This study demonstrated a dependence of liver shMOLLI T1 values on liver glycogen concentration and overall body hydration status. Interparticipant variation of hydration status should be minimized in future liver MRI studies. Additionally, caution is advised when interpreting liver T1 measurements in participants with excess liver glycogen.
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Affiliation(s)
- Ferenc E Mózes
- The Oxford Centre for Clinical Magnetic Resonance Research (OCMR), University of Oxford, Oxford, UK
| | - Ladislav Valkovič
- The Oxford Centre for Clinical Magnetic Resonance Research (OCMR), University of Oxford, Oxford, UK
- Department of Imaging Methods, Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Michael Pavlides
- The Oxford Centre for Clinical Magnetic Resonance Research (OCMR), University of Oxford, Oxford, UK
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, University of Oxford and Oxford Radcliffe Hospitals NHS Trust, Oxford, UK
| | - Matthew D Robson
- The Oxford Centre for Clinical Magnetic Resonance Research (OCMR), University of Oxford, Oxford, UK
- Perspectum, Gemini One, Oxford, UK
| | - Elizabeth M Tunnicliffe
- The Oxford Centre for Clinical Magnetic Resonance Research (OCMR), University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, University of Oxford and Oxford Radcliffe Hospitals NHS Trust, Oxford, UK
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60
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Liu CH, Ampuero J, Pavlides M, Wong VWS, Fan JG, Bai L, Li H, Wu DB, Zhou LY, Du LY, Yang TK, Jiang W, Shi Y, Gil-Gómez A, Zhang WT, Liang JX, Romero-Gómez M, Tang H. Simple non-invasive scoring systems and histological scores in predicting mortality in patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis. J Gastroenterol Hepatol 2021; 36:1754-1768. [PMID: 33569851 DOI: 10.1111/jgh.15431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/24/2020] [Accepted: 01/31/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM There is debate among the hepatology community regarding the simple non-invasive scoring systems and histological scores (even it was developed for histological classification) in predicting clinical outcomes in patients with non-alcoholic fatty liver disease (NAFLD). This study aimed to determine whether the presence of simple non-invasive scoring systems and histological scores could predict all-cause mortality, liver-related mortality, and liver disease decompensation (liver failure, cirrhosis, hepatocellular carcinoma, or decompensated liver disease). METHODS The pooled hazard ratio of prognostic factors and incidence rate per 1000 person-years in patients with NAFLD was calculated and further adjusted by two different models of handling the duplicated data. RESULTS A total of 19 longitudinal studies were included. Most simple non-invasive scoring systems (Fibrosis-4 Score, BARD, and aspartate aminotransferase-to-platelet ratio index ) and histological scores (NAFLD activity score, Brunt, and "steatosis, activity, and fibrosis" ) failed in predicting mortality, and only the NAFLD fibrosis score > 0.676 showed prognostic ability to all-cause mortality (four studies, 7564 patients, 118 352 person-years followed up, pooled hazard ratio 1.44, 95% confidence interval [CI] 1.05-1.96). The incidence rate per 1000 person-years of all-cause mortality, liver-related mortality, cardiovascular-related mortality, and liver disease decompensation resulted in a pooled incidence rate per 1000 person-years of 22.65 (14 studies, 95% CI 9.62-53.31), 3.19 (7 studies, 95% CI 1.14-8.93), 6.02 (6 studies, 95% CI 4.69-7.74), and 11.46 (4 studies, 95% CI 5.33-24.63), respectively. CONCLUSION Non-alcoholic fatty liver disease fibrosis score showed promising prognostic value to all-cause mortality. Most present simple non-invasive scoring systems and histological scores failed to predict clinical outcomes.
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Affiliation(s)
- Chang-Hai Liu
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.,Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Javier Ampuero
- Digestive Diseases Unit, Virgen del Rocío University Hospital, SeLiver Group at Institute of Biomedicine of Seville (IBIS), University of Seville, Seville, Spain
| | - Michael Pavlides
- Oxford NIHR Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust and the University of Oxford, Oxford, UK
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Jian-Gao Fan
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lang Bai
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.,Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Li
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.,Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Dong-Bo Wu
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.,Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Ling-Yun Zhou
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.,Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Ling-Yao Du
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.,Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Tian-Kuo Yang
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.,Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Jiang
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.,Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Shi
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.,Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Antonio Gil-Gómez
- Digestive Diseases Unit, Virgen del Rocío University Hospital, SeLiver Group at Institute of Biomedicine of Seville (IBIS), University of Seville, Seville, Spain
| | - Wen-Ting Zhang
- Digestive Diseases Unit, Virgen del Rocío University Hospital, SeLiver Group at Institute of Biomedicine of Seville (IBIS), University of Seville, Seville, Spain
| | - Jia-Xu Liang
- Digestive Diseases Unit, Virgen del Rocío University Hospital, SeLiver Group at Institute of Biomedicine of Seville (IBIS), University of Seville, Seville, Spain
| | - Manuel Romero-Gómez
- Digestive Diseases Unit, Virgen del Rocío University Hospital, SeLiver Group at Institute of Biomedicine of Seville (IBIS), University of Seville, Seville, Spain
| | - Hong Tang
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.,Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China
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Correlation of Native Liver Parenchyma T1 and T2 Relaxation Times and Liver Synthetic Function Tests: A Pilot Study. Diagnostics (Basel) 2021; 11:diagnostics11061125. [PMID: 34203008 PMCID: PMC8233916 DOI: 10.3390/diagnostics11061125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/16/2022] Open
Abstract
MR relaxometry increasingly contributes to liver imaging. Studies on native relaxation times mainly describe relation to the presence of fibrosis. The hypothesis was that relaxation times are also influenced by other inherent factors, including changes in liver synthesis function. With the approval of the local ethics committee and written informed consent, data from 94 patients referred for liver MR imaging, of which 20 patients had cirrhosis, were included. Additionally to standard sequences, both native T1 and T2 parametric maps and T1 maps in the hepatobiliary phase of gadoxetate disodium were acquired. Associations with laboratory variables were assessed. Altogether, there was a negative correlation between albumin and all acquired relaxation times in cirrhotic patients. In non-cirrhotic patients, only T1 values exhibited a negative correlation with albumin. In all patients, bilirubin correlated significantly with post-contrast T1 relaxation times, whereas native relaxation times correlated only in cirrhotic patients. Evaluating patients with pathological INR values, post-contrast relaxation times were significantly higher, whereas native relaxation times did not correlate. In conclusion, apart from confirming the value of hepatobiliary phase T1 mapping, our results show a correlation of native T1 with serum albumin even in non-cirrhotic liver parenchyma, suggesting a direct influence of liver’s synthesis capacity on T1 relaxation times.
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62
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Papachristodoulou A, Kavvadas D, Karamitsos A, Papamitsou T, Chatzidimitriou M, Sioga A. Diagnosis and Staging of Pediatric Non-Alcoholic Fatty Liver Disease: Is Classical Ultrasound the Answer? Pediatr Rep 2021; 13:312-321. [PMID: 34201230 PMCID: PMC8293345 DOI: 10.3390/pediatric13020039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/19/2021] [Accepted: 06/01/2021] [Indexed: 12/15/2022] Open
Abstract
The increased prevalence of non-alcoholic fatty liver disease (NAFLD) requires special attention in pediatric patients, as it manifests in them in a more severe and progressive way compared to adults. The implementation of the appropriate therapeutic interventions is determinant of the attempts to treat it. For that purpose, early diagnosis and staging of the disease is essential. The purpose of this review was to find and reveal the most appropriate diagnostic strategies and tools for diagnosis and staging of pediatric NAFLD/NASH based on their accuracy, safety and effectiveness. The methodology followed was that of the literature review. Particular emphasis was put on the recent bibliography. A comparative study of published articles about the diagnosis and management of pediatric NAFLD/NASH was also performed. In terms of diagnosis, the findings converged on the use of classical ultrasound. Ultrasound presented average sensitivity and specificity for diagnosing the disease in children, while in the adult population, sensitivity and specificity were significantly higher. Proton density fat fraction magnetic resonance imaging has been increasingly used for the diagnosis of steatosis in pediatric patients. Elastography is an effective tool for staging liver fibrosis and discriminating NASH from NAFLD in children. Even though liver biopsy is the gold standard, especially for NASH, it should be avoided for pediatric patients. Biochemical tests are less specific and less sensitive for the diagnosis of NAFLD, and some of them are of high cost. It seems that diagnostic imaging should be a first-line tool for the staging and monitoring pediatric NAFLD/NASH in order for appropriate interventions to be implanted in a timely way.
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Affiliation(s)
- Angeliki Papachristodoulou
- Laboratory of Histology and Embryology, School of Medicine, Faculty of Health, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (A.P.); (D.K.); (A.S.)
| | - Dimitrios Kavvadas
- Laboratory of Histology and Embryology, School of Medicine, Faculty of Health, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (A.P.); (D.K.); (A.S.)
| | - Athanasios Karamitsos
- 2nd Department of Ophthalmology, School of Medicine, Faculty of Health, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Theodora Papamitsou
- Laboratory of Histology and Embryology, School of Medicine, Faculty of Health, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (A.P.); (D.K.); (A.S.)
| | - Maria Chatzidimitriou
- Department of Biomedical Sciences, School of Health Sciences, International University of Greece, 574 00 Thessaloniki, Greece;
| | - Antonia Sioga
- Laboratory of Histology and Embryology, School of Medicine, Faculty of Health, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (A.P.); (D.K.); (A.S.)
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63
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Evrimler S, Swensson JK, Are VS, Tirkes T, Vuppalanchi R, Akisik F. Quantitative assessment of disease severity of primary sclerosing cholangitis with T1 mapping and extracellular volume imaging. Abdom Radiol (NY) 2021; 46:2433-2443. [PMID: 33135100 DOI: 10.1007/s00261-020-02839-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Assess the relationship between liver T1 relaxation time and extracellular volume (ECV) fraction and the disease severity of primary sclerosing cholangitis (PSC). METHODS This retrospective study included 93 patients with PSC and 66 healthy patients in the control group. T1 relaxation times were measured in the right and left lobe, as well as in the area of stricture. T1PSC and ECVPSC were calculated by averaging T1 and ECV of both lobes and stricture site. T1 and ECV were compared between the two groups and according to PSC phenotypes and severity based on Mayo Risk Score (MRS). We also examined the relationship between T1 and ECV with non-invasive measures of fibrosis such as Fibrosis-4 index (FIB-4) and liver stiffness measurement (LSM) by transient elastography. RESULTS Mean liver T1 (774 ± 111 ms, p < 0.001) and liver ECV (0.40 ± 0.14, p < 0.05) were significantly higher with both large-duct and small-duct-type PSC which may lack classic imaging findings on MRCP compared to the control group (p < 0.001). T1PSC and ECVPSC showed weak-moderate correlation with LSM, FIB-4, and MRS (p < 0.05). Cut-off values of liver T1 to detect patients in low-risk and high-risk MRS groups were 677 ms (AUC: 0.68, sensitivity: 76%, specificity: 53%, p = 0.03) and 743 ms (AUC: 0.83, sensitivity: 79%, specificity: 76%, p < 0.001), respectively. CONCLUSION T1 relaxation time and ECV fraction can be used for quantitative assessment of disease severity in patients with PSC.
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64
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Arndtz K, Shumbayawonda E, Hodson J, Eddowes PJ, Dennis A, Thomaides-Brears H, Mouchti S, Kelly MD, Banerjee R, Neubauer S, Hirschfield GM. Multiparametric Magnetic Resonance Imaging, Autoimmune Hepatitis, and Prediction of Disease Activity. Hepatol Commun 2021; 5:1009-1020. [PMID: 34141986 PMCID: PMC8183180 DOI: 10.1002/hep4.1687] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/05/2021] [Accepted: 01/18/2021] [Indexed: 02/06/2023] Open
Abstract
Noninvasive monitoring of disease activity in autoimmune hepatitis (AIH) has potential advantages for patients for whom liver biopsy is invasive and with risk. We sought to understand the association of multiparametric magnetic resonance imaging (mpMRI) with clinical course of patients with AIH. We prospectively recruited 62 patients (median age, 55 years; 82% women) with clinically confirmed AIH. At recruitment, patients underwent mpMRI with LiverMultiScan alongside clinical investigations, which were repeated after 12-18 months. Associations between iron-corrected T1 (cT1) and other markers of disease were investigated at baseline and at follow-up. Discriminative performance of cT1, liver stiffness, and enhanced liver fibrosis (ELF) to identify those who failed to maintain remission over follow-up was investigated using the areas under the receiver operating characteristic curves (AUCs). Baseline cT1 correlated with alanine aminotransferase (Spearman's correlation coefficient [r S] = 0.28, P = 0.028), aspartate aminotransferase (r S = 0.26, P = 0.038), international normalized ratio (r S = 0.35 P = 0.005), Model for End-Stage Liver Disease (r S = 0.32, P = 0.020), ELF (r S = 0.29, P = 0.022), and liver stiffness r S = 0.51, P < 0.001). After excluding those not in remission at baseline (n = 12), 32% of the remainder failed to maintain remission during follow-up. Failure to maintain remission was associated with significant increases in cT1 over follow-up (AUC, 0.71; 95% confidence interval [CI], 0.52-0.90; P = 0.035) but not with changes in liver stiffness (AUC, 0.68; 95% CI, 0.49-0.87; P = 0.067) or ELF (AUC, 0.57; 95% CI, 0.37-0.78; P = 0.502). cT1 measured at baseline was a significant predictor of future loss of biochemical remission (AUC, 0.68; 95% CI, 0.53-0.83; P = 0.042); neither liver stiffness (AUC, 0.53; 95% CI, 0.34-0.71; P = 0.749) nor ELF (AUC, 0.52; 95% CI, 0.33-0.70; P = 0.843) were significant predictors of loss of biochemical remission. Conclusion: Noninvasive mpMRI has potential to contribute to risk stratification in patients with AIH.
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Affiliation(s)
- Katherine Arndtz
- Centre for Liver and Gastrointestinal ResearchNational Institute for Health Research (NIHR) Birmingham Liver Biomedical Research CentreBirminghamUnited Kingdom.,University Hospitals Birmingham National Health Service (NHS) Foundation TrustBirminghamUnited Kingdom
| | | | - James Hodson
- University Hospitals Birmingham National Health Service (NHS) Foundation TrustBirminghamUnited Kingdom
| | - Peter J Eddowes
- Centre for Liver and Gastrointestinal ResearchNational Institute for Health Research (NIHR) Birmingham Liver Biomedical Research CentreBirminghamUnited Kingdom.,NIHR Nottingham Biomedical Research CentreNottingham University Hospitals NHS Trust and University of NottinghamNottinghamUnited Kingdom
| | | | | | | | | | | | | | - Gideon M Hirschfield
- Centre for Liver and Gastrointestinal ResearchNational Institute for Health Research (NIHR) Birmingham Liver Biomedical Research CentreBirminghamUnited Kingdom.,Toronto Centre for Liver DiseaseUniversity Health NetworkTorontoONCanada
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65
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Jayaswal ANA, Levick C, Collier J, Tunnicliffe EM, Kelly MD, Neubauer S, Barnes E, Pavlides M. Liver cT 1 decreases following direct-acting antiviral therapy in patients with chronic hepatitis C virus. Abdom Radiol (NY) 2021; 46:1947-1957. [PMID: 33247768 PMCID: PMC8131342 DOI: 10.1007/s00261-020-02860-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/04/2020] [Accepted: 11/07/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Direct-acting antiviral therapies (DAAs) for treatment of chronic hepatitis C virus (HCV) have excellent rates of viral eradication, but their effect on regression of liver fibrosis is unclear. The primary aim was to use magnetic resonance imaging (MRI) and spectroscopy (MRS) to evaluate changes in liver fibrosis, liver fat and liver iron content (LIC) in patients with chronic HCV following treatment with DAAs. METHODS In this prospective study, 15 patients with chronic HCV due to start treatment with DAAs and with transient elastography (TE) > 8 kPa were recruited consecutively. Patients underwent MRI and MRS at baseline (before treatment), and at 24 weeks and 48 weeks after the end of treatment (EoT) for the measurement of liver cT1 (fibroinflammation), liver fat and T2* (LIC). RESULTS All patients achieved a sustained virological response. Liver cT1 showed significant decreases from baseline to 24 weeks post EoT (876 vs 806 ms, p = 0.002, n = 15), baseline to 48 weeks post EoT (876 vs 788 ms, p = 0.0002, n = 13) and 24 weeks post EoT to 48 weeks post EoT (806 vs 788 ms, p = 0.016, n = 13). Between baseline and 48 weeks EoT significant reduction in liver fat (5.17% vs 2.65%, p = 0.027) and an increase in reported LIC (0.913 vs 0.950 mg/g, p = 0.021) was observed. CONCLUSION Liver cT1 decreases in patients with chronic HCV undergoing successful DAA treatment. The relatively fast reduction in cT1 suggests a reduction in inflammation rather than regression of fibrosis.
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Affiliation(s)
- Arjun N A Jayaswal
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Christina Levick
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
| | - Jane Collier
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
| | - Elizabeth M Tunnicliffe
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
| | | | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Eleanor Barnes
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK
| | - Michael Pavlides
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK.
- Oxford NIHR Biomedical Research Centre, Oxford, UK.
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66
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Amerikanou C, Kanoni S, Kaliora AC, Barone A, Bjelan M, D'Auria G, Gioxari A, Gosalbes MJ, Mouchti S, Stathopoulou MG, Soriano B, Stojanoski S, Banerjee R, Halabalaki M, Mikropoulou EV, Kannt A, Lamont J, Llorens C, Marascio F, Marascio M, Roig FJ, Smyrnioudis I, Varlamis I, Visvikis‐Siest S, Vukic M, Milic N, Medic‐Stojanoska M, Cesarini L, Campolo J, Gastaldelli A, Deloukas P, Trivella MG, Francino MP, Dedoussis GV. Effect of Mastiha supplementation on NAFLD: The MAST4HEALTH Randomised, Controlled Trial. Mol Nutr Food Res 2021; 65:e2001178. [DOI: 10.1002/mnfr.202001178] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/28/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Charalampia Amerikanou
- Department of Nutrition and Dietetics, School of Health Science and Education Harokopio University Athens Greece
| | - Stavroula Kanoni
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry Queen Mary University of London London EC1M 6BQ UK
| | - Andriana C. Kaliora
- Department of Nutrition and Dietetics, School of Health Science and Education Harokopio University Athens Greece
| | | | - Mladen Bjelan
- Faculty of Medicine University of Novi Sad Novi Sad Serbia
| | - Giuseppe D'Auria
- Sequencing and Bioinformatics Service Fundació per al Foment de la Investigació Sanitària i Biomèdica de la Comunitat Valenciana (FISABIO‐Salut Pública) Avda. Catalunya 21 València 46020 Spain
- CIBER en Epidemiología y Salud Pública Av. Monforte de Lemos 3–5 Madrid 28029 Spain
| | - Aristea Gioxari
- Department of Nutrition and Dietetics, School of Health Science and Education Harokopio University Athens Greece
| | - María José Gosalbes
- CIBER en Epidemiología y Salud Pública Av. Monforte de Lemos 3–5 Madrid 28029 Spain
- Joint Research Unit in Genomics and Health Fundació per al Foment de la Investigació Sanitària i Biomèdica de la Comunitat Valenciana (FISABIO) and Institut de Biologia Integrativa de Sistemes (Universitat de València / Consejo Superior de Investigaciones Científicas) Avda. Catalunya 21 València 46020 Spain
| | | | | | - Beatriz Soriano
- Biotechvana, Parc Científic Universitat de València Paterna Valencia Spain
| | - Stefan Stojanoski
- Faculty of Medicine University of Novi Sad Novi Sad Serbia
- Centre for Imaging Diagnostics Oncology Insitute of Vojvodina Sremska Kamenica Serbia
| | | | - Maria Halabalaki
- Division of Pharmacognosy and Natural Products Chemistry Department of Pharmacy National and Kapodistrian University of Athens Athens Greece
| | - Eleni V. Mikropoulou
- Division of Pharmacognosy and Natural Products Chemistry Department of Pharmacy National and Kapodistrian University of Athens Athens Greece
| | - Aimo Kannt
- Sanofi Research and Development Industriepark Hoechst Frankfurt 65926 Germany
- Institute of Clinical Pharmacology Goethe University Frankfurt Frankfurt 60590 Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP Frankfurt 60596 Germany
| | - John Lamont
- Randox Laboratories Limited, Crumlin, Co. Antrim Northern Ireland UK
| | - Carlos Llorens
- Biotechvana, Parc Científic Universitat de València Paterna Valencia Spain
| | | | | | - Francisco J. Roig
- Biotechvana, Parc Científic Universitat de València Paterna Valencia Spain
- Facultad de Ciencias de la Salud Universidad San Jorge Zaragoza 50830 Spain
| | | | - Iraklis Varlamis
- Department of Informatics and Telematics Harokopio University Athens Greece
| | | | - Milan Vukic
- Department of Food Technology, Faculty of Technology Zvornik University of East Sarajevo Zvornik 75400 Bosnia and Herzegovina
| | - Natasa Milic
- Faculty of Medicine University of Novi Sad Novi Sad Serbia
| | - Milica Medic‐Stojanoska
- Faculty of Medicine University of Novi Sad Novi Sad Serbia
- Clinic for Endocrinology, Diabetes and Metabolic Diseases Clinical Centre of Vojvodina Novi Sad Serbia
| | - Lucia Cesarini
- Division of Hepatology and Gastroenterology Niguarda Ca' Grande Hospital Milan Italy
| | | | - Amalia Gastaldelli
- Cardiometabolic Risk Unit Institute of Clinical Physiology, CNR Pisa Italy
| | - Panos Deloukas
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry Queen Mary University of London London EC1M 6BQ UK
- Centre for Genomic Health, Life Sciences Queen Mary University of London London UK
| | - Maria Giovanna Trivella
- Institute of Clinical Physiology CNR Milan Italy
- Cardiometabolic Risk Unit Institute of Clinical Physiology, CNR Pisa Italy
| | - M. Pilar Francino
- CIBER en Epidemiología y Salud Pública Av. Monforte de Lemos 3–5 Madrid 28029 Spain
- Joint Research Unit in Genomics and Health Fundació per al Foment de la Investigació Sanitària i Biomèdica de la Comunitat Valenciana (FISABIO) and Institut de Biologia Integrativa de Sistemes (Universitat de València / Consejo Superior de Investigaciones Científicas) Avda. Catalunya 21 València 46020 Spain
| | - George V. Dedoussis
- Department of Nutrition and Dietetics, School of Health Science and Education Harokopio University Athens Greece
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Beyer C, Hutton C, Andersson A, Imajo K, Nakajima A, Kiker D, Banerjee R, Dennis A. Comparison between magnetic resonance and ultrasound-derived indicators of hepatic steatosis in a pooled NAFLD cohort. PLoS One 2021; 16:e0249491. [PMID: 33793651 PMCID: PMC8016312 DOI: 10.1371/journal.pone.0249491] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/17/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND & AIMS MRI-based proton density fat fraction (PDFF) and the ultrasound-derived controlled attenuation parameter (CAP) are non-invasive techniques for quantifying liver fat, which can be used to assess steatosis in patients with non-alcoholic fatty liver disease (NAFLD). This study compared both of these techniques to histopathological graded steatosis for the assessment of fat levels in a large pooled NAFLD cohort. METHODS This retrospective study pooled N = 581 participants from two suspected NAFLD cohorts (mean age (SD) 56 (12.7), 60% females). Steatosis was graded according to NASH-CRN criteria. Liver fat was measured non-invasively using PDFF (with Liver MultiScan's Iterative Decomposition of water and fat with Echo Asymmetry and Least-squares estimation method, LMS-IDEAL, Perspectum, Oxford) and CAP (FibroScan, Echosens, France), and their diagnostic performances were compared. RESULTS LMS-IDEAL and CAP detected steatosis grade ≥ 1 with AUROCs of 1.00 (95% CI, 0.99-1.0) and 0.95 (95% CI, 0.91-0.99), respectively. LMS-IDEAL was superior to CAP for detecting steatosis grade ≥ 2 with AUROCs of 0.77 (95% CI, 0.73-0.82] and 0.60 (95% CI, 0.55-0.65), respectively. Similarly, LMS-IDEAL outperformed CAP for detecting steatosis grade ≥ 3 with AUROCs of 0.81 (95% CI, 0.76-0.87) and 0.63 (95% CI, 0.56-0.70), respectively. CONCLUSION LMS-IDEAL was able to diagnose individuals accurately across the spectrum of histological steatosis grades. CAP performed well in identifying individuals with lower levels of fat (steatosis grade ≥1); however, its diagnostic performance was inferior to LMS-IDEAL for higher levels of fat (steatosis grades ≥2 and ≥3). TRIAL REGISTRATION ClinicalTrials.gov (NCT03551522); https://clinicaltrials.gov/ct2/show/NCT03551522. UMIN Clinical Trials Registry (UMIN000026145); https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000026145.
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Affiliation(s)
| | | | | | - Kento Imajo
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Dustin Kiker
- Texas Digestive Disease Consultants, Dallas, Texas, United States of America
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Roca-Fernández A, Dennis A, Nicholls R, McGonigle J, Kelly M, Banerjee R, Banerjee A, Sanyal AJ. Hepatic Steatosis, Rather Than Underlying Obesity, Increases the Risk of Infection and Hospitalization for COVID-19. Front Med (Lausanne) 2021; 8:636637. [PMID: 33855033 PMCID: PMC8039134 DOI: 10.3389/fmed.2021.636637] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/03/2021] [Indexed: 12/15/2022] Open
Abstract
Objective: Obesity is a risk factor for SARS-COV2 infection and is often associated with hepatic steatosis. The aim of this study was to determine if pre-existing hepatic steatosis affects the risk of infection and severity for COVID-19. Design: Prospective cohort study (UK Biobank). Univariate and stepwise multivariate logistic regression analyses were performed on liver phenotypic biomarkers to determine if these variables increased risk of testing positive and being hospitalized for COVID-19; then compared to previously described risk factors associated with COVID-19, including age, ethnicity, gender, obesity, socio-economic status. Setting: UK biobank study. Participants: 502,506 participants (healthy at baseline) in the UK Biobank, of whom 41,791 underwent MRI (aged 50-83) for assessment of liver fat, liver fibro-inflammatory disease, and liver iron. Positive COVID-19 test was determined from UK testing data, starting in March 2020 and censored in January 2021. Primary and Secondary Outcome Measures: Liver fat measured as proton density fat fraction (PDFF%) MRI and body mass index (BMI, Kg/m2) to assess prior to February 2020 using MRI of the liver to assess hepatic steatosis. Results: Within the imaged cohort (n = 41, 791), 4,458 had been tested and 1,043 (2.49% of the imaged population) tested positive for COVID-19. Individuals with fatty liver (≥10%) were at increased risk of testing positive (OR: 1.35, p = 0.007) and those participants with obesity and fatty liver, were at increased risk of hospitalization with a positive test result by 5.14 times (p = 0.0006). Conclusions: UK Biobank data revealed obese individuals with fatty liver disease were at increased risk of infection and hospitalization for COVID-19. Public policy measures and personalized medicine should be considered in order to protect these high-risk individuals.
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Affiliation(s)
| | | | | | | | | | | | - Amitava Banerjee
- University College London Hospitals National Health Service Trust, London, United Kingdom.,Institute of Health Informatics, University College London, London, United Kingdom.,Barts Health National Health Service Trust, The Royal London Hospital, London, United Kingdom
| | - Arun J Sanyal
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
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T2 mapping in gadoxetic acid-enhanced MRI: utility for predicting decompensation and death in cirrhosis. Eur Radiol 2021; 31:8376-8387. [PMID: 33782768 DOI: 10.1007/s00330-021-07805-0] [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: 10/04/2020] [Revised: 12/21/2020] [Accepted: 02/17/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To determine whether T2 mapping in liver MRI can predict decompensation and death in cirrhotic patients. METHODS This retrospective study included 292 cirrhotic patients who underwent gadoxetic acid-enhanced MRI, including T1 and T2 mapping at 10-min hepatobiliary phase by using the Look-Locker and radial turbo spin-echo sequences, respectively. T1 and T2 values of the liver and spleen were measured. The association of MR parameters and serum markers with decompensation and death was investigated. Risk models combining T2Liver, serum albumin level, and Model for End-Stage Liver Disease (MELD) score were created for predicting decompensation (T2Liver, < 49.3 versus ≥ 49.3 ms) and death (< 57.4 versus ≥ 57.4 ms). RESULTS In patients with compensated cirrhosis at baseline and in the full patient cohort, 9.6% (19 of 197) and 5.1% (15 of 292) developed decompensation and died during the mean follow-up periods of 18.7 and 19.2 months, respectively. A prolonged T2Liver (hazard ratio (HR), 2.59; 95% confidence interval (CI), 1.26, 5.31) was independently predictive of decompensation along with the serum albumin level (HR, 0.28; 95% CI, 0.12, 0.68) and MELD score (HR, 1.34; 95% CI, 1.08, 1.66). T2Liver (HR, 2.61; 95% CI, 1.19, 5.72) and serum albumin level (HR, 0.46; 95% CI, 0.19, 1.14) were independent predictors of death. The mean times to decompensation (12.9 versus 29.2 months) and death (16.5 versus 29.6 months) were significantly different between the high- and low-risk groups (p < 0.001). CONCLUSION T2Liver from T2 mapping can predict decompensation and death in patients with cirrhosis. KEY POINTS • Liver T2 values from the radial turbo spin-echo (TSE) T2 mapping sequence with tiered echo sharing and pseudo golden-angle (pGA) reordering were significantly higher in decompensated cirrhosis than compensated cirrhosis. • Liver T2 values from the radial TSE T2 mapping sequence with tiered echo sharing and pGA reordering can predict decompensation and death in patients with cirrhosis. • T2 mapping is recommended as part of liver MRI examinations for cirrhotic patients because it can provide a noninvasive prognostic marker for the development of decompensation and death.
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Imajo K, Tetlow L, Dennis A, Shumbayawonda E, Mouchti S, Kendall TJ, Fryer E, Yamanaka S, Honda Y, Kessoku T, Ogawa Y, Yoneda M, Saito S, Kelly C, Kelly MD, Banerjee R, Nakajima A. Quantitative multiparametric magnetic resonance imaging can aid non-alcoholic steatohepatitis diagnosis in a Japanese cohort. World J Gastroenterol 2021; 27:609-623. [PMID: 33642832 PMCID: PMC7901049 DOI: 10.3748/wjg.v27.i7.609] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/17/2020] [Accepted: 12/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Non-invasive assessment of non-alcoholic steatohepatitis (NASH) is increasing in desirability due to the invasive nature and costs associated with the current form of assessment; liver biopsy. Quantitative multiparametric magnetic resonance imaging (mpMRI) to measure liver fat (proton density fat fraction) and fibroinflammatory disease [iron-corrected T1 (cT1)], as well as elastography techniques [vibration-controlled transient elastography (VCTE) liver stiffness measure], magnetic resonance elastography (MRE) and 2D Shear-Wave elastography (SWE) to measure stiffness and fat (controlled attenuated parameter, CAP) are emerging alternatives which could be utilised as safe surrogates to liver biopsy.
AIM To evaluate the agreement of non-invasive imaging modalities with liver biopsy, and their subsequent diagnostic accuracy for identifying NASH patients.
METHODS From January 2019 to February 2020, Japanese patients suspected of NASH were recruited onto a prospective, observational study and were screened using non-invasive imaging techniques; mpMRI with LiverMultiScan®, VCTE, MRE and 2D-SWE. Patients were subsequently biopsied, and samples were scored by three independent pathologists. The diagnostic performances of the non-invasive imaging modalities were assessed using area under receiver operating characteristic curve (AUC) with the median of the histology scores as the gold standard diagnoses. Concordance between all three independent pathologists was further explored using Krippendorff’s alpha (a) from weighted kappa statistics.
RESULTS N = 145 patients with mean age of 60 (SD: 13 years.), 39% females, and 40% with body mass index ≥ 30 kg/m2 were included in the analysis. For identifying patients with NASH, MR liver fat and cT1 were the strongest performing individual measures (AUC: 0.80 and 0.75 respectively), and the mpMRI metrics combined (cT1 and MR liver fat) were the overall best non-invasive test (AUC: 0.83). For identifying fibrosis ≥ 1, MRE performed best (AUC: 0.97), compared to VCTE-liver stiffness measure (AUC: 0.94) and 2D-SWE (AUC: 0.94). For assessment of steatosis ≥ 1, MR liver fat was the best performing non-invasive test (AUC: 0.92), compared to controlled attenuated parameter (AUC: 0.75). Assessment of the agreement between pathologists showed that concordance was best for steatosis (a = 0.58), moderate for ballooning (a = 0.40) and fibrosis (a = 0.40), and worst for lobular inflammation (a = 0.11).
CONCLUSION Quantitative mpMRI is an effective alternative to liver biopsy for diagnosing NASH and non-alcoholic fatty liver, and thus may offer clinical utility in patient management.
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Affiliation(s)
- Kento Imajo
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama 236-0004, Japan
| | - Louise Tetlow
- Innovation, Perspectum, Oxford OX4 2LL, United Kingdom
| | - Andrea Dennis
- Innovation, Perspectum, Oxford OX4 2LL, United Kingdom
| | | | - Sofia Mouchti
- Innovation, Perspectum, Oxford OX4 2LL, United Kingdom
| | - Timothy J Kendall
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom, Edinburgh EH16 4TJ, United Kingdom
| | - Eve Fryer
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, United Kingdom
| | - Shogi Yamanaka
- Anatomic and Clinical Pathology Department, Yokohoma City University Hospital, Yokohoma 236-0004, Japan
| | - Yasushi Honda
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama 236-0004, Japan
| | - Takaomi Kessoku
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama 236-0004, Japan
| | - Yuji Ogawa
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama 236-0004, Japan
| | - Masato Yoneda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
| | - Satoru Saito
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama 236-0004, Japan
| | | | - Matt D Kelly
- Innovation, Perspectum, Oxford OX4 2LL, United Kingdom
| | | | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama 236-0004, Japan
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Sethi P, Thavanesan N, Welsh FK, Connell J, Pickles E, Kelly M, Fallowfield JA, Kendall TJ, Mole DJ, Rees M. Quantitative multiparametric MRI allows safe surgical planning in patients undergoing liver resection for colorectal liver metastases: report of two patients. BJR Case Rep 2021; 7:20200172. [PMID: 34131498 PMCID: PMC8171142 DOI: 10.1259/bjrcr.20200172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/16/2020] [Accepted: 12/26/2020] [Indexed: 01/11/2023] Open
Abstract
It is not uncommon for clinicians to encounter varying degrees of hepatic steatosis in patients undergoing resection for colorectal liver metastases (CRLM). Magnetic resonance imaging is currently the preferred investigation for identification and pre-operative planning of these patients. An objective assessment of liver quality and degree of steatosis is paramount for planning a safe resection, which is seldom provided by routine MRI sequences. We studied two patients who underwent an additional pre-operative multiparametric MRI scan (LiverMultiScanTM) as a part of an observational clinical trial (HepaT1ca, NCT03213314) to assess the quality of liver. Outcome was assessed in the form of post-hepatectomy liver failure. Both patients (Patient 1 and 2) had comparable pre-operative characteristics. Both patients were planned for an extended right hepatectomy with an estimated future liver remnant of approximately 30%. Conventional preoperative contrast MRI showed mild liver steatosis in both patients. Patient one developed post-hepatectomy liver failure leading to prolonged hospital stay compared to patient two who had uneventful post-operative course. Retrospective evaluation of multiparametric MRI scan revealed findings consistent with fibro-inflammatory disease and steatosis (cT1 829 ms, PDFF 14%) for patient 1 whereas patient two had normal parameters (cT1 735 ms, PDFF 2.4%). These findings corresponded with the resection specimen histology. Multiparametric MRI can objectively evaluate future liver health and volume which may help refine surgical decision-making and improve patient outcomes.
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Affiliation(s)
- Pulkit Sethi
- Department of Hepatobiliary Surgery, Basingstoke and North Hampshire Hospital, Basingstoke, Hampshire, United Kingdom
| | - Navamayooran Thavanesan
- Department of Hepatobiliary Surgery, Basingstoke and North Hampshire Hospital, Basingstoke, Hampshire, United Kingdom
| | - Fenella Ks Welsh
- Department of Hepatobiliary Surgery, Basingstoke and North Hampshire Hospital, Basingstoke, Hampshire, United Kingdom
| | | | | | - Matt Kelly
- Perspectum, Gemini One, Oxford, United Kingdom
| | - Jonathan A Fallowfield
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Timothy J Kendall
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | | | - Myrddin Rees
- Department of Hepatobiliary Surgery, Basingstoke and North Hampshire Hospital, Basingstoke, Hampshire, United Kingdom
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Association between liver diffusion-weighted imaging apparent diffusion coefficient values and other measures of liver disease in pediatric autoimmune liver disease patients. Abdom Radiol (NY) 2021; 46:197-204. [PMID: 32462385 DOI: 10.1007/s00261-020-02595-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Multiple quantitative magnetic resonance imaging (MRI) methods have been described to noninvasively detect and characterize liver fibrosis, including diffusion-weighted imaging (DWI). PURPOSE To evaluate associations between liver MRI DWI apparent diffusion coefficient (ADC) values and clinical factors and other quantitative liver MRI metrics in pediatric patients with autoimmune liver disease (AILD). MATERIALS AND METHODS Fifty-seven research liver MRI examinations performed from January 2017 to August 2018 for pediatric AILD registry participants were evaluated. Liver DWI ADC values, liver and spleen stiffness (kPa), and iron-corrected T1 (cT1; Perspectum Diagnostics) were measured at four anatomic levels. Participant age, sex, and laboratory data (alanine aminotransferase [ALT], total bilirubin, alkaline phosphatase, gamma-glutamyl transferase [GGT]) were recorded. Spearman's rank-order correlation (rho) and multiple linear regression were used to evaluate the associations between liver ADC values and predictor variables. RESULTS Mean (SD) participant age was 14.8 (4.0) years, 45.6% (26/57) were girls. Mean liver DWI ADC value was 1.34 (0.14 × 10-3) mm2/s. Liver ADC values showed weak to moderate correlations with liver stiffness (r = - 0.42, p = 0.001), spleen stiffness (r = - 0.34; p = 0.015), whole-liver mean cT1 (r = - 0.39; p = 0.007), ALT (r = - 0.50; p = 0.0001), and GGT (r = - 0.48; p = 0.0004). Multiple linear regression showed liver stiffness (p = 0.0009) and sex (p = 0.023) to be independent predictors of liver ADC values. CONCLUSION Liver DWI ADC values are significantly associated with liver and spleen stiffnesses, liver cT1, ALT, GGT, and participant sex, with liver stiffness and sex remaining significant at multivariable regression. Liver ADC ultimately may play a role in multi-parametric prediction of chronic liver disease/fibrosis severity.
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73
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Albhaisi S, Noureddin M. Current and Potential Therapies Targeting Inflammation in NASH. Front Endocrinol (Lausanne) 2021; 12:767314. [PMID: 34925237 PMCID: PMC8678040 DOI: 10.3389/fendo.2021.767314] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/15/2021] [Indexed: 12/12/2022] Open
Abstract
Nonalcoholic steatohepatitis (NASH) is the advanced form of nonalcoholic fatty liver disease (NAFLD). It is characterized by hepatic steatosis, inflammation, hepatocellular injury, and fibrosis. Inflammation plays a key role in the progression of NASH and can be provoked by intrahepatic (e.g., lipotoxicity, immune responses, oxidative stress and cell death) and extrahepatic sources (adipose tissue or gut). The identification of triggers of inflammation is central to understanding the mechanisms in NASH development and progression and in designing targeted therapies that can halt or reverse the disease. In this review, we summarize the current and potential therapies targeting inflammation in NASH.
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Affiliation(s)
- Somaya Albhaisi
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, United States
- *Correspondence: Somaya Albhaisi,
| | - Mazen Noureddin
- Karsh Division of Gastroenterology and Hepatology Comprehensive Transplant Center, Cedars Sinai Medical Center, Los Angeles, CA, United States
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Multiparametric Magnetic Resonance Imaging to Monitor Pediatric Liver Disease: Looks Interesting but More Work to Do. J Pediatr Gastroenterol Nutr 2021; 72:3-4. [PMID: 32960826 DOI: 10.1097/mpg.0000000000002949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Multiparametric MRI as a Noninvasive Monitoring Tool for Children With Autoimmune Hepatitis. J Pediatr Gastroenterol Nutr 2021; 72:108-114. [PMID: 32925554 DOI: 10.1097/mpg.0000000000002930] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Autoimmune hepatitis (AIH) is a progressive liver disease managed with corticosteroids and immunosuppression and monitored using a combination of liver biochemistry and histology. However, liver biopsy is invasive with risk of pain and bleeding. The aim of the present study was to investigate the utility of noninvasive imaging with multiparametric magnetic resonance imaging (MRI) (mpMRI) to provide clinically useful information on the presence and extent of hepatic inflammation, potentially guiding immunosuppression. METHODS Eighty-one participants (aged 6-18), 21 healthy and 60 AIH patients, underwent multiparametric MRI to measure fibro-inflammation with iron-corrected T1 (cT1) at the Children's Memorial Health Institute in Warsaw alongside other clinical blood tests and liver biopsy at recruitment and after an average of 16-month follow-up (range 9-22 months). Correlation analyses were used to investigate the associations between cT1 with blood serum markers and histological scores. RESULTS At recruitment, patients with AIH had a higher cT1 value than healthy controls (P < 0.01). cT1 correlated significantly with key histopathological features of disease. Treatment naïve AIH patients showed evidence of inflammation and heterogeneity across the liver compared to healthy controls.At follow-up, cT1 showed utility in monitoring disease regression as most patients showed significantly reduced fibro-inflammation with treatment (P < 0.0001) over the observational period. Six patients had histological fibrosis and clear fibro-inflammation on MR despite biochemical remission (normalized aspartate aminotransferase (AST), alanine aminotransferase (ALT), and immunoglobulin G [IgG]). CONCLUSIONS Multiparametric MRI can measure disease burden in pediatric AIH and can show changes over time in response to therapy. Active disease can be seen even in biochemical remission in children.
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Obmann VC, Berzigotti A, Catucci D, Ebner L, Gräni C, Heverhagen JT, Christe A, Huber AT. T1 mapping of the liver and the spleen in patients with liver fibrosis-does normalization to the blood pool increase the predictive value? Eur Radiol 2020; 31:4308-4318. [PMID: 33313965 PMCID: PMC8128789 DOI: 10.1007/s00330-020-07447-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/03/2020] [Accepted: 10/29/2020] [Indexed: 02/07/2023]
Abstract
Purpose To analyze whether the T1 relaxation time of the liver is a good predictor of significant liver fibrosis and whether normalization to the blood pool improves the predictive value. Methods This prospective study was conducted between 03/2016 and 02/2018. One hundred seventy-three patients underwent multiparametric liver MRI at 3 T. The T1 relaxation time was measured in the liver and the spleen, in the aorta, the portal vein, and the inferior vena cava (IVC). T1 relaxation times with and without normalization to the blood pool were compared between patients with (n = 26) and without (n = 141) significant liver fibrosis, based on a cutoff value of 3.5 kPa in MRE as the noninvasive reference standard. For statistics, Student’s t test, receiver operating characteristic (ROC) curve analysis, and Pearson’s correlation were used. Results The T1 relaxation time of the liver was significantly longer in patients with liver fibrosis, both with and without blood pool normalization (p < 0.001). T1 relaxation time of the liver allowed prediction of significant liver fibrosis (AUC = 0.88), while normalization to the IVC resulted in a slightly lower performance (AUC = 0.82). The lowest performance was achieved when the T1 relaxation times of the liver were normalized to the aorta (AUC = 0.66) and to the portal vein (AUC = 0.62). The T1 relaxation time of the spleen detected significant liver fibrosis with an AUC of 0.68, and 0.51–0.64 with normalization to the blood pool. Conclusion The T1 relaxation time of the liver is a good predictor of significant liver fibrosis. However, normalization of the blood pool did not improve the predictive value. Key Points • The T1 relaxation time of the liver is a good predictor of significant liver fibrosis. • Normalization to the blood pool did not improve the predictive value of T1 mapping. • If the blood pool normalization was weighted 30% to the aorta and 70% to the portal vein, the performance was better than normalization to the aorta alone but still lower than normalization to the IVC.
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Affiliation(s)
- Verena Carola Obmann
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Annalisa Berzigotti
- Hepatology, Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Damiano Catucci
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johannes Thomas Heverhagen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Andreas Christe
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Adrian Thomas Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
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Kupczyk PA, Mesropyan N, Isaak A, Endler C, Faron A, Kuetting D, Sprinkart AM, Mädler B, Thomas D, Attenberger UI, Luetkens JA. Quantitative MRI of the liver: Evaluation of extracellular volume fraction and other quantitative parameters in comparison to MR elastography for the assessment of hepatopathy. Magn Reson Imaging 2020; 77:7-13. [PMID: 33309923 DOI: 10.1016/j.mri.2020.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 11/27/2020] [Accepted: 12/06/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Chronic liver diseases pose a major health problem worldwide, while common tests for diagnosis and monitoring of diffuse hepatopathy have considerable limitations. Preliminary data on the quantification of hepatic extracellular volume fraction (ECV) with magnetic resonance imaging (MRI) for non-invasive assessment of liver fibrosis are encouraging, with ECV having the potential to overcome several of these constraints. PURPOSE To clinically evaluate ECV provided by quantitative MRI for assessing the severity of liver disease. MATERIALS AND METHODS In this prospective study, multiparametric liver MRI, including T1 mapping and magnetic resonance elastography (MRE), was performed in subjects with and without hepatopathy between November 2018 and October 2019. T1, T2, T2*, proton density fat fraction and stiffness were extracted from parametric maps by regions of interest and ECV was calculated from T1 relaxometries. Serum markers of liver disease were obtained by clinical database research. For correlation analysis, Spearman rank correlation was used. ROC analysis of serum markers and quantitative MRI data for discrimination of liver cirrhosis was performed with MRE as reference standard. RESULTS 109 participants were enrolled (50.7 ± 16.1 years, 61 men). ECV, T1 and MRE correlated significantly with almost all serum markers of liver disease, with ECV showing the strongest associations (up to r = 0.67 with MELD, p < 0.01). ECV and T1 correlated with MRE (0.75 and 0.73, p < 0.01 each). ECV (AUC 0.89, cutoff 32.2%, sensitivity 85%, specificity 87%) and T1 mapping (AUC 0.85, cutoff 592.5 ms, sensitivity 83%, specificity 75%) featured good performances in detection of liver cirrhosis with only ECV performing significantly superior to model of end stage liver disease (MELD), AST/ALT ratio and international normalized ratio (p < 0.01, respectively). CONCLUSION Quantification of hepatic extracellular volume fraction with MRI is suitable for estimating the severity of liver disease when using MRE as the standard of reference. It represents a promising tool for non-invasive assessment of liver fibrosis and cirrhosis.
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Affiliation(s)
- P A Kupczyk
- University Hospital Bonn, Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany.
| | - N Mesropyan
- University Hospital Bonn, Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
| | - A Isaak
- University Hospital Bonn, Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
| | - C Endler
- University Hospital Bonn, Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
| | - A Faron
- University Hospital Bonn, Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
| | - D Kuetting
- University Hospital Bonn, Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
| | - A M Sprinkart
- University Hospital Bonn, Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
| | - B Mädler
- Philips Healthcare, Hamburg, Germany
| | - D Thomas
- University Hospital Bonn, Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
| | - U I Attenberger
- University Hospital Bonn, Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
| | - J A Luetkens
- University Hospital Bonn, Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
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Mole DJ, Fallowfield JA, Sherif AE, Kendall T, Semple S, Kelly M, Ridgway G, Connell JJ, McGonigle J, Banerjee R, Brady JM, Zheng X, Hughes M, Neyton L, McClintock J, Tucker G, Nailon H, Patel D, Wackett A, Steven M, Welsh F, Rees M. Quantitative magnetic resonance imaging predicts individual future liver performance after liver resection for cancer. PLoS One 2020; 15:e0238568. [PMID: 33264327 PMCID: PMC7710097 DOI: 10.1371/journal.pone.0238568] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/19/2020] [Indexed: 12/12/2022] Open
Abstract
The risk of poor post-operative outcome and the benefits of surgical resection as a curative therapy require careful assessment by the clinical care team for patients with primary and secondary liver cancer. Advances in surgical techniques have improved patient outcomes but identifying which individual patients are at greatest risk of poor post-operative liver performance remains a challenge. Here we report results from a multicentre observational clinical trial (ClinicalTrials.gov NCT03213314) which aimed to inform personalised pre-operative risk assessment in liver cancer surgery by evaluating liver health using quantitative multiparametric magnetic resonance imaging (MRI). We combined estimation of future liver remnant (FLR) volume with corrected T1 (cT1) of the liver parenchyma as a representation of liver health in 143 patients prior to treatment. Patients with an elevated preoperative liver cT1, indicative of fibroinflammation, had a longer post-operative hospital stay compared to those with a cT1 within the normal range (6.5 vs 5 days; p = 0.0053). A composite score combining FLR and cT1 predicted poor liver performance in the 5 days immediately following surgery (AUROC = 0.78). Furthermore, this composite score correlated with the regenerative performance of the liver in the 3 months following resection. This study highlights the utility of quantitative MRI for identifying patients at increased risk of poor post-operative liver performance and a longer stay in hospital. This approach has the potential to inform the assessment of individualised patient risk as part of the clinical decision-making process for liver cancer surgery.
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Affiliation(s)
- Damian J. Mole
- Clinical Surgery, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Inflammation Research, University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, United Kingdom
| | - Jonathan A. Fallowfield
- Centre for Inflammation Research, University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, United Kingdom
| | - Ahmed E. Sherif
- Clinical Surgery, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, United Kingdom
- Department of HPB Surgery, National Liver Institute, Menoufia University, Shibin Elkom, Egypt
| | - Timothy Kendall
- Institute of Genetics and Molecular Medicine, Edinburgh, United Kingdom
- Department of Pathology, NHS Lothian, Edinburgh, United Kingdom
| | - Scott Semple
- Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Matt Kelly
- Perspectum, Gemini One, Oxford, United Kingdom
| | | | | | | | | | | | - Xiaozhong Zheng
- Centre for Inflammation Research, University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, United Kingdom
| | - Michael Hughes
- Clinical Surgery, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, United Kingdom
| | - Lucile Neyton
- Centre for Inflammation Research, University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, United Kingdom
| | | | - Garry Tucker
- Clinical Research Facility, NHS Lothian, Edinburgh, United Kingdom
| | - Hilary Nailon
- Clinical Research Facility, NHS Lothian, Edinburgh, United Kingdom
| | - Dilip Patel
- Clinical Radiology, NHS Lothian, Edinburgh, United Kingdom
| | | | | | - Fenella Welsh
- Hampshire Hospitals Foundation Trust, Basingstoke, United Kingdom
| | - Myrddin Rees
- Hampshire Hospitals Foundation Trust, Basingstoke, United Kingdom
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Jayaswal ANA, Levick C, Selvaraj EA, Dennis A, Booth JC, Collier J, Cobbold J, Tunnicliffe EM, Kelly M, Barnes E, Neubauer S, Banerjee R, Pavlides M. Prognostic value of multiparametric magnetic resonance imaging, transient elastography and blood-based fibrosis markers in patients with chronic liver disease. Liver Int 2020; 40:3071-3082. [PMID: 32730664 DOI: 10.1111/liv.14625] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/03/2020] [Accepted: 07/22/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIMS Liver cT1 , liver T1 , transient elastography (TE) and blood-based biomarkers have independently been shown to predict clinical outcomes but have not been directly compared in a single cohort of patients. Our aim was to compare these tests' prognostic value in a cohort of patients with compensated chronic liver disease. METHODS Patients with unselected compensated liver disease aetiologies had baseline assessments and were followed up for development of clinical outcomes, blinded to the imaging results. The prognostic value of non-invasive liver tests at prespecified thresholds was assessed for a combined clinical endpoint comprising ascites, variceal bleeding, hepatic encephalopathy, hepatocellular carcinoma, liver transplantation and mortality. RESULTS One hundred and ninety-seven patients (61% male) with median age of 54 years were followed up for 693 patient-years (median (IQR) 43 (26-58) months). The main diagnoses were NAFLD (41%), viral hepatitis (VH, 25%) and alcohol-related liver disease (ArLD; 14%). During follow-up 14 new clinical events, and 11 deaths occurred. Clinical outcomes were predicted by liver cT1 > 825ms with HR 9.9 (95% CI: 1.29-76.4, P = .007), TE > 8kPa with HR 7.8 (95% CI: 0.97-62.3, P = .02) and FIB-4 > 1.45 with HR 4.09 (95% CI: 0.90-18.4, P = .05). In analysis taking into account technical failure and unreliability, liver cT1 > 825 ms could predict clinical outcomes (P = .03), but TE > 8kPa could not (P = .4). CONCLUSIONS We provide further evidence that liver cT1 , TE and serum-based biomarkers can predict clinical outcomes, but when taking into account technical failure/unreliability, TE cut-offs perform worse than those of cT1 and blood biomarkers.
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Affiliation(s)
- Arjun N A Jayaswal
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Christina Levick
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
| | - Emmanuel A Selvaraj
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.,Translational Gastroenterology Unit, University of Oxford, Oxford, UK.,Oxford NIHR Biomedical Research Centre, Oxford, UK
| | | | | | - Jane Collier
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
| | - Jeremy Cobbold
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
| | - Elizabeth M Tunnicliffe
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Eleanor Barnes
- Peter Medawar Building, University of Oxford, Oxford, UK
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Michael Pavlides
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.,Translational Gastroenterology Unit, University of Oxford, Oxford, UK.,Oxford NIHR Biomedical Research Centre, Oxford, UK
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80
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Kennedy P, Bane O, Hectors SJ, Fischman A, Schiano T, Lewis S, Taouli B. Noninvasive imaging assessment of portal hypertension. Abdom Radiol (NY) 2020; 45:3473-3495. [PMID: 32926209 PMCID: PMC10124623 DOI: 10.1007/s00261-020-02729-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/16/2020] [Accepted: 08/30/2020] [Indexed: 02/07/2023]
Abstract
Portal hypertension (PH) is a spectrum of complications of chronic liver disease (CLD) and cirrhosis, with manifestations including ascites, gastroesophageal varices, splenomegaly, hypersplenism, hepatic hydrothorax, hepatorenal syndrome, hepatopulmonary syndrome and portopulmonary hypertension. PH can vary in severity and is diagnosed via invasive hepatic venous pressure gradient measurement (HVPG), which is considered the reference standard. Accurate diagnosis of PH and assessment of severity are highly relevant as patients with clinically significant portal hypertension (CSPH) are at higher risk for developing acute variceal bleeding and mortality. In this review, we discuss current and upcoming noninvasive imaging methods for diagnosis and assessment of severity of PH.
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81
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Taouli B, Alves FC. Imaging biomarkers of diffuse liver disease: current status. Abdom Radiol (NY) 2020; 45:3381-3385. [PMID: 32583139 DOI: 10.1007/s00261-020-02619-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/09/2020] [Accepted: 06/13/2020] [Indexed: 12/15/2022]
Abstract
We are happy to introduce this special issue of Abdominal Radiology on "diffuse liver disease". We have invited imaging experts to discuss various topics pertaining to diffuse liver disease, covering a vast array of imaging techniques including ultrasound (US), CT, MRI and new molecular imaging agents. Below, we briefly discussed the current status, limitations, and future directions of imaging biomarkers of diffuse liver disease.
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Affiliation(s)
- Bachir Taouli
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine At Mount Sinai, 1470 Madison Avenue, New York, NY, 10029, USA.
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine At Mount Sinai, New York, NY, USA.
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82
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Zhou IY, Catalano OA, Caravan P. Advances in functional and molecular MRI technologies in chronic liver diseases. J Hepatol 2020; 73:1241-1254. [PMID: 32585160 PMCID: PMC7572718 DOI: 10.1016/j.jhep.2020.06.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 02/06/2023]
Abstract
MRI has emerged as the most comprehensive non-invasive diagnostic tool for liver diseases. In recent years, the value of MRI in hepatology has been significantly enhanced by a wide range of contrast agents, both clinically available and under development, that add functional information to anatomically detailed morphological images, or increase the distinction between normal and pathological tissues by targeting molecular and cellular events. Several classes of contrast agents are available for contrast-enhanced hepatic MRI, including i) conventional non-specific extracellular fluid contrast agents for assessing tissue perfusion; ii) hepatobiliary-specific contrast agents that are taken up by functioning hepatocytes and excreted through the biliary system for evaluating hepatobiliary function; iii) superparamagnetic iron oxide particles that accumulate in Kupffer cells; and iv) novel molecular contrast agents that are biochemically targeted to specific molecular/cellular processes for staging liver diseases or detecting treatment responses. The use of different functional and molecular MRI methods enables the non-invasive assessment of disease burden, progression, and treatment response in a variety of liver diseases. A high diagnostic performance can be achieved with MRI by combining imaging biomarkers.
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Affiliation(s)
- Iris Y. Zhou
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States.,Harvard Medical School, Boston, MA, USA,Institute for Innovation in Imaging (i3), Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Onofrio A. Catalano
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States.,Harvard Medical School, Boston, MA, USA,Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Peter Caravan
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States; Harvard Medical School, Boston, MA, USA; Institute for Innovation in Imaging (i(3)), Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.
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83
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Thomaides-Brears HB, Lepe R, Banerjee R, Duncker C. Multiparametric MR mapping in clinical decision-making for diffuse liver disease. Abdom Radiol (NY) 2020; 45:3507-3522. [PMID: 32761254 PMCID: PMC7593302 DOI: 10.1007/s00261-020-02684-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/12/2020] [Accepted: 07/22/2020] [Indexed: 02/07/2023]
Abstract
Accurate diagnosis, monitoring and treatment decisions in patients with chronic liver disease currently rely on biopsy as the diagnostic gold standard, and this has constrained early detection and management of diseases that are both varied and can be concurrent. Recent developments in multiparametric magnetic resonance imaging (mpMRI) suggest real potential to bridge the diagnostic gap between non-specific blood-based biomarkers and invasive and variable histological diagnosis. This has implications for the clinical care and treatment pathway in a number of chronic liver diseases, such as haemochromatosis, steatohepatitis and autoimmune or viral hepatitis. Here we review the relevant MRI techniques in clinical use and their limitations and describe recent potential applications in various liver diseases. We exemplify case studies that highlight how these techniques can improve clinical practice. These techniques could allow clinicians to increase their arsenals available to utilise on patients and direct appropriate treatments.
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Affiliation(s)
| | - Rita Lepe
- Texas Liver Institute, 607 Camden St, Suite 101, San Antonio, TX, 78215, USA
| | | | - Carlos Duncker
- Perspectum, 600 N. Pearl St. Suite 1960, Plaza of The Americas, Dallas, TX, 75201, USA
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84
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Mukherjee S. Advances in the treatment of nonalcoholic steatohepatitis. World J Pharmacol 2020; 9:1-12. [DOI: 10.5497/wjp.v9.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/19/2020] [Accepted: 09/28/2020] [Indexed: 02/06/2023] Open
Abstract
Nonalcoholic steatohepatitis is a subtype of metabolic dysfunction-associated liver disease which has emerged as one of the most common causes of cirrhosis and liver transplantation in the United States and many western countries. The two leading risk factors associated with nonalcoholic steatohepatitis are obesity and insulin resistance with patients often demonstrating features of the metabolic syndrome. Histological improvement including arrest or improvement in fibrosis can occur in patients who are able to modify these risk factors when diagnosed early in the course of their disease. In addition to the development of cirrhosis and its life-threatening complications including hepatocellular carcinoma, variceal bleeding, ascites and hepatic encephalopathy, nonalcoholic steatohepatitis is also associated with coronary artery, carotid artery and peripheral vascular disease with coronary artery disease identified as the most common cause of death. Although multiple clinical trials evaluating a variety of medications targeted at different aspects in the pathogenesis and progression of nonalcoholic steatohepatitis have been completed and are still in progress, there is currently no approved treatment for this disease except for risk factor modification. This article will review the most recent and salient medical advances in the treatment of nonalcoholic steatohepatitis.
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Affiliation(s)
- Sandeep Mukherjee
- Department of Medicine, Creighton University Medical Center, Division of Gastroenterology, Omaha, NE 68124, United States
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85
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Imajo K, Honda Y, Yoneda M, Saito S, Nakajima A. Magnetic resonance imaging for the assessment of pathological hepatic findings in nonalcoholic fatty liver disease. J Med Ultrason (2001) 2020; 47:535-548. [PMID: 33108553 DOI: 10.1007/s10396-020-01059-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023]
Abstract
The prevalence of nonalcoholic fatty liver disease (NAFLD) is expected to increase because of the current epidemics of obesity and diabetes, and NAFLD has become a major cause of chronic liver disease worldwide. Liver fibrosis is associated with poor long-term outcomes in patients with NAFLD. Additionally, increased mortality and liver-related complications are primarily seen in patients with nonalcoholic steatohepatitis (NASH); however, nonalcoholic fatty liver (NAFL) is believed to be benign and non-progressive. Therefore, distinguishing between NASH and NAFL is clinically important. Liver biopsy is the gold standard method for the staging of liver fibrosis and distinguishing between NASH and NAFL. Unfortunately, liver biopsy is an invasive and expensive procedure. Therefore, noninvasive methods, to replace biopsy, are urgently needed for the staging of liver fibrosis and diagnosing NASH. In this review, we discuss the recent studies on magnetic resonance imaging (MRI), including magnetic resonance elastography, proton density fat fraction measurement, and multiparametric MRI (mpMRI) that can be used in the assessment of NASH components such as liver fibrosis, steatosis, and liver injury including inflammation and ballooning.
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Affiliation(s)
- Kento Imajo
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, 236-0004, Japan
| | - Yasushi Honda
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, 236-0004, Japan
| | - Masato Yoneda
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, 236-0004, Japan
| | - Satoru Saito
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, 236-0004, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, 236-0004, Japan.
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86
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Tonev D, Shumbayawonda E, Tetlow LA, Herdman L, French M, Rymell S, Thomaides-Brears H, Caseiro-Alves F, Castelo-Branco M, Ferreira C, Coenraad M, Lamb H, Beer M, Kelly M, Banerjee R, Dollinger M. The Effect of Multi-Parametric Magnetic Resonance Imaging in Standard of Care for Nonalcoholic Fatty Liver Disease: Protocol for a Randomized Control Trial. JMIR Res Protoc 2020; 9:e19189. [PMID: 33104014 PMCID: PMC7652684 DOI: 10.2196/19189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The rising prevalence of nonalcoholic fatty liver disease (NAFLD) and the more aggressive subtype, nonalcoholic steatohepatitis (NASH), is a global public health concern. Left untreated, NAFLD/NASH can lead to cirrhosis, liver failure, and death. The current standard for diagnosing and staging liver disease is a liver biopsy, which is costly, invasive, and carries risk for the patient. Therefore, there is a growing need for a reliable, feasible, and cost-effective, noninvasive diagnostic tool for these conditions. LiverMultiScan is one such promising tool that uses multi-parametric magnetic resonance imaging (mpMRI) to characterize liver tissue and to aid in the diagnosis and monitoring of liver diseases of various etiologies. OBJECTIVE The primary objective of this trial (RADIcAL1) is to evaluate the cost-effectiveness of the introduction of LiverMultiScan as a standardized diagnostic test for liver disease in comparison to standard care for NAFLD, in different EU territories. METHODS RADIcAL1 is a multi-center randomized control trial with 2 arms conducted in 4 European territories (13 sites, from across Germany, Netherlands, Portugal, and the United Kingdom). In total, 1072 adult patients with suspected fatty liver disease will be randomized to be treated according to the result of the mpMRI in the intervention arm, so that further diagnostic evaluation is recommended only when values for metrics of liver fat or fibro-inflammation are elevated. Patients in the control arm will be treated as per center guidelines for standard of care. The primary outcome for this trial is to compare the difference in the proportion of patients with suspected NAFLD incurring liver-related hospital consultations or liver biopsies between the study arms, from the date of randomization to the end of the study follow-up. Secondary outcomes include patient feedback from a patient satisfaction questionnaire, at baseline and all follow-up visits to the end of the study, and time, from randomization to diagnosis by the physician, as recorded at the final follow-up visit. RESULTS This trial is currently open for recruitment. The anticipated completion date for the study is December 2020. CONCLUSIONS This randomized controlled trial will provide the evidence to accelerate decision making regarding the inclusion of mpMRI-based tools in existing NAFLD/NASH clinical care. RADIcAL1 is among the first and largest European health economic studies of imaging technologies for fatty liver disease. Strengths of the trial include a high-quality research design and an in-depth assessment of the implementation of the cost-effectiveness of the mpMRI diagnostic. If effective, the trial may highlight the health economic burden on tertiary-referral hepatology clinics imposed by unnecessary consultations and invasive diagnostic investigations, and demonstrate that including LiverMultiScan as a NAFLD diagnostic test may be cost-effective compared to liver-related hospital consultations or liver biopsies. TRIAL REGISTRATION ClinicalTrials.gov NCT03289897 https://clinicaltrials.gov/ct2/show/NCT03289897. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/19189.
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Affiliation(s)
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- See Authors' Contributions,
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87
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Native T1 Mapping Magnetic Resonance Imaging as a Quantitative Biomarker for Characterization of the Extracellular Matrix in a Rabbit Hepatic Cancer Model. Biomedicines 2020; 8:biomedicines8100412. [PMID: 33066169 PMCID: PMC7601966 DOI: 10.3390/biomedicines8100412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 12/16/2022] Open
Abstract
To characterize the tumor extracellular matrix (ECM) using native T1 mapping magnetic resonance imaging (MRI) in an experimental hepatic cancer model, a total of 27 female New Zealand white rabbits with hepatic VX2 tumors were examined by MRI at different time points following tumor implantation (day 14, 21, 28). A steady-state precession readout single-shot MOLLI sequence was acquired in a 3 T MRI scanner in prone position using a head-neck coil. The tumors were segmented into a central, marginal, and peritumoral region in anatomical images and color-coded T1 maps. In histopathological sections, stained with H&E and Picrosirius red, the regions corresponded to central tumor necrosis and accumulation of viable cells with fibrosis in the tumor periphery. Another region of interest (ROI) was placed in healthy liver tissue. T1 times were correlated with quantitative data of collagen area staining. A two-way repeated-measures ANOVA was used to compare cohorts and tumor regions. Hepatic tumors were successfully induced in all rabbits. T1 mapping demonstrated significant differences between the different tumor regions (F(1.43,34.26) = 106.93, p < 0.001) without interaction effects between time points and regions (F(2.86,34.26) = 0.74, p = 0.53). In vivo T1 times significantly correlated with ex vivo collagen stains (area %), (center: r = 0.78, p < 0.001; margin: r = 0.84, p < 0.001; peritumoral: r = 0.73, p < 0.001). Post hoc tests using Sidak’s correction revealed significant differences in T1 times between all three regions (p < 0.001). Native T1 mapping is feasible and allows the differentiation of tumor regions based on ECM composition in a longitudinal tumor study in an experimental small animal model, making it a potential quantitative biomarker of ECM remodeling and a promising technique for future treatment studies.
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88
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Caussy C, Johansson L. Magnetic resonance-based biomarkers in nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Endocrinol Diabetes Metab 2020; 3:e00134. [PMID: 33102797 PMCID: PMC7576227 DOI: 10.1002/edm2.134] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 02/16/2020] [Accepted: 03/14/2020] [Indexed: 12/11/2022] Open
Abstract
Nonalcoholic fatty liver disease is a growing epidemic affecting 30% of the adult population in the Western world. Its progressive form, nonalcoholic steatohepatitis (NASH), is associated with an increased risk of advanced fibrosis, cirrhosis and liver-related mortality. Therefore, the detection of NAFLD and risk stratification according to the severity of the disease is crucial for the management of patients with NAFLD. Liver biopsy for such risk stratification strategies is limited by its cost and risks; therefore, noninvasive alternatives have been developed. Among noninvasive biomarkers developed in NAFLD, magnetic resonance (MR)-based biomarkers have emerged as key noninvasive biomarkers in NAFLD with the ability to accurately detect hepatic steatosis and liver fibrosis. The potential utility of MRI for the detection of NASH and functional liver assessment has also recently emerged. In the current review, we will discuss the data supporting the utility of MR-based biomarker for the detection of features of NAFLD and its potential use in clinical practice and clinical research in NAFLD.
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Affiliation(s)
- Cyrielle Caussy
- Univ LyonCarMen LaboratoryINSERMINRAINSA LyonUniversité Claude Bernard Lyon 1Pierre‐BéniteFrance
- Hospices Civils de LyonDépartement EndocrinologieDiabète et NutritionHôpital Lyon SudPierre‐BéniteFrance
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89
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A composite biomarker using multiparametric magnetic resonance imaging and blood analytes accurately identifies patients with non-alcoholic steatohepatitis and significant fibrosis. Sci Rep 2020; 10:15308. [PMID: 32943694 PMCID: PMC7499258 DOI: 10.1038/s41598-020-71995-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/21/2020] [Indexed: 02/07/2023] Open
Abstract
Non-alcoholic steatohepatitis (NASH) is major health burden lacking effective pharmacological therapies. Clinical trials enrol patients with histologically-defined NAFLD (non-alcoholic fatty liver disease) activity score (NAS) ≥ 4 and Kleiner-Brunt fibrosis stage (F) ≥ 2; however, screen failure rates are often high following biopsy. This study evaluated a non-invasive MRI biomarker, iron-corrected T1 mapping (cT1), as a diagnostic pre-screening biomarker for NASH. In a retrospective analysis of 86 biopsy confirmed NAFLD patients we explored the potential of blood and imaging biomarkers, both in isolation and in combination, to discriminate those who have NAS ≥ 4 and F ≥ 2 from those without. Stepwise logistic regression was performed to select the optimal combination of biomarkers, diagnostic accuracy was determined using area under the receiver operator curve and model validated confirmed with and fivefold cross-validation. Results showed that levels of cT1, AST, GGT and fasting glucose were all good predictors of NAS ≥ 4 and F ≥ 2, and the model identified the combination of cT1-AST-fasting glucose (cTAG) as far superior to any individual biomarker (AUC 0.90 [0.84–0.97]). This highlights the potential utility of the composite cTAG score for screening patients prior to biopsy to identify those suitable for NASH clinical trial enrolment.
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90
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Cruz M, Ferreira AA, Papanikolaou N, Banerjee R, Alves FC. New boundaries of liver imaging: from morphology to function. Eur J Intern Med 2020; 79:12-22. [PMID: 32571581 DOI: 10.1016/j.ejim.2020.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/20/2020] [Accepted: 06/04/2020] [Indexed: 12/12/2022]
Abstract
From an invisible organ to one of the most explored non-invasively, the liver is, today, one of the cornerstones for current cross-sectional imaging techniques and minimally invasive procedures. After the achievements of US, CT and, most recently, MRI in providing highly accurate morphological and structural information about the organ, a significant scientific development has gained momentum for the last decades, coupling morphology to liver function and contributing far most to what we know today as precision medicine. In fact, dedicated tailor-made investigations are now possible in order to detect and, most of all, quantify physiopathological processes with unprecedented certitude. It is the intention of this review to provide a better insight to the reader of several functional imaging techniques applied to liver imaging. Contrast enhanced imaging, diffusion weighted imaging, elastography, spectral computed tomography and fat and iron assessment techniques are commonly performed clinically. Diffusion kurtosis imaging, magnetic resonance spectroscopy, T1 relaxometry and radiomics remain largely limited to advanced clinical research. Each of them has its own value and place on the diagnostic armamentarium and provide unique qualitative and quantitative information regarding the pathophysiology of diseases, contributing at a large scale to model therapeutic decisions and patient follow-up. Therefore, state-of-the-art liver imaging acts today as a non-invasive surrogate biomarker of many focal and diffuse liver diseases.
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Affiliation(s)
- Manuel Cruz
- Department of Radiology, Faculty of Medicine, University Hospital Coimbra and CIBIT/ICNAS research center, University of Coimbra, Coimbra, Portugal.
| | - Ana Aguiar Ferreira
- Department of Radiology, Faculty of Medicine, University Hospital Coimbra and CIBIT/ICNAS research center, University of Coimbra, Coimbra, Portugal
| | - Nikolaos Papanikolaou
- Computational Clinical Imaging Group, Centre for the Unknown, Champalimaud Foundation, Lisbon, Portugal
| | - Rajarshi Banerjee
- Department of Acute Medicine, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Filipe Caseiro Alves
- Department of Radiology, Faculty of Medicine, University Hospital Coimbra and CIBIT/ICNAS research center, University of Coimbra, Coimbra, Portugal
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91
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Goldfinger MH, Ridgway GR, Ferreira C, Langford CR, Cheng L, Kazimianec A, Borghetto A, Wright TG, Woodward G, Hassanali N, Nicholls RC, Simpson H, Waddell T, Vikal S, Mavar M, Rymell S, Wigley I, Jacobs J, Kelly M, Banerjee R, Brady JM. Quantitative MRCP Imaging: Accuracy, Repeatability, Reproducibility, and Cohort-Derived Normative Ranges. J Magn Reson Imaging 2020; 52:807-820. [PMID: 32147892 PMCID: PMC7496952 DOI: 10.1002/jmri.27113] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Magnetic resonance cholangiopancreatography (MRCP) is an important tool for noninvasive imaging of biliary disease, however, its assessment is currently subjective, resulting in the need for objective biomarkers. PURPOSE To investigate the accuracy, scan/rescan repeatability, and cross-scanner reproducibility of a novel quantitative MRCP tool on phantoms and in vivo. Additionally, to report normative ranges derived from the healthy cohort for duct measurements and tree-level summary metrics. STUDY TYPE Prospective. PHANTOMS/SUBJECTS Phantoms: two bespoke designs, one with varying tube-width, curvature, and orientation, and one exhibiting a complex structure based on a real biliary tree. Subjects Twenty healthy volunteers, 10 patients with biliary disease, and 10 with nonbiliary liver disease. SEQUENCE/FIELD STRENGTH MRCP data were acquired using heavily T2 -weighted 3D multishot fast/turbo spin echo acquisitions at 1.5T and 3T. ASSESSMENT Digital instances of the phantoms were synthesized with varying resolution and signal-to-noise ratio. Physical 3D-printed phantoms were scanned across six scanners (two field strengths for each of three manufacturers). Human subjects were imaged on four scanners (two fieldstrengths for each of two manufacturers). STATISTICAL TESTS Bland-Altman analysis and repeatability coefficient (RC). RESULTS Accuracy of the diameter measurement approximated the scanning resolution, with 95% limits of agreement (LoA) from -1.1 to 1.0 mm. Excellent phantom repeatability was observed, with LoA from -0.4 to 0.4 mm. Good reproducibility was observed across the six scanners for both phantoms, with a range of LoA from -1.1 to 0.5 mm. Inter- and intraobserver agreement was high. Quantitative MRCP detected strictures and dilatations in the phantom with 76.6% and 85.9% sensitivity and 100% specificity in both. Patients and healthy volunteers exhibited significant differences in metrics including common bile duct (CBD) maximum diameter (7.6 mm vs. 5.2 mm P = 0.002), and overall biliary tree volume 12.36 mL vs. 4.61 mL, P = 0.0026). DATA CONCLUSION The results indicate that quantitative MRCP provides accurate, repeatable, and reproducible measurements capable of objectively assessing cholangiopathic change. Evidence Level: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;52:807-820.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - J. Michael Brady
- Perspectum LtdOxfordUK
- Department of Oncology, Medical Sciences DivisionUniversity of OxfordOxfordUK
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92
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Schaapman JJ, Tushuizen ME, Coenraad MJ, Lamb HJ. Multiparametric MRI in Patients With Nonalcoholic Fatty Liver Disease. J Magn Reson Imaging 2020; 53:1623-1631. [PMID: 32822095 PMCID: PMC8247423 DOI: 10.1002/jmri.27292] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 12/12/2022] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease in the world, affecting more than 25% of the adult population. NAFLD covers a spectrum including simple steatosis, in which lipid accumulation in hepatocytes is the predominant histological characteristic, and nonalcoholic steatohepatitis (NASH), which is characterized by additional hepatic inflammation with or without fibrosis. Liver biopsy is currently the reference standard to discriminate between hepatic steatosis and steatohepatitis. Since liver biopsy has several disadvantages, noninvasive diagnostic methods with high sensitivity and specificity are desirable for the analysis of NAFLD. Improvements in magnetic resonance imaging (MRI) technology are continuously being implemented in clinical practice, specifically multiparametric MRI methods such as proton density fat‐fraction (PDFF), T2*, and T1 mapping, along with MR elastography. Multiparametric imaging of the liver has a promising role in the clinical management of NAFLD with quantification of fat content, iron load, and fibrosis, which are features in NAFLD. In the present article, we review the utility and limitations of multiparametric quantitative imaging of the liver for diagnosis and management of patients with NAFLD. Level of Evidence 5. Technical Efficacy Stage 3.
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Affiliation(s)
- Jelte J Schaapman
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten E Tushuizen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Minneke J Coenraad
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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93
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Usefulness of Different Imaging Modalities in Evaluation of Patients with Non-Alcoholic Fatty Liver Disease. Biomedicines 2020; 8:biomedicines8090298. [PMID: 32839409 PMCID: PMC7556032 DOI: 10.3390/biomedicines8090298] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/13/2020] [Accepted: 08/19/2020] [Indexed: 12/14/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are becoming some of the major health problems in well-developed countries, together with the increasing prevalence of obesity, metabolic syndrome, and all of their systemic complications. As the future prognoses are even more disturbing and point toward further increase in population affected with NAFLD/NASH, there is an urgent need for widely available and reliable diagnostic methods. Consensus on a non-invasive, accurate diagnostic modality for the use in ongoing clinical trials is also required, particularly considering a current lack of any registered drug for the treatment of NAFLD/NASH. The aim of this narrative review was to present current information on methods used to assess liver steatosis and fibrosis. There are several imaging modalities for the assessment of hepatic steatosis ranging from simple density analysis by computed tomography or conventional B-mode ultrasound to magnetic resonance spectroscopy (MRS), magnetic resonance imaging proton density fat fraction (MRI-PDFF) or controlled attenuation parameter (CAP). Fibrosis stage can be assessed by magnetic resonance elastography (MRE) or different ultrasound-based techniques: transient elastography (TE), shear-wave elastography (SWE) and acoustic radiation force impulse (ARFI). Although all of these methods have been validated against liver biopsy as the reference standard and provided good accuracy, the MRS and MRI-PDFF currently outperform other methods in terms of diagnosis of steatosis, and MRE in terms of evaluation of fibrosis.
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94
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Zormpas-Petridis K, Poon E, Clarke M, Jerome NP, Boult JKR, Blackledge MD, Carceller F, Koers A, Barone G, Pearson ADJ, Moreno L, Anderson J, Sebire N, McHugh K, Koh DM, Chesler L, Yuan Y, Robinson SP, Jamin Y. Noninvasive MRI Native T 1 Mapping Detects Response to MYCN-targeted Therapies in the Th- MYCN Model of Neuroblastoma. Cancer Res 2020; 80:3424-3435. [PMID: 32595135 DOI: 10.1158/0008-5472.can-20-0133] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/02/2020] [Accepted: 06/11/2020] [Indexed: 11/16/2022]
Abstract
Noninvasive early indicators of treatment response are crucial to the successful delivery of precision medicine in children with cancer. Neuroblastoma is a common solid tumor of young children that arises from anomalies in neural crest development. Therapeutic approaches aiming to destabilize MYCN protein, such as small-molecule inhibitors of Aurora A and mTOR, are currently being evaluated in early phase clinical trials in children with high-risk MYCN-driven disease, with limited ability to evaluate conventional pharmacodynamic biomarkers of response. T1 mapping is an MRI scan that measures the proton spin-lattice relaxation time T1. Using a multiparametric MRI-pathologic cross-correlative approach and computational pathology methodologies including a machine learning-based algorithm for the automatic detection and classification of neuroblasts, we show here that T1 mapping is sensitive to the rich histopathologic heterogeneity of neuroblastoma in the Th-MYCN transgenic model. Regions with high native T1 corresponded to regions dense in proliferative undifferentiated neuroblasts, whereas regions characterized by low T1 were rich in apoptotic or differentiating neuroblasts. Reductions in tumor-native T1 represented a sensitive biomarker of response to treatment-induced apoptosis with two MYCN-targeted small-molecule inhibitors, Aurora A kinase inhibitor alisertib (MLN8237) and mTOR inhibitor vistusertib (AZD2014). Overall, we demonstrate the potential of T1 mapping, a scan readily available on most clinical MRI scanners, to assess response to therapy and guide clinical trials for children with neuroblastoma. The study reinforces the potential role of MRI-based functional imaging in delivering precision medicine to children with neuroblastoma. SIGNIFICANCE: This study shows that MRI-based functional imaging can detect apoptotic responses to MYCN-targeted small-molecule inhibitors in a genetically engineered murine model of MYCN-driven neuroblastoma.
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Affiliation(s)
- Konstantinos Zormpas-Petridis
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London and The Royal Marsden NHS Trust, Sutton, Surrey, United Kingdom
| | - Evon Poon
- Division of Clinical Studies, The Institute of Cancer Research, London and The Royal Marsden NHS Trust, Sutton, Surrey, United Kingdom
| | - Matthew Clarke
- Division of Molecular Pathology, The Institute of Cancer Research, London and The Royal Marsden NHS Trust, Sutton, Surrey, United Kingdom
| | - Neil P Jerome
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London and The Royal Marsden NHS Trust, Sutton, Surrey, United Kingdom
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim, Norway
| | - Jessica K R Boult
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London and The Royal Marsden NHS Trust, Sutton, Surrey, United Kingdom
| | - Matthew D Blackledge
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London and The Royal Marsden NHS Trust, Sutton, Surrey, United Kingdom
| | - Fernando Carceller
- Division of Clinical Studies, The Institute of Cancer Research, London and The Royal Marsden NHS Trust, Sutton, Surrey, United Kingdom
- Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
| | - Alexander Koers
- Division of Clinical Studies, The Institute of Cancer Research, London and The Royal Marsden NHS Trust, Sutton, Surrey, United Kingdom
| | - Giuseppe Barone
- Department of Pediatric Oncology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Andrew D J Pearson
- Division of Clinical Studies, The Institute of Cancer Research, London and The Royal Marsden NHS Trust, Sutton, Surrey, United Kingdom
| | - Lucas Moreno
- Pediatric Hematology & Oncology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - John Anderson
- Department of Pediatric Oncology, Great Ormond Street Hospital for Children, London, United Kingdom
- Institute of Child Health, University College London, London, United Kingdom
| | - Neil Sebire
- Institute of Child Health, University College London, London, United Kingdom
- Department of Pathology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Kieran McHugh
- Department of Radiology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Dow-Mu Koh
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London and The Royal Marsden NHS Trust, Sutton, Surrey, United Kingdom
| | - Louis Chesler
- Division of Clinical Studies, The Institute of Cancer Research, London and The Royal Marsden NHS Trust, Sutton, Surrey, United Kingdom
| | - Yinyin Yuan
- Division of Molecular Pathology, The Institute of Cancer Research, London and The Royal Marsden NHS Trust, Sutton, Surrey, United Kingdom
| | - Simon P Robinson
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London and The Royal Marsden NHS Trust, Sutton, Surrey, United Kingdom
| | - Yann Jamin
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London and The Royal Marsden NHS Trust, Sutton, Surrey, United Kingdom.
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95
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Parisinos CA, Wilman HR, Thomas EL, Kelly M, Nicholls RC, McGonigle J, Neubauer S, Hingorani AD, Patel RS, Hemingway H, Bell JD, Banerjee R, Yaghootkar H. Genome-wide and Mendelian randomisation studies of liver MRI yield insights into the pathogenesis of steatohepatitis. J Hepatol 2020; 73:241-251. [PMID: 32247823 PMCID: PMC7372222 DOI: 10.1016/j.jhep.2020.03.032] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 03/03/2020] [Accepted: 03/19/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS MRI-based corrected T1 (cT1) is a non-invasive method to grade the severity of steatohepatitis and liver fibrosis. We aimed to identify genetic variants influencing liver cT1 and use genetics to understand mechanisms underlying liver fibroinflammatory disease and its link with other metabolic traits and diseases. METHODS First, we performed a genome-wide association study (GWAS) in 14,440 Europeans, with liver cT1 measures, from the UK Biobank. Second, we explored the effects of the cT1 variants on liver blood tests, and a range of metabolic traits and diseases. Third, we used Mendelian randomisation to test the causal effects of 24 predominantly metabolic traits on liver cT1 measures. RESULTS We identified 6 independent genetic variants associated with liver cT1 that reached the GWAS significance threshold (p <5×10-8). Four of the variants (rs759359281 in SLC30A10, rs13107325 in SLC39A8, rs58542926 in TM6SF2, rs738409 in PNPLA3) were also associated with elevated aminotransferases and had variable effects on liver fat and other metabolic traits. Insulin resistance, type 2 diabetes, non-alcoholic fatty liver and body mass index were causally associated with elevated cT1, whilst favourable adiposity (instrumented by variants associated with higher adiposity but lower risk of cardiometabolic disease and lower liver fat) was found to be protective. CONCLUSION The association between 2 metal ion transporters and cT1 indicates an important new mechanism in steatohepatitis. Future studies are needed to determine whether interventions targeting the identified transporters might prevent liver disease in at-risk individuals. LAY SUMMARY We estimated levels of liver inflammation and scarring based on magnetic resonance imaging of 14,440 UK Biobank participants. We performed a genetic study and identified variations in 6 genes associated with levels of liver inflammation and scarring. Participants with variations in 4 of these genes also had higher levels of markers of liver cell injury in blood samples, further validating their role in liver health. Two identified genes are involved in the transport of metal ions in our body. Further investigation of these variations may lead to better detection, assessment, and/or treatment of liver inflammation and scarring.
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Affiliation(s)
- Constantinos A Parisinos
- Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London, UK.
| | - Henry R Wilman
- Research Centre for Optimal Health, School of Life Sciences, University of Westminster, London, UK; Perspectum Diagnostics Ltd., Oxford, UK
| | - E Louise Thomas
- Research Centre for Optimal Health, School of Life Sciences, University of Westminster, London, UK
| | | | | | | | - Stefan Neubauer
- Perspectum Diagnostics Ltd., Oxford, UK; Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Aroon D Hingorani
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
| | - Riyaz S Patel
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
| | - Harry Hemingway
- Health Data Research UK London, Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London, UK
| | - Jimmy D Bell
- Research Centre for Optimal Health, School of Life Sciences, University of Westminster, London, UK
| | | | - Hanieh Yaghootkar
- Research Centre for Optimal Health, School of Life Sciences, University of Westminster, London, UK; Genetics of Complex Traits, College of Medicine and Health, University of Exeter, Exeter, UK; Division of Medical Sciences, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden.
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96
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Fang C, An J, Bruno A, Cai X, Fan J, Fujimoto J, Golfieri R, Hao X, Jiang H, Jiao LR, Kulkarni AV, Lang H, Lesmana CRA, Li Q, Liu L, Liu Y, Lau W, Lu Q, Man K, Maruyama H, Mosconi C, Örmeci N, Pavlides M, Rezende G, Sohn JH, Treeprasertsuk S, Vilgrain V, Wen H, Wen S, Quan X, Ximenes R, Yang Y, Zhang B, Zhang W, Zhang P, Zhang S, Qi X. Consensus recommendations of three-dimensional visualization for diagnosis and management of liver diseases. Hepatol Int 2020; 14:437-453. [PMID: 32638296 PMCID: PMC7366600 DOI: 10.1007/s12072-020-10052-y] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 05/04/2020] [Indexed: 12/14/2022]
Abstract
Three-dimensional (3D) visualization involves feature extraction and 3D reconstruction of CT images using a computer processing technology. It is a tool for displaying, describing, and interpreting 3D anatomy and morphological features of organs, thus providing intuitive, stereoscopic, and accurate methods for clinical decision-making. It has played an increasingly significant role in the diagnosis and management of liver diseases. Over the last decade, it has been proven safe and effective to use 3D simulation software for pre-hepatectomy assessment, virtual hepatectomy, and measurement of liver volumes in blood flow areas of the portal vein; meanwhile, the use of 3D models in combination with hydrodynamic analysis has become a novel non-invasive method for diagnosis and detection of portal hypertension. We herein describe the progress of research on 3D visualization, its workflow, current situation, challenges, opportunities, and its capacity to improve clinical decision-making, emphasizing its utility for patients with liver diseases. Current advances in modern imaging technologies have promised a further increase in diagnostic efficacy of liver diseases. For example, complex internal anatomy of the liver and detailed morphological features of liver lesions can be reflected from CT-based 3D models. A meta-analysis reported that the application of 3D visualization technology in the diagnosis and management of primary hepatocellular carcinoma has significant or extremely significant differences over the control group in terms of intraoperative blood loss, postoperative complications, recovery of postoperative liver function, operation time, hospitalization time, and tumor recurrence on short-term follow-up. However, the acquisition of high-quality CT images and the use of these images for 3D visualization processing lack a unified standard, quality control system, and homogeneity, which might hinder the evaluation of application efficacy in different clinical centers, causing enormous inconvenience to clinical practice and scientific research. Therefore, rigorous operating guidelines and quality control systems need to be established for 3D visualization of liver to develop it to become a mature technology. Herein, we provide recommendations for the research on diagnosis and management of 3D visualization in liver diseases to meet this urgent need in this research field.
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Affiliation(s)
- Chihua Fang
- The First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, 510282, China.
| | - Jihyun An
- Department of Gastroenterology, Hanyang University College of Medicine and Hanyang University Guri Hospital, Guri, 11923, South Korea
| | - Antonio Bruno
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Via Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Xiujun Cai
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jia Fan
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Fudan University, Shanghai, 200032, China.,Key Laboratory of Medical Epigenetics and Metabolism, Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China
| | - Jiro Fujimoto
- Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Rita Golfieri
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Via Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Xishan Hao
- Department of Gastrointestinal Cancer Biology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Hongchi Jiang
- Department of Liver Surgery, The First Affiliated Hospital Harbin Medical University, Harbin, 150001, Heilongjiang, China
| | - Long R Jiao
- HPB Surgical Unit, Department of Surgery and Cancer, Imperial College, London, W12 0HS, UK
| | - Anand V Kulkarni
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Hauke Lang
- Department of General, Visceral and Transplantation Surgery, University Medical Center of the Johannes Gutenberg-University, Langenbeckst. 1, 55131, Mainz, Germany
| | - Cosmas Rinaldi A Lesmana
- Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, 10430, Indonesia
| | - Qiang Li
- National Clinical Research Center for Cancer and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Lianxin Liu
- Department of Hepatobillirary Surgery, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Yingbin Liu
- Department of General Surgery, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wanyee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Qiping Lu
- Department of General Surgery, Central theater General Hospital of the Chinese people's Liberation Army, Wuhan, 430070, Hubei, China
| | - Kwan Man
- Department of Surgery, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Hitoshi Maruyama
- Department of Gastroenterology, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Cristina Mosconi
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Via Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Necati Örmeci
- Department of Gastroenterology, Ankara University Medical School, Ibn'i Sina Hospital, Sihhiye, 06100, Ankara, Turkey
| | - Michael Pavlides
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Guilherme Rezende
- Internal Medicine Department, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Joo Hyun Sohn
- Department of Gastroenterology, Hanyang University College of Medicine and Hanyang University Guri Hospital, Guri, 11923, South Korea
| | - Sombat Treeprasertsuk
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, 10700, Thailand
| | - Valérie Vilgrain
- Department of Radiology, Assistance-Publique Hôpitaux de Paris, APHP, HUPNVS, Hôpital Beaujon, 100 bd du Général Leclerc, 92110, Clichy, France
| | - Hao Wen
- Department of Hydatid & Hepatobiliary Surgery, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China
| | - Sai Wen
- The First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, 510282, China
| | - Xianyao Quan
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Rafael Ximenes
- Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Yinmo Yang
- Department of General Surgery, Peking University First Hospital, Beijing, China
| | - Bixiang Zhang
- Department of Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weiqi Zhang
- The First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, 510282, China
| | - Peng Zhang
- The First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, 510282, China
| | - Shaoxiang Zhang
- Institute of Digital Medicine, School of Biomedical Engineering and Medical Imaging, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Xiaolong Qi
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China.
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97
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Dillman JR, Serai SD, Miethke AG, Singh R, Tkach JA, Trout AT. Comparison of liver T1 relaxation times without and with iron correction in pediatric autoimmune liver disease. Pediatr Radiol 2020; 50:935-942. [PMID: 32409910 DOI: 10.1007/s00247-020-04663-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/21/2020] [Accepted: 03/12/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) T1 relaxometry (mapping) has been reported as a quantitative biomarker of liver injury due to inflammation and fibrosis. OBJECTIVE To assess the relationship between liver MRI T1 relaxometry measurements obtained using a modified Look-Locker inversion recovery (MOLLI) pulse sequence without and with iron (T2*) correction (cT1) in pediatric autoimmune liver disease. MATERIALS AND METHODS This cross-sectional study was institutional review board-approved, with informed consent obtained. MRI was acquired at 1.5 T in patients participating in an autoimmune liver disease registry. T1 relaxometry was performed using a MOLLI sequence with a 5(3)3-s acquisition strategy. A multi-echo gradient echo sequence was used to measure liver T2*. Non-iron-corrected native T1 (ms), calculated as the mean of four slices through the mid-liver, was measured using T1 parametric maps generated off-line. A proprietary T2* correction (Perspectum Diagnostics, Oxford, UK), blinded to native T1 values, calculated cT1 values. The relationship between native T1 and cT1 measurements was assessed using Spearman rank correlation and Bland-Altman analyses. RESULTS Forty-eight patients with a mean (standard deviation [SD]) age of 15.2 (4.1) years were included. Mean (SD) liver native T1 was 651.2 (123.9) ms and mean (SD) cT1 was 919.5 (86.8) ms, with excellent positive correlation between values (r=0.91 [95% confidence interval (CI): 0.85-0.95]; P<0.0001). Mean bias between native T1 and cT1 measurements was 268.3 ms (95% limits of agreement: 131.9-404.7 ms). CONCLUSION There is excellent positive correlation between liver native T1 and cT1 measurements in pediatric patients with autoimmune liver disease. This relationship brings into question the need to perform T1 iron correction in this patient population. T1 and cT1 measurements are not interchangeable, however, due to considerable systematic bias with cT1 values being considerably higher.
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Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA. .,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Suraj D Serai
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alexander G Miethke
- Division of Hepatology, Gastroenterology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ruchi Singh
- Division of Hepatology, Gastroenterology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Jaubert O, Arrieta C, Cruz G, Bustin A, Schneider T, Georgiopoulos G, Masci P, Sing‐Long C, Botnar RM, Prieto C. Multi‐parametric liver tissue characterization using MR fingerprinting: Simultaneous T
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*, and fat fraction mapping. Magn Reson Med 2020; 84:2625-2635. [DOI: 10.1002/mrm.28311] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/23/2020] [Accepted: 04/16/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Olivier Jaubert
- School of Biomedical Engineering and Imaging Sciences King’s College London London United Kingdom
| | - Cristobal Arrieta
- Biomedical Imaging Center and Millennium Nucleus for Cardiovascular Magnetic Resonance Pontificia Universidad Católica de Chile Santiago Chile
| | - Gastão Cruz
- School of Biomedical Engineering and Imaging Sciences King’s College London London United Kingdom
| | - Aurélien Bustin
- School of Biomedical Engineering and Imaging Sciences King’s College London London United Kingdom
| | | | - Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences King’s College London London United Kingdom
| | - Pier‐Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences King’s College London London United Kingdom
| | - Carlos Sing‐Long
- Biomedical Imaging Center and Millennium Nucleus for Cardiovascular Magnetic Resonance Pontificia Universidad Católica de Chile Santiago Chile
- Instituto de Ingeniería Matemática y Computacional and Millennium Nucleus for the Discovery of Structures in Complex Data Pontificia Universidad Católica de Chile Santiago Chile
| | - Rene M. Botnar
- School of Biomedical Engineering and Imaging Sciences King’s College London London United Kingdom
- Escuela de Ingeniería Pontificia Universidad Católica de Chile Santiago Chile
| | - Claudia Prieto
- School of Biomedical Engineering and Imaging Sciences King’s College London London United Kingdom
- Escuela de Ingeniería Pontificia Universidad Católica de Chile Santiago Chile
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Zhou IY, Clavijo Jordan V, Rotile NJ, Akam E, Krishnan S, Arora G, Krishnan H, Slattery H, Warner N, Mercaldo N, Farrar CT, Wellen J, Martinez R, Schlerman F, Tanabe KK, Fuchs BC, Caravan P. Advanced MRI of Liver Fibrosis and Treatment Response in a Rat Model of Nonalcoholic Steatohepatitis. Radiology 2020; 296:67-75. [PMID: 32343209 DOI: 10.1148/radiol.2020192118] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Liver biopsy is the reference standard to diagnose nonalcoholic steatohepatitis (NASH) but is invasive with potential complications. Purpose To evaluate molecular MRI with type 1 collagen-specific probe EP-3533 and allysine-targeted fibrogenesis probe Gd-Hyd, MR elastography, and native T1 to characterize fibrosis and to assess treatment response in a rat model of NASH. Materials and Methods MRI was performed prospectively (June-November 2018) in six groups of male Wistar rats (a) age- and (b) weight-matched animals received standard chow (n = 12 per group); (c) received choline-deficient, l-amino acid-defined, high-fat diet (CDAHFD) for 6 weeks or (d) 9 weeks (n = 8 per group); (e) were fed 6 weeks of CDAHFD and switched to standard chow for 3 weeks (n = 12); (f) were fed CDAHFD for 9 weeks with daily treatment of elafibranor beginning at week 6 (n = 14). Differences in imaging measurements and tissue analyses among groups were tested with one-way analysis of variance. The ability of each imaging measurement to stage fibrosis was quantified by using area under the receiver operating characteristic curve (AUC) with quantitative digital pathology (collagen proportionate area [CPA]) as reference standard. Optimal cutoff values for distinguishing advanced fibrosis were used to assess treatment response. Results AUC for distinguishing fibrotic (CPA >4.8%) from nonfibrotic (CPA ≤4.8%) livers was 0.95 (95% confidence interval [CI]: 0.91, 1.00) for EP-3533, followed by native T1, Gd-Hyd, and MR elastography with AUCs of 0.90 (95% CI: 0.83, 0.98), 0.84 (95% CI: 0.74, 0.95), and 0.65 (95% CI: 0.51, 0.79), respectively. AUCs for discriminating advanced fibrosis (CPA >10.3%) were 0.86 (95% CI: 0.76, 0.97), 0.96 (95% CI: 0.90, 1.01), 0.84 (95% CI: 0.70, 0.98), and 0.74 (95% CI: 0.63, 0.86) for EP-3533, Gd-Hyd, MR elastography, and native T1, respectively. Gd-Hyd MRI had the highest accuracy (24 of 26, 92%; 95% CI: 75%, 99%) in identifying responders and nonresponders in the treated groups compared with MR elastography (23 of 26, 88%; 95% CI: 70%, 98%), EP-3533 (20 of 26, 77%; 95% CI: 56%, 91%), and native T1 (14 of 26, 54%; 95% CI: 33%, 73%). Conclusion Collagen-targeted molecular MRI most accurately detected early onset of fibrosis, whereas the fibrogenesis probe Gd-Hyd proved most accurate for detecting treatment response. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Iris Y Zhou
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Veronica Clavijo Jordan
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Nicholas J Rotile
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Eman Akam
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Smitha Krishnan
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Gunisha Arora
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Hema Krishnan
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Hannah Slattery
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Noah Warner
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Nathaniel Mercaldo
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Christian T Farrar
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Jeremy Wellen
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Robert Martinez
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Franklin Schlerman
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Kenneth K Tanabe
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Bryan C Fuchs
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Peter Caravan
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
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Piazzolla VA, Mangia A. Noninvasive Diagnosis of NAFLD and NASH. Cells 2020; 9:E1005. [PMID: 32316690 PMCID: PMC7226476 DOI: 10.3390/cells9041005] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/09/2020] [Accepted: 04/14/2020] [Indexed: 02/07/2023] Open
Abstract
The aim of this review is to outline emerging biomarkers that can serve as early diagnostic tools to identify patients with nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) and, among them, the subgroup of best candidates for clinical trials on emerging compounds. Regarding possible predictors of NAFLD, a number of studies evaluated a combination of serum biomarkers either available in routine practice (or investigational) or proprietary and expensive. So far, magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF) appears to be the most accurate for fatty liver diagnosis. In clinical practice, the main question is how to diagnose NASH early. There are new promising biomarkers that can help in diagnosing early stages of NASH, yet they include variables not routinely tested. In the setting of NASH, most studies confirm that, in spite of several well-known limitations, transient elastography or point shear wave elastography can help in enriching the pool of patients that should be screened for investigational treatments. Newer multiomics biomarkers including those focusing on microbiota can be useful but require methods to be standardized and implemented. To date, one biomarker alone is not able to non- or minimally invasively identify patients with NASH and mild to moderate fibrosis.
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Affiliation(s)
| | - Alessandra Mangia
- Liver Unit, Department of Medical Sciences, IRCCS Fondazione, “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy;
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