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Green CJ, Parry SA, Gunn PJ, Ceresa CDL, Rosqvist F, Piché ME, Hodson L. Studying non-alcoholic fatty liver disease: the ins and outs of in vivo, ex vivo and in vitro human models. Horm Mol Biol Clin Investig 2018; 41:/j/hmbci.ahead-of-print/hmbci-2018-0038/hmbci-2018-0038.xml. [PMID: 30098284 DOI: 10.1515/hmbci-2018-0038] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 06/22/2018] [Indexed: 02/07/2023]
Abstract
The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing. Determining the pathogenesis and pathophysiology of human NAFLD will allow for evidence-based prevention strategies, and more targeted mechanistic investigations. Various in vivo, ex situ and in vitro models may be utilised to study NAFLD; but all come with their own specific caveats. Here, we review the human-based models and discuss their advantages and limitations in regards to studying the development and progression of NAFLD. Overall, in vivo whole-body human studies are advantageous in that they allow for investigation within the physiological setting, however, limited accessibility to the liver makes direct investigations challenging. Non-invasive imaging techniques are able to somewhat overcome this challenge, whilst the use of stable-isotope tracers enables mechanistic insight to be obtained. Recent technological advances (i.e. normothermic machine perfusion) have opened new opportunities to investigate whole-organ metabolism, thus ex situ livers can be investigated directly. Therefore, investigations that cannot be performed in vivo in humans have the potential to be undertaken. In vitro models offer the ability to perform investigations at a cellular level, aiding in elucidating the molecular mechanisms of NAFLD. However, a number of current models do not closely resemble the human condition and work is ongoing to optimise culturing parameters in order to recapitulate this. In summary, no single model currently provides insight into the development, pathophysiology and progression across the NAFLD spectrum, each experimental model has limitations, which need to be taken into consideration to ensure appropriate conclusions and extrapolation of findings are made.
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Affiliation(s)
- Charlotte J Green
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Churchill Hospital, Oxford, UK
| | - Siôn A Parry
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Churchill Hospital, Oxford, UK
| | - Pippa J Gunn
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Churchill Hospital, Oxford, UK
| | - Carlo D L Ceresa
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Churchill Hospital, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Fredrik Rosqvist
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Churchill Hospital, Oxford, UK
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Marie-Eve Piché
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Churchill Hospital, Oxford, UK
- Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| | - Leanne Hodson
- University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, Churchill Hospital,Old Road Headington, Oxford OX3 7LE, United Kingdom of Great Britain and Northern Ireland
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Roberts NT, Hernando D, Holmes JH, Wiens CN, Reeder SB. Noise properties of proton density fat fraction estimated using chemical shift-encoded MRI. Magn Reson Med 2018; 80:685-695. [PMID: 29322549 PMCID: PMC5910302 DOI: 10.1002/mrm.27065] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 12/07/2017] [Accepted: 12/08/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this work is to characterize the noise distribution of proton density fat fraction (PDFF) measured using chemical shift-encoded MRI, and to provide alternative strategies to reduce bias in PDFF estimation. THEORY We derived the probability density function for PDFF estimated using chemical shift-encoded MRI, and found it to exhibit an asymmetric noise distribution that contributes to signal-to-noise-ratio dependent bias. METHODS To study PDFF noise bias, we performed (at 1.5 T) numerical simulations, phantom acquisitions, and a retrospective in vivo experiment. In each experiment, we compared the performance of three statistics (mean, median, and maximum likelihood estimator) in estimating the PDFF in a region of interest. RESULTS We demonstrated the presence of the asymmetric noise distribution in simulations, phantoms, and in vivo. In each experiment we demonstrated that both the median and proposed maximum likelihood estimator statistics outperformed the mean statistic in mitigating noise-related bias for low signal-to-noise-ratio acquisitions. CONCLUSIONS Characterization of the noise distribution of PDFF estimated using chemical shift-encoded MRI enabled new strategies based on median and maximum likelihood estimator statistics to mitigate noise-related bias for accurate PDFF measurement from a region of interest. Such strategies are important for quantitative chemical shift-encoded MRI applications that typically operate in low signal-to-noise-ratio regimes. Magn Reson Med 80:685-695, 2018. © 2018 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Nathan T Roberts
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Electrical and Computer Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Diego Hernando
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - James H Holmes
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Curtis N Wiens
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Scott B Reeder
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Caussy C, Reeder SB, Sirlin CB, Loomba R. Noninvasive, Quantitative Assessment of Liver Fat by MRI-PDFF as an Endpoint in NASH Trials. Hepatology 2018; 68:763-772. [PMID: 29356032 PMCID: PMC6054824 DOI: 10.1002/hep.29797] [Citation(s) in RCA: 278] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/17/2018] [Accepted: 07/17/2018] [Indexed: 12/12/2022]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is currently the most common cause of chronic liver disease worldwide, and the progressive form of this condition, nonalcoholic steatohepatitis (NASH), has become one of the leading indications for liver transplantation. Despite intensive investigations, there are currently no United States Food and Drug Administration-approved therapies for treating NASH. A major barrier for drug development in NASH is that treatment response assessment continues to require liver biopsy, which is invasive and interpreted subjectively. Therefore, there is a major unmet need for developing noninvasive, objective, and quantitative biomarkers for diagnosis and assessment of treatment response. Emerging data support the use of magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF) as a noninvasive, quantitative, and accurate measure of liver fat content to assess treatment response in early-phase NASH trials. In this review, we discuss the role and utility, including potential sample size reduction, of MRI-PDFF as a quantitative and noninvasive imaging-based biomarker in early-phase NASH trials. Nonalcoholic fatty liver disease (NAFLD) is currently the most common cause of chronic liver disease worldwide.() NAFLD can be broadly classified into two categories: nonalcoholic fatty liver, which has a minimal risk of progression to cirrhosis, and nonalcoholic steatohepatitis (NASH), the more progressive form of NAFLD, which has a significantly increased risk of progression to cirrhosis.() Over the past two decades, NASH-related cirrhosis has become the second leading indication for liver transplantation in the United States.() For these reasons, pharmacological therapy for NASH is needed urgently. Despite intensive investigations, there are currently no therapies for treating NASH that have been approved by the United States Food and Drug Administration.().
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Affiliation(s)
- Cyrielle Caussy
- NAFLD Research Center, Department of Medicine, La Jolla, CA,Université Lyon 1, Hospices Civils de Lyon, Lyon, France
| | - Scott B. Reeder
- Department of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine University of Wisconsin-Madison, Madison, WI
| | - Claude B. Sirlin
- Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, CA
| | - Rohit Loomba
- NAFLD Research Center, Department of Medicine, La Jolla, CA,Division of Gastroenterology, Department of Medicine, La Jolla, CA,Division of Epidemiology, Department of Family and Preventive Medicine, University of California at San Diego, La Jolla, CA
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104
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Chicca FD, Schwarz A, Meier D, Grest P, Liesegang A, Kircher PR. Non-invasive quantification of hepatic fat content in healthy dogs by using proton magnetic resonance spectroscopy and dual gradient echo magnetic resonance imaging. J Vet Sci 2018; 19:570-576. [PMID: 29486536 PMCID: PMC6070598 DOI: 10.4142/jvs.2018.19.4.570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/19/2018] [Accepted: 02/20/2018] [Indexed: 11/20/2022] Open
Abstract
The objective of the present study was to describe two non-invasive methods for fat quantification in normal canine liver by using magnetic resonance imaging (MRI) and spectroscopy. Eleven adult beagle dogs were anesthetized and underwent magnetic resonance examination of the cranial abdomen by performing morphologic, modified Dixon (mDixon) dual gradient echo sequence, and proton magnetic resonance spectroscopy (1H MRS) imaging. In addition, ultrasonographic liver examination was performed, fine-needle liver aspirates and liver biopsies were obtained, and hepatic triglyceride content was assayed. Ultrasonographic, cytologic, and histologic examination results were unremarkable in all cases. The median hepatic fat fraction calculated was 2.1% (range, 1.3%-5.5%) using mDixon, 0.3% (range, 0.1%-1.0%) using 1H MRS, and 1.6% (range 1.0%-2.5%) based on triglyceride content. The hepatic fat fractions calculated using mDixon and 1H MRS imaging were highly correlated to that based on triglyceride content. A weak correlation between mDixon and 1H MRS imaging was detected. The results show that hepatic fat content can be estimated using non-invasive techniques (mDixon or 1H MRS) in healthy dogs. Further studies are warranted to evaluate the use of these techniques in dogs with varying hepatic fat content and different hepatic disorders.
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Affiliation(s)
- Francesca Del Chicca
- Clinic of Diagnostic Imaging, Equine Department, University of Zurich, 8057 Zurich, Switzerland.,Graduate School for Cellular and Biomedical Sciences, University of Bern, 3012 Bern, Switzerland
| | - Andrea Schwarz
- Section of Anesthesiology, Equine Department, University of Zurich, 8057 Zurich, Switzerland
| | - Dieter Meier
- Institute of Biomedical Engineering, University of Zurich, 8057 Zurich, Switzerland.,Swiss Federal Institute of Technology (ETH Zurich), 8092 Zurich, Switzerland
| | - Paula Grest
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland
| | - Annette Liesegang
- Institute of Animal Nutrition, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland
| | - Patrick R Kircher
- Clinic of Diagnostic Imaging, Equine Department, University of Zurich, 8057 Zurich, Switzerland
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Abstract
Fatty liver disease is characterized histologically by hepatic steatosis, the abnormal accumulation of lipid in hepatocytes. It is classified into alcoholic fatty liver disease and nonalcoholic fatty liver disease, and is an increasingly important cause of chronic liver disease and cirrhosis. Assessing the severity of hepatic steatosis in these conditions is important for diagnostic and prognostic purposes, as hepatic steatosis is potentially reversible if diagnosed early. The criterion standard for assessing hepatic steatosis is liver biopsy, which is limited by sampling error, its invasive nature, and associated morbidity. As such, noninvasive imaging-based methods of assessing hepatic steatosis are needed. Ultrasound and computed tomography are able to suggest the presence of hepatic steatosis based on imaging features, but are unable to accurately quantify hepatic fat content. Since Dixon's seminal work in 1984, magnetic resonance imaging has been used to compute the signal fat fraction from chemical shift-encoded imaging, commonly implemented as out-of-phase and in-phase imaging. However, signal fat fraction is confounded by several factors that limit its accuracy and reproducibility. Recently, advanced chemical shift-encoded magnetic resonance imaging methods have been developed that address these confounders and are able to measure the proton density fat fraction, a standardized, accurate, and reproducible biomarker of fat content. The use of these methods in the liver, as well as in other abdominal organs such as the pancreas, adrenal glands, and adipose tissue will be discussed in this review.
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106
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Free-breathing quantification of hepatic fat in healthy children and children with nonalcoholic fatty liver disease using a multi-echo 3-D stack-of-radial MRI technique. Pediatr Radiol 2018; 48:941-953. [PMID: 29728744 DOI: 10.1007/s00247-018-4127-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/07/2018] [Accepted: 03/25/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND In adults, noninvasive chemical shift encoded Cartesian magnetic resonance imaging (MRI) and single-voxel magnetic resonance (MR) spectroscopy (SVS) accurately quantify hepatic steatosis but require breath-holding. In children, especially young and sick children, breath-holding is often limited or not feasible. Sedation can facilitate breath-holding but is highly undesirable. For these reasons, there is a need to develop free-breathing MRI technology that accurately quantifies steatosis in all children. OBJECTIVE This study aimed to compare non-sedated free-breathing multi-echo 3-D stack-of-radial (radial) MRI versus standard breath-holding MRI and SVS techniques in a group of children for fat quantification with respect to image quality, accuracy and repeatability. MATERIALS AND METHODS Healthy children (n=10, median age [±interquartile range]: 10.9 [±3.3] years) and overweight children with nonalcoholic fatty liver disease (NAFLD) (n=9, median age: 15.2 [±3.2] years) were imaged at 3 Tesla using free-breathing radial MRI, breath-holding Cartesian MRI and breath-holding SVS. Acquisitions were performed twice to assess repeatability (within-subject mean difference, MDwithin). Images and hepatic proton-density fat fraction (PDFF) maps were scored for image quality. Free-breathing and breath-holding PDFF were compared using linear regression (correlation coefficient, r and concordance correlation coefficient, ρc) and Bland-Altman analysis (mean difference). P<0.05 was considered significant. RESULTS In patients with NAFLD, free-breathing radial MRI demonstrated significantly less motion artifacts compared to breath-holding Cartesian (P<0.05). Free-breathing radial PDFF demonstrated a linear relationship (P<0.001) versus breath-holding SVS PDFF and breath-holding Cartesian PDFF with r=0.996 and ρc=0.994, and r=0.997 and ρc=0.995, respectively. The mean difference in PDFF between free-breathing radial MRI, breath-holding Cartesian MRI and breath-holding SVS was <0.7%. Repeated free-breathing radial MRI had MDwithin=0.25% for PDFF. CONCLUSION In this pediatric study, non-sedated free-breathing radial MRI provided accurate and repeatable hepatic PDFF measurements and improved image quality, compared to standard breath-holding MR techniques.
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107
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Fazeli Dehkordy S, Fowler KJ, Wolfson T, Igarashi S, Lamas Constantino CP, Hooker JC, Hong CW, Mamidipalli A, Gamst AC, Hemming A, Sirlin CB. Technical report: gadoxetate-disodium-enhanced 2D R2* mapping: a novel approach for assessing bile ducts in living donors. Abdom Radiol (NY) 2018; 43:1656-1660. [PMID: 29086007 DOI: 10.1007/s00261-017-1365-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE Gadoxetate-disodium (Gd-EOB-DTPA)-enhanced 3D T1- weighted (T1w) MR cholangiography (MRC) is an efficient method to evaluate biliary anatomy due to T1 shortening of excreted contrast in the bile. A method that exploits both T1 shortening and T2* effects may produce even greater bile duct conspicuity. The aim of our study is to determine feasibility and compare the diagnostic performance of two-dimensional (2D) T1w multi-echo (ME) spoiled gradient-recalled-echo (SPGR) derived R2* maps against T1w MRC for bile duct visualization in living liver donor candidates. MATERIALS AND METHODS Ten potential living liver donor candidates underwent pretransplant 3T MRI and were included in our study. Following injection of Gd-EOBDTPA and a 20-min delay, 3D T1w MRC and 2D T1w ME SPGR images were acquired. 2D R2* maps were generated inline by the scanner assuming exponential decay. The 3D T1w MRC and 2D R2* maps were retrospectively and independently reviewed in two separate sessions by three radiologists. Visualization of eight bile duct segments was scored using a 4-point ordinal scale. The scores were compared using mixed effects regression model. RESULTS Imaging was tolerated by all donors and R2* maps were successfully generated in all cases. Visualization scores of 2D R2* maps were significantly higher than 3D T1w MRC for right anterior (p = 0.003) and posterior (p = 0.0001), segment 2 (p < 0.0001), segment 3 (p = 0.0001), and segment 4 (p < 0.0001) ducts. CONCLUSIONS Gd-EOB-DTPA-enhanced 2D R2* mapping is a feasible method for evaluating the bile ducts in living donors and may be a valuable addition to the living liver donor MR protocol for delineating intrahepatic biliary anatomy.
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Affiliation(s)
- Soudabeh Fazeli Dehkordy
- Liver Imaging Group, Department of Radiology, University of California San Diego, 200 W. Arbor Drive #8756, San Diego, CA, 92103-8756, USA.
| | - Kathryn J Fowler
- Department of Radiology, Washington University, Saint Louis, MO, USA
| | - Tanya Wolfson
- Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California San Diego, San Diego, CA, USA
| | - Saya Igarashi
- Liver Imaging Group, Department of Radiology, University of California San Diego, 200 W. Arbor Drive #8756, San Diego, CA, 92103-8756, USA
| | - Carolina P Lamas Constantino
- Liver Imaging Group, Department of Radiology, University of California San Diego, 200 W. Arbor Drive #8756, San Diego, CA, 92103-8756, USA
- Dimagem Diagnóstico por Imagem, Rio de Janeiro, Brazil
| | - Jonathan C Hooker
- Liver Imaging Group, Department of Radiology, University of California San Diego, 200 W. Arbor Drive #8756, San Diego, CA, 92103-8756, USA
| | - Cheng W Hong
- Liver Imaging Group, Department of Radiology, University of California San Diego, 200 W. Arbor Drive #8756, San Diego, CA, 92103-8756, USA
| | - Adrija Mamidipalli
- Liver Imaging Group, Department of Radiology, University of California San Diego, 200 W. Arbor Drive #8756, San Diego, CA, 92103-8756, USA
| | - Anthony C Gamst
- Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California San Diego, San Diego, CA, USA
| | - Alan Hemming
- Department of Surgery, University of California San Diego, San Diego, CA, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego, 200 W. Arbor Drive #8756, San Diego, CA, 92103-8756, USA
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Hayashi T, Fukuzawa K, Kondo H, Onodera H, Tojo R, Yano S, Miyati T, Kotoku J, Okamoto T, Toyoda K, Oba H. Influence of Gd-EOB-DTPA on T1 dependence of the proton density fat fraction using magnetic resonance spectroscopy. Radiol Phys Technol 2018; 11:338-344. [PMID: 29858768 DOI: 10.1007/s12194-018-0466-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 02/07/2023]
Abstract
This phantom study assessed the effect of Gd-EOB-DTPA on T1 bias (difference in T1 between water and fat) of the proton density fat fraction when using magnetic resonance spectroscopy. Phantoms containing varying fat percentages, without and with Gd-EOB-DTPA (precontrast and postcontrast, respectively), were scanned with repetition times ranging from 1000 to 5000 ms. The relationship between the proton density fat fraction at a reference repetition time of 5000 ms and that using different repetition times, was evaluated in the precontrast and postcontrast phantoms using linear regression and Bland-Altman analyses. In the precontrast phantom, as the repetition time increased, the slope tended to approach one. In the postcontrast phantom, the slope and intercept were near one and zero, respectively. The mean difference was smaller in the postcontrast phantom (range - 0.24 to - 0.01%) than in the precontrast phantom (range 0.12 to 3.52%). We conclude that I1 bias is minimized by Gd-EOB-DTPA.
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Affiliation(s)
- Tatsuya Hayashi
- Graduate School of Medical Technology, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
| | - Kei Fukuzawa
- Department of Radiological Technology, Toranomon Hospital, Tokyo, Japan
| | - Hiroshi Kondo
- Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Hiroshi Onodera
- Central of Radiology, Teikyo University Hospital, Tokyo, Japan
| | - Rie Tojo
- Central of Radiology, Teikyo University Hospital, Tokyo, Japan
| | - Shimpei Yano
- Central of Radiology, Teikyo University Hospital, Tokyo, Japan
| | - Tosiaki Miyati
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Jun'ichi Kotoku
- Graduate School of Medical Technology, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Takahide Okamoto
- Graduate School of Medical Technology, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Keiko Toyoda
- Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Hiroshi Oba
- Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
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109
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Chalasani N, Vuppalanchi R, Rinella M, Middleton MS, Siddiqui MS, Barritt AS, Kolterman O, Flores O, Alonso C, Iruarrizaga‐Lejarreta M, Gil‐Redondo R, Sirlin CB, Zemel MB. Randomised clinical trial: a leucine-metformin-sildenafil combination (NS-0200) vs placebo in patients with non-alcoholic fatty liver disease. Aliment Pharmacol Ther 2018; 47:1639-1651. [PMID: 29696666 PMCID: PMC6001629 DOI: 10.1111/apt.14674] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 02/24/2018] [Accepted: 03/27/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Sirtuin 1 (Sirt1) is suppressed in non-alcoholic fatty liver disease (NAFLD), while its' stimulation or overexpression results in reduced disease severity in pre-clinical NAFLD models. Leucine allosterically activates Sirt1 and synergise with other Sirt/AMPK/NO pathway activators. We developed a triple combination of leucine, metformin and sildenafil (NS-0200), which was effective in a mouse model of non-alcoholic steatohepatitis (NASH). AIM To report the results from a Phase 2, randomised clinical trial of of NS-0200 in 91 subjects with NAFLD (liver fat ≥15% by magnetic resonance imaging-proton-density fat fraction (MRI-PDFF)). METHODS Subjects were randomised to placebo, low-dose (1.1 g leucine/0.5 g metformin/0.5 mg sildenafil) or high-dose NS-0200 (1.1 g leucine/0.5 g metformin/1.0 mg sildenafil) b.d. for 16 weeks; change in hepatic fat was assessed via MRI-PDFF, and lipid metabolism was assessed via changes in the lipidomic signature. Seventy subjects completed the trial and met a priori compliance criteria. Analyses were conducted on the full cohort and on those with alanine aminotransferase (ALT) values above median (50 U/L; n = 35). RESULTS In the full cohort, active treatments did not separate from placebo. High dose NS-0200 reduced hepatic fat by 15.7% (relative change from baseline) in the high ALT group (P < 0.005) while low dose NS-0200 and placebo did not significantly change hepatic fat. Lipidomic analysis showed dose-responsive treatment effects in both overall and high ALT cohorts, with significant decreases in metabolically active lipids and up-regulation of fatty acid oxidation. CONCLUSION These data support further evaluation of high-dose NS-0200 for treating NASH, especially in those with elevated ALT (NCT 02546609).
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Affiliation(s)
- N. Chalasani
- Indiana University School of MedicineIndianapolisINUSA
| | | | | | | | | | | | | | | | | | | | | | - C. B. Sirlin
- University of California at San DiegoSan DiegoCAUSA
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Nakai Y, Gonoi W, Hagiwara A, Nishioka Y, Abe H, Shindoh J, Hasegawa K. MRI Detection of Intratumoral Fat in Colorectal Liver Metastases After Preoperative Chemotherapy. AJR Am J Roentgenol 2018; 210:W196-W204. [PMID: 29629795 DOI: 10.2214/ajr.17.18814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
- Yudai Nakai
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
- Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Wataru Gonoi
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Akifumi Hagiwara
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yujiro Nishioka
- Department of Surgery, Hepato-Biliary-Pancreatic Surgery Division, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Digestive Surgery, Hepatobiliary-Pancreatic Surgery Division, Toranomon Hospital, Tokyo, Japan
| | - Hiroyuki Abe
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junichi Shindoh
- Department of Digestive Surgery, Hepatobiliary-Pancreatic Surgery Division, Toranomon Hospital, Tokyo, Japan
| | - Kiyoshi Hasegawa
- Department of Surgery, Hepato-Biliary-Pancreatic Surgery Division, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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111
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Hong CW, Wolfson T, Sy EZ, Schlein AN, Hooker JC, Dehkordy SF, Hamilton G, Reeder SB, Loomba R, Sirlin CB. Optimization of region-of-interest sampling strategies for hepatic MRI proton density fat fraction quantification. J Magn Reson Imaging 2018; 47:988-994. [PMID: 28842937 PMCID: PMC5826828 DOI: 10.1002/jmri.25843] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 08/07/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Clinical trials utilizing proton density fat fraction (PDFF) as an imaging biomarker for hepatic steatosis have used a laborious region-of-interest (ROI) sampling strategy of placing an ROI in each hepatic segment. PURPOSE To identify a strategy with the fewest ROIs that consistently achieves close agreement with the nine-ROI strategy. STUDY TYPE Retrospective secondary analysis of prospectively acquired clinical research data. POPULATION A total of 391 adults (173 men, 218 women) with known or suspected NAFLD. FIELD STRENGTH/SEQUENCE Confounder-corrected chemical-shift-encoded 3T MRI using a 2D multiecho gradient-recalled echo technique. ASSESSMENT An ROI was placed in each hepatic segment. Mean nine-ROI PDFF and segmental PDFF standard deviation were computed. Segmental and lobar PDFF were compared. PDFF was estimated using every combinatorial subset of ROIs and compared to the nine-ROI average. STATISTICAL TESTING Mean nine-ROI PDFF and segmental PDFF standard deviation were summarized descriptively. Segmental PDFF was compared using a one-way analysis of variance, and lobar PDFF was compared using a paired t-test and a Bland-Altman analysis. The PDFF estimated by every subset of ROIs was informally compared to the nine-ROI average using median intraclass correlation coefficients (ICCs) and Bland-Altman analyses. RESULTS The study population's mean whole-liver PDFF was 10.1 ± 8.9% (range: 1.1-44.1%). Although there was no significant difference in average segmental (P = 0.452) or lobar (P = 0.154) PDFF, left and right lobe PDFF differed by at least 1.5 percentage points in 25.1% (98/391) of patients. Any strategy with ≥4 ROIs had ICC >0.995. 115 of 126 four-ROI strategies (91%) had limits of agreement (LOA) <1.5%, including four-ROI strategies with two ROIs from each lobe, which all had LOA <1.5%. 14/36 (39%) of two-ROI strategies and 74/84 (88%) of three-ROI strategies had ICC >0.995, and 2/36 (6%) of two-ROI strategies and 46/84 (55%) of three-ROI strategies had LOA <1.5%. DATA CONCLUSION Four-ROI sampling strategies with two ROIs in the left and right lobes achieve close agreement with nine-ROI PDFF. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:988-994.
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Affiliation(s)
- Cheng William Hong
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Tanya Wolfson
- Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, California, USA
| | - Ethan Z. Sy
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Alexandra N. Schlein
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Jonathan C. Hooker
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Soudabeh Fazeli Dehkordy
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Gavin Hamilton
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Scott B. Reeder
- Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Claude B. Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, California, USA
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112
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Middleton MS, Van Natta ML, Heba ER, Alazraki A, Trout AT, Masand P, Brunt EM, Kleiner DE, Doo E, Tonascia J, Lavine JE, Shen W, Hamilton G, Schwimmer JB, Sirlin CB. Diagnostic accuracy of magnetic resonance imaging hepatic proton density fat fraction in pediatric nonalcoholic fatty liver disease. Hepatology 2018; 67:858-872. [PMID: 29028128 PMCID: PMC6211296 DOI: 10.1002/hep.29596] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 09/11/2017] [Accepted: 10/12/2017] [Indexed: 12/11/2022]
Abstract
UNLABELLED We assessed the performance of magnetic resonance imaging (MRI) proton density fat fraction (PDFF) in children to stratify hepatic steatosis grade before and after treatment in the Cysteamine Bitartrate Delayed-Release for the Treatment of Nonalcoholic Fatty Liver Disease in Children (CyNCh) trial, using centrally scored histology as reference. Participants had multiecho 1.5 Tesla (T) or 3T MRI on scanners from three manufacturers. Of 169 enrolled children, 110 (65%) and 83 (49%) had MRI and liver biopsy at baseline and at end of treatment (EOT; 52 weeks), respectively. At baseline, 17% (19 of 110), 28% (31 of 110), and 55% (60 of 110) of liver biopsies showed grades 1, 2, and 3 histological steatosis; corresponding PDFF (mean ± SD) values were 10.9 ± 4.1%, 18.4 ± 6.2%, and 25.7 ± 9.7%, respectively. PDFF classified grade 1 versus 2-3 and 1-2 versus 3 steatosis with areas under receiving operator characteristic curves (AUROCs) of 0.87 (95% confidence interval [CI], 0.80, 0.94) and 0.79 (0.70, 0.87), respectively. PDFF cutoffs at 90% specificity were 17.5% for grades 2-3 steatosis and 23.3% for grade 3 steatosis. At EOT, 47% (39 of 83), 41% (34 of 83), and 12% (10 of 83) of biopsies showed improved, unchanged, and worsened steatosis grade, respectively, with corresponding PDFF (mean ± SD) changes of -7.8 ± 6.3%, -1.2 ± 7.8%, and 4.9 ± 5.0%, respectively. PDFF change classified steatosis grade improvement and worsening with AUROCs (95% CIs) of 0.76 (0.66, 0.87) and 0.83 (0.73, 0.92), respectively. PDFF change cut-off values at 90% specificity were -11.0% and +5.5% for improvement and worsening. CONCLUSION MRI-estimated PDFF has high diagnostic accuracy to both classify and predict histological steatosis grade and change in histological steatosis grade in children with NAFLD. (Hepatology 2018;67:858-872).
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Affiliation(s)
- Michael S. Middleton
- Liver Imaging Group, Department of Radiology, UCSD School of Medicine, San Diego, California
| | - Mark L. Van Natta
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Elhamy R. Heba
- Liver Imaging Group, Department of Radiology, UCSD School of Medicine, San Diego, California
| | - Adina Alazraki
- Emory University School of Medicine, Department of Radiology and Imaging Sciences, Atlanta, Georgia
| | - Andrew T. Trout
- Cincinnati Children’s Hospital, Department of Radiology, Cincinnati, Ohio
| | | | | | | | - Edward Doo
- Liver Diseases Section, Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases
| | - James Tonascia
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Joel E. Lavine
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Wei Shen
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Gavin Hamilton
- Liver Imaging Group, Department of Radiology, UCSD School of Medicine, San Diego, California
| | - Jeffrey B. Schwimmer
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California; and Department of Gastroenterology, Rady Children’s Hospital, San Diego, California
| | - Claude B. Sirlin
- Liver Imaging Group, Department of Radiology, UCSD School of Medicine, San Diego, California
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113
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Estimation of hepatic fat fraction using modified Dixon magnetic resonance imaging techniques: effect of liver cirrhosis. Clin Imaging 2018; 51:50-58. [PMID: 29448119 DOI: 10.1016/j.clinimag.2018.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 01/12/2018] [Accepted: 02/02/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate modified Dixon MRI techniques in hepatic fat estimation and to assess the effect of cirrhosis. METHODS 235 patients who underwent liver MRI were included. Correlation between modified Dixon techniques with MRS was assessed. Accuracy of MR techniques in hepatic fat estimation was calculated, and the result was compared between patients with/without liver cirrhosis. RESULTS Correlation between modified Dixon and MRS was better in group without liver cirrhosis, and accuracy of modified Dixon method was higher in group without liver cirrhosis. CONCLUSIONS Modified Dixon techniques estimate hepatic fat fraction noninvasively, but the result can be influenced by the presence of liver cirrhosis.
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114
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Yokoo T, Serai SD, Pirasteh A, Bashir MR, Hamilton G, Hernando D, Hu HH, Hetterich H, Kühn JP, Kukuk GM, Loomba R, Middleton MS, Obuchowski NA, Song JS, Tang A, Wu X, Reeder SB, Sirlin CB. Linearity, Bias, and Precision of Hepatic Proton Density Fat Fraction Measurements by Using MR Imaging: A Meta-Analysis. Radiology 2018; 286:486-498. [PMID: 28892458 PMCID: PMC5813433 DOI: 10.1148/radiol.2017170550] [Citation(s) in RCA: 210] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose To determine the linearity, bias, and precision of hepatic proton density fat fraction (PDFF) measurements by using magnetic resonance (MR) imaging across different field strengths, imager manufacturers, and reconstruction methods. Materials and Methods This meta-analysis was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic literature search identified studies that evaluated the linearity and/or bias of hepatic PDFF measurements by using MR imaging (hereafter, MR imaging-PDFF) against PDFF measurements by using colocalized MR spectroscopy (hereafter, MR spectroscopy-PDFF) or the precision of MR imaging-PDFF. The quality of each study was evaluated by using the Quality Assessment of Studies of Diagnostic Accuracy 2 tool. De-identified original data sets from the selected studies were pooled. Linearity was evaluated by using linear regression between MR imaging-PDFF and MR spectroscopy-PDFF measurements. Bias, defined as the mean difference between MR imaging-PDFF and MR spectroscopy-PDFF measurements, was evaluated by using Bland-Altman analysis. Precision, defined as the agreement between repeated MR imaging-PDFF measurements, was evaluated by using a linear mixed-effects model, with field strength, imager manufacturer, reconstruction method, and region of interest as random effects. Results Twenty-three studies (1679 participants) were selected for linearity and bias analyses and 11 studies (425 participants) were selected for precision analyses. MR imaging-PDFF was linear with MR spectroscopy-PDFF (R2 = 0.96). Regression slope (0.97; P < .001) and mean Bland-Altman bias (-0.13%; 95% limits of agreement: -3.95%, 3.40%) indicated minimal underestimation by using MR imaging-PDFF. MR imaging-PDFF was precise at the region-of-interest level, with repeatability and reproducibility coefficients of 2.99% and 4.12%, respectively. Field strength, imager manufacturer, and reconstruction method each had minimal effects on reproducibility. Conclusion MR imaging-PDFF has excellent linearity, bias, and precision across different field strengths, imager manufacturers, and reconstruction methods. © RSNA, 2017 Online supplemental material is available for this article. An earlier incorrect version of this article appeared online. This article was corrected on October 2, 2017.
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115
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Esterson YB, Grimaldi GM. Radiologic Imaging in Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis. Clin Liver Dis 2018; 22:93-108. [PMID: 29128063 DOI: 10.1016/j.cld.2017.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The article reviews the multimodality (ultrasound, computed tomography, and magnetic resonance [MR]) imaging appearance of nonalcoholic fatty liver disease (NAFLD) and discusses the radiologic diagnostic criteria as well as the sensitivity and specificity of these imaging methods. The authors review the role of both ultrasound and MR elastography for the diagnosis of fibrosis and for the longitudinal evaluation of patients following therapeutic intervention. Lastly, the authors briefly discuss the screening and diagnosis of hepatocellular carcinoma in patients with NAFLD, as there are special considerations in this population.
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Affiliation(s)
- Yonah B Esterson
- Department of Radiology, Northwell Health System, Hofstra Northwell School of Medicine, 300 Community Drive, Manhasset, NY 11030, USA.
| | - Gregory M Grimaldi
- Department of Radiology, Northwell Health System, Hofstra Northwell School of Medicine, 300 Community Drive, Manhasset, NY 11030, USA
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116
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Haufe WM, Wolfson T, Hooker CA, Hooker JC, Covarrubias Y, Schlein AN, Hamilton G, Middleton MS, Angeles JE, Hernando D, Reeder SB, Schwimmer JB, Sirlin CB. Accuracy of PDFF estimation by magnitude-based and complex-based MRI in children with MR spectroscopy as a reference. J Magn Reson Imaging 2017; 46:1641-1647. [PMID: 28323377 PMCID: PMC5608618 DOI: 10.1002/jmri.25699] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 02/21/2017] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To assess and compare the accuracy of magnitude-based magnetic resonance imaging (MRI-M) and complex-based MRI (MRI-C) for estimating hepatic proton density fat fraction (PDFF) in children, using MR spectroscopy (MRS) as the reference standard. A secondary aim was to assess the agreement between MRI-M and MRI-C. MATERIALS AND METHODS This was a HIPAA-compliant, retrospective analysis of data collected in children enrolled in prospective, Institutional Review Board (IRB)-approved studies between 2012 and 2014. Informed consent was obtained from 200 children (ages 8-19 years) who subsequently underwent 3T MR exams that included MRI-M, MRI-C, and T1 -independent, T2 -corrected, single-voxel stimulated echo acquisition mode (STEAM) MRS. Both MRI methods acquired six echoes at low flip angles. T2*-corrected PDFF parametric maps were generated. PDFF values were recorded from regions of interest (ROIs) drawn on the maps in each of the nine Couinaud segments and three ROIs colocalized to the MRS voxel location. Regression analyses assessing agreement with MRS were performed to evaluate the accuracy of each MRI method, and Bland-Altman and intraclass correlation coefficient (ICC) analyses were performed to assess agreement between the MRI methods. RESULTS MRI-M and MRI-C PDFF were accurate relative to the colocalized MRS reference standard, with regression intercepts of 0.63% and -0.07%, slopes of 0.998 and 0.975, and proportion-of-explained-variance values (R2 ) of 0.982 and 0.979, respectively. For individual Couinaud segments and for the whole liver averages, Bland-Altman biases between MRI-M and MRI-C were small (ranging from 0.04 to 1.11%) and ICCs were high (≥0.978). CONCLUSION Both MRI-M and MRI-C accurately estimated hepatic PDFF in children, and high intermethod agreement was observed. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1641-1647.
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Affiliation(s)
- William M Haufe
- Liver Imaging Group, Department of Radiology, University of California - San Diego, San Diego, California, USA
| | - Tanya Wolfson
- Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California - San Diego, San Diego, California, USA
| | - Catherine A Hooker
- Liver Imaging Group, Department of Radiology, University of California - San Diego, San Diego, California, USA
| | - Jonathan C Hooker
- Liver Imaging Group, Department of Radiology, University of California - San Diego, San Diego, California, USA
| | - Yesenia Covarrubias
- Liver Imaging Group, Department of Radiology, University of California - San Diego, San Diego, California, USA
| | - Alex N Schlein
- Liver Imaging Group, Department of Radiology, University of California - San Diego, San Diego, California, USA
| | - Gavin Hamilton
- Liver Imaging Group, Department of Radiology, University of California - San Diego, San Diego, California, USA
| | - Michael S Middleton
- Liver Imaging Group, Department of Radiology, University of California - San Diego, San Diego, California, USA
| | - Jorge E Angeles
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California - San Diego, San Diego, California, USA
| | - Diego Hernando
- Department of Radiology, University of Wisconsin - Madison, Madison, Wisconsin, USA
- Department of Medical Physics, University of Wisconsin - Madison, Madison, Wisconsin, USA
- Department of Biomedical Engineering, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Scott B Reeder
- Department of Radiology, University of Wisconsin - Madison, Madison, Wisconsin, USA
- Department of Medical Physics, University of Wisconsin - Madison, Madison, Wisconsin, USA
- Department of Biomedical Engineering, University of Wisconsin - Madison, Madison, Wisconsin, USA
- Department of Medicine, University of Wisconsin - Madison, Madison, Wisconsin, USA
- Department of Emergency Medicine, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Jeffrey B Schwimmer
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California - San Diego, San Diego, California, USA
- Department of Gastroenterology, Rady Children's Hospital San Diego, San Diego, California, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California - San Diego, San Diego, California, USA
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117
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Kang BK, Kim M, Song SY, Jun DW, Jang K. Feasibility of modified Dixon MRI techniques for hepatic fat quantification in hepatic disorders: validation with MRS and histology. Br J Radiol 2017; 91:20170378. [PMID: 29022777 DOI: 10.1259/bjr.20170378] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To assess the feasibility of proton density fat fraction (PDFF) MRI for estimating hepatic fat fraction with magnetic resonance spectroscopy (MRS) and histology as references and to investigate intrahepatic fat distribution and variability. METHODS Between November 2014 and September 2015, 85 adults (48 males, 47 females) who underwent MRI-PDFF (n = 139), MRS-PDFF (n = 49) and liver biopsy (n = 29) were enrolled in this study. Data were compared using linear regression. MRI-PDFF and standard deviations (variability) and differences between maximum and minimum PDFF (PDFF range) for whole liver, the lobes, and segment levels were calculated for each subject. RESULTS Whole-liver MRI-PDFF showed good correlation with MRS-PDFF (r = 0.961) and histologic degree of hepatic steatosis (σ = 0.809). Hepatic fat fraction is different between lobes and segments. Mean PDFF and mean PDFF range of the right lobe were higher than for the left lobe, whereas variability in the right lobe was lower than in the left lobe. CONCLUSION MRI-PDFF is an accurate non-invasive method for quantifying hepatic fat for various hepatic disorders, and may be preferable for measuring fat fraction in the right liver for more precise values in longitudinal monitoring, while avoiding FF measurement in the left liver. Advances in knowledge: MRI-PDFF provides a non-invasive and accurate quantification of hepatic steatosis in various hepatic disorders. It would be preferable to measure FF in the right liver than in the left liver.
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Affiliation(s)
- Bo-Kyeong Kang
- 1 Department of Radiology, Hanyang University School of Medicine, Hanyang University Medical Center , Seoul , Korea
| | - Mimi Kim
- 1 Department of Radiology, Hanyang University School of Medicine, Hanyang University Medical Center , Seoul , Korea
| | - Soon-Young Song
- 1 Department of Radiology, Hanyang University School of Medicine, Hanyang University Medical Center , Seoul , Korea
| | - Dae Won Jun
- 2 Department of Internal Medicine, Hanyang University School of Medicine, Hanyang University Medical Center , Seoul , Korea
| | - Kiseok Jang
- 3 Department of Pathology, Hanyang University School of Medicine, Hanyang University Medical Center , Seoul , Korea
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118
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Lee DH. Imaging evaluation of non-alcoholic fatty liver disease: focused on quantification. Clin Mol Hepatol 2017; 23:290-301. [PMID: 28994271 PMCID: PMC5760010 DOI: 10.3350/cmh.2017.0042] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 08/17/2017] [Indexed: 12/26/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) has been an emerging major health problem, and the most common cause of chronic liver disease in Western countries. Traditionally, liver biopsy has been gold standard method for quantification of hepatic steatosis. However, its invasive nature with potential complication as well as measurement variability are major problem. Thus, various imaging studies have been used for evaluation of hepatic steatosis. Ultrasonography provides fairly good accuracy to detect moderate-to-severe degree hepatic steatosis, but limited accuracy for mild steatosis. Operator-dependency and subjective/qualitative nature of examination are another major drawbacks of ultrasonography. Computed tomography can be considered as an unsuitable imaging modality for evaluation of NAFLD due to potential risk of radiation exposure and limited accuracy in detecting mild steatosis. Both magnetic resonance spectroscopy and magnetic resonance imaging using chemical shift technique provide highly accurate and reproducible diagnostic performance for evaluating NAFLD, and therefore, have been used in many clinical trials as a non-invasive reference of standard method.
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Affiliation(s)
- Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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119
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Mills AF, Sakai O, Anderson SW, Jara H. Principles of Quantitative MR Imaging with Illustrated Review of Applicable Modular Pulse Diagrams. Radiographics 2017; 37:2083-2105. [PMID: 28985137 DOI: 10.1148/rg.2017160099] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Continued improvements in diagnostic accuracy using magnetic resonance (MR) imaging will require development of methods for tissue analysis that complement traditional qualitative MR imaging studies. Quantitative MR imaging is based on measurement and interpretation of tissue-specific parameters independent of experimental design, compared with qualitative MR imaging, which relies on interpretation of tissue contrast that results from experimental pulse sequence parameters. Quantitative MR imaging represents a natural next step in the evolution of MR imaging practice, since quantitative MR imaging data can be acquired using currently available qualitative imaging pulse sequences without modifications to imaging equipment. The article presents a review of the basic physical concepts used in MR imaging and how quantitative MR imaging is distinct from qualitative MR imaging. Subsequently, the article reviews the hierarchical organization of major applicable pulse sequences used in this article, with the sequences organized into conventional, hybrid, and multispectral sequences capable of calculating the main tissue parameters of T1, T2, and proton density. While this new concept offers the potential for improved diagnostic accuracy and workflow, awareness of this extension to qualitative imaging is generally low. This article reviews the basic physical concepts in MR imaging, describes commonly measured tissue parameters in quantitative MR imaging, and presents the major available pulse sequences used for quantitative MR imaging, with a focus on the hierarchical organization of these sequences. ©RSNA, 2017.
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Affiliation(s)
- Andrew F Mills
- From the Department of Radiology (A.F.M., O.S., S.W.A., H.J.), Boston Medical Center, 820 Harrison Ave, FGH Building Third Floor, Boston, MA 02118; and the Department of Otolaryngology-Head and Neck Surgery and Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Mass (O.S.)
| | - Osamu Sakai
- From the Department of Radiology (A.F.M., O.S., S.W.A., H.J.), Boston Medical Center, 820 Harrison Ave, FGH Building Third Floor, Boston, MA 02118; and the Department of Otolaryngology-Head and Neck Surgery and Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Mass (O.S.)
| | - Stephan W Anderson
- From the Department of Radiology (A.F.M., O.S., S.W.A., H.J.), Boston Medical Center, 820 Harrison Ave, FGH Building Third Floor, Boston, MA 02118; and the Department of Otolaryngology-Head and Neck Surgery and Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Mass (O.S.)
| | - Hernan Jara
- From the Department of Radiology (A.F.M., O.S., S.W.A., H.J.), Boston Medical Center, 820 Harrison Ave, FGH Building Third Floor, Boston, MA 02118; and the Department of Otolaryngology-Head and Neck Surgery and Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Mass (O.S.)
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A data-oriented self-calibration and robust chemical-shift encoding by using clusterization (OSCAR): Theory, optimization and clinical validation in neuromuscular disorders. Magn Reson Imaging 2017; 45:84-96. [PMID: 28982632 DOI: 10.1016/j.mri.2017.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/29/2017] [Accepted: 09/29/2017] [Indexed: 12/15/2022]
Abstract
Multi-echo Chemical Shift-Encoded (CSE) methods for Fat-Water quantification are growing in clinical use due to their ability to estimate and correct some confounding effects. State of the art CSE water/fat separation approaches rely on a multi-peak fat spectrum with peak frequencies and relative amplitudes kept constant over the entire MRI dataset. However, the latter approximation introduces a systematic error in fat percentage quantification in patients where the differences in lipid chemical composition are significant (such as for neuromuscular disorders) because of the spatial dependence of the peak amplitudes. The present work aims to overcome this limitation by taking advantage of an unsupervised clusterization-based approach offering a reliable criterion to carry out a data-driven segmentation of the input MRI dataset into multiple regions. Results established that the presented algorithm is able to identify at least 4 different partitions from MRI dataset under which to perform independent self-calibration routines and was found robust in NMD imaging studies (as evaluated on a cohort of 24 subjects) against latest CSE techniques with either calibrated or non-calibrated approaches. Particularly, the PDFF of the thigh was more reproducible for the quantitative estimation of pathological muscular fat infiltrations, which may be promising to evaluate disease progression in clinical practice.
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121
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The Clinical Implications of Fatty Pancreas: A Concise Review. Dig Dis Sci 2017; 62:2658-2667. [PMID: 28791556 DOI: 10.1007/s10620-017-4700-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 07/27/2017] [Indexed: 12/19/2022]
Abstract
Fatty pancreas is a newly recognized condition which is poorly investigated until today as compared to nonalcoholic fatty liver disease. It is characterized by pancreatic fat accumulation and subsequent development of pancreatic and metabolic complications. Association of fatty pancreas have been described with type 2 diabetes mellitus, acute and chronic pancreatitis and even pancreatic carcinoma. In this review article, we provide an update on clinical implications, pathogenesis, diagnosis, treatment and outcomes.
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Park JE, Han K, Sung YS, Chung MS, Koo HJ, Yoon HM, Choi YJ, Lee SS, Kim KW, Shin Y, An S, Cho HM, Park SH. Selection and Reporting of Statistical Methods to Assess Reliability of a Diagnostic Test: Conformity to Recommended Methods in a Peer-Reviewed Journal. Korean J Radiol 2017; 18:888-897. [PMID: 29089821 PMCID: PMC5639154 DOI: 10.3348/kjr.2017.18.6.888] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 07/28/2017] [Indexed: 12/13/2022] Open
Abstract
Objective To evaluate the frequency and adequacy of statistical analyses in a general radiology journal when reporting a reliability analysis for a diagnostic test. Materials and Methods Sixty-three studies of diagnostic test accuracy (DTA) and 36 studies reporting reliability analyses published in the Korean Journal of Radiology between 2012 and 2016 were analyzed. Studies were judged using the methodological guidelines of the Radiological Society of North America-Quantitative Imaging Biomarkers Alliance (RSNA-QIBA), and COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) initiative. DTA studies were evaluated by nine editorial board members of the journal. Reliability studies were evaluated by study reviewers experienced with reliability analysis. Results Thirty-one (49.2%) of the 63 DTA studies did not include a reliability analysis when deemed necessary. Among the 36 reliability studies, proper statistical methods were used in all (5/5) studies dealing with dichotomous/nominal data, 46.7% (7/15) of studies dealing with ordinal data, and 95.2% (20/21) of studies dealing with continuous data. Statistical methods were described in sufficient detail regarding weighted kappa in 28.6% (2/7) of studies and regarding the model and assumptions of intraclass correlation coefficient in 35.3% (6/17) and 29.4% (5/17) of studies, respectively. Reliability parameters were used as if they were agreement parameters in 23.1% (3/13) of studies. Reproducibility and repeatability were used incorrectly in 20% (3/15) of studies. Conclusion Greater attention to the importance of reporting reliability, thorough description of the related statistical methods, efforts not to neglect agreement parameters, and better use of relevant terminology is necessary.
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Affiliation(s)
- Ji Eun Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Kyunghwa Han
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Yu Sub Sung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Mi Sun Chung
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Youngbin Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Suah An
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Hyo-Min Cho
- Korea Research Institute of Standards and Science, Daejeon 34113, Korea
| | - Seong Ho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
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Influence of Gd-EOB-DTPA on proton density fat fraction using the six-echo Dixon method in 3 Tesla magnetic resonance imaging. Radiol Phys Technol 2017; 10:483-488. [DOI: 10.1007/s12194-017-0420-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/03/2017] [Accepted: 09/04/2017] [Indexed: 12/25/2022]
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Middleton MS, Heba ER, Hooker CA, Bashir MR, Fowler KJ, Sandrasegaran K, Brunt EM, Kleiner DE, Doo E, Van Natta ML, Tonascia J, Lavine JE, Neuschwander-Tetri BA, Sanyal A, Loomba R, Sirlin CB. Agreement Between Magnetic Resonance Imaging Proton Density Fat Fraction Measurements and Pathologist-Assigned Steatosis Grades of Liver Biopsies From Adults With Nonalcoholic Steatohepatitis. Gastroenterology 2017; 153. [PMID: 28624576 PMCID: PMC5695870 DOI: 10.1053/j.gastro.2017.06.005] [Citation(s) in RCA: 188] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS We assessed the diagnostic performance of magnetic resonance imaging (MRI) proton density fat fraction (PDFF) in grading hepatic steatosis and change in hepatic steatosis in adults with nonalcoholic steatohepatitis (NASH) in a multi-center study, using central histology as reference. METHODS We collected data from 113 adults with NASH participating in a multi-center, randomized, double-masked, placebo-controlled, phase 2b trial to compare the efficacy cross-sectionally and longitudinally of obeticholic acid vs placebo. Hepatic steatosis was assessed at baseline and after 72 weeks of obeticholic acid or placebo by liver biopsy and MRI (scanners from different manufacturers, at 1.5T or 3T). We compared steatosis estimates by PDFF vs histology. Histologic steatosis grade was scored in consensus by a pathology committee. Cross-validated receiver operating characteristic (ROC) analyses were performed. RESULTS At baseline, 34% of subjects had steatosis grade 0 or 1, 39% had steatosis grade 2, and 27% had steatosis grade 3; corresponding mean PDFF values were 9.8%±3.7%, 18.1%±4.3%, and 30.1%±8.1%. PDFF classified steatosis grade 0-1 vs 2-3 with an area under the ROC curve (AUROC) of 0.95 (95% CI, 0.91-0.98), and grade 0-2 vs grade 3 steatosis with an AUROC of 0.96 (95% CI, 0.93-0.99). PDFF cut-off values at 90% specificity were 16.3% for grades 2-3 and 21.7% for grade 3, with corresponding sensitivities of 83% and 84%. After 72 weeks' of obeticholic vs placebo, 42% of subjects had a reduced steatosis grade (mean reduction in PDFF from baseline of 7.4%±8.7%), 49% had no change in steatosis grade (mean increase in PDFF from baseline of 0.3%±6.3%), and 9% had an increased steatosis grade (mean increase in PDFF from baseline of 7.7%±6.0%). PDFF change identified subjects with reduced steatosis grade with an AUROC of 0.81 (95% CI, 0.71-0.91) and increased steatosis grade with an AUROC of 0.81 (95% CI, 0.63-0.99). A PDFF reduction of 5.15% identified subjects with reduced steatosis grade with 90% specificity and 58% sensitivity, whereas a PDFF increase of 5.6% identified those with increased steatosis grade with 90% specificity and 57% sensitivity. CONCLUSIONS Based on data from a phase 2 randomized controlled trial of adults with NASH, PDFF estimated by MRI scanners of different field strength and at different sites, accurately classifies grades and changes in hepatic steatosis when histologic analysis of biopsies is used as a reference.
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Affiliation(s)
| | - Elhamy R. Heba
- Department of Radiology, UCSD School of Medicine, San Diego, California
| | | | - Mustafa R. Bashir
- Department of Radiology, Duke University Medical Center, 3808, Durham, North Carolina
| | | | - Kumar Sandrasegaran
- Department of Radiology, Indiana University School of Medicine, Indianapolis, Indiana
| | | | | | - Edward Doo
- Liver Diseases Section, Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases
| | - Mark L. Van Natta
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - James Tonascia
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Joel E. Lavine
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | | | - Arun Sanyal
- Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Rohit Loomba
- NAFLD Translational Research Unit, Division of Gastroenterology, UCSD School of Medicine, San Diego, California
| | - Claude B. Sirlin
- Department of Radiology, UCSD School of Medicine, San Diego, California
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Hong CW, Mamidipalli A, Hooker JC, Hamilton G, Wolfson T, Chen DH, Fazeli Dehkordy S, Middleton MS, Reeder SB, Loomba R, Sirlin CB. MRI proton density fat fraction is robust across the biologically plausible range of triglyceride spectra in adults with nonalcoholic steatohepatitis. J Magn Reson Imaging 2017; 47:995-1002. [PMID: 28851124 DOI: 10.1002/jmri.25845] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/08/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Proton density fat fraction (PDFF) estimation requires spectral modeling of the hepatic triglyceride (TG) signal. Deviations in the TG spectrum may occur, leading to bias in PDFF quantification. PURPOSE To investigate the effects of varying six-peak TG spectral models on PDFF estimation bias. STUDY TYPE Retrospective secondary analysis of prospectively acquired clinical research data. POPULATION Forty-four adults with biopsy-confirmed nonalcoholic steatohepatitis. FIELD STRENGTH/SEQUENCE Confounder-corrected chemical-shift-encoded 3T MRI (using a 2D multiecho gradient-recalled echo technique with magnitude reconstruction) and MR spectroscopy. ASSESSMENT In each patient, 61 pairs of colocalized MRI-PDFF and MRS-PDFF values were estimated: one pair used the standard six-peak spectral model, the other 60 were six-peak variants calculated by adjusting spectral model parameters over their biologically plausible ranges. MRI-PDFF values calculated using each variant model and the standard model were compared, and the agreement between MRI-PDFF and MRS-PDFF was assessed. STATISTICAL TESTS MRS-PDFF and MRI-PDFF were summarized descriptively. Bland-Altman (BA) analyses were performed between PDFF values calculated using each variant model and the standard model. Linear regressions were performed between BA biases and mean PDFF values for each variant model, and between MRI-PDFF and MRS-PDFF. RESULTS Using the standard model, mean MRS-PDFF of the study population was 17.9 ± 8.0% (range: 4.1-34.3%). The difference between the highest and lowest mean variant MRI-PDFF values was 1.5%. Relative to the standard model, the model with the greatest absolute BA bias overestimated PDFF by 1.2%. Bias increased with increasing PDFF (P < 0.0001 for 59 of the 60 variant models). MRI-PDFF and MRS-PDFF agreed closely for all variant models (R2 = 0.980, P < 0.0001). DATA CONCLUSION Over a wide range of hepatic fat content, PDFF estimation is robust across the biologically plausible range of TG spectra. Although absolute estimation bias increased with higher PDFF, its magnitude was small and unlikely to be clinically meaningful. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:995-1002.
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Affiliation(s)
- Cheng William Hong
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Adrija Mamidipalli
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Jonathan C Hooker
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Gavin Hamilton
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Tanya Wolfson
- Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, California, USA
| | - Dennis H Chen
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Soudabeh Fazeli Dehkordy
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Michael S Middleton
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Scott B Reeder
- Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin Madison, Madison, Wisconsin
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, California, USA
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Evaluation of six-point modified dixon and magnetic resonance spectroscopy for fat quantification: a fat–water–iron phantom study. Radiol Phys Technol 2017; 10:349-358. [DOI: 10.1007/s12194-017-0410-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 07/27/2017] [Accepted: 07/27/2017] [Indexed: 01/11/2023]
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127
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Gotra A, Sivakumaran L, Chartrand G, Vu KN, Vandenbroucke-Menu F, Kauffmann C, Kadoury S, Gallix B, de Guise JA, Tang A. Liver segmentation: indications, techniques and future directions. Insights Imaging 2017; 8:377-392. [PMID: 28616760 PMCID: PMC5519497 DOI: 10.1007/s13244-017-0558-1] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 04/03/2017] [Accepted: 05/02/2017] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Liver volumetry has emerged as an important tool in clinical practice. Liver volume is assessed primarily via organ segmentation of computed tomography (CT) and magnetic resonance imaging (MRI) images. The goal of this paper is to provide an accessible overview of liver segmentation targeted at radiologists and other healthcare professionals. METHODS Using images from CT and MRI, this paper reviews the indications for liver segmentation, technical approaches used in segmentation software and the developing roles of liver segmentation in clinical practice. RESULTS Liver segmentation for volumetric assessment is indicated prior to major hepatectomy, portal vein embolisation, associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and transplant. Segmentation software can be categorised according to amount of user input involved: manual, semi-automated and fully automated. Manual segmentation is considered the "gold standard" in clinical practice and research, but is tedious and time-consuming. Increasingly automated segmentation approaches are more robust, but may suffer from certain segmentation pitfalls. Emerging applications of segmentation include surgical planning and integration with MRI-based biomarkers. CONCLUSIONS Liver segmentation has multiple clinical applications and is expanding in scope. Clinicians can employ semi-automated or fully automated segmentation options to more efficiently integrate volumetry into clinical practice. TEACHING POINTS • Liver volume is assessed via organ segmentation on CT and MRI examinations. • Liver segmentation is used for volume assessment prior to major hepatic procedures. • Segmentation approaches may be categorised according to the amount of user input involved. • Emerging applications include surgical planning and integration with MRI-based biomarkers.
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Affiliation(s)
- Akshat Gotra
- Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Saint-Luc Hospital, 1058 rue Saint-Denis, Montreal, QC, H2X 3J4, Canada.,Department of Radiology, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
| | - Lojan Sivakumaran
- University of Montreal, 2900 boulevard Eduoard-Montpetit, Montreal, QC, H3T 1J4, Canada.,Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montreal, QC, H2X 0A9, Canada
| | - Gabriel Chartrand
- Imaging and Orthopaedics Research Laboratory (LIO), École de technologie supérieure, Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montreal, QC, H2X 0A9, Canada
| | - Kim-Nhien Vu
- Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Saint-Luc Hospital, 1058 rue Saint-Denis, Montreal, QC, H2X 3J4, Canada
| | - Franck Vandenbroucke-Menu
- Department of Hepato-biliary and Pancreatic Surgery, University of Montreal, Saint-Luc Hospital, 1058 rue Saint-Denis, Montreal, QC, H2X 3J4, Canada
| | - Claude Kauffmann
- Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Saint-Luc Hospital, 1058 rue Saint-Denis, Montreal, QC, H2X 3J4, Canada
| | - Samuel Kadoury
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montreal, QC, H2X 0A9, Canada.,École Polytechnique de Montréal, University of Montreal, 2500 chemin de Polytechnique Montréal, Montreal, QC, H3T 1J4, Canada
| | - Benoît Gallix
- Department of Radiology, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
| | - Jacques A de Guise
- Imaging and Orthopaedics Research Laboratory (LIO), École de technologie supérieure, Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montreal, QC, H2X 0A9, Canada
| | - An Tang
- Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Saint-Luc Hospital, 1058 rue Saint-Denis, Montreal, QC, H2X 3J4, Canada. .,Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montreal, QC, H2X 0A9, Canada.
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Kühn JP, Meffert P, Heske C, Kromrey ML, Schmidt CO, Mensel B, Völzke H, Lerch MM, Hernando D, Mayerle J, Reeder SB. Prevalence of Fatty Liver Disease and Hepatic Iron Overload in a Northeastern German Population by Using Quantitative MR Imaging. Radiology 2017; 284:706-716. [PMID: 28481195 DOI: 10.1148/radiol.2017161228] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose To quantify liver fat and liver iron content by measurement of confounder-corrected proton density fat fraction (PDFF) and R2* and to identify clinical associations for fatty liver disease and liver iron overload and their prevalence in a large-scale population-based study. Materials and Methods From 2008 to 2013, 2561 white participants (1336 women; median age, 52 years; 25th and 75th quartiles, 42 and 62 years) were prospectively recruited to the Study of Health in Pomerania (SHIP). Complex chemical shift-encoded magnetic resonance (MR) examination of the liver was performed, from which PDFF and R2* were assessed. On the basis of previous histopathologic calibration, participants were stratified according to their liver fat and iron content as follows: none (PDFF, ≤5.1%; R2*, ≤41.0 sec-1), mild (PDFF, >5.1%; R2*, >41 sec-1), moderate (PDFF, >14.1%; R2*, >62.5 sec-1), high (PDFF: >28.0%; R2*: >70.1 sec-1). Prevalence of fatty liver diseases and iron overload was calculated (weighted by probability of participation). Clinical associations were identified by using boosting for generalized linear models. Results Median PDFF was 3.9% (range, 0.6%-41.5%). Prevalence of fatty liver diseases was 42.2% (1082 of 2561 participants); mild, 28.5% (730 participants); moderate, 12.0% (307 participants); high content, 1.8% (45 participants). Median R2* was 34.4 sec-1 (range, 14.0-311.8 sec-1). Iron overload was observed in 17.4% (447 of 2561 participants; mild, 14.7% [376 participants]; moderate, 0.8% [20 participants]; high content, 2.0% [50 participants]). Liver fat content correlated with waist-to-height ratio, alanine transaminase, uric acid, serum triglycerides, and blood pressure. Liver iron content correlated with mean serum corpuscular hemoglobin, male sex, and age. Conclusion In a white German population, the prevalence of fatty liver diseases and liver iron overload is 42.2% (1082 of 2561) and 17.4% (447 of 2561). Whereas liver fat is associated with predictors related to the metabolic syndrome, liver iron content is mainly associated with mean serum corpuscular hemoglobin. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Jens-Peter Kühn
- From the Institute of Diagnostic Radiology and Neuroradiology (J.P.K., C.H., M.L.K., C.O.S., B.M.), Institute for Community Medicine (P.M., H.V.), and Department of Medicine A, University Medicine (M.M.L., J.M.), Ernst Moritz Arndt University Greifswald, Berthold-Beitz-Platz, 17495 Greifswald, Germany; Department of Radiology, University of Wisconsin, Madison, Wis (D.H., S.B.R.); and Department of Medical Physics, Biomedical Engineering, Medicine and Emergency Medicine, University of Wisconsin, Madison, Wis (S.B.R.)
| | - Peter Meffert
- From the Institute of Diagnostic Radiology and Neuroradiology (J.P.K., C.H., M.L.K., C.O.S., B.M.), Institute for Community Medicine (P.M., H.V.), and Department of Medicine A, University Medicine (M.M.L., J.M.), Ernst Moritz Arndt University Greifswald, Berthold-Beitz-Platz, 17495 Greifswald, Germany; Department of Radiology, University of Wisconsin, Madison, Wis (D.H., S.B.R.); and Department of Medical Physics, Biomedical Engineering, Medicine and Emergency Medicine, University of Wisconsin, Madison, Wis (S.B.R.)
| | - Christian Heske
- From the Institute of Diagnostic Radiology and Neuroradiology (J.P.K., C.H., M.L.K., C.O.S., B.M.), Institute for Community Medicine (P.M., H.V.), and Department of Medicine A, University Medicine (M.M.L., J.M.), Ernst Moritz Arndt University Greifswald, Berthold-Beitz-Platz, 17495 Greifswald, Germany; Department of Radiology, University of Wisconsin, Madison, Wis (D.H., S.B.R.); and Department of Medical Physics, Biomedical Engineering, Medicine and Emergency Medicine, University of Wisconsin, Madison, Wis (S.B.R.)
| | - Marie-Luise Kromrey
- From the Institute of Diagnostic Radiology and Neuroradiology (J.P.K., C.H., M.L.K., C.O.S., B.M.), Institute for Community Medicine (P.M., H.V.), and Department of Medicine A, University Medicine (M.M.L., J.M.), Ernst Moritz Arndt University Greifswald, Berthold-Beitz-Platz, 17495 Greifswald, Germany; Department of Radiology, University of Wisconsin, Madison, Wis (D.H., S.B.R.); and Department of Medical Physics, Biomedical Engineering, Medicine and Emergency Medicine, University of Wisconsin, Madison, Wis (S.B.R.)
| | - Carsten O Schmidt
- From the Institute of Diagnostic Radiology and Neuroradiology (J.P.K., C.H., M.L.K., C.O.S., B.M.), Institute for Community Medicine (P.M., H.V.), and Department of Medicine A, University Medicine (M.M.L., J.M.), Ernst Moritz Arndt University Greifswald, Berthold-Beitz-Platz, 17495 Greifswald, Germany; Department of Radiology, University of Wisconsin, Madison, Wis (D.H., S.B.R.); and Department of Medical Physics, Biomedical Engineering, Medicine and Emergency Medicine, University of Wisconsin, Madison, Wis (S.B.R.)
| | - Birger Mensel
- From the Institute of Diagnostic Radiology and Neuroradiology (J.P.K., C.H., M.L.K., C.O.S., B.M.), Institute for Community Medicine (P.M., H.V.), and Department of Medicine A, University Medicine (M.M.L., J.M.), Ernst Moritz Arndt University Greifswald, Berthold-Beitz-Platz, 17495 Greifswald, Germany; Department of Radiology, University of Wisconsin, Madison, Wis (D.H., S.B.R.); and Department of Medical Physics, Biomedical Engineering, Medicine and Emergency Medicine, University of Wisconsin, Madison, Wis (S.B.R.)
| | - Henry Völzke
- From the Institute of Diagnostic Radiology and Neuroradiology (J.P.K., C.H., M.L.K., C.O.S., B.M.), Institute for Community Medicine (P.M., H.V.), and Department of Medicine A, University Medicine (M.M.L., J.M.), Ernst Moritz Arndt University Greifswald, Berthold-Beitz-Platz, 17495 Greifswald, Germany; Department of Radiology, University of Wisconsin, Madison, Wis (D.H., S.B.R.); and Department of Medical Physics, Biomedical Engineering, Medicine and Emergency Medicine, University of Wisconsin, Madison, Wis (S.B.R.)
| | - Markus M Lerch
- From the Institute of Diagnostic Radiology and Neuroradiology (J.P.K., C.H., M.L.K., C.O.S., B.M.), Institute for Community Medicine (P.M., H.V.), and Department of Medicine A, University Medicine (M.M.L., J.M.), Ernst Moritz Arndt University Greifswald, Berthold-Beitz-Platz, 17495 Greifswald, Germany; Department of Radiology, University of Wisconsin, Madison, Wis (D.H., S.B.R.); and Department of Medical Physics, Biomedical Engineering, Medicine and Emergency Medicine, University of Wisconsin, Madison, Wis (S.B.R.)
| | - Diego Hernando
- From the Institute of Diagnostic Radiology and Neuroradiology (J.P.K., C.H., M.L.K., C.O.S., B.M.), Institute for Community Medicine (P.M., H.V.), and Department of Medicine A, University Medicine (M.M.L., J.M.), Ernst Moritz Arndt University Greifswald, Berthold-Beitz-Platz, 17495 Greifswald, Germany; Department of Radiology, University of Wisconsin, Madison, Wis (D.H., S.B.R.); and Department of Medical Physics, Biomedical Engineering, Medicine and Emergency Medicine, University of Wisconsin, Madison, Wis (S.B.R.)
| | - Julia Mayerle
- From the Institute of Diagnostic Radiology and Neuroradiology (J.P.K., C.H., M.L.K., C.O.S., B.M.), Institute for Community Medicine (P.M., H.V.), and Department of Medicine A, University Medicine (M.M.L., J.M.), Ernst Moritz Arndt University Greifswald, Berthold-Beitz-Platz, 17495 Greifswald, Germany; Department of Radiology, University of Wisconsin, Madison, Wis (D.H., S.B.R.); and Department of Medical Physics, Biomedical Engineering, Medicine and Emergency Medicine, University of Wisconsin, Madison, Wis (S.B.R.)
| | - Scott B Reeder
- From the Institute of Diagnostic Radiology and Neuroradiology (J.P.K., C.H., M.L.K., C.O.S., B.M.), Institute for Community Medicine (P.M., H.V.), and Department of Medicine A, University Medicine (M.M.L., J.M.), Ernst Moritz Arndt University Greifswald, Berthold-Beitz-Platz, 17495 Greifswald, Germany; Department of Radiology, University of Wisconsin, Madison, Wis (D.H., S.B.R.); and Department of Medical Physics, Biomedical Engineering, Medicine and Emergency Medicine, University of Wisconsin, Madison, Wis (S.B.R.)
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Accurate simultaneous quantification of liver steatosis and iron overload in diffuse liver diseases with MRI. Abdom Radiol (NY) 2017; 42:1434-1443. [PMID: 28110367 DOI: 10.1007/s00261-017-1048-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the diagnostic performances of 3 Tesla multi-echo chemical shift-encoded gradient echo magnetic resonance (MECSE-MR) imaging to simultaneously quantify liver steatosis and iron overload in a wide spectrum of diffuse liver diseases having biopsy as reference standard. METHODS MECSE-MR-acquired images were used to calculate fat fraction and iron content in a single breath-hold in 109 adult patients. Proton density fat fraction (PDFF) was prospectively estimated using complex-based data reconstruction with multipeak fat modeling. Water R2* was used to estimate iron content. Biopsy was obtained in all cases, grading liver steatosis, siderosis, inflammation, and fibrosis. Differences in PDFF and R2* values across histopathological grades were analyzed, and ROC curves analyses evaluated the MR diagnostic performance. RESULTS Calculated fat fraction measurements showed significant differences (p < 0.001) among steatosis grades, being unaffected by the presence of inflammation or fibrosis (p ≥ 0.05). A strong correlation was found between fat fraction and steatosis grade (R S = 0.718, p < 0.001). Iron deposits did not affect fat fraction quantitation (p ≥ 0.05), except in cases with severe iron overload (grade 4). A strong positive correlation was also observed between R2* measurements and iron grades (R S = 0.704, p < 0.001). Calculated R2* values were not different across grades of steatosis, inflammation, and fibrosis (p ≥ 0.05). CONCLUSION A MECSE-MR sequence simultaneously quantifies liver steatosis and siderosis, regardless coexisting liver inflammation or fibrosis, with high accuracy in a wide spectrum of diffuse liver disorders. This sequence can be acquired within a single breath-hold and can be implemented in the routine MR evaluation of the liver.
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Armstrong T, Dregely I, Stemmer A, Han F, Natsuaki Y, Sung K, Wu HH. Free-breathing liver fat quantification using a multiecho 3D stack-of-radial technique. Magn Reson Med 2017; 79:370-382. [PMID: 28419582 DOI: 10.1002/mrm.26693] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 02/22/2017] [Accepted: 03/09/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE The diagnostic gold standard for nonalcoholic fatty liver disease is an invasive biopsy. Noninvasive Cartesian MRI fat quantification remains limited to a breath-hold (BH). In this work, a novel free-breathing 3D stack-of-radial (FB radial) liver fat quantification technique is developed and evaluated in a preliminary study. METHODS Phantoms and healthy subjects (n = 11) were imaged at 3 Tesla. The proton-density fat fraction (PDFF) determined using FB radial (with and without scan acceleration) was compared to BH single-voxel MR spectroscopy (SVS) and BH 3D Cartesian MRI using linear regression (correlation coefficient ρ and concordance coefficient ρc ) and Bland-Altman analysis. RESULTS In phantoms, PDFF showed significant correlation (ρ > 0.998, ρc > 0.995) and absolute mean differences < 2.2% between FB radial and BH SVS, as well as significant correlation (ρ > 0.999, ρc > 0.998) and absolute mean differences < 0.6% between FB radial and BH Cartesian. In the liver and abdomen, PDFF showed significant correlation (ρ > 0.986, ρc > 0.985) and absolute mean differences < 1% between FB radial and BH SVS, as well as significant correlation (ρ > 0.996, ρc > 0.995) and absolute mean differences < 0.9% between FB radial and BH Cartesian. CONCLUSION Accurate 3D liver fat quantification can be performed in 1 to 2 min using a novel FB radial technique. Magn Reson Med 79:370-382, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Tess Armstrong
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, USA.,Department of Physics and Biology in Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Isabel Dregely
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, USA.,Department of Biomedical Engineering, King's College London, London, United Kingdom
| | | | - Fei Han
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, USA
| | | | - Kyunghyun Sung
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, USA.,Department of Physics and Biology in Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Holden H Wu
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, USA.,Department of Physics and Biology in Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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131
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Hayashi T, Saitoh S, Takahashi J, Tsuji Y, Ikeda K, Kobayashi M, Kawamura Y, Fujii T, Inoue M, Miyati T, Kumada H. Hepatic fat quantification using the two-point Dixon method and fat color maps based on non-alcoholic fatty liver disease activity score. Hepatol Res 2017; 47:455-464. [PMID: 27351583 DOI: 10.1111/hepr.12767] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 06/20/2016] [Accepted: 06/22/2016] [Indexed: 02/08/2023]
Abstract
AIM The two-point Dixon method for magnetic resonance imaging (MRI) is commonly used to non-invasively measure fat deposition in the liver. The aim of the present study was to assess the usefulness of MRI-fat fraction (MRI-FF) using the two-point Dixon method based on the non-alcoholic fatty liver disease activity score. METHODS This retrospective study included 106 patients who underwent liver MRI and MR spectroscopy, and 201 patients who underwent liver MRI and histological assessment. The relationship between MRI-FF and MR spectroscopy-fat fraction was used to estimate the corrected MRI-FF for hepatic multi-peaks of fat. Then, a color FF map was generated with the corrected MRI-FF based on the non-alcoholic fatty liver disease activity score. We defined FF variability as the standard deviation of FF in regions of interest. Uniformity of hepatic fat was visually graded on a three-point scale using both gray-scale and color FF maps. Confounding effects of histology (iron, inflammation and fibrosis) on corrected MRI-FF were assessed by multiple linear regression. RESULTS The linear correlations between MRI-FF and MR spectroscopy-fat fraction, and between corrected MRI-FF and histological steatosis were strong (R2 = 0.90 and R2 = 0.88, respectively). Liver fat variability significantly increased with visual fat uniformity grade using both of the maps (ρ = 0.67-0.69, both P < 0.001). Hepatic iron, inflammation and fibrosis had no significant confounding effects on the corrected MRI-FF (all P > 0.05). CONCLUSIONS The two-point Dixon method and the gray-scale or color FF maps based on the non-alcoholic fatty liver disease activity score were useful for fat quantification in the liver of patients without severe iron deposition.
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Affiliation(s)
- Tatsuya Hayashi
- Department of Radiological Technology, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Tokyo, Japan.,Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan.,Department of Medical Radiology, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Satoshi Saitoh
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan.,Department of Hepatology, Toranomon Hospital, Tokyo, Japan.,Department of Radiology, Toranomon Hospital, Tokyo, Japan
| | - Junji Takahashi
- Department of Radiological Technology, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Yoshinori Tsuji
- Department of Radiological Technology, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Kenji Ikeda
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan.,Department of Hepatology, Toranomon Hospital, Tokyo, Japan
| | - Masahiro Kobayashi
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan.,Department of Hepatology, Toranomon Hospital, Tokyo, Japan
| | - Yusuke Kawamura
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan.,Department of Hepatology, Toranomon Hospital, Tokyo, Japan
| | - Takeshi Fujii
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan.,Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Masafumi Inoue
- Department of Ophthalmology, Japan Community Health Care Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Tosiaki Miyati
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hiromitsu Kumada
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan.,Department of Hepatology, Toranomon Hospital, Tokyo, Japan
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Park CC, Hamilton G, Desai A, Zand KA, Wolfson T, Hooker JC, Costa E, Heba E, Clark L, Gamst A, Loomba R, Middleton MS, Sirlin CB. Effect of intravenous gadoxetate disodium and flip angle on hepatic proton density fat fraction estimation with six-echo, gradient-recalled-echo, magnitude-based MR imaging at 3T. Abdom Radiol (NY) 2017; 42:1189-1198. [PMID: 28028556 DOI: 10.1007/s00261-016-0992-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE The aim of the study was to determine in patients undergoing gadoxetate disodium (Gx)-enhanced MR exams whether proton density fat fraction (PDFF) estimation accuracy of magnitude-based multi-gradient-echo MRI (MRI-M) could be improved by using high flip angle (FA) on post-contrast images. MATERIALS AND METHODS Thirty-one adults with known or suspected hepatic steatosis undergoing 3T clinical Gx-enhanced liver MRI were enrolled prospectively. MR spectroscopy (MRS), the reference standard, was performed before Gx to measure MRS-PDFF. Low (10°)- and high (50°)-flip angle (FA) MRI-M sequences were acquired before and during the hepatobiliary phase after Gx administration; MRI-PDFF was estimated in the MRS-PDFF voxel location. Linear regression parameters (slope, intercept, average bias, R 2) were calculated for MRS-PDFF as a function of MRI-PDFF for each MRI-M sequence (pre-Gx low-FA, pre-Gx high-FA, post-Gx low-FA, post-Gx high-FA) for all patients and for patients with MRS-PDFF <10%. Regression parameters were compared (Bonferroni-adjusted bootstrap-based tests). RESULTS Three of the four MRI-M sequences (pre-Gx low-FA, post-Gx low-FA, post-Gx high-FA) provided relatively unbiased PDFF estimates overall and in the low-PDFF range, with regression slopes close to 1 and intercepts and biases close to zero. Pre-Gx high-FA MRI overestimated PDFF in proportion to MRS-PDFF, with slopes of 0.72 (overall) and 0.63 (low-PDFF range). Based on regression bias closest to 0, the post-Gx high-FA sequence was the most accurate overall and in the low-PDFF range. This sequence provided statistically significant improvements in at least two regression parameters compared to every other sequence. CONCLUSION In patients undergoing Gx-enhanced MR exams, PDFF estimation accuracy of MRI-M can be improved by using high-FA on post-contrast images.
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Affiliation(s)
- Charlie C Park
- MR3T Bydder Laboratory, Liver Imaging Group, Department of Radiology, University of California, San Diego, 408 Dickinson Street, MC 8226, San Diego, CA, 92103-8226, USA
| | - Gavin Hamilton
- MR3T Bydder Laboratory, Liver Imaging Group, Department of Radiology, University of California, San Diego, 408 Dickinson Street, MC 8226, San Diego, CA, 92103-8226, USA
| | - Ajinkya Desai
- Department of Diagnostic and Interventional Radiology, Rochester General Hospital, Rochester, NY, USA
| | - Kevin A Zand
- MR3T Bydder Laboratory, Liver Imaging Group, Department of Radiology, University of California, San Diego, 408 Dickinson Street, MC 8226, San Diego, CA, 92103-8226, USA
| | - Tanya Wolfson
- Computational and Applied Statistics Laboratory (CASL), San Diego Supercomputer Center (SDSC), University of California, San Diego, La Jolla, CA, USA
| | - Jonathan C Hooker
- MR3T Bydder Laboratory, Liver Imaging Group, Department of Radiology, University of California, San Diego, 408 Dickinson Street, MC 8226, San Diego, CA, 92103-8226, USA
| | - Eduardo Costa
- MR3T Bydder Laboratory, Liver Imaging Group, Department of Radiology, University of California, San Diego, 408 Dickinson Street, MC 8226, San Diego, CA, 92103-8226, USA
| | - Elhamy Heba
- MR3T Bydder Laboratory, Liver Imaging Group, Department of Radiology, University of California, San Diego, 408 Dickinson Street, MC 8226, San Diego, CA, 92103-8226, USA
| | - Lisa Clark
- MR3T Bydder Laboratory, Liver Imaging Group, Department of Radiology, University of California, San Diego, 408 Dickinson Street, MC 8226, San Diego, CA, 92103-8226, USA
| | - Anthony Gamst
- Computational and Applied Statistics Laboratory (CASL), San Diego Supercomputer Center (SDSC), University of California, San Diego, La Jolla, CA, USA
| | - Rohit Loomba
- Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
- Division of Epidemiology, Department of Family Medicine and Preventive Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Michael S Middleton
- MR3T Bydder Laboratory, Liver Imaging Group, Department of Radiology, University of California, San Diego, 408 Dickinson Street, MC 8226, San Diego, CA, 92103-8226, USA
| | - Claude B Sirlin
- MR3T Bydder Laboratory, Liver Imaging Group, Department of Radiology, University of California, San Diego, 408 Dickinson Street, MC 8226, San Diego, CA, 92103-8226, USA.
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A Pilot Comparative Study of Quantitative Ultrasound, Conventional Ultrasound, and MRI for Predicting Histology-Determined Steatosis Grade in Adult Nonalcoholic Fatty Liver Disease. AJR Am J Roentgenol 2017; 208:W168-W177. [PMID: 28267360 DOI: 10.2214/ajr.16.16726] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of this study is to explore the diagnostic performance of two investigational quantitative ultrasound (QUS) parameters, attenuation coefficient and backscatter coefficient, in comparison with conventional ultrasound (CUS) and MRI-estimated proton density fat fraction (PDFF) for predicting histology-confirmed steatosis grade in adults with nonalcoholic fatty liver disease (NAFLD). SUBJECTS AND METHODS In this prospectively designed pilot study, 61 adults with histology-confirmed NAFLD were enrolled from September 2012 to February 2014. Subjects underwent QUS, CUS, and MRI examinations within 100 days of clinical-care liver biopsy. QUS parameters (attenuation coefficient and backscatter coefficient) were estimated using a reference phantom technique by two analysts independently. Three-point ordinal CUS scores intended to predict steatosis grade (1, 2, or 3) were generated independently by two radiologists on the basis of QUS features. PDFF was estimated using an advanced chemical shift-based MRI technique. Using histologic examination as the reference standard, ROC analysis was performed. Optimal attenuation coefficient, backscatter coefficient, and PDFF cutoff thresholds were identified, and the accuracy of attenuation coefficient, backscatter coefficient, PDFF, and CUS to predict steatosis grade was determined. Interobserver agreement for attenuation coefficient, backscatter coefficient, and CUS was analyzed. RESULTS CUS had 51.7% grading accuracy. The raw and cross-validated steatosis grading accuracies were 61.7% and 55.0%, respectively, for attenuation coefficient, 68.3% and 68.3% for backscatter coefficient, and 76.7% and 71.3% for MRI-estimated PDFF. Interobserver agreements were 53.3% for CUS (κ = 0.61), 90.0% for attenuation coefficient (κ = 0.87), and 71.7% for backscatter coefficient (κ = 0.82) (p < 0.0001 for all). CONCLUSION Preliminary observations suggest that QUS parameters may be more accurate and provide higher interobserver agreement than CUS for predicting hepatic steatosis grade in patients with NAFLD.
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Manning PM, Hamilton G, Wang K, Park C, Hooker JC, Wolfson T, Gamst A, Haufe WM, Schlein AN, Middleton MS, Sirlin CB. Agreement between region-of-interest- and parametric map-based hepatic proton density fat fraction estimation in adults with chronic liver disease. Abdom Radiol (NY) 2017; 42:833-841. [PMID: 27688063 DOI: 10.1007/s00261-016-0925-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE To compare agreement between region-of-interest (ROI)- and parametric map-based methods of hepatic proton density fat fraction (PDFF) estimation in adults with known or suspected hepatic steatosis secondary to chronic liver disease over a range of imaging and analysis conditions. MATERIALS AND METHODS In this IRB approved HIPAA compliant prospective single-site study, 31 adults with chronic liver disease undergoing clinical gadoxetic acid-enhanced liver magnetic resonance imaging at 3 T were recruited. Multi-echo gradient-echo imaging at flip angles of 10° and 50° was performed before and after administration of gadoxetic acid. Six echoes were acquired at successive nominally out-of-phase and in-phase echo times. PDFF was estimated with a nonlinear fitting algorithm using the first two, three, four, five, and (all) six echoes. Hence, 20 different imaging and analysis conditions were used (pre/post contrast x low/high flip angle x 2/3/4/5/6 echoes). For each condition, PDFF estimation was done in corresponding liver locations using two methods: a region-of-interest (ROI)-based method in which mean signal intensity values within ROIs were run through the fitting algorithm, and a parametric map-based method in which individual signal intensities were run through the fitting algorithm pixel by pixel. Agreement between ROI- and map-based PDFF estimation was assessed by Bland-Altman and intraclass correlation (ICC) analysis. RESULTS Depending on the condition and method, PDFF ranged from -2.52% to 45.57%. Over all conditions, mean differences between ROI- and map-based PDFF estimates ranged from 0.04% to 0.24%, with all ICCs ≥0.999. CONCLUSION Agreement between ROI- and parametric map-based PDFF estimation is excellent over a wide range of imaging and analysis conditions.
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Affiliation(s)
- Paul M Manning
- Liver Imaging Group, Department of Radiology, University of California at San Diego, 408 Dickinson Street, San Diego, CA, 92103-8226, USA.
| | - Gavin Hamilton
- Liver Imaging Group, Department of Radiology, University of California at San Diego, 408 Dickinson Street, San Diego, CA, 92103-8226, USA
| | - Kang Wang
- Liver Imaging Group, Department of Radiology, University of California at San Diego, 408 Dickinson Street, San Diego, CA, 92103-8226, USA
| | - Chulhyun Park
- Liver Imaging Group, Department of Radiology, University of California at San Diego, 408 Dickinson Street, San Diego, CA, 92103-8226, USA
| | - Jonathan C Hooker
- Liver Imaging Group, Department of Radiology, University of California at San Diego, 408 Dickinson Street, San Diego, CA, 92103-8226, USA
| | - Tanya Wolfson
- Computational and Applied Statistics Laboratory (CASL), SDSC, University of California, San Diego, La Jolla, CA, USA
| | - Anthony Gamst
- Computational and Applied Statistics Laboratory (CASL), SDSC, University of California, San Diego, La Jolla, CA, USA
| | - William M Haufe
- Liver Imaging Group, Department of Radiology, University of California at San Diego, 408 Dickinson Street, San Diego, CA, 92103-8226, USA
| | - Alex N Schlein
- Liver Imaging Group, Department of Radiology, University of California at San Diego, 408 Dickinson Street, San Diego, CA, 92103-8226, USA
| | - Michael S Middleton
- Liver Imaging Group, Department of Radiology, University of California at San Diego, 408 Dickinson Street, San Diego, CA, 92103-8226, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California at San Diego, 408 Dickinson Street, San Diego, CA, 92103-8226, USA
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Motosugi U, Hernando D, Wiens C, Bannas P, Reeder SB. High SNR Acquisitions Improve the Repeatability of Liver Fat Quantification Using Confounder-corrected Chemical Shift-encoded MR Imaging. Magn Reson Med Sci 2017; 16:332-339. [PMID: 28190853 PMCID: PMC5554738 DOI: 10.2463/mrms.mp.2016-0081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To determine whether high signal-to-noise ratio (SNR) acquisitions improve the repeatability of liver proton density fat fraction (PDFF) measurements using confounder-corrected chemical shift-encoded magnetic resonance (MR) imaging (CSE-MRI). MATERIALS AND METHODS Eleven fat-water phantoms were scanned with 8 different protocols with varying SNR. After repositioning the phantoms, the same scans were repeated to evaluate the test-retest repeatability. Next, an in vivo study was performed with 20 volunteers and 28 patients scheduled for liver magnetic resonance imaging (MRI). Two CSE-MRI protocols with standard- and high-SNR were repeated to assess test-retest repeatability. MR spectroscopy (MRS)-based PDFF was acquired as a standard of reference. The standard deviation (SD) of the difference (Δ) of PDFF measured in the two repeated scans was defined to ascertain repeatability. The correlation between PDFF of CSE-MRI and MRS was calculated to assess accuracy. The SD of Δ and correlation coefficients of the two protocols (standard- and high-SNR) were compared using F-test and t-test, respectively. Two reconstruction algorithms (complex-based and magnitude-based) were used for both the phantom and in vivo experiments. RESULTS The phantom study demonstrated that higher SNR improved the repeatability for both complex- and magnitude-based reconstruction. Similarly, the in vivo study demonstrated that the repeatability of the high-SNR protocol (SD of Δ = 0.53 for complex- and = 0.85 for magnitude-based fit) was significantly higher than using the standard-SNR protocol (0.77 for complex, P < 0.001; and 0.94 for magnitude-based fit, P = 0.003). No significant difference was observed in the accuracy between standard- and high-SNR protocols. CONCLUSION Higher SNR improves the repeatability of fat quantification using confounder-corrected CSE-MRI.
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Affiliation(s)
- Utaroh Motosugi
- Department of Radiology, University of Wisconsin.,Department of Radiology, University of Yamanashi
| | | | - Curtis Wiens
- Department of Radiology, University of Wisconsin
| | - Peter Bannas
- Department of Radiology, University of Wisconsin.,Department of Radiology, University Hospital Hamburg-Eppendorf
| | - Scott B Reeder
- Department of Radiology, University of Wisconsin.,Department of Biomedical Engineering, University of Wisconsin.,Department of Medical Physics, University of Wisconsin.,Department of Medicine, University of Wisconsin.,Department of Emergency Medicine, University of Wisconsin
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Non-alcoholic fatty liver disease and subclinical atherosclerosis: A comparison of metabolically- versus genetically-driven excess fat hepatic storage. Atherosclerosis 2017; 257:232-239. [PMID: 28027788 DOI: 10.1016/j.atherosclerosis.2016.12.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/09/2016] [Accepted: 12/15/2016] [Indexed: 02/06/2023]
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Lacasse MC, Tang A, Dubois J, Alvarez F, Spahis S, Chagnon M, Deschênes S, Levy E. Monitoring the efficacy of omega-3 supplementation on liver steatosis and carotid intima-media thickness: a pilot study. Obes Sci Pract 2017; 3:201-211. [PMID: 28702213 PMCID: PMC5478813 DOI: 10.1002/osp4.91] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 11/13/2016] [Accepted: 11/16/2016] [Indexed: 12/12/2022] Open
Abstract
Purpose To determine the effects of omega‐3 supplementation on liver fat and carotid intima–media thickness (IMT) and to assess accuracy of ultrasound (US) for grading liver steatosis. Materials and Methods In this one‐way crossover pilot study, we assigned children with obesity and liver steatosis to receive 1.2 g daily of omega‐3 supplementation vs. inactive sunflower oil for 24 or 12 weeks. Liver fat content was assessed by magnetic resonance spectroscopy (MRS), magnetic resonance imaging (MRI) and US, and common carotid IMT by US. Statistical analysis included Chi‐square, Student's t‐tests, ANOVA tests and receiver operating characteristic (ROC) curves. Results Omega‐3 supplementation was associated with a trend towards decrease in MRS‐determined liver fat fraction (0.7% and 2.1% decrease in the 24‐week and 12‐week omega‐3 group, respectively) compared with the sunflower oil group (1.0% increase). These changes were not significant, whether assessed by MRS (P = 0.508), MRI (P = 0.508) or US (P = 0.678). Using US, the area under the ROC curves were 0.964, 0.817 and 0.783 for distinguishing inferred steatosis grades 0 vs. 1–2–3, 0–1 vs. 2–3 and 0–1–2 vs. 3, respectively, indicating good accuracy of US‐based fat grading. Omega‐3 supplementation was associated with a decrease in US‐determined IMT (0.05‐mm decrease in the 24‐week omega‐3 group. A 0.015‐mm increase was found in the 12‐week omega‐3 group, and a 0.007‐mm decrease in the sunflower oil group (P = 0.003). Conclusion Omega‐3 supplementation had no significant effect on liver fat fraction, but led to carotid IMT decrease in children with obesity and liver steatosis.
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Affiliation(s)
- M-C Lacasse
- Department of Radiology Centre Hospitalier de l'Université de Montréal (CHUM) Montréa Québec Canada
| | - A Tang
- Department of Radiology Centre Hospitalier de l'Université de Montréal (CHUM) Montréa Québec Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) Montréal Québec Canada
| | - J Dubois
- Department of Radiology Centre Hospitalier Universitaire Ste-Justine Montréal Québec Canada.,Centre de Recherche du Centre Hospitalier Universitaire Ste-Justine Montréal Québec Canada
| | - F Alvarez
- Centre de Recherche du Centre Hospitalier Universitaire Ste-Justine Montréal Québec Canada.,Department of Gastroenterology, Hepatology and NutritionCentre Hospitalier Universitaire Ste-Justine Montréal Québec Canada
| | - S Spahis
- Centre de Recherche du Centre Hospitalier Universitaire Ste-Justine Montréal Québec Canada.,Department of Gastroenterology, Hepatology and NutritionCentre Hospitalier Universitaire Ste-Justine Montréal Québec Canada.,Department of Nutrition Université de Montréal Québec Canada
| | - M Chagnon
- Department of Mathematics and Statistics, Pavillon André-Aisenstadt Université de Montréal Montréal Québec Canada
| | - S Deschênes
- Department of Radiology Centre Hospitalier Universitaire Ste-Justine Montréal Québec Canada.,Centre de Recherche du Centre Hospitalier Universitaire Ste-Justine Montréal Québec Canada
| | - E Levy
- Centre de Recherche du Centre Hospitalier Universitaire Ste-Justine Montréal Québec Canada.,Department of Gastroenterology, Hepatology and NutritionCentre Hospitalier Universitaire Ste-Justine Montréal Québec Canada
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Dulai PS, Sirlin CB, Loomba R. MRI and MRE for non-invasive quantitative assessment of hepatic steatosis and fibrosis in NAFLD and NASH: Clinical trials to clinical practice. J Hepatol 2016; 65:1006-1016. [PMID: 27312947 PMCID: PMC5124376 DOI: 10.1016/j.jhep.2016.06.005] [Citation(s) in RCA: 244] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 05/19/2016] [Accepted: 06/06/2016] [Indexed: 02/07/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) represents one of the most common causes of chronic liver disease, and its prevalence is rising worldwide. The occurrence of non-alcoholic steatohepatitis (NASH) is associated with a substantial increase in disease related morbidity and mortality. Accordingly, there has been a surge of innovation surrounding drug development in an effort to off-set the natural progression and long-term risks of this disease. Disease assessment within clinical trials and clinical practice for NAFLD is currently done with liver biopsies. Liver biopsy-based assessments, however, remain imprecise and are not without cost or risk. This carries significant implications for the feasibility and costs of bringing therapeutic interventions to market. A need therefore arises for reliable and highly accurate surrogate end-points that can be used in phase 2 and 3 clinical trials to reduce trial size requirements and costs, while improving feasibility and ease of implementation in clinical practice. Significant advances have now been made in magnetic resonance technology, and magnetic resonance imaging (MRI) and elastrography (MRE) have been demonstrated to be highly accurate diagnostic tools for the detection of hepatic steatosis and fibrosis. In this review article, we will summarize the currently available evidence regarding the use of MRI and MRE among NAFLD patients, and the evolving role these surrogate biomarkers will play in the rapidly advancing arena of clinical trials in NASH and hepatic fibrosis. Furthermore, we will highlight how these tools can be readily applied to routine clinical practice, where the growing burden of NAFLD will need to be met with enhanced monitoring algorithms.
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Affiliation(s)
- Parambir S Dulai
- Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, CA, United States
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, CA, United States
| | - Rohit Loomba
- Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, CA, United States; NAFLD Research Center, Department of Medicine, University of California at San Diego, La Jolla, CA, United States.
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Di Martino M, Pacifico L, Bezzi M, Di Miscio R, Sacconi B, Chiesa C, Catalano C. Comparison of magnetic resonance spectroscopy, proton density fat fraction and histological analysis in the quantification of liver steatosis in children and adolescents. World J Gastroenterol 2016; 22:8812-8819. [PMID: 27818597 PMCID: PMC5075556 DOI: 10.3748/wjg.v22.i39.8812] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/30/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To establish a threshold value for liver fat content between healthy children and those with non-alcoholic fatty liver disease (NAFLD) by using magnetic resonance imaging (MRI), with liver biopsy serving as a reference standard.
METHODS The study was approved by the local ethics committee, and written informed consent was obtained from all participants and their legal guardians before the study began. Twenty-seven children with NAFLD underwent liver biopsy to assess the presence of nonalcoholic steatohepatitis. The assessment of liver fat fraction was performed using MRI, with a high field magnet and 2D gradient-echo and multiple-echo T1-weighted sequence with low flip angle and single-voxel point-resolved ¹H MR-Spectroscopy (¹H-MRS), corrected for T1 and T2* decays. Receiver operating characteristic curve analysis was used to determine the best cut-off value. Lin coefficient test was used to evaluate the correlation between histology, MRS and MRI-PDFF. A Mann-Whitney U-test and multivariate analysis were performed to analyze the continuous variables.
RESULTS According to MRS, the threshold value between healthy children and those with NAFLD is 6%; using MRI-PDFF, a cut-off value of 3.5% is suggested. The Lin analysis revealed a good fit between the histology and MRS as well as MRI-PDFF.
CONCLUSION MRS is an accurate and precise method for detecting NAFLD in children.
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Mitra S, Fernandez-Del-Valle M, Hill JE. The role of MRI in understanding the underlying mechanisms in obesity associated diseases. Biochim Biophys Acta Mol Basis Dis 2016; 1863:1115-1131. [PMID: 27639834 DOI: 10.1016/j.bbadis.2016.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/08/2016] [Accepted: 09/08/2016] [Indexed: 02/07/2023]
Abstract
Obesity and its possible association with diseases including diabetes and cardiovascular diseases have been studied for decades for its impact on healthcare. Recent studies clearly indicate the need for developing accurate and reproducible methodologies for assessing body fat content and distribution. Body fat distribution plays a significant role in developing an insight in the underlying mechanisms in which adipose tissue is linked with various diseases. Among imaging technologies including computerized axial tomography (CAT or CT), magnetic resonance imaging (MRI), and magnetic resonance spectroscopy (MRS), MRI and MRS seem to be the best emerging techniques and together are being considered as the gold standard for body fat content and distribution. This paper reviews studies up to the present time involving different methodologies of these two emerging technologies and presents the basic concepts of MRI and MRS with required novel image analysis techniques in accurate, quantitative, and direct assessment of body fat content and distribution. This article is part of a Special Issue entitled: Oxidative Stress and Mitochondrial Quality in Diabetes/Obesity and Critical Illness Spectrum of Diseases - edited by P. Hemachandra Reddy.
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Affiliation(s)
| | | | - Jason E Hill
- Texas Tech University, Lubbock, TX, United States
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141
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Pirasteh A, Clark HR, Sorra EA, Pedrosa I, Yokoo T. Effect of steatosis on liver signal and enhancement on multiphasic contrast-enhanced magnetic resonance imaging. Abdom Radiol (NY) 2016; 41:1744-50. [PMID: 27108126 DOI: 10.1007/s00261-016-0736-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To investigate the effect of steatosis on liver signal and enhancement in multiphasic contrast-enhanced (MCE) MRI. MATERIALS AND METHODS In this IRB-approved, HIPAA-compliant, retrospective, observational study, 1217 MCE abdominal MRIs performed during 2014 at a single institution were reviewed. Of these, 1085 were excluded, due to potential factors other than steatosis that may affect liver signal intensity and/or enhancement. In the remaining 132, liver fat fraction (FF) was calculated from the in- and opposed-phase 2D T1-weighted images. Liver signal intensity, absolute enhancement, and relative enhancement on fat-suppressed (Dixon method) 3D T1-weighted images before and after injection of gadobutrol (arterial, portal venous, and equilibrium phases) were plotted against co-localized FF values and the linear trend was evaluated by Pearson correlation coefficient (r). P values <0.05 were considered statistically significant. RESULTS Liver signal intensity negatively correlated with FF for all phases (r = -0.388 to -0.544, p < 0.001). Absolute enhancement negatively correlated with FF for the portal venous and equilibrium phases (r = -0.286 and -0.289, respectively, p < 0.001), but not for the arterial phase (r = -0.042, p = 0.632). Relative enhancement did not significantly correlate with FF for any phase (p ≥ 0.125). CONCLUSION Steatosis reduces liver signal intensity in MCE MRI. This effect of steatosis was reduced in calculated absolute enhancement and eliminated in calculated relative enhancement.
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Affiliation(s)
- Ali Pirasteh
- Department of Radiology, University of Texas Southwestern Medical Center, 2201 Inwood Road, NE2.210B, Dallas, TX, 75390-9085, USA
| | - Haley R Clark
- Department of Radiology, University of Texas Southwestern Medical Center, 2201 Inwood Road, NE2.210B, Dallas, TX, 75390-9085, USA
| | - Endel A Sorra
- Department of Radiology, University of Texas Southwestern Medical Center, 2201 Inwood Road, NE2.210B, Dallas, TX, 75390-9085, USA
| | - Ivan Pedrosa
- Department of Radiology, University of Texas Southwestern Medical Center, 2201 Inwood Road, NE2.210B, Dallas, TX, 75390-9085, USA
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, 2201 Inwood Road, NE2.210B, Dallas, TX, 75390-9085, USA
| | - Takeshi Yokoo
- Department of Radiology, University of Texas Southwestern Medical Center, 2201 Inwood Road, NE2.210B, Dallas, TX, 75390-9085, USA.
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, 2201 Inwood Road, NE2.210B, Dallas, TX, 75390-9085, USA.
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Patel J, Bettencourt R, Cui J, Salotti J, Hooker J, Bhatt A, Hernandez C, Nguyen P, Aryafar H, Valasek M, Haufe W, Hooker C, Richards L, Sirlin CB, Loomba R. Association of noninvasive quantitative decline in liver fat content on MRI with histologic response in nonalcoholic steatohepatitis. Therap Adv Gastroenterol 2016; 9:692-701. [PMID: 27582882 PMCID: PMC4984335 DOI: 10.1177/1756283x16656735] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Magnetic resonance imaging-estimated proton-density-fat-fraction (MRI-PDFF) has been shown to be a noninvasive, accurate and reproducible imaging-based biomarker for assessing steatosis and treatment response in nonalcoholic steatohepatitis (NASH) clinical trials. However, there are no data on the magnitude of MRI-PDFF reduction corresponding to histologic response in the setting of a NASH clinical trial. The aim of this study was to quantitatively compare the magnitude of MRI-PDFF reduction between histologic responders versus histologic nonresponders in NASH patients. METHODS This study is a secondary analysis of the MOZART trial, which included 50 patients with biopsy-proven NASH randomized to ezetimibe 10 mg/day orally or placebo for 24 weeks. The primary aim was to perform a head-to-head comparative analysis of histologic responders [defined as a ⩾2-point reduction in the nonalcoholic fatty liver disease (NAFLD) Activity Score (NAS) without worsening fibrosis] versus nonresponders, and the corresponding quantitative change in liver fat content measured via MRI-PDFF. RESULTS Of the 35 patients who underwent paired liver biopsy and MRI-PDFF assessment at the beginning and end of treatment, 10 demonstrated a histologic response. Compared with histologic nonresponders, histologic responders had a statistically significant reduction in MRI-PDFF of -4.1% ± 4.9 versus -0.6 ± 4.1 (p < 0.04) with a mean relative percent change of -29.3% ± 33.0 versus +2.0% ± 24.0 (p < 0.004), respectively. CONCLUSIONS Utilizing paired MRI-PDFF and liver histology data, we demonstrate that a relative reduction of 29% in liver fat on MRI-PDFF is associated with a histologic response in NASH. After external validation by independent research groups, these results can be incorporated into designing future NASH clinical trials, especially those utilizing change in hepatic fat quantified by MRI-PDFF, as a treatment endpoint.
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Affiliation(s)
- Janki Patel
- Department of Internal Medicine, University of California at San Diego, La Jolla, CA, USA
| | - Ricki Bettencourt
- NAFLD Translational Research Unit, Department of Medicine, University of California at San Diego, La Jolla, CA, USA Division of Epidemiology, Department of Family and Preventive Medicine, University of California at San Diego, La Jolla, CA, USA
| | - Jeffrey Cui
- NAFLD Translational Research Unit, Department of Medicine, University of California at San Diego, La Jolla, CA, USA
| | - Joanie Salotti
- NAFLD Translational Research Unit, Department of Medicine, University of California at San Diego, La Jolla, CA, USA Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, CA, USA
| | - Jonathan Hooker
- Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, CA, USA
| | - Archana Bhatt
- NAFLD Translational Research Unit, Department of Medicine, University of California at San Diego, La Jolla, CA, USA
| | - Carolyn Hernandez
- NAFLD Translational Research Unit, Department of Medicine, University of California at San Diego, La Jolla, CA, USA
| | - Phirum Nguyen
- NAFLD Translational Research Unit, Department of Medicine, University of California at San Diego, La Jolla, CA, USA Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, CA, USA
| | - Hamed Aryafar
- Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, CA, USA
| | - Mark Valasek
- Department of Pathology, University of California at San Diego, La Jolla, CA, USA
| | - William Haufe
- Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, CA, USA
| | - Catherine Hooker
- Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, CA, USA
| | - Lisa Richards
- NAFLD Translational Research Unit, Department of Medicine, University of California at San Diego, La Jolla, CA, USA Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, CA, USA
| | - Claude B. Sirlin
- Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, CA, USA
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143
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Intra- and inter-examination repeatability of magnetic resonance spectroscopy, magnitude-based MRI, and complex-based MRI for estimation of hepatic proton density fat fraction in overweight and obese children and adults. ACTA ACUST UNITED AC 2016; 40:3070-7. [PMID: 26350282 DOI: 10.1007/s00261-015-0542-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE Determine intra- and inter-examination repeatability of magnitude-based magnetic resonance imaging (MRI-M), complex-based magnetic resonance imaging (MRI-C), and magnetic resonance spectroscopy (MRS) at 3T for estimating hepatic proton density fat fraction (PDFF), and using MRS as a reference, confirm MRI-M and MRI-C accuracy. METHODS Twenty-nine overweight and obese pediatric (n = 20) and adult (n = 9) subjects (23 male, 6 female) underwent three same-day 3T MR examinations. In each examination MRI-M, MRI-C, and single-voxel MRS were acquired three times. For each MRI acquisition, hepatic PDFF was estimated at the MRS voxel location. Intra- and inter-examination repeatability were assessed by computing standard deviations (SDs) and intra-class correlation coefficients (ICCs). Aggregate SD was computed for each method as the square root of the average of first repeat variances. MRI-M and MRI-C PDFF estimation accuracy was assessed using linear regression with MRS as a reference. RESULTS For MRI-M, MRI-C, and MRS acquisitions, respectively, mean intra-examination SDs were 0.25%, 0.42%, and 0.49%; mean intra-examination ICCs were 0.999, 0.997, and 0.995; mean inter-examination SDs were 0.42%, 0.45%, and 0.46%; and inter-examination ICCs were 0.995, 0.992, and 0.990. Aggregate SD for each method was <0.9%. Using MRS as a reference, regression slope, intercept, average bias, and R (2), respectively, for MRI-M were 0.99%, 1.73%, 1.61%, and 0.986, and for MRI-C were 0.96%, 0.43%, 0.40%, and 0.991. CONCLUSION MRI-M, MRI-C, and MRS showed high intra- and inter-examination hepatic PDFF estimation repeatability in overweight and obese subjects. Longitudinal hepatic PDFF change >1.8% (twice the maximum aggregate SD) may represent real change rather than measurement imprecision. Further research is needed to assess whether examinations performed on different days or with different MR technologists affect repeatability of MRS voxel placement and MRS-based PDFF measurements.
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144
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Achmad E, Yokoo T, Hamilton G, Heba ER, Hooker JC, Changchien C, Schroeder M, Wolfson T, Gamst A, Schwimmer JB, Lavine JE, Sirlin CB, Middleton MS. Feasibility of and agreement between MR imaging and spectroscopic estimation of hepatic proton density fat fraction in children with known or suspected nonalcoholic fatty liver disease. ACTA ACUST UNITED AC 2016. [PMID: 26205992 DOI: 10.1007/s00261-015-0506-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To assess feasibility of and agreement between magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) for estimating hepatic proton density fat fraction (PDFF) in children with known or suspected nonalcoholic fatty liver disease (NAFLD). MATERIALS AND METHODS Children were included in this study from two previous research studies in each of which three MRI and three MRS acquisitions were obtained. Sequence acceptability, and MRI- and MRS-estimated PDFF were evaluated. Agreement of MRI- with MRS-estimated hepatic PDFF was assessed by linear regression and Bland-Altman analysis. Age, sex, BMI-Z score, acquisition time, and artifact score effects on MRI- and MRS-estimated PDFF agreement were assessed by multiple linear regression. RESULTS Eighty-six children (61 boys and 25 girls) were included in this study. Slope and intercept from regressing MRS-PDFF on MRI-PDFF were 0.969 and 1.591%, respectively, and the Bland-Altman bias and 95% limits of agreement were 1.17% ± 2.61%. MRI motion artifact score was higher in boys than girls (by 0.21, p = 0.021). Higher BMI-Z score was associated with lower agreement between MRS and MRI (p = 0.045). CONCLUSION Hepatic PDFF estimation by both MRI and MRS is feasible, and MRI- and MRS-estimated PDFF agree closely in children with known or suspected NAFLD.
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Affiliation(s)
- Emil Achmad
- Liver Imaging Group, Department of Radiology, School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Takeshi Yokoo
- Liver Imaging Group, Department of Radiology, School of Medicine, University of California, San Diego, San Diego, CA, USA
- Department of Radiology and Advanced Imaging Research Center, UT Southwestern School of Medicine, Dallas, TX, USA
| | - Gavin Hamilton
- Liver Imaging Group, Department of Radiology, School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Elhamy R Heba
- Liver Imaging Group, Department of Radiology, School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Jonathan C Hooker
- Liver Imaging Group, Department of Radiology, School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Christopher Changchien
- Liver Imaging Group, Department of Radiology, School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Michael Schroeder
- Liver Imaging Group, Department of Radiology, School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Tanya Wolfson
- Computational and Applied Statistics Laboratory (CASL), San Diego Supercomputing Center (SDSC), University of California, San Diego, San Diego, CA, USA
| | - Anthony Gamst
- Computational and Applied Statistics Laboratory (CASL), San Diego Supercomputing Center (SDSC), University of California, San Diego, San Diego, CA, USA
| | - Jeffrey B Schwimmer
- Liver Imaging Group, Department of Radiology, School of Medicine, University of California, San Diego, San Diego, CA, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, School of Medicine, University of California, San Diego, San Diego, CA, USA
- Department of Gastroenterology, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Joel E Lavine
- Department of Pediatrics, Columbia University, New York, NY, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Michael S Middleton
- Liver Imaging Group, Department of Radiology, School of Medicine, University of California, San Diego, San Diego, CA, USA.
- UCSD Department of Radiology, UCSD MRI Institute, 410 West Dickinson Street, San Diego, CA, 92103-8749, USA.
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Stability of liver proton density fat fraction and changes in R 2* measurements induced by administering gadoxetic acid at 3T MRI. Abdom Radiol (NY) 2016; 41:1555-64. [PMID: 27052456 DOI: 10.1007/s00261-016-0728-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess changes in liver proton density fat fraction (PDFF) and R 2* measurements in the presence of changes in tissue relaxation rates induced by administrating gadoxetic acid, using two different image reconstruction methods at 3T MRI. METHODS Forty-five patients were imaged at 3T with chemical-shift-based MRI sequences before and 20 min after administration of gadoxetic acid. Image reconstructions were performed using hybrid and complex methods to obtain PDFF and R 2* images. A single radiologist measured PDFF and R 2* values on precontrast and postcontrast images. Precontrast and postcontrast PDFF values were compared using intraclass correlation coefficient (ICC), linear regression, and Bland-Altman analysis. Changes in R 2* values from precontrast to postcontrast were correlated with relative liver enhancement (RLE) based on signal intensities on T 1-weighted images using Spearman's rank correlation. RESULTS PDFF values were similar between precontrast and postcontrast images (ICC = 0.99, linear regression slopes = 0.98, mean difference = -0.21 to -0.31%). PDFF measurements were stable between precontrast and postcontrast images. Changes in R 2* values were correlated with RLE (p < 0.001, r = 0.49-0.71). CONCLUSIONS PDFF measurements from both image reconstruction methods are stable in the presence of changes in tissue relaxation rates after administering gadoxetic acid at 3T MRI. Changes in R 2* values correlate with established measures of gadoxetic acid uptake based on T 1-weighted images.
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146
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Kim RG, Nguyen P, Bettencourt R, Dulai PS, Haufe W, Hooker J, Minocha J, Valasek MA, Aryafar H, Brenner DA, Sirlin CB, Loomba R. Magnetic resonance elastography identifies fibrosis in adults with alpha-1 antitrypsin deficiency liver disease: a prospective study. Aliment Pharmacol Ther 2016; 44:287-99. [PMID: 27279429 DOI: 10.1111/apt.13691] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 04/28/2016] [Accepted: 05/19/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Limited data exist on the clinical presentation and non-invasive detection of liver fibrosis in adults with homozygous Z genotype alpha-1 antitrypsin (AAT) deficiency. AIMS To compare demographic, biochemical, histological and imaging data of AAT deficient patients to normal-control and biopsy-proven non-alcoholic fatty liver disease (NAFLD) patients, and to assess the diagnostic accuracy of magnetic resonance elastography (MRE) in detecting fibrosis in AAT deficiency. METHODS Study includes 33 participants, 11 per group, who underwent clinical research evaluation, liver biopsy (AAT and NAFLD groups), and MRE. Histological fibrosis was quantified using a modified Ishak 6-point scale and liver stiffness by MRE. Diagnostic performance of MRE in detecting fibrosis was assessed by receiver operating characteristic (ROC) analysis. RESULTS Mean (±s.d.) of age and BMI of normal-control, AAT and NAFLD groups was 57 (±19), 57 (±18), and 57 (±13) years, and 22.7 (±2.5), 24.8 (±4.0) and 31.0 (±5.1) kg/m(2) respectively. Serum ALT [mean ± s.d.] was similar within normal-control [16.4 ± 4.0] and AAT groups [23.5 ± 10.8], but was significantly lower in AAT than NAFLD even after adjustment for stage of fibrosis (P < 0.05, P = 0.0172). For fibrosis detection, MRE-estimated stiffness had an area under the ROC curve of 0.90 (P < 0.0001); an MRE threshold of ≥3.0 kPa provided 88.9% accuracy, with 80% sensitivity and 100% specificity to detect presence of any fibrosis (stage ≥1). CONCLUSIONS This pilot prospective study suggests magnetic resonance elastography may be accurate for identifying fibrosis in patients with alpha-1 antitrypsin deficiency. Larger validation studies are warranted.
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Affiliation(s)
- R G Kim
- Division of Internal Medicine, Department of Medicine, University of California at San Diego, La Jolla, CA, USA
| | - P Nguyen
- Department of Medicine, NAFLD Translational Research Unit, University of California at San Diego, La Jolla, CA, USA
| | - R Bettencourt
- Department of Medicine, NAFLD Translational Research Unit, University of California at San Diego, La Jolla, CA, USA.,Division of Epidemiology, Department of Family Medicine and Public Health, University of California at San Diego, La Jolla, CA, USA
| | - P S Dulai
- Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, CA, USA
| | - W Haufe
- Department of Radiology, Liver Imaging Group, University of California at San Diego, La Jolla, CA, USA
| | - J Hooker
- Department of Radiology, Liver Imaging Group, University of California at San Diego, La Jolla, CA, USA
| | - J Minocha
- Department of Radiology, University of California at San Diego, La Jolla, CA, USA
| | - M A Valasek
- Department of Pathology, University of California at San Diego, La Jolla, CA, USA
| | - H Aryafar
- Department of Radiology, University of California at San Diego, La Jolla, CA, USA
| | - D A Brenner
- Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, CA, USA
| | - C B Sirlin
- Department of Radiology, Liver Imaging Group, University of California at San Diego, La Jolla, CA, USA
| | - R Loomba
- Department of Medicine, NAFLD Translational Research Unit, University of California at San Diego, La Jolla, CA, USA.,Division of Epidemiology, Department of Family Medicine and Public Health, University of California at San Diego, La Jolla, CA, USA.,Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, CA, USA
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147
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Horng DE, Hernando D, Reeder SB. Quantification of liver fat in the presence of iron overload. J Magn Reson Imaging 2016; 45:428-439. [PMID: 27405703 DOI: 10.1002/jmri.25382] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/20/2016] [Indexed: 01/10/2023] Open
Abstract
PURPOSE To evaluate the accuracy of R2* models (1/T2 * = R2*) for chemical shift-encoded magnetic resonance imaging (CSE-MRI)-based proton density fat-fraction (PDFF) quantification in patients with fatty liver and iron overload, using MR spectroscopy (MRS) as the reference standard. MATERIALS AND METHODS Two Monte Carlo simulations were implemented to compare the root-mean-squared-error (RMSE) performance of single-R2* and dual-R2* correction in a theoretical liver environment with high iron. Fatty liver was defined as hepatic PDFF >5.6% based on MRS; only subjects with fatty liver were considered for analyses involving fat. From a group of 40 patients with known/suspected iron overload, nine patients were identified at 1.5T, and 13 at 3.0T with fatty liver. MRS linewidth measurements were used to estimate R2* values for water and fat peaks. PDFF was measured from CSE-MRI data using single-R2* and dual-R2* correction with magnitude and complex fitting. RESULTS Spectroscopy-based R2* analysis demonstrated that the R2* of water and fat remain close in value, both increasing as iron overload increases: linear regression between R2*W and R2*F resulted in slope = 0.95 [0.79-1.12] (95% limits of agreement) at 1.5T and slope = 0.76 [0.49-1.03] at 3.0T. MRI-PDFF using dual-R2* correction had severe artifacts. MRI-PDFF using single-R2* correction had good agreement with MRS-PDFF: Bland-Altman analysis resulted in -0.7% (bias) ± 2.9% (95% limits of agreement) for magnitude-fit and -1.3% ± 4.3% for complex-fit at 1.5T, and -1.5% ± 8.4% for magnitude-fit and -2.2% ± 9.6% for complex-fit at 3.0T. CONCLUSION Single-R2* modeling enables accurate PDFF quantification, even in patients with iron overload. LEVEL OF EVIDENCE 1 J. Magn. Reson. Imaging 2017;45:428-439.
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Affiliation(s)
- Debra E Horng
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA.,Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Diego Hernando
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Scott B Reeder
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA.,Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA.,Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, USA.,Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA.,Department of Emergency Medicine, University of Wisconsin, Madison, Wisconsin, USA
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148
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Ferolla SM, Couto CA, Costa-Silva L, Armiliato GNA, Pereira CAS, Martins FS, Ferrari MDLA, Vilela EG, Torres HOG, Cunha AS, Ferrari TCA. Beneficial Effect of Synbiotic Supplementation on Hepatic Steatosis and Anthropometric Parameters, But Not on Gut Permeability in a Population with Nonalcoholic Steatohepatitis. Nutrients 2016; 8:nu8070397. [PMID: 27367724 PMCID: PMC4963873 DOI: 10.3390/nu8070397] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/10/2016] [Accepted: 06/20/2016] [Indexed: 02/06/2023] Open
Abstract
Nonalcoholic fatty liver disease is the most prevalent chronic liver disease in Western countries; it can progress to nonalcoholic steatohepatitis (NASH), cirrhosis and hepatocarcinoma. The importance of gut-liver-adipose tissue axis has become evident and treatments targeting gut microbiota may improve inflammatory and metabolic parameters in NASH patients. In a randomized, controlled clinical trial, involving 50 biopsy-proven NASH patients, we investigated the effects of synbiotic supplementation on metabolic parameters, hepatic steatosis, intestinal permeability, small intestinal bacterial overgrowth (SIBO) and lipopolysaccharide (LPS) serum levels. Patients were separated into two groups receiving Lactobacillus reuteri with guar gum and inulin for three months and healthy balanced nutritional counseling versus nutritional counseling alone. Before and after the intervention we assessed steatosis by magnetic resonance imaging, intestinal permeability by lactulose/mannitol urinary excretion and SIBO by glucose breath testing. NASH patients presented high gut permeability, but low prevalence of SIBO. After the intervention, only the synbiotic group presented a reduction in steatosis, lost weight, diminished BMI and waist circumference measurement. Synbiotic did not improve intestinal permeability or LPS levels. We concluded that synbiotic supplementation associated with nutritional counseling seems superior to nutritional counseling alone for NASH treatment as it attenuates steatosis and may help to achieve weight loss.
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Affiliation(s)
- Silvia M Ferolla
- Departamento de ClínicaMédica, Faculdade de Medicina, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Brazil.
| | - Cláudia A Couto
- Departamento de ClínicaMédica, Faculdade de Medicina, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Brazil.
| | - Luciana Costa-Silva
- Departamento de Anatomia e Imagem, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Brazil.
| | - Geyza N A Armiliato
- Departamento de ClínicaMédica, Faculdade de Medicina, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Brazil.
| | - Cristiano A S Pereira
- Departamento de ClínicaMédica, Faculdade de Medicina, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Brazil.
| | - Flaviano S Martins
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte31270-901, Brazil.
| | - Maria de Lourdes A Ferrari
- Departamento de ClínicaMédica, Faculdade de Medicina, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Brazil.
| | - Eduardo G Vilela
- Departamento de ClínicaMédica, Faculdade de Medicina, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Brazil.
| | - Henrique O G Torres
- Departamento de ClínicaMédica, Faculdade de Medicina, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Brazil.
| | - Aloísio S Cunha
- Departamento de ClínicaMédica, Faculdade de Medicina, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Brazil.
| | - Teresa C A Ferrari
- Departamento de ClínicaMédica, Faculdade de Medicina, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Brazil.
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Fifty Years of Technological Innovation: Potential and Limitations of Current Technologies in Abdominal Magnetic Resonance Imaging and Computed Tomography. Invest Radiol 2016; 50:584-93. [PMID: 26039773 DOI: 10.1097/rli.0000000000000173] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Magnetic resonance imaging (MRI) has become an important modality for the diagnosis of intra-abdominal pathology. Hardware and pulse sequence developments have made it possible to derive not only morphologic but also functional information related to organ perfusion (dynamic contrast-enhanced MRI), oxygen saturation (blood oxygen level dependent), tissue cellularity (diffusion-weighted imaging), and tissue composition (spectroscopy). These techniques enable a more specific assessment of pathologic lesions and organ functionality. Magnetic resonance imaging has thus transitioned from a purely morphologic examination to a modality from which image-based disease biomarkers can be derived. This fits well with several emerging trends in radiology, such as the need to accurately assess response to costly treatment strategies and the need to improve lesion characterization to potentially avoid biopsy. Meanwhile, the cost-effectiveness, availability, and robustness of computed tomography (CT) ensure its place as the current workhorse for clinical imaging. Although the lower soft tissue contrast of CT relative to MRI is a long-standing limitation, other disadvantages such as ionizing radiation exposure have become a matter of public concern. Nevertheless, recent technical developments such as dual-energy CT or dynamic volume perfusion CT also provide more functional imaging beyond morphology.The aim of this article was to review and discuss the most important recent technical developments in abdominal MRI and state-of-the-art CT, with an eye toward the future, providing examples of their clinical utility for the evaluation of hepatic and renal pathologies.
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Vogt LJ, Steveling A, Meffert PJ, Kromrey ML, Kessler R, Hosten N, Krüger J, Gärtner S, Aghdassi AA, Mayerle J, Lerch MM, Kühn JP. Magnetic Resonance Imaging of Changes in Abdominal Compartments in Obese Diabetics during a Low-Calorie Weight-Loss Program. PLoS One 2016; 11:e0153595. [PMID: 27110719 PMCID: PMC4844151 DOI: 10.1371/journal.pone.0153595] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 03/31/2016] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To investigate changes in the fat content of abdominal compartments and muscle area during weight loss using confounder-adjusted chemical-shift-encoded magnetic resonance imaging (MRI) in overweight diabetics. METHODS Twenty-nine obese diabetics (10/19 men/women, median age: 59.0 years, median body mass index (BMI): 34.0 kg/m2) prospectively joined a standardized 15-week weight-loss program (six weeks of formula diet exclusively, followed by reintroduction of regular food with gradually increasing energy content over nine weeks) over 15 weeks. All subjects underwent a standardized MRI protocol including a confounder-adjusted chemical-shift-encoded MR sequence with water/fat separation before the program as well at the end of the six weeks of formula diet and at the end of the program at 15 weeks. Fat fractions of abdominal organs and vertebral bone marrow as well as volumes of visceral and subcutaneous fat were determined. Furthermore, muscle area was evaluated using the L4/L5 method. Data were compared using the Wilcoxon signed-rank test for paired samples. RESULTS Median BMI decreased significantly from 34.0 kg/m2 to 29.9 kg/m2 (p < 0.001) at 15 weeks. Liver fat content was normalized (14.2% to 4.1%, p < 0.001) and vertebral bone marrow fat (57.5% to 53.6%, p = 0.018) decreased significantly throughout the program, while fat content of pancreas (9.0%), spleen (0.0%), and psoas muscle (0.0%) did not (p > 0.15). Visceral fat volume (3.2 L to 1.6 L, p < 0.001) and subcutaneous fat diameter (3.0 cm to 2.2 cm, p < 0.001) also decreased significantly. Muscle area declined by 6.8% from 243.9 cm2 to 226.8 cm2. CONCLUSION MRI allows noninvasive monitoring of changes in abdominal compartments during weight loss. In overweight diabetics, weight loss leads to fat reduction in abdominal compartments, such as visceral fat, as well as liver fat and vertebral bone marrow fat while pancreas fat remains unchanged.
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Affiliation(s)
- Lena J. Vogt
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Antje Steveling
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Peter J. Meffert
- Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Marie-Luise Kromrey
- Department of Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Rebecca Kessler
- Department of Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Norbert Hosten
- Department of Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Janine Krüger
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Simone Gärtner
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Ali A. Aghdassi
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Julia Mayerle
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Markus M. Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Jens-Peter Kühn
- Department of Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
- * E-mail:
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