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Wu T, Liu C, Thamizhchelvan AM, Fleischer C, Peng X, Liu G, Mao H. Label-Free Chemically and Molecularly Selective Magnetic Resonance Imaging. CHEMICAL & BIOMEDICAL IMAGING 2023; 1:121-139. [PMID: 37235188 PMCID: PMC10207347 DOI: 10.1021/cbmi.3c00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/20/2023] [Accepted: 04/01/2023] [Indexed: 05/28/2023]
Abstract
Biomedical imaging, especially molecular imaging, has been a driving force in scientific discovery, technological innovation, and precision medicine in the past two decades. While substantial advances and discoveries in chemical biology have been made to develop molecular imaging probes and tracers, translating these exogenous agents to clinical application in precision medicine is a major challenge. Among the clinically accepted imaging modalities, magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) exemplify the most effective and robust biomedical imaging tools. Both MRI and MRS enable a broad range of chemical, biological and clinical applications from determining molecular structures in biochemical analysis to imaging diagnosis and characterization of many diseases and image-guided interventions. Using chemical, biological, and nuclear magnetic resonance properties of specific endogenous metabolites and native MRI contrast-enhancing biomolecules, label-free molecular and cellular imaging with MRI can be achieved in biomedical research and clinical management of patients with various diseases. This review article outlines the chemical and biological bases of several label-free chemically and molecularly selective MRI and MRS methods that have been applied in imaging biomarker discovery, preclinical investigation, and image-guided clinical management. Examples are provided to demonstrate strategies for using endogenous probes to report the molecular, metabolic, physiological, and functional events and processes in living systems, including patients. Future perspectives on label-free molecular MRI and its challenges as well as potential solutions, including the use of rational design and engineered approaches to develop chemical and biological imaging probes to facilitate or combine with label-free molecular MRI, are discussed.
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Affiliation(s)
- Tianhe Wu
- Department
of Radiology and Imaging Sciences, Emory
University School of Medicine, Atlanta, Georgia 30322, United States
| | - Claire Liu
- F.M.
Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland 21205, United States
| | - Anbu Mozhi Thamizhchelvan
- Department
of Radiology and Imaging Sciences, Emory
University School of Medicine, Atlanta, Georgia 30322, United States
| | - Candace Fleischer
- Department
of Radiology and Imaging Sciences, Emory
University School of Medicine, Atlanta, Georgia 30322, United States
| | - Xingui Peng
- Jiangsu
Key Laboratory of Molecular and Functional Imaging, Department of
Radiology, Zhongda Hospital, Medical School
of Southeast University, Nanjing, Jiangsu 210009, China
| | - Guanshu Liu
- F.M.
Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland 21205, United States
- Russell
H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, United States
| | - Hui Mao
- Department
of Radiology and Imaging Sciences, Emory
University School of Medicine, Atlanta, Georgia 30322, United States
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Hnilicova P, Kantorova E, Sutovsky S, Grofik M, Zelenak K, Kurca E, Zilka N, Parvanovova P, Kolisek M. Imaging Methods Applicable in the Diagnostics of Alzheimer's Disease, Considering the Involvement of Insulin Resistance. Int J Mol Sci 2023; 24:ijms24043325. [PMID: 36834741 PMCID: PMC9958721 DOI: 10.3390/ijms24043325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023] Open
Abstract
Alzheimer's disease (AD) is an incurable neurodegenerative disease and the most frequently diagnosed type of dementia, characterized by (1) perturbed cerebral perfusion, vasculature, and cortical metabolism; (2) induced proinflammatory processes; and (3) the aggregation of amyloid beta and hyperphosphorylated Tau proteins. Subclinical AD changes are commonly detectable by using radiological and nuclear neuroimaging methods such as magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography (PET), and single-photon emission computed tomography (SPECT). Furthermore, other valuable modalities exist (in particular, structural volumetric, diffusion, perfusion, functional, and metabolic magnetic resonance methods) that can advance the diagnostic algorithm of AD and our understanding of its pathogenesis. Recently, new insights into AD pathoetiology revealed that deranged insulin homeostasis in the brain may play a role in the onset and progression of the disease. AD-related brain insulin resistance is closely linked to systemic insulin homeostasis disorders caused by pancreas and/or liver dysfunction. Indeed, in recent studies, linkages between the development and onset of AD and the liver and/or pancreas have been established. Aside from standard radiological and nuclear neuroimaging methods and clinically fewer common methods of magnetic resonance, this article also discusses the use of new suggestive non-neuronal imaging modalities to assess AD-associated structural changes in the liver and pancreas. Studying these changes might be of great clinical importance because of their possible involvement in AD pathogenesis during the prodromal phase of the disease.
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Affiliation(s)
- Petra Hnilicova
- Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia
- Correspondence: (P.H.); (M.K.)
| | - Ema Kantorova
- Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia
| | - Stanislav Sutovsky
- 1st Department of Neurology, Faculty of Medicine, Comenius University in Bratislava and University Hospital, 813 67 Bratislava, Slovakia
| | - Milan Grofik
- Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia
| | - Kamil Zelenak
- Clinic of Radiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia
| | - Egon Kurca
- Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia
| | - Norbert Zilka
- Institute of Neuroimmunology, Slovak Academy of Sciences, 845 10 Bratislava, Slovakia
| | - Petra Parvanovova
- Department of Medical Biochemistry, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia
| | - Martin Kolisek
- Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia
- Correspondence: (P.H.); (M.K.)
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Moon CM, Shin SS, Heo SH, Jeong YY. Metabolic Alterations Associated with Early-Stage Hepatocellular Carcinoma and Their Correlation with Aging and Enzymatic Activity in Patients with Viral Hepatitis-Induced Liver Cirrhosis: A Preliminary Study. J Clin Med 2020; 9:jcm9030765. [PMID: 32178316 PMCID: PMC7141398 DOI: 10.3390/jcm9030765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 02/26/2020] [Accepted: 03/10/2020] [Indexed: 02/06/2023] Open
Abstract
Liver cirrhosis (LC) can develop hepatocellular carcinoma (HCC). However, noninvasive early diagnosis of HCCs in the cirrhotic liver is still challenging. We aimed to quantify the hepatic metabolites in normal control (NC), cirrhotic liver without HCC, cirrhotic liver with HCC (CLH), and early-stage HCC groups using proton magnetic resonance spectroscopy (1H-MRS) with a long echo-time (TE) and to assess the potential association between the levels of hepatic metabolites in these four groups and aging and enzymatic activity. Thirty NCs, 30 viral hepatitis-induced LC patients without HCC, and 30 viral hepatitis-induced LC patients with HCC were included in this study. 1H-MRS measurements were performed on a localized voxel of the normal liver parenchyma (n = 30) from NCs, cirrhotic liver parenchyma (n = 30) from LC patients without HCC, and each of the cirrhotic liver parenchyma (n = 30) and HCC (n = 30) from the same patients in the CLH group. Generalized estimating equations were used to evaluate potential risk factors for changes in metabolite levels. Potential associations between metabolite levels and age and serum enzymatic activities were assessed by correlation analysis. The levels of lactate+triglyceride (Lac+TG) and choline (Cho) in HCC were significantly higher compared to those in LC and CLH. A potential risk factor for changes in the Lac+TG and Cho levels was age, specifically 60–80 years of age. In particular, the Lac+TG level was associated with a high odds ratio of HCC in males aged 60–80 years. The Lac+TG and Cho concentrations were positively correlated with lactate dehydrogenase and alkaline phosphatase activities, respectively. Our findings suggested that 1H-MRS measurement with a long TE was useful in quantifying hepatic Lac+TG and Cho levels, where higher Lac+TG and Cho levels were most likely associated with HCC-related metabolism in the viral hepatitis-induced cirrhotic liver. Further, the level of Lac+TG in HCC was highly correlated with older age and lactate dehydrogenase activity.
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Affiliation(s)
- Chung-Man Moon
- Quantitative Medical Imaging Section, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD 20892, USA;
- Research Institute of Medical Sciences, Chonnam National University, Gwangju 61469, Korea
| | - Sang Soo Shin
- Department of Radiology, Chonnam National University Medical School, Gwangju 61469, Korea; (S.H.H.); (Y.Y.J.)
- Department of Radiology, Chonnam National University Hospital, Gwangju 61469, Korea
- Correspondence: ; Tel.: +82-62-220-5882; Fax: +82-62-226-4380
| | - Suk Hee Heo
- Department of Radiology, Chonnam National University Medical School, Gwangju 61469, Korea; (S.H.H.); (Y.Y.J.)
- Department of Radiology, Chonnam National University, Hwasun Hospital, Hwasun 58128, Korea
| | - Yong Yeon Jeong
- Department of Radiology, Chonnam National University Medical School, Gwangju 61469, Korea; (S.H.H.); (Y.Y.J.)
- Department of Radiology, Chonnam National University, Hwasun Hospital, Hwasun 58128, Korea
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Wang YS, Ye J, Cao YH, Zhang R, Han XF, Zou LL, Kuang L, Zhang J, Lian H, Xia JX, Zhang Q, Dai W. Association of [ 1H]-MRS quantified liver fat content with glucose metabolism status. Diabetol Metab Syndr 2020; 12:51. [PMID: 32528557 PMCID: PMC7282165 DOI: 10.1186/s13098-020-00558-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/30/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Previous literatures have implied that the liver fat deposition plays a crucial role in the development and progression of insulin resistance. In the present study, we aimed to investigate the association of liver fat content (LFC) with glucose metabolism status in the population of newly diagnosed type 2 diabetes mellitus (nT2DM), prediabetes mellitus (PDM) and normal controls (NC), and assessing if the LFC could as an indicator for the prediction of T2DM. METHODS A total of 242 subjects (including 141 nT2DM patients, 48 PDM subjects and 53 NC) were enrolled. The levels of LFC were quantified by using the proton magnetic resonance spectroscopy ([1H]-MRS) technique. Clinical and laboratory parameters of study subjects were collected by medical records and biochemical detection. One-way ANOVA or nonparametric test (Kruskal-Wallis) was applied for intergroup comparisons; intergroup comparison was performed in using of Bonferroni multiple-significance-test correction. RESULTS There were significantly increased LFC levels in nT2DM (14.72% ± 6.37%) than in PDM (9.62% ± 4.41%) and that of NC groups (5.11% ± 3.66%) (all p < 0.001). The prevalence of nonalcoholic fatty liver disease (NAFLD) was also found to be increased in nT2DM (91.48%) than in PDM (85.41%) and that of NC (32.07%) groups. Correlation analysis revealed that the increase of LFC positively associated with fast plasma glucose (FPG), 2 h plasma glucose (PG), Delta G30 and homeostatic model assessment of insulin resistance (HOMA-IR), negatively associated with Delta Ins30, Delta C30, Ins30/G30 AUC, CP30/G30 AUC, Ins AUC/G AUC, CP AUC/G AUC, homeostatic model assessment for β-cell function index (HOMA-β) and matsuda insulin sensitivity index (Matsuda ISI). Multilinear regression analysis showed that LFC, body mass index (BMI) and diastolic blood pressure (DBP) contributed for the prediction of HOMA-IR, and total cholesterol (TC), age, waist circumference (WC) and low-density lipoprotein cholesterol (LDL-C) were the significant contributors for HOMA-β. CONCLUSIONS Our study revealed an increased LFC level and prevalence of NAFLD in nT2DM than in PDM and that of NC groups, the increase of LFC was closely associated with insulin resistance and impaired glucose metabolism status, may be regarded as potential indicator contributing to the development and progression of T2DM.
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Affiliation(s)
- Yun-Sheng Wang
- Department of Endocrinology, The Second People’s Hospital of Hefei, The Affiliated Hefei Hospital of Anhui Medical University, Hefei, 230011 Anhui China
| | - Jun Ye
- Department of Endocrinology, The Second People’s Hospital of Hefei, The Affiliated Hefei Hospital of Anhui Medical University, Hefei, 230011 Anhui China
| | - Yong-Hong Cao
- Department of Endocrinology, The Second People’s Hospital of Hefei, The Affiliated Hefei Hospital of Anhui Medical University, Hefei, 230011 Anhui China
| | - Rong Zhang
- Department of Endocrinology, The Second People’s Hospital of Hefei, The Affiliated Hefei Hospital of Anhui Medical University, Hefei, 230011 Anhui China
| | - Xiao-Fang Han
- Department of Endocrinology, The Second People’s Hospital of Hefei, The Affiliated Hefei Hospital of Anhui Medical University, Hefei, 230011 Anhui China
| | - Ling-Ling Zou
- Department of Endocrinology, The Second People’s Hospital of Hefei, The Affiliated Hefei Hospital of Anhui Medical University, Hefei, 230011 Anhui China
| | - Lei Kuang
- Department of Endocrinology, The Second People’s Hospital of Hefei, The Affiliated Hefei Hospital of Anhui Medical University, Hefei, 230011 Anhui China
| | - Ji Zhang
- Department of Magnetic Resonance Imaging, The Second People’s Hospital of Hefei, The Affiliated Hefei Hospital of Anhui Medical University, Hefei, 230011 Anhui China
| | - Hu Lian
- Department of Magnetic Resonance Imaging, The Second People’s Hospital of Hefei, The Affiliated Hefei Hospital of Anhui Medical University, Hefei, 230011 Anhui China
| | - Jin-Xiang Xia
- Department of Magnetic Resonance Imaging, The Second People’s Hospital of Hefei, The Affiliated Hefei Hospital of Anhui Medical University, Hefei, 230011 Anhui China
| | - Qiu Zhang
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022 Anhui China
| | - Wu Dai
- Department of Endocrinology, The Second People’s Hospital of Hefei, The Affiliated Hefei Hospital of Anhui Medical University, Hefei, 230011 Anhui China
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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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Bril F, Barb D, Portillo-Sanchez P, Biernacki D, Lomonaco R, Suman A, Weber MH, Budd JT, Lupi ME, Cusi K. Metabolic and histological implications of intrahepatic triglyceride content in nonalcoholic fatty liver disease. Hepatology 2017; 65:1132-1144. [PMID: 27981615 DOI: 10.1002/hep.28985] [Citation(s) in RCA: 174] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/18/2016] [Accepted: 11/30/2016] [Indexed: 12/13/2022]
Abstract
UNLABELLED The cut-off point of intrahepatic triglyceride (IHTG) content to define nonalcoholic fatty liver disease (NAFLD) by proton magnetic resonance spectroscopy (1 H-MRS) was established based on the 95th percentile in a group of healthy individuals (i.e., ≥5.56%). Whether this threshold correlates with metabolic and histological changes and whether a further accumulation of IHTG is associated with worsening of these parameters has not been properly assessed in a large cohort of patients. In this cross-sectional study, 352 subjects were carefully characterized with the following studies: liver 1 H-MRS; euglycemic insulin clamp with measurement of glucose turnover; oral glucose tolerance test; and a liver biopsy. Hepatic insulin sensitivity (suppression of endogenous glucose production by insulin) was affected early on after IHTG content was ∼1.5% and remained uniformly impaired (∼40%-45%), regardless of further IHTG accumulation. Skeletal muscle insulin sensitivity showed a gradual impairment at low degrees of IHTG accumulation, but remained unchanged after IHTG content reached the ∼6 ± 2% threshold. A similar pattern was observed for metabolic changes typically associated with NAFLD, such as hypertriglyceridemia and low high-density lipoprotein cholesterol (HDL-C). In contrast, adipose tissue insulin sensitivity (suppression of free fatty acids by insulin) showed a continuous worsening across the spectrum of IHTG accumulation in NAFLD (r = -0.38; P < 0.001). Histological severity of liver disease (inflammation, ballooning, and fibrosis) was not associated with the amount of IHTG content. CONCLUSION IHTG accumulation is strongly associated with adipose tissue insulin resistance (IR), supporting the current theory of lipotoxicity as a driver of IHTG accumulation. Once IHTG accumulation reaches ∼6 ± 2%, skeletal muscle IR, hypertriglyceridemia, and low HDL-C become fully established. Histological activity appears to have an early threshold and is not significantly influenced by increasing amounts of IHTG accumulation. (Hepatology 2017;65:1132-1144).
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Affiliation(s)
- Fernando Bril
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL
| | - Diana Barb
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL
| | - Paola Portillo-Sanchez
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL
| | - Diane Biernacki
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL
| | - Romina Lomonaco
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL
| | - Amitabh Suman
- Division of Gastroenterology, Hepatology and Nutrition, Malcom Randall VAMC, Gainesville, FL
| | | | - Jeffrey T Budd
- Department of Medicine, University of Florida, Gainesville, FL
| | - Maria E Lupi
- Division of Family Medicine, University of Florida, Gainesville, FL
| | - Kenneth Cusi
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL.,Division of Endocrinology, Diabetes and Metabolism, Malcom Randall VAMC, Gainesville, FL
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Lomonaco R, Bril F, Portillo-Sanchez P, Ortiz-Lopez C, Orsak B, Biernacki D, Lo M, Suman A, Weber MH, Cusi K. Metabolic Impact of Nonalcoholic Steatohepatitis in Obese Patients With Type 2 Diabetes. Diabetes Care 2016; 39:632-8. [PMID: 26861926 PMCID: PMC5864108 DOI: 10.2337/dc15-1876] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 01/07/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Nonalcoholic steatohepatitis (NASH) is increasingly common in obese patients. However, its metabolic consequences in patients with type 2 diabetes mellitus (T2DM) are unknown. RESEARCH DESIGN AND METHODS We studied 154 obese patients divided in four groups: 1) control (no T2DM or NAFLD), 2) T2DM without NAFLD, 3) T2DM with isolated steatosis, and 4) T2DM with NASH. We evaluated intrahepatic triglycerides by proton MRS ((1)H-MRS) and assessed insulin secretion/resistance during an oral glucose tolerance test and a euglycemic-hyperinsulinemic clamp with glucose turnover measurements. RESULTS No significant differences among groups were observed in sex, BMI, or total body fat. Metabolic parameters worsened progressively with the presence of T2DM and the development of hepatic steatosis, with worse hyperinsulinemia, insulin resistance, and dyslipidemia (hypertriglyceridemia and low HDL cholesterol) in those with NASH (P < 0.001). Compared with isolated steatosis, NASH was associated with more dysfunctional and insulin-resistant adipose tissue (either as insulin suppression of plasma FFA [33 ± 3 vs. 48 ± 6%] or adipose tissue insulin resistance index [9.8 ± 1.0 vs. 5.9 ± 0.8 mmol/L ⋅ µIU/mL]; both P < 0.03). Furthermore, insulin suppression of plasma FFA correlated well with hepatic steatosis (r = -0.62; P < 0.001) and severity of steatohepatitis (rs = -0.52; P < 0.001). Hepatic insulin sensitivity was also more significantly impaired among patients with T2DM and NASH, both fasting and with increasing insulin levels within the physiological range (10 to 140 µIU/mL), compared with other groups. CONCLUSIONS In obese patients with T2DM, the presence of NAFLD is associated with more severe hyperinsulinemia, dyslipidemia, and adipose tissue/hepatic insulin resistance compared with patients without NAFLD. The unfavorable metabolic profile linked to NAFLD should prompt strategies to identify and treat this population early on.
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Affiliation(s)
- Romina Lomonaco
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL Department of Medicine, University of Florida, Gainesville, FL
| | - Fernando Bril
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL
| | - Paola Portillo-Sanchez
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL
| | - Carolina Ortiz-Lopez
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Beverly Orsak
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Diane Biernacki
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL
| | - Margaret Lo
- Department of Medicine, University of Florida, Gainesville, FL
| | - Amitabh Suman
- Division of Gastroenterology, Hepatology, and Nutrition, Malcom Randall VA Medical Center, Gainesville, FL
| | - Michelle H Weber
- Division of Pathology, Malcom Randall VA Medical Center, Gainesville, FL
| | - Kenneth Cusi
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL Division of Endocrinology, Malcom Randall VA Medical Center, Gainesville, FL
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Bril F, Ortiz-Lopez C, Lomonaco R, Orsak B, Freckleton M, Chintapalli K, Hardies J, Lai S, Solano F, Tio F, Cusi K. Clinical value of liver ultrasound for the diagnosis of nonalcoholic fatty liver disease in overweight and obese patients. Liver Int 2015; 35:2139-46. [PMID: 25847730 DOI: 10.1111/liv.12840] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 03/23/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Liver ultrasound (US) is usually used in the clinical setting for the diagnosis and follow-up of patients with nonalcoholic fatty liver disease (NAFLD). However, no large study has carefully assessed its performance using a semiquantitative ultrasonographic scoring system in overweight/obese patients, in comparison to magnetic resonance spectroscopy ((1) H-MRS) and histology. METHODS We recruited 146 patients and performed: a liver US using a 5-parameter scoring system, a liver (1) H-MRS to quantify liver fat content, and a liver biopsy to assess histology. All measurements were repeated in a subgroup of patients (n = 62) after 18 months of follow-up. RESULTS The performance of liver US (parenchymal echo alone) was rather modest, and significantly worse than (1) H-MRS (AUROC: 0.82 [0.69-0.94] vs. 0.96 [0.90-1.00]; P = 0.04). However, the AUROC improved when different echographic parameters were taken into account (AUROC: 0.89 [0.83-0.96], P = 0.15 against (1) H-MRS). Optimum sensitivity for liver US was achieved at a liver fat content ≥12.5%, suggesting that below this threshold, liver US is less sensitive. Liver (1) H-MRS showed a high accuracy for the diagnosis of NAFLD, and correlated strongly with histological steatosis (r = 0.73, P < 0.0001). None of the imaging tests was adequate enough to predict changes over time in histology. CONCLUSIONS Despite its widespread use, liver US has several important limitations that healthcare providers should recognize, particularly because of its low sensitivity. Using a combination of echographic parameters, liver US showed a significant improvement in its diagnostic performance, but still was of limited value for monitoring treatment over time.
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Affiliation(s)
- Fernando Bril
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, USA.,Malcom Randall Veterans Administration Medical Center, Gainesville, FL, USA
| | - Carolina Ortiz-Lopez
- Division of Diabetes, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, TX, USA
| | - Romina Lomonaco
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, USA.,Malcom Randall Veterans Administration Medical Center, Gainesville, FL, USA
| | - Beverly Orsak
- Division of Diabetes, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, TX, USA
| | - Michael Freckleton
- Radiology Department, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, TX, USA
| | - Kedar Chintapalli
- Radiology Department, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, TX, USA
| | - Jean Hardies
- Radiology Department, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, TX, USA
| | - Song Lai
- Clinical Translational Science Institute Human Imaging Core, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Felipe Solano
- Pathology Department, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, TX, USA
| | - Fermin Tio
- Pathology Department, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, TX, USA
| | - Kenneth Cusi
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, USA.,Malcom Randall Veterans Administration Medical Center, Gainesville, FL, USA.,Division of Diabetes, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, TX, USA.,Audie L. Murphy Veterans Administration Medical Center, San Antonio, TX, USA
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Wang D, Li Y. 1H Magnetic Resonance Spectroscopy Predicts Hepatocellular Carcinoma in a Subset of Patients With Liver Cirrhosis: A Randomized Trial. Medicine (Baltimore) 2015; 94:e1066. [PMID: 26166077 PMCID: PMC4504652 DOI: 10.1097/md.0000000000001066] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The goal of this study was to investigate the utility of H magnetic resonance spectroscopy (H-MRS) to quantify the differences in liver metabolites. Magnetic resonance spectroscopy was used as a means of predicting the probability of developing hepatocellular carcinoma (HCC) in patients with liver cirrhosis secondary to chronic hepatitis B.This study included 20 healthy volunteers, 20 patients with liver cirrhosis secondary to chronic hepatitis B (cirrhosis group), and 20 patients with small HCC secondary to cirrhosis liver parenchyma (HCC group). All patients underwent routine MRI and H-MRS scanning. LCModel software was used to quantify Cho (Choline), Lip (lipid), and Cho/Lip in the 3 groups, and a one-way ANOVA was used to compare the differences in these metabolites between groups.Choline levels were significantly different between the control and HCC group and between the cirrhosis group and the HCC group (all P < 0.001). There was also a significant difference in Lip levels between the control and cirrhosis group and the control and HCC groups (all P < 0.001). There were also differences in Cho/Lip between the control and cirrhosis groups, the control and HCC groups, and the cirrhosis and HCC groups (all P < 0.001).H-MRS followed by the analysis with LCModel can be used to measure changes in hepatic metabolite levels in patients with liver cirrhosis secondary to chronic hepatitis B and HCC. Thus, H-MRS may be helpful in monitoring HCC and liver cirrhosis development.
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Affiliation(s)
- Dan Wang
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Wicklow BA, Griffith AT, Dumontet JN, Venugopal N, Ryner LN, McGavock JM. Pancreatic lipid content is not associated with beta cell dysfunction in youth-onset type 2 diabetes. Can J Diabetes 2015; 39:398-404. [PMID: 26099932 DOI: 10.1016/j.jcjd.2015.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/31/2015] [Accepted: 04/06/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine whether pancreatic lipid content is associated with type 2 diabetes and beta cell function in Indigenous and Caucasian adolescents. METHODS This was a cross-sectional study comparing (1)H-magnetic resonance spectroscopy-derived pancreatic triglyceride content in adolescents 13 to 18 years of age with type 2 diabetes (n=20) and body mass index-matched normoglycemic controls (n=34). Beta cell function was measured by the acute insulin response and disposition index derived from intravenous glucose tolerance tests. RESULTS Pancreatic lipid content was not significantly different in youth with type 2 diabetes and their normoglycemic body mass index-matched peers (2.41 [95% CI: 0.63, 5.60] vs. 1.22 [0.08, 5.93]; p=0.27). Pancreatic triglyceride levels were not associated with measures of beta cell function in the cohort. In subgroup analyses, pancreatic lipid content was ∼4-fold higher in youth with type 2 diabetes who were carriers of the G319S mutation in the HNF-1alpha gene (7.45 [2.85, 26.8] vs. 2.20 [0.350, 3.30] % Fat to Water Ratio F/W; p=0.032). CONCLUSIONS Pancreatic lipid content is not elevated in Indigenous or Caucasian youth with type 2 diabetes compared to normoglycemic youth, nor is it associated with beta cell function. The presence of the G319S mutation in the HNF-1alpha gene in Indigenous youth with type 2 diabetes is associated with higher pancreatic lipid content. Further research is needed to understand the mechanisms that explain beta cell failure in overweight youth with type 2 diabetes.
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Affiliation(s)
- Brandy A Wicklow
- Manitoba Institute of Child Health, Winnipeg, Manitoba, Canada; University of Manitoba, Department of Pediatrics and Child Health, Faculty of Medicine, Winnipeg, Manitoba, Canada.
| | | | | | - Niranjan Venugopal
- National Research Council Canada Institute for Biodiagnostics, Winnipeg, Manitoba, Canada
| | - Lawrence N Ryner
- National Research Council Canada Institute for Biodiagnostics, Winnipeg, Manitoba, Canada
| | - Jonathan M McGavock
- Manitoba Institute of Child Health, Winnipeg, Manitoba, Canada; University of Manitoba, Department of Pediatrics and Child Health, Faculty of Medicine, Winnipeg, Manitoba, Canada
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Shen ZW, Cao Z, You KZ, Yang ZX, Xiao YY, Cheng XF, Chen YW, Wu RH. Quantification of choline concentration following liver cell apoptosis using 1H magnetic resonance spectroscopy. World J Gastroenterol 2012; 18:1130-6. [PMID: 22416190 PMCID: PMC3296989 DOI: 10.3748/wjg.v18.i10.1130] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 07/27/2011] [Accepted: 10/14/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the feasibility of quantifying liver choline concentrations in both normal and apoptotic rabbit livers in vivo, using 1H magnetic resonance spectroscopy (1H-MRS).
METHODS: 1H-MRS was performed in 18 rabbits using a 1.5T GE MR system with an eight-channel head/neck receiving coil. Fifteen rabbits were injected with sodium selenite at a dose of 10 μmol/kg to induce the liver cell apoptosis. Point-resolved spectroscopy sequence-localized spectra were obtained from 10 livers once before and once 24 h after sodium selenite injection in vivo. T1 and T2 relaxation time of water and choline was measured separately in the livers of three healthy rabbits and three selenite-treated rabbits. Hematoxylin and eosin and dUTP-biotin nick end labeling (TUNEL) staining was used to detect and confirm apoptosis. Choline peak areas were measured relative to unsuppressed water using LCModel. Relaxation attenuation was corrected using the average of T1 and T2 relaxation time. The choline concentration was quantified using a formula, which was tested by a phantom with a known concentration.
RESULTS: Apoptosis of hepatic cells was confirmed by TUNEL assay. In phantom experiment, the choline concentration (3.01 mmol/L), measured by 1H-MRS, was in good agreement with the actual concentration (3 mmol/L). The average T1 and T2 relaxation time of choline was 612 ± 15 ms and 74 ± 4 ms in the control group and 670 ± 27 ms and 78 ± 5 ms in apoptotic livers in vivo, respectively. Choline was quantified in 10 rabbits, once before and once after the injection with sodium selenite. The choline concentration decreased from 14.5 ± 7.57 mmol/L before sodium selenite injection to 10.8 ± 6.58 mmol/L (mean ± SD, n = 10) after treatment (Z = -2.395, P < 0.05, two-sample paired Wilcoxon test).
CONCLUSION: 1H-MRS can be used to quantify liver choline in vivo using unsuppressed water as an internal reference. Decreased liver choline concentrations are found in sodium selenite-treated rabbits undergoing liver cell apoptosis.
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Heymsfield SB, Müller MJ, Bosy-Westphal A, Thomas D, Shen W. Human brain mass: similar body composition associations as observed across mammals. Am J Hum Biol 2012; 24:479-85. [PMID: 22362729 DOI: 10.1002/ajhb.22249] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 01/03/2012] [Accepted: 01/04/2012] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES A classic association is the link between brain mass and body mass across mammals that has now been shown to derive from fat-free mass (FFM) and not fat mass (FM). This study aimed to establish for the first time the associations between human brain mass and body composition and to compare these relations with those established for liver as a reference organ. METHODS Subjects were 112 men and 148 women who had brain and liver mass measured by magnetic resonance imaging with FM and FFM measured by dual-energy X-ray absorptiometry. RESULTS Brain mass scaled to height (H) with powers of ≤0.6 in men and women; liver mass and FFM both scaled similarly as H(~2) . The fraction of FFM as brain thus scaled inversely to height (P < 0.001) while liver mass/FFM was independent of height. After controlling for age, brain, and liver mass were associated with FFM while liver was additionally associated with FM (all models P ≤ 0.01). After controlling for age and sex, FFM accounted for ~5% of the variance in brain mass while levels were substantially higher for liver mass (~60%). Brain mass was significantly larger (P < 0.001) in men than in women, even after controlling for age and FFM. CONCLUSIONS As across mammals, human brain mass associates significantly, although weakly, with FFM and not FM; the fraction of FFM as brain relates inversely to height; brain differs in these relations from liver, another small high metabolic rate organ; and the sexual dimorphism in brain mass persists even after adjusting for age and FFM.
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Affiliation(s)
- Steven B Heymsfield
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA 70808, USA.
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Chow AM, Chan KW, Fan SJ, Yang J, Cheung JS, Khong PL, Wu EX. In vivo proton magnetic resonance spectroscopy of hepatic ischemia/reperfusion injury in an experimental model. Acad Radiol 2011; 18:246-52. [PMID: 21111640 DOI: 10.1016/j.acra.2010.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 06/02/2010] [Accepted: 09/20/2010] [Indexed: 01/03/2023]
Abstract
RATIONALE AND OBJECTIVES Hepatic ischemia/reperfusion injury (IRI) occurs during certain hepatobiliary surgeries, hemorrhagic shock, and veno-occlusive disease. Biochemical changes caused by hepatic IRI lead to hepatocellular remodeling, including cellular regeneration or irreversible apoptosis. This study aims to characterize and monitor the metabolic changes in hepatic IRI using proton magnetic resonance spectroscopy (¹H MRS). MATERIALS AND METHODS Sprague-Dawley rats (n = 8) were scanned with ¹H MRS using 5.0 × 5.0 × 5.0 mm³ voxel over a homogeneous liver parenchyma at 7 Tesla with a respiratory-gated point-resolved spectroscopy sequence at 1 day before, 6 hours, 1 day, and 1 week after 30 minutes total hepatic IRI. Signal integral ratios of choline-containing compounds (CCC), glycogen and glucose complex (Glyu), methylene proton ((-CH₂-)(n)), and methene proton (-CH=CH-) to lipid (integral sum of methyl proton (-CH₃), (-CH₂-)(n) and -CH=CH-) were quantified by areas under peaks longitudinally. RESULTS The CCC-to-lipid and Glyu-to-lipid ratios at 6 hours after IRI were significantly higher than those at 1 day before, 1 day, and 1 week after injury. The (-CH₂-)(n)-to-lipid, and -CH=CH-to-lipid ratios showed no significant differences over different time points. Hepatocellular regeneration was observed at 6 hours after IRI in histology with immunohistochemical technique. CONCLUSIONS Changes in CCC-to-lipid and Glyu-to-lipid ratios likely reflect the hepatocellular remodeling and impaired glucose utilization upon hepatic IRI, respectively. The experimental findings in the current study demonstrated that ¹H MRS is a valuable tool for characterizing either global or regional metabolic changes in liver noninvasively and longitudinally. Such capability has the potential to lead to early diagnosis and detection of impaired liver function.
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