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Fujita N, Ushijima Y, Itoyama M, Okamoto D, Ishimatsu K, Tabata K, Itoh S, Ishigami K. Value of gadoxetic acid-enhanced MR imaging for preoperative prediction of future liver regeneration after hemihepatectomy. Jpn J Radiol 2024:10.1007/s11604-024-01629-w. [PMID: 39150642 DOI: 10.1007/s11604-024-01629-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 07/15/2024] [Indexed: 08/17/2024]
Abstract
PURPOSE Liver resection is currently considered the most effective treatment for patients with liver cancer. To the best of our knowledge, no study has investigated the association between gadoxetic acid-enhanced magnetic resonance imaging (MRI) findings and liver regeneration in patients who underwent hemihepatectomy. We aimed to clarify the relationship between the signal intensity (SI) of the liver parenchyma on gadoxetic acid-enhanced MRI and the degree of liver regeneration in patients who underwent hemihepatectomy. MATERIALS AND METHODS Forty-one patients who underwent gadoxetic acid-enhanced MRI before hemihepatectomy were enrolled. We calculated the liver-to-erector spinae muscle SI ratio (LMR) in the hepatobiliary phase and the precontrast images. ΔLMR was calculated using the following equation: ΔLMR = (LMR in the hepatobiliary phase-LMR in the precontrast image)/LMR in the precontrast image. The preoperative and postoperative remnant liver volumes (LVs) were calculated using CT volumetry. We calculated the resection rate (RR) and liver regeneration index (LRI) using the following formulas: RR = Resected LV/Total LV × 100 and LRI = (postoperative remnant LV-preoperative remnant LV)/preoperative remnant LV × 100. The relationships among LRI, imaging, and clinicopathological factors were analyzed. RESULTS Univariate analysis showed RR and ΔLMR showed a positive correlation with LRI (ρ = 0.4133, p = 0.0072 and ρ = 0.7773, p < 0.001, respectively). Spleen volume showed a negative correlation with LRI (ρ = -0.3138, p = 0.0486). Stepwise multiple regression analysis showed ΔLMR and RR were independently correlated with LRI (β coefficient = 44.8771, p = 0.0198 and β coefficient = 1.9653, p < 0.001, respectively). CONCLUSION ΔLMR may serve as a preoperative predictor of liver regeneration in patients undergoing hemihepatectomy.
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Affiliation(s)
- Nobuhiro Fujita
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Yasuhiro Ushijima
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Masahiro Itoyama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Daisuke Okamoto
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Keisuke Ishimatsu
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kosuke Tabata
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shinji Itoh
- Departments of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Qi H, Jiang S, Nan J, Guo H, Cheng C, He X, Jin H, Zhang R, Lei J. Application and research progress of magnetic resonance proton density fat fraction in metabolic dysfunction-associated steatotic liver disease: a comprehensive review. Abdom Radiol (NY) 2024:10.1007/s00261-024-04448-9. [PMID: 39048719 DOI: 10.1007/s00261-024-04448-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/06/2024] [Accepted: 06/07/2024] [Indexed: 07/27/2024]
Abstract
Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), formerly known as Non-Alcoholic Fatty Liver Disease (NAFLD), is a chronic liver disorder associated with disturbances in lipid metabolism. The disease is prevalent worldwide, particularly closely linked with metabolic syndromes such as obesity and diabetes. Magnetic Resonance Proton Density Fat Fraction (MRI-PDFF), serving as a non-invasive and highly quantitative imaging assessment tool, holds promising applications in the diagnosis and research of MASLD. This paper aims to comprehensively review and summarize the applications and research progress of MRI-PDFF technology in MASLD, analyze its strengths and challenges, and anticipate its future developments in clinical practice.
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Affiliation(s)
- Hongyan Qi
- The First Clinical Medical College of Lanzhou University, No.1 Donggang West Road, Chengguan District, Lanzhou City, 730000, Gansu Province, China
| | | | - Jiang Nan
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Hang Guo
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Cai Cheng
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Xin He
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Hongyang Jin
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Rongfan Zhang
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Junqiang Lei
- The First Clinical Medical College of Lanzhou University, No.1 Donggang West Road, Chengguan District, Lanzhou City, 730000, Gansu Province, China.
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China.
- Radiological Clinical Medicine Research Center of Gansu Province, Lanzhou, Gansu, China.
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Chen X, Fu L, Zhu Z, Wang Y. Exploring the association between dietary fiber intake and hepatic steatosis: insights from NHANES. BMC Gastroenterol 2024; 24:160. [PMID: 38730369 PMCID: PMC11088015 DOI: 10.1186/s12876-024-03256-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/07/2024] [Indexed: 05/12/2024] Open
Abstract
PURPOSE The link between dietary fiber intake and Non-alcoholic fatty liver disease (NAFLD) is under exploration, yielding inconsistent findings. Considering the limitations of previous research and the significance of dietary fiber in hepatic steatosis, this study investigates the association between dietary fiber intake and Controlled Attenuation Parameter (CAP) among 5935 participants from the National Health and Nutrition Examination Survey (NHANES). MATERIALS AND METHODS Multivariable regression was used to evaluate the association between dietary fiber intake and CAP. Smoothed curve fitting and threshold effect analysis techniques were applied to illustrate non-linear relationships. RESULTS After adjusting for other variables, a negative correlation emerged between dietary fiber intake and CAP. Subgroup analysis by gender and race/ethnicity revealed a sustained negative association between dietary fiber intake and CAP among females and Whites. Additionally, an inverted U-shaped relationship was observed between dietary fiber intake and CAP among women and other race, with inflection points at 13.80 g/day and 33.45 g/day, respectively. CONCLUSION Our research indicates that in the majority of Americans, there is an inverse relationship between dietary fiber intake and hepatic steatosis. This relationship exhibits an inverted U-shaped curve in women and other race, with a threshold effect. The findings of this study hold potential significance for clinical nutrition interventions, personalized dietary guidance, and advancing research into the diet-disease mechanism relationship.
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Affiliation(s)
- Xingxing Chen
- Clinical Research Center, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, 311200, P.R. China
| | - Liying Fu
- Voluntary Blood Donation Service Center of Xiaoshan District, Hangzhou, Zhejiang, 311200, P.R. China
| | - Zhongxin Zhu
- Clinical Research Center, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, 311200, P.R. China
| | - Yunchao Wang
- Department of General Practice, The First People's Hospital of Xiaoshan District, No. 199 South Shixin Road, Hangzhou, Zhejiang, 311200, P.R. China.
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Gupta A, Dixit R, Prakash A. Non-invasive hepatic fat quantification: Can multi-echo Dixon help? Radiol Bras 2024; 57:e20230125. [PMID: 38993969 PMCID: PMC11235074 DOI: 10.1590/0100-3984.2023.0125] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/12/2023] [Accepted: 01/24/2024] [Indexed: 07/13/2024] Open
Abstract
Objective To evaluate the diagnostic accuracy of multi-echo Dixon magnetic resonance imaging (MRI) in hepatic fat quantification, in comparison with that of magnetic resonance spectroscopy (MRS), on 3.0-T MRI. Materials and Methods Fifty-five adults with no known liver disease underwent MRI in a 3.0-T scanner for determination of the hepatic fat fraction, with two techniques: multi-echo Dixon, in a manually drawn region of interest (ROI) and in the entire liver parenchyma (automated segmentation); and MRS. The diagnostic accuracy and cutoff value for multi-echo Dixon were determined, with MRS being used as the reference standard. Results The mean fat fraction obtained by multi-echo Dixon in the manually drawn ROI and in the entire liver was 5.2 ± 5.8% and 6.6 ± 5.2%, respectively, whereas the mean hepatic fat fraction obtained by MRS was 5.7 ± 6.4%. A very strong positive correlation and good agreement were observed between MRS and multi-echo Dixon, for the ROI (r = 0.988, r2 = 0.978, p < 0.001) and for the entire liver parenchyma (r = 0.960, r2 = 0.922, p < 0.001). A moderate positive correlation was observed between the hepatic fat fraction and body mass index of the participants, regardless of the fat estimation technique employed. Conclusion For hepatic fat quantification, multi-echo Dixon MRI demonstrated a very strong positive correlation and good agreement with MRS (often considered the gold-standard noninvasive technique). Because multi-echo Dixon MRI is more readily available than is MRS, it can be used as a rapid tool for hepatic fat quantification, especially when the hepatic fat distribution is not homogeneous.
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Affiliation(s)
- Akarshi Gupta
- Department of Radiodiagnosis, Lok Nayak Hospital - Maulana Azad
Medical College, New Delhi, India
| | - Rashmi Dixit
- Department of Radiodiagnosis, Lok Nayak Hospital - Maulana Azad
Medical College, New Delhi, India
| | - Anjali Prakash
- Department of Radiodiagnosis, Lok Nayak Hospital - Maulana Azad
Medical College, New Delhi, India
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Jang W, Song JS. Non-Invasive Imaging Methods to Evaluate Non-Alcoholic Fatty Liver Disease with Fat Quantification: A Review. Diagnostics (Basel) 2023; 13:diagnostics13111852. [PMID: 37296703 DOI: 10.3390/diagnostics13111852] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Hepatic steatosis without specific causes (e.g., viral infection, alcohol abuse, etc.) is called non-alcoholic fatty liver disease (NAFLD), which ranges from non-alcoholic fatty liver (NAFL) to non-alcoholic steatohepatitis (NASH), fibrosis, and NASH-related cirrhosis. Despite the usefulness of the standard grading system, liver biopsy has several limitations. In addition, patient acceptability and intra- and inter-observer reproducibility are also concerns. Due to the prevalence of NAFLD and limitations of liver biopsies, non-invasive imaging methods such as ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) that can reliably diagnose hepatic steatosis have developed rapidly. US is widely available and radiation-free but cannot examine the entire liver. CT is readily available and helpful for detection and risk classification, significantly when analyzed using artificial intelligence; however, it exposes users to radiation. Although expensive and time-consuming, MRI can measure liver fat percentage with magnetic resonance imaging proton density fat fraction (MRI-PDFF). Specifically, chemical shift-encoded (CSE)-MRI is the best imaging indicator for early liver fat detection. The purpose of this review is to provide an overview of each imaging modality with an emphasis on the recent progress and current status of liver fat quantification.
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Affiliation(s)
- Weon Jang
- Department of Radiology, Jeonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Jeonbuk, Republic of Korea
- Research Institute of Clinical Medicine, Jeonbuk National University, Jeonju 54907, Jeonbuk, Republic of Korea
- Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju 54907, Jeonbuk, Republic of Korea
| | - Ji Soo Song
- Department of Radiology, Jeonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Jeonbuk, Republic of Korea
- Research Institute of Clinical Medicine, Jeonbuk National University, Jeonju 54907, Jeonbuk, Republic of Korea
- Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju 54907, Jeonbuk, Republic of Korea
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Low G, Ferguson C, Locas S, Tu W, Manolea F, Sam M, Wilson MP. Multiparametric MR assessment of liver fat, iron, and fibrosis: a concise overview of the liver "Triple Screen". Abdom Radiol (NY) 2023; 48:2060-2073. [PMID: 37041393 DOI: 10.1007/s00261-023-03887-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 04/13/2023]
Abstract
Chronic liver disease (CLD) is a common source of morbidity and mortality worldwide. Non-alcoholic fatty liver disease (NAFLD) serves as a major cause of CLD with a rising annual prevalence. Additionally, iron overload can be both a cause and effect of CLD with a negative synergistic effect when combined with NAFLD. The development of state-of-the-art multiparametric MR solutions has led to a change in the diagnostic paradigm in CLD, shifting from traditional liver biopsy to innovative non-invasive methods for providing accurate and reliable detection and quantification of the disease burden. Novel imaging biomarkers such as MRI-PDFF for fat, R2 and R2* for iron, and liver stiffness for fibrosis provide important information for diagnosis, surveillance, risk stratification, and treatment. In this article, we provide a concise overview of the MR concepts and techniques involved in the detection and quantification of liver fat, iron, and fibrosis including their relative strengths and limitations and discuss a practical abbreviated MR protocol for clinical use that integrates these three MR biomarkers into a single simplified MR assessment. Multiparametric MR techniques provide accurate and reliable non-invasive detection and quantification of liver fat, iron, and fibrosis. These techniques can be combined in a single abbreviated MR "Triple Screen" assessment to offer a more complete metabolic imaging profile of CLD.
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Affiliation(s)
- Gavin Low
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, WMC 2B2.41 8440-112 ST, Edmonton, AB, T6G2B7, Canada
| | - Craig Ferguson
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, WMC 2B2.41 8440-112 ST, Edmonton, AB, T6G2B7, Canada
| | - Stephanie Locas
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, WMC 2B2.41 8440-112 ST, Edmonton, AB, T6G2B7, Canada
| | - Wendy Tu
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, WMC 2B2.41 8440-112 ST, Edmonton, AB, T6G2B7, Canada
| | - Florin Manolea
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, WMC 2B2.41 8440-112 ST, Edmonton, AB, T6G2B7, Canada
| | - Medica Sam
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, WMC 2B2.41 8440-112 ST, Edmonton, AB, T6G2B7, Canada
| | - Mitchell P Wilson
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, WMC 2B2.41 8440-112 ST, Edmonton, AB, T6G2B7, Canada.
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Tang R, Tang G, Hua T, Tu Y, Ji R, Zhu J. mDIXON-Quant technique diagnostic accuracy for assessing bone mineral density in male adult population. BMC Musculoskelet Disord 2023; 24:125. [PMID: 36788513 PMCID: PMC9926741 DOI: 10.1186/s12891-023-06225-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/06/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND To investigate the diagnostic efficacy of mDIXON-Quant technique for prediction of bone loss in male adults. METHODS One hundred thirty-eight male adults were divided into normal, osteopenia, and osteoporosis groups based on DXA and QCT for the lumbar spine. Differences in mDIXON-Quant parameters [fat fraction (FF) and T2* value] among three groups, as well as the correlation of mDIXON-Quant parameters and bone mineral density (BMD) were analyzed. The areas under the curves (AUCs) for mDIXON-Quant parameters for prediction of low bone mass were calculated. RESULTS According to DXA standard, FF and T2* value were significantly increased in osteoporosis group compared with normal group (P = 0.012 and P < 0.001). According to QCT standard, FF was significantly increased in osteopenia and osteoporosis groups compared with normal group (both P < 0.001). T2* values were significantly different among three groups (all P < 0.05). After correction for age and body mass index, FF was negatively correlated with areal BMD and volumetric BMD (r = -0.205 and -0.604, respectively; both P < 0.05), and so was T2* value (r = -0.324 and -0.444, respectively; both P < 0.05). The AUCs for predicting low bone mass according to DXA and QCT standards were 0.642 and 0.898 for FF, 0.648 and 0.740 for T2* value, and 0.677 and 0.920 for both combined, respectively. CONCLUSIONS FF combined with T2* value has a better diagnostic efficacy than FF or T2* value alone in prediction of low bone mass in male adults, which is expected to be a promising MRI method for the screening of bone quality. TRIAL REGISTRATION ChiCTR1900024511 (Registered 13-07-2019).
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Affiliation(s)
- Rui Tang
- grid.412538.90000 0004 0527 0050Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai, 200072 China
| | - Guangyu Tang
- grid.412538.90000 0004 0527 0050Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai, 200072 China
| | - Ting Hua
- grid.412538.90000 0004 0527 0050Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai, 200072 China
| | - Yun Tu
- grid.412538.90000 0004 0527 0050Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai, 200072 China
| | - Rui Ji
- grid.412538.90000 0004 0527 0050Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai, 200072 China
| | - Jingqi Zhu
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai, 200072, China.
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Kim JW, Lee CH, Yang Z, Kim BH, Lee YS, Kim KA. The spectrum of magnetic resonance imaging proton density fat fraction (MRI-PDFF), magnetic resonance spectroscopy (MRS), and two different histopathologic methods (artificial intelligence vs. pathologist) in quantifying hepatic steatosis. Quant Imaging Med Surg 2022; 12:5251-5262. [PMID: 36330193 PMCID: PMC9622443 DOI: 10.21037/qims-22-393] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/05/2022] [Indexed: 07/26/2023]
Abstract
BACKGROUND The grade of hepatic steatosis is assessed semi-quantitatively and graded as a discrete value. However, the proton density fat fraction (PDFF) measured by magnetic resonance imaging (MRI) and FF measured by MR spectroscopy (FFMRS) are continuous values. Therefore, a quantitative histopathologic method may be needed. This study aimed to (I) provide a spectrum of values of MRI-PDFF, FFMRS, and FFs measured by two different histopathologic methods [artificial intelligence (AI) and pathologist], (II) to evaluate the correlation among them, and (III) to evaluate the diagnostic performance of MRI-PDFF and MRS for grading hepatic steatosis. METHODS Forty-seven patients who underwent liver biopsy and MRI for nonalcoholic steatohepatitis (NASH) evaluation were included. The agreement between MRI-PDFF and MRS was evaluated through Bland-Altman analysis. Correlations among MRI-PDFF, MRS, and two different histopathologic methods were assessed using Pearson correlation coefficient (r). The diagnostic performance of MRI-PDFF and MRS was assessed using receiver operating characteristic curve analyses and the area under the curve (AUC) were obtained. RESULTS The means±standard deviation of MRI-PDFF, FFMRS, FF measured by pathologist (FFpathologist), and FF measured by AI (FFAI) were 12.04±6.37, 14.01±6.16, 34.26±19.69, and 6.79±4.37 (%), respectively. Bland-Altman bias [mean of MRS - (MRI-PDFF) differences] was 2.06%. MRI-PDFF and MRS had a very strong correlation (r=0.983, P<0.001). The two different histopathologic methods also showed a very strong correlation (r=0.872, P<0.001). Both MRI-PDFF and MRS demonstrated a strong correlation with FFpathologist (r=0.701, P<0.001 and r=0.709, P<0.001, respectively) and with FFAI (r=0.700, P<0.001 and r=0.690, P<0.001, respectively). The AUCs of MRI-PDFF for grading ≥S2 and ≥S3 were 0.846 and 0.855, respectively. The AUCs of MRS for grading ≥S2 and ≥S3 were 0.860 and 0.878, respectively. CONCLUSIONS Since MRS and MRI-PDFF demonstrated a strong correlation with each other and with the two different histopathologic methods, they can be used as an alternative noninvasive reference standard in nonalcoholic fatty liver disease (NAFLD) patients. However, these preliminary results should be interpreted with caution until they are validated in further studies.
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Affiliation(s)
- Jeong Woo Kim
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chang Hee Lee
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Zepa Yang
- Biomedical Research Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Baek-Hui Kim
- Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young-Sun Lee
- Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyeong Ah Kim
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Li YW, Jiao Y, Chen N, Gao Q, Chen YK, Zhang YF, Wen QP, Zhang ZM. How to select the quantitative magnetic resonance technique for subjects with fatty liver: A systematic review. World J Clin Cases 2022; 10:8906-8921. [PMID: 36157636 PMCID: PMC9477046 DOI: 10.12998/wjcc.v10.i25.8906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/25/2022] [Accepted: 07/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Early quantitative assessment of liver fat content is essential for patients with fatty liver disease. Mounting evidence has shown that magnetic resonance (MR) technique has high accuracy in the quantitative analysis of fatty liver, and is suitable for monitoring the therapeutic effect on fatty liver. However, many packaging methods and postprocessing functions have puzzled radiologists in clinical applications. Therefore, selecting a quantitative MR imaging technique for patients with fatty liver disease remains challenging.
AIM To provide information for the proper selection of commonly used quantitative MR techniques to quantify fatty liver.
METHODS We completed a systematic literature review of quantitative MR techniques for detecting fatty liver, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Studies were retrieved from PubMed, Embase, and Cochrane Library databases, and their quality was assessed using the Quality Assessment of Diagnostic Studies criteria. The Reference Citation Analysis database (https://www.referencecitationanalysis.com) was used to analyze citation of articles which were included in this review.
RESULTS Forty studies were included for spectroscopy, two-point Dixon imaging, and multiple-point Dixon imaging comparing liver biopsy to other imaging methods. The advantages and disadvantages of each of the three techniques and their clinical diagnostic performances were analyzed.
CONCLUSION The proton density fat fraction derived from multiple-point Dixon imaging is a noninvasive method for accurate quantitative measurement of hepatic fat content in the diagnosis and monitoring of fatty liver progression.
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Affiliation(s)
- You-Wei Li
- Department of Radiology, Beijing Rehabilitation Hospital, Capital Medical University, Beijing 100144, China
| | - Yang Jiao
- Department of Rehabilitation Psychology, Beijing Rehabilitation Hospital, Capital Medical University, Beijing 100144, China
| | - Na Chen
- Department of Otorhinolaryngology, Beijing Rehabilitation Hospital, Capital Medical University, Beijing 100144, China
| | - Qiang Gao
- Department of Gastroenterology and Hepatology, Beijing Rehabilitation Hospital, Capital Medical University, Beijing 100144, China
| | - Yu-Kun Chen
- Department of Radiology, Beijing Rehabilitation Hospital, Capital Medical University, Beijing 100144, China
| | - Yuan-Fang Zhang
- Department of Radiology, Beijing Rehabilitation Hospital, Capital Medical University, Beijing 100144, China
| | - Qi-Ping Wen
- Department of Radiology, Beijing Rehabilitation Hospital, Capital Medical University, Beijing 100144, China
| | - Zong-Ming Zhang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
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Brancato V, Della Pepa G, Bozzetto L, Vitale M, Annuzzi G, Basso L, Cavaliere C, Salvatore M, Rivellese AA, Monti S. Evaluation of a Whole-Liver Dixon-Based MRI Approach for Quantification of Liver Fat in Patients with Type 2 Diabetes Treated with Two Isocaloric Different Diets. Diagnostics (Basel) 2022; 12:diagnostics12020514. [PMID: 35204604 PMCID: PMC8871286 DOI: 10.3390/diagnostics12020514] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/04/2022] [Accepted: 02/15/2022] [Indexed: 02/04/2023] Open
Abstract
Dixon-based methods for the detection of fatty liver have the advantage of being non-invasive, easy to perform and analyze, and to provide a whole-liver coverage during the acquisition. The aim of the study was to assess the feasibility of a whole-liver Dixon-based approach for liver fat quantification in type 2 diabetes (T2D) patients who underwent two different isocaloric dietary treatments: a diet rich in monosaturated fatty acids (MUFA) and a multifactorial diet. Thirty-nine T2D patients were randomly assigned to MUFA diet (n = 21) and multifactorial diet (n = 18). The mean values of the proton density fat fraction (PDFF) over the whole liver and over the ROI corresponding to that chosen for MRS were compared to MRS-PDFF using Spearman’s correlation (ρ). Before–after changes in percentage of liver volume corresponding to MRI-PDFF above thresholds associated with hepatic steatosis (LV%TH, with TH = 5.56%, 7.97% and 8.8%) were considered to assess the proposed approach and compared between diets using Wilcoxon rank-sum test. Statistical significance set at p < 0.05. A strong linear relationship was found between MRS-PDFF and MRI-PDFFs (ρ = 0.85, p < 0.0001). Changes in LV%TH% were significantly higher (p < 0.05) in the multifactorial diet than in MUFA diet (25% vs. 9%, 35% vs. 12%, and 38% vs. 13% decrease, respectively, for TH = 5.56%, 7.97%, and 8.8%) and this was reproducible compared to results obtained using the standard liver fat analysis. A volumetric approach based on Dixon method could be an effective, non-invasive technique that could be used for the quantitative analysis of hepatic steatosis in T2D patients.
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Affiliation(s)
- Valentina Brancato
- IRCCS Synlab SDN, 80143 Naples, Italy; (L.B.); (C.C.); (M.S.)
- Correspondence:
| | - Giuseppe Della Pepa
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (G.D.P.); (L.B.); (M.V.); (G.A.); (A.A.R.)
| | - Lutgarda Bozzetto
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (G.D.P.); (L.B.); (M.V.); (G.A.); (A.A.R.)
| | - Marilena Vitale
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (G.D.P.); (L.B.); (M.V.); (G.A.); (A.A.R.)
| | - Giovanni Annuzzi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (G.D.P.); (L.B.); (M.V.); (G.A.); (A.A.R.)
| | - Luca Basso
- IRCCS Synlab SDN, 80143 Naples, Italy; (L.B.); (C.C.); (M.S.)
| | - Carlo Cavaliere
- IRCCS Synlab SDN, 80143 Naples, Italy; (L.B.); (C.C.); (M.S.)
| | - Marco Salvatore
- IRCCS Synlab SDN, 80143 Naples, Italy; (L.B.); (C.C.); (M.S.)
| | - Angela Albarosa Rivellese
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (G.D.P.); (L.B.); (M.V.); (G.A.); (A.A.R.)
| | - Serena Monti
- Institute of Biostructures and Bioimaging, National Research Council, 80145 Naples, Italy;
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11
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Yang Y, Xu K, Chen X, Ding J, Shi J, Li J. The Accuracy and Clinical Relevance of the Multi-echo Dixon Technique for Evaluating Changes to Hepatic Steatosis in Patients with Non-alcoholic Fatty Liver Disease Treated with Formulated Food. Magn Reson Med Sci 2022; 22:263-271. [PMID: 35676065 PMCID: PMC10086395 DOI: 10.2463/mrms.mp.2021-0168] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The Multi-echo Dixon (ME-Dixon) is a non-invasive quantitative MRI technique to diagnose non-alcoholic fatty liver disease (NAFLD). In this study, the hydrogen proton MR spectroscopy (1H-MRS) was used as a reference to explore the accuracy of the ME-Dixon technique in evaluating hepatic steatosis in NAFLD patients after ingesting formulated food and its correlation with changes in clinical indicators. METHODS Twenty-seven patients with NAFLD were enrolled. Fifteen patients completed 12 weeks of treatment with prebiotics and dietary fiber. In addition, abdominal MRI scans and blood tests were performed before and after treatment. The MRI-proton density fat fraction (MRI-PDFF) and MRS-PDFF were measured using the ME-Dixon and 1H-MRS techniques. The Bland-Altman method and Pearson correlation analysis were used to test the consistency of the two techniques for measuring the liver fat content and the changed values. Besides, correlation analysis was conducted between the MRI-PDFF value and metabolic indicators. RESULTS In the PDFF quantification of 42 person-times and the monitoring of the PDFF change in 15 patients under treatment, there was a good consistency and a correlation between MRI and MRS. At baseline, MRI-PDFF was positively correlated with insulin resistance index (HOMA-IR), fatty liver index (FLI), and liver enzymes. After treatment, the changes in MRI-PDFF were positively correlated with the recovery degree of FLI and liver enzymes. CONCLUSION ME-Dixon has a good consistency and a correlation with MRS in quantifying the liver fat content and monitoring the treatment effect, which may be used as an accurate indicator for clinical monitoring of changes in the liver fat content.
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Affiliation(s)
- Ying Yang
- Department of Radiology, Linping Campus, The Second Affiliated Hospital of Zhejiang University School of Medicine
| | - Kuanghui Xu
- Department of Radiology, Hangzhou Normal University Affiliated Hospital
| | - Xiaofei Chen
- Department of Radiology, Hangzhou Normal University Affiliated Hospital
| | - Jianping Ding
- Department of Radiology, Hangzhou Normal University Affiliated Hospital
| | - Junping Shi
- Department of Clinical Medicine, Medical College, Hangzhou Normal University
| | - Jie Li
- Department of Radiology, Hangzhou Normal University Affiliated Hospital
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12
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Quantification of Hepatic Fat Fraction in Patients With Nonalcoholic Fatty Liver Disease: Comparison of Multimaterial Decomposition Algorithm and Fat (Water)-Based Material Decomposition Algorithm Using Single-Source Dual-Energy Computed Tomography. J Comput Assist Tomogr 2021; 45:12-17. [PMID: 33186174 PMCID: PMC7834908 DOI: 10.1097/rct.0000000000001112] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
METHODS Hepatic fat fractions were quantified by noncontrast (HFFnon-CE) and contrast-enhanced single-source dual-energy computed tomography in arterial phase (HFFAP), portal venous phase (HFFPVP) and equilibrium phase (HFFEP) using MMD in 19 nonalcoholic fatty liver disease patients. The fat concentration was measured on fat (water)-based images. As the standard of reference, magnetic resonance iterative decomposition of water and fat with echo asymmetry and least-squares estimation-iron quantification images were reconstructed to obtain HFF (HFFIDEAL-IQ). RESULTS There was a strong correlation between HFFnon-CE, HFFAP, HFFPVP, HFFEP, fat concentration and HFFIDEAL-IQ (r = 0.943, 0.923, 0.942, 0.952, and 0.726) with HFFs having better correlation with HFFIDEAL-IQ. Hepatic fat fractions did not significantly differ across scanning phases. The HFFs of 3-phase contrast-enhanced computed tomography had a good consistency with HFFnon-CE. CONCLUSIONS Hepatic fat fraction using MMD has excellent correlation with that of magnetic resonance imaging, is independent of the computed tomography scanning phases, and may be used as a routine technique for quantitative assessment of HFF.
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13
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Lim DH, Kim M, Jun DW, Kwak MJ, Yoon JH, Lee KN, Lee HL, Lee OY, Yoon BC, Choi HS, Kang BK. Diagnostic Performance of Serum Asialo α 1-Acid Glycoprotein Levels to Predict Liver Cirrhosis. Gut Liver 2021; 15:109-116. [PMID: 32066208 PMCID: PMC7817921 DOI: 10.5009/gnl19282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/24/2019] [Accepted: 12/09/2019] [Indexed: 12/13/2022] Open
Abstract
Background/Aims To date, studies on various noninvasive techniques have been suggested to evaluate the degree of liver fibrosis. We aimed to investigate the diagnostic performance of serum asialo α1-acid glycoprotein (AsAGP) in the diagnosis of liver cirrhosis compared with chronic hepatitis for clinically useful result. Methods We conducted a case-control study of 96 patients with chronic liver disease. Chronic hepatitis was defined as the presence of chronic liver disease on ultrasonography, with a liver stiffness of less than 5.0 kPa as shown on magnetic resonance elastography (MRE). Liver cirrhosis was defined as liver stiffness of more than 5.0 kPa on MRE. The serum AsAGP concentration was compared between the two groups. Results Serum AsAGP levels were significantly higher in patients with cirrhosis than in those with chronic hepatitis (1.83 µg/mL vs 1.42 µg/mL, p<0.001). Additionally, when comparing patients in each cirrhotic group (Child-Pugh grades A, B, and C) to those with chronic hepatitis, AsAGP levels were significantly higher in all the cirrhotic groups (p<0.05, p<0.01, p<0.001, respectively). The sensitivity and specificity of AsAGP for detecting cirrhosis were 79.2% and 64.6%, respectively, and the area under the curve value was 0.733. The best diagnostic cutoff to predict cirrhosis was 1.4 µg/mL. AsAGP and bilirubin were found to be independent risk factors for the prediction of cirrhosis in the logistic regression analysis. Conclusions Serum AsAGP showed an acceptable diagnostic performance in predicting liver cirrhosis.
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Affiliation(s)
- Dae Hyun Lim
- Departments of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Mimi Kim
- Departments of Radiology, Hanyang University College of Medicine, Seoul, Korea
| | - Dae Won Jun
- Departments of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Min Jung Kwak
- Department of Data Information and Statistics, Pyeongtaek University, Pyeongtaek, Korea
| | - Jai Hoon Yoon
- Departments of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Kang Nyeong Lee
- Departments of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hang Lak Lee
- Departments of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Oh Young Lee
- Departments of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Byung Chul Yoon
- Departments of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ho Soon Choi
- Departments of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Bo Kyeong Kang
- Departments of Radiology, Hanyang University College of Medicine, Seoul, Korea
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14
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Del Chicca F, Richter H, Steger GL, Salesov E, Reusch CE, Kircher PR. Sample strategies for quantification of hepatic fat fraction mean MRI in healthy cats during body weight gain. PLoS One 2020; 15:e0241905. [PMID: 33180808 PMCID: PMC7660519 DOI: 10.1371/journal.pone.0241905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/22/2020] [Indexed: 11/26/2022] Open
Abstract
Hepatic fat fraction (HFF) can be non-invasively estimated with magnetic resonance imaging (MRI) multiple echo gradient recalled echo (GRE) sequence. The aim of this study was to test different methods of sampling strategies to quantify the HFF in healthy cats during body weight gain. Twelve healthy adult male cats were examined in a 3 Tesla MRI unit. Sequences included morphological images, and multiple echo GRE sequence. Cats were scanned at the beginning of the study and twice, each 20 weeks apart during body weight gain. HFF was calculated with 5 different methods of sampling on the multiple echo GRE sequence with different number, size and position of regions of interest (ROIs) and by 2 operators. Results indicated that HFF increased with increasing body weight, and the increase was appreciated with all the 5 methods. There was overall excellent agreement (interclass correlation coefficient = 0.820 (95% confidence interval:0.775–0.856)) between the 2 operators. HFF in the left lateral hepatic lobe was lower than in the other analyzed lobes. HFF measured on large free-hand drawn ROIs was higher than HFF measured with smaller ROIs size. This study proves that different sampling methods for quantification of HFF on multiple echo GRE sequence have overall excellent repeatability and ability to appreciate increased HFF.
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Affiliation(s)
- Francesca Del Chicca
- Clinic for Diagnostic Imaging, Department of Diagnostics and Clinical Services, Vetsuisse-Faculty Zurich, Zurich, Switzerland
- * E-mail:
| | - Henning Richter
- Clinic for Diagnostic Imaging, Department of Diagnostics and Clinical Services, Vetsuisse-Faculty Zurich, Zurich, Switzerland
| | - Gian-Luca Steger
- Clinic for Diagnostic Imaging, Department of Diagnostics and Clinical Services, Vetsuisse-Faculty Zurich, Zurich, Switzerland
| | - Elena Salesov
- Clinic of Small Animal Internal Medicine, Vetsuisse-Faculty Zurich, Zurich, Switzerland
| | - Claudia E. Reusch
- Clinic of Small Animal Internal Medicine, Vetsuisse-Faculty Zurich, Zurich, Switzerland
| | - Patrick R. Kircher
- Clinic for Diagnostic Imaging, Department of Diagnostics and Clinical Services, Vetsuisse-Faculty Zurich, Zurich, Switzerland
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15
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Abstract
Objective Today, a biopsy is the gold standard in the diagnosis of non-alcoholic fatty liver. However, a biopsy is an invasive technique, limited to the sample taken, and it may lead to misdiagnosis. Therefore, novel noninvasive options are needed. The objective of this study was to investigate the accuracy of magnetic resonance (MR) Dixon sequence and elastography using magnetic resonance spectroscopy (MRS) as a reference in the quantification of hepatic steatosis. Methods A total of 60 patients were included in the study. All patients underwent magnetic resonance imaging (MRI), MRS, and elastography in order to quantify hepatosteatosis. MRI and MRS imaging studies were performed using MR Dixon and high-speed T2-corrected multiple-echo 1H-MRS sequence (HISTO) sequences, respectively, in order to calculate proton density fat fraction (PDFF) values. Results The mean MRI-PDFF value with the MRS region of interest (ROI) was found as 9.4% ± 12.1%. The mean MRS-PDFF was found as 8.9% ± 11.3%. No statistically significant difference was found between MRS-PDFF and MRI-PDFF values measured in ROI (p < 0.005). The correlation between MRS-PDFF and MRI-PDFF was examined with Spearman’s correlation analysis. Accordingly, there was an excellent correlation between MRS and MRI values measured in ROI (r ≥ 0.8, p < 0.001). Sensitivity, specificity, positive predictive value, and negative predictive value were calculated as 96%, 100%, 89.5%, and 92.6%, respectively, for MRI-PDFF in predicting hepatic steatosis for the same ROI localization with MRS. The optimum cut-off value of MRS-PDFF in predicting hepatic steatosis was found as 5.3% using the same ROI localization with MRS. Conclusion The results of this study indicated an excellent correlation between MRI-PDFF and MRS-PDFF. The multi-echo Dixon MRI technique seems a promising alternative method in the detection of non-alcoholic fatty liver disease.
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Affiliation(s)
- Isil Yurdaisik
- Radiology, Istinye University Gaziosmanpasa Medical Park Hospital, Istanbul, TUR
| | - Fuad Nurili
- Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
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Hu F, Yang R, Huang Z, Wang M, Yuan F, Xia C, Wei Y, Song B. 3D Multi-Echo Dixon technique for simultaneous assessment of liver steatosis and iron overload in patients with chronic liver diseases: a feasibility study. Quant Imaging Med Surg 2019; 9:1014-1024. [PMID: 31367555 PMCID: PMC6629573 DOI: 10.21037/qims.2019.05.20] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Patients with chronic liver diseases (CLDs) often suffer from lipidosis or siderosis. Proton density fat fraction (PDFF) and R2* can be used as quantitative parameters to assess the fat/iron content of the liver. The aim of this study was to evaluate the influence of liver fibrosis and inflammation on the 3D Multi-echo Dixon (3D ME Dixon) parameters (MRI-PDFF and R2*) in patients with CLDs and to determine the feasibility of 3D ME Dixon technique for the simultaneous assessment of liver steatosis and iron overload using histopathologic findings as the reference standard. METHODS Ninety-nine consecutive patients with CLDs underwent T1-independent, T2*-corrected 3D ME Dixon sequence with reconstruction using multipeak spectral modeling on a 3T MR scanner. Liver specimen was reviewed in all cases, grading liver steatosis, siderosis, fibrosis, and inflammation. Spearman correlation analysis was performed to determine the relationship between 3D ME Dixon parameters (MRI-PDFF and R2*) and histopathological and biochemical features [liver steatosis, iron overload, liver fibrosis, inflammation, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL)]. Multiple regression analysis was applied to identify variables associated with 3D ME Dixon parameters. Receiver operating characteristic (ROC) analysis was performed to determine the diagnostic performance of these parameters to differentiate liver steatosis or iron overload. RESULTS In multivariate analysis, only liver steatosis independently influenced PDFF values (R2=0.803, P<0.001), liver iron overload and fibrosis influenced R2* values (R2=0.647, P<0.001). The Spearman analyses showed that R2* values were moderately correlated with fibrosis stages (r=0.542, P<0.001) in the subgroup with the absence of iron overload. The area under the ROC curve of PDFF was 0.989 for the diagnosis of steatosis grade 1 or greater, and 0.986 for steatosis grade 2 or greater. The area under the ROC curve of R2* was 0.815 for identifying iron overload grade 1 or greater, and 0.876 for iron overload grade 2 or greater. CONCLUSIONS 3D Multi-Echo Dixon can be used to simultaneously evaluate liver steatosis and iron overload in patients with CLDs, especially for quantification of liver steatosis. However, liver R2* value may be affected by the liver fibrosis in the setting of CLDs with absence of iron overload.
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Affiliation(s)
- Fubi Hu
- Department of Radiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610041, China
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Ru Yang
- Department of Radiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610041, China
| | - Zixing Huang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Min Wang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Fang Yuan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chunchao Xia
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yi Wei
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
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17
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Zhao YZ, Gan YG, Zhou JL, Liu JQ, Cao WG, Cheng SM, Bai DM, Wang MZ, Gao FQ, Zhou SM. Accuracy of multi-echo Dixon sequence in quantification of hepatic steatosis in Chinese children and adolescents. World J Gastroenterol 2019; 25:1513-1523. [PMID: 30948914 PMCID: PMC6441915 DOI: 10.3748/wjg.v25.i12.1513] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 01/29/2019] [Accepted: 02/23/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is currently the outstanding cause of chronic liver disease in children and adolescents, especially in overweight and obese groups. Liver biopsy is the reference standard to diagnose NAFLD but invasive, thus it is not the best choice in clinical diagnosis and follow-up. Magnetic resonance (MR) is widely used in clinical trials to noninvasively quantify liver fat content in adults and children in foreign countries. While currently, it is rarely used in Chinese children and adolescents. We postulated that quantifying hepatic steatosis by MR could be extended to children and adolescents in China.
AIM To investigate the accuracy of MR imaging (MRI) in quantifying liver fat with MR spectroscopy (MRS) as a reference. A secondary goal was to assess the prevalence of NAFLD in overweight and obese Chinese children and adolescents.
METHODS There were 86 children and adolescents enrolled in this study, including 65 overweight and obese children and 21 healthy children. The participants underwent MRI and MRS. MRI and MRS were performed using multi-echo Dixon and HISTO sequences, respectively, to calculate hepatic proton density fat fraction (PDFF). Hepatic steatosis was diagnosed using MRS-PDFF > 5% as the threshold. Spearman’s analysis was used to evaluate the correlation between MRI and MRS. The agreement between these two methods was assessed by Bland-Altman analysis.
RESULTS The MRI-PDFF in the MRS region of interest and the entire liver was 9.9% ± 10.3% with a range of 0.3%-39.9%, and 10.6% ± 9.4% with a range of 1.9%-38.9%, respectively. The MRS-PDFF was 9.1% ± 10.0%, with a range of 0.5%-37.8%. The incidence of hepatic steatosis detected by MRS-PDFF was 46.5% (40/86) of all participants, all of whom belonged to the overweight and obese group. Spearman’s analysis indicated an excellent correlation between multi-echo Dixon and MRS (r > 0.9, P < 0.01). Bland-Altman analysis also demonstrated a good agreement between these two methods.
CONCLUSION Multi-echo Dixon shows an excellent correlation and agreement with MRS in quantifying liver fat content and could be a potential tool to detect hepatic steatosis in Chinese children and adolescents.
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Affiliation(s)
- Yu-Zhen Zhao
- Department of Gastroenterology, Shenzhen Children’s Hospital, Shenzhen 518038, Guangdong Province, China
| | - Yun-Gen Gan
- Department of Radiology, Shenzhen Children’s Hospital, Shenzhen 518038, Guangdong Province, China
| | - Jian-Li Zhou
- Department of Gastroenterology, Shenzhen Children’s Hospital, Shenzhen 518038, Guangdong Province, China
| | - Jia-Qi Liu
- Department of Gastroenterology, Shenzhen Children’s Hospital, Shenzhen 518038, Guangdong Province, China
| | - Wei-Guo Cao
- Department of Radiology, Shenzhen Children’s Hospital, Shenzhen 518038, Guangdong Province, China
| | - Shu-Mei Cheng
- Department of Physical Examination, Futian District Maternity and Child Healthcare Hospital, Shenzhen 518048, Guangdong Province, China
| | - Da-Ming Bai
- Department of Gastroenterology, Shenzhen Children’s Hospital, Shenzhen 518038, Guangdong Province, China
| | - Meng-Zhu Wang
- Department of MR Scientific Marketing, Siemens Healthineers, Guangzhou 510620, Guangdong Province, China
| | - Fang-Qin Gao
- Department of MR Clinical Marketing, Siemens Healthineers, Guangzhou 510620, Guangdong Province, China
| | - Shao-Ming Zhou
- Department of Gastroenterology, Shenzhen Children’s Hospital, Shenzhen 518038, Guangdong Province, China
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Affiliation(s)
- Stuart A Taylor
- 1 UCL Centre for Medical Imaging, Division of Medicine, University College London , London , UK
| | - Laura R Carucci
- 2 Department of Radiology, VCU Health System , Richmond, VA , United States
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