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Chiyanika C, Hui SCN, Sin DMC, Shumbayawonda E, Wong SKH, Ng EKW, Yip TCF, Wong VWS, Chu WCW. The effectiveness of magnetic resonance imaging (MRI) iron corrected T1 in monitoring metabolic dysfunction-associated steatohepatitis in obesity following bariatric surgery and lifestyle modification: a prospective cohort study. Quant Imaging Med Surg 2024; 14:4659-4674. [PMID: 39022255 PMCID: PMC11250305 DOI: 10.21037/qims-24-148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/29/2024] [Indexed: 07/20/2024]
Abstract
Background Bariatric surgery and lifestyle modification are important treatments for obesity, a risk factor for metabolic dysfunction-associated steatohepatitis (MASH). Studies have related weight reduction with changes in MASH, however, few have used imaging to investigate effects on liver health. We evaluated differences in liver response to obesity treatment using disease activity iron corrected T1 (cT1) and proton density fat fraction (PDFF) in patients with both obesity and metabolic dysfunction-associated steatotic liver disease (MASLD). Methods Thirty-four patients with obesity and MASLD were recruited between March 2019 to February 2022 from a tertiary hospital in this longitudinal study; 13 underwent laparoscopic sleeve gastrectomy (LSG) alongside intraoperative liver biopsy, and 21 underwent a 4-month lifestyle modification program (LMP). All patients had multi-parametric magnetic resonance imaging (MRI) at baseline and 4-months. Diagnostic accuracy to identify MASH was assessed using the area under receiver operating characteristic (AUROC) curve. Results Four (31%) of patients in the LSG group had MASH [non-alcoholic steatohepatitis (NAS) activity score ≥4] on liver biopsy. PDFF and cT1 correlated with the NAS activity score [r=0.81, 95% confidence interval (CI): 0.453 to 0.943, P<0.001] and (r=0.70, 95% CI: 0.228 to 0.907, P=0.008, respectively). There was good AUROC curve for cT1 (0.89, 95% CI: 0.67 to 1.00, P=0.031) and PDFF (0.83, 95% CI: 0.57 to 1.00, P=0.064) to identify MASH. At follow-up, weight reduction -22.8% (P=0.013) vs. -1.3% (P=0.262) resulted in cT1 reduction of -8.04% (864 ms, P=0.025) vs. -3.87% (907 ms, P=0.083) in the LSG vs. LMP group, respectively. Significant differences between interventions were observed for percentage PDFF decrease (-64.52% vs. -29.16%, P=0.001). Both biomarkers were significantly reduced in the LSG group (cT1 by -8.04%, P=0.025, PDFF by -64.52%, P=0.012), while only PDFF (-29.16%, P=0.012) was significantly reduced in the LMP group. Conclusions MRI biomarkers may have some utility to monitor MASH following intervention in patients with obesity allowing objective comparison between intervention strategies. Compared to LMP, LSG was more effective in improving liver health.
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Affiliation(s)
- Chileka Chiyanika
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Steve Cheuk Ngai Hui
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Developing Brain Institute, Children’s National Hospital, Washington, DC, USA
- Department of Radiology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Daisy Man Ching Sin
- School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Simon Kin Hung Wong
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Enders Kwok Wai Ng
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Terry Cheuk-Fung Yip
- Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong, China
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Vincent Wai-Sun Wong
- Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong, China
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Winnie Chiu Wing Chu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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Kara YB, Buluc H, Elgezen M, Yildiz E, Yardimci S. A Simple Way to Estimate a Difficult Sleeve Gastrectomy Prior to Operating. Obes Surg 2024; 34:1159-1167. [PMID: 38374321 PMCID: PMC11026237 DOI: 10.1007/s11695-024-07093-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/03/2024] [Accepted: 02/07/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Today, bariatric procedures are common. These surgeries' difficulties are classified as patient- or surgical team-related and are estimated by body mass index (BMI). More efficient methods are needed to help surgeons. This study evaluated the effect of measuring patients' subcutaneous fat tissue thickness (SFT) and umbilicus-xiphoid (DXU) to anticipate surgical difficulties. MATERIAL AND METHODS This was a prospective retrospective data analysis study. Laparoscopic sleeve gastrectomy patients seen between May and October 2022 were included in the analysis and divided into three groups, according to a surgeon's assessment. All patients' SFT, DXU, rectus muscle thickness, total fat tissue amount (TFT), and operational time were recorded prospectively and analyzed. RESULTS In all, 151 patients were included in the study; of these, 124 (82.1%) were women and 27 (17.9%) were men. Their mean BMI value was 41.1 ± 6.2. Based on expert's opinion, we classified three groups: easy (n = 123, 81.5%), intermediate (n = 22, 14.6%), or difficult (n = 6, 4%). When the easy group was compared to the intermediate/difficult groups, we found that intermediate/difficult groups' SFT values were statistically significantly higher than the easy group (p = 0.000). Also, the intermediate/difficult group's TFT value was statistically significantly higher than the easy group (p = 0.000). We found no statistically significant differences between groups' DXU and rectus muscle thickness. CONCLUSION This is the first study to anticipate sleeve gastrectomy difficulty using SFT and TFT. This is an easy technique to apply and no additional costs. Anticipating difficulties based on these criteria can ensure necessary preparations are made and help avoid complications.
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Affiliation(s)
- Yalcin Burak Kara
- General Surgery Department, Bahcesehir University VM Medical Park Pendik Hospital, Fevzi Çakmak Mahallesi, D100, Cemal Gürsel Cd. No: 9, Pendik, 34899, Istanbul, Turkey.
| | - Halil Buluc
- Department of Anestesiology, VM Medical Park Pendik Hospital, Fevzi Çakmak Mahallesi, D100, Cemal Gürsel Cd. No: 9, Pendik, 34899, Istanbul, Turkey
| | - Mehmet Elgezen
- Department of Radiology, VM Medical Park Pendik Hospital, Fevzi Çakmak Mahallesi, D100, Cemal Gürsel Cd. No: 9, Pendik, 34899, Istanbul, Turkey
| | - Edanur Yildiz
- School of Medicine, Bahcesehir University, Sahrayı Cedit, Batman Sk., No: 66, Kadıkoy, 34734, Istanbul, Turkey
| | - Samet Yardimci
- General Surgery Department, Istinye University VM Medical Park Pendik Hospital, Fevzi Çakmak Mahallesi, D100, Cemal Gürsel Cd. No: 9, Pendik, 34899, Istanbul, Turkey
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Changes in Lean Tissue Mass, Fat Mass, Biological Parameters and Resting Energy Expenditure over 24 Months Following Sleeve Gastrectomy. Nutrients 2023; 15:nu15051201. [PMID: 36904198 PMCID: PMC10004853 DOI: 10.3390/nu15051201] [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: 01/31/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/08/2023] Open
Abstract
Sleeve gastrectomy (SG) induces weight loss but its effects on body composition (BC) are less well known. The aims of this longitudinal study were to analyse the BC changes from the acute phase up to weight stabilization following SG. Variations in the biological parameters related to glucose, lipids, inflammation, and resting energy expenditure (REE) were concomitantly analysed. Fat mass (FM), lean tissue mass (LTM), and visceral adipose tissue (VAT) were determined by dual-energy X-ray absorptiometry in 83 obese patients (75.9% women) before SG and 1, 12 and 24 months later. After 1 month, LTM and FM losses were comparable, whereas at 12 months the loss of FM exceeded that of LTM. Over this period, VAT also decreased significantly, biological parameters became normalized, and REE was reduced. For most of the BC, biological and metabolic parameters, no substantial variation was demonstrated beyond 12 months. In summary, SG induced a modification in BC changes during the first 12 months following SG. Although the significant LTM loss was not associated with an increase in sarcopenia prevalence, the preservation of LTM might have limited the reduction in REE, which is a longer-term weight-regain criterion.
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Greco F, Salgado R, Van Hecke W, Del Buono R, Parizel PM, Mallio CA. Epicardial and pericardial fat analysis on CT images and artificial intelligence: a literature review. Quant Imaging Med Surg 2022; 12:2075-2089. [PMID: 35284252 PMCID: PMC8899943 DOI: 10.21037/qims-21-945] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/03/2021] [Indexed: 07/24/2023]
Abstract
The present review summarizes the available evidence on artificial intelligence (AI) algorithms aimed to the segmentation of epicardial and pericardial adipose tissues on computed tomography (CT) images. Body composition imaging is a novel concept based on quantitative analysis of body tissues. Manual segmentation of medical images allows to obtain quantitative and qualitative data on several tissues including epicardial and pericardial fat. However, since manual segmentation requires a considerable amount of time, the analysis of adipose tissue compartments based on AI has been proposed as an automatic, reliable, accurate and fast tool. The literature research was performed on March 2021 using MEDLINE PubMed Central and "adipose tissue artificial intelligence", "adipose tissue deep learning" or "adipose tissue machine learning" as keywords for articles search. Relevant articles concerning epicardial adipose tissue, pericardial adipose tissue and AI were selected. The evaluation of adipose tissue compartments can provide additional information on the pathogenesis and prognosis of several diseases, including cardiovascular. AI can assist physicians to obtain important information, possibly improving the patient's quality of life and identifying patients at risk of developing variable disorders.
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Affiliation(s)
- Federico Greco
- U.O.C. Diagnostica per Immagini Territoriale Aziendale, Cittadella della Salute Azienda Sanitaria Locale di Lecce, Lecce, Italy
| | - Rodrigo Salgado
- Department of Radiology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Wim Van Hecke
- AI Supported Modelling in Clinical Sciences (AIMS), Vrije Universiteit Brussel, 1050 Brussels, Belgium and founder of icoMetrix, Leuven, Belgium
| | - Romualdo Del Buono
- Unit of Anesthesia, Resuscitation, Intensive Care and Pain Management, ASST Gaetano Pini, Milano, Italy
| | - Paul M. Parizel
- Royal Perth Hospital & University of Western Australia, Perth, Western Australia, Australia
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Sun J, Lv H, Zhang M, Li M, Zhao L, Zeng N, Liu Y, Wei X, Chen Q, Ren P, Liu Y, Zhang P, Yang Z, Zhang Z, Wang Z. The Appropriateness Criteria of Abdominal Fat Measurement at the Level of the L1-L2 Intervertebral Disc in Patients With Obesity. Front Endocrinol (Lausanne) 2021; 12:784056. [PMID: 34970225 PMCID: PMC8712928 DOI: 10.3389/fendo.2021.784056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/19/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In this study, we proposed to use MR images at L1-L2 (lumbar) intervertebral disc level to measure abdominal fat area in patients with obesity. The quantitative results would provide evidence for the individualized assessment of the severity of obesity. METHODS All patients in the IRB-approved database of Beijing Friendship Hospital who underwent bariatric surgery between November 2017 and November 2019 were recruited. We retrospectively reviewed upper abdominal magnetic resonance (MR) data before surgery. We analyzed the correlation and consistency of the area of abdominal subcutaneous adipose tissue (ASAT) and visceral adipose tissue (VAT) measured at the L1-L2 and L2-L3 levels on MR images. We randomly distributed the cases into prediction model training data and testing data at a ratio of 7:3. RESULTS Two hundred and forty-five subjects were included. The ASAT and VAT results within the L1-L2 and L2-L3 levels were very similar and highly correlated (maleASAT: r=0.98, femaleASAT: r=0.93; maleVAT: r=0.91, femaleVAT: r=0.88). There was no substantial systematic deviation among the results at the two levels, except for the ASAT results in males. The intraclass correlation coefficients (ICCs) were 0.91 and 0.93 for maleASAT and femaleASAT, and 0.88 and 0.87 for maleVAT and femaleVAT, respectively. The ASAT/VAT area at the L2-L3 level was well predicted. The coefficient β of linear regression that predicted L2-L3 ASAT from L1-L2 ASAT was 1.11 for males and 0.99 for females. The R-squares were 0.97 and 0.91, respectively. For VAT prediction, the coefficient β was 1.02 for males and 0.96 for females. The R-squares were 0.82 and 0.77, respectively. CONCLUSION For patients with obesity, the L1-L2 intervertebral disc level can be used as the substitution of L2-L3 level in abdominal fat measurement.
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Affiliation(s)
- Jing Sun
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Han Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- *Correspondence: Zhenchang Wang, ; Han Lv,
| | - Meng Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Mengyi Li
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Lei Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Na Zeng
- National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yawen Liu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xuan Wei
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qian Chen
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Pengling Ren
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yang Liu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Peng Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- *Correspondence: Zhenchang Wang, ; Han Lv,
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