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Gomes NBN, Torres US, Caiado AHM, Fucuta PS, Ferraz MLCG, D'Ippolito G. Diagnostic accuracy of an uncorrected native T1 mapping sequence for liver fibrosis and inflammation in autoimmune hepatitis: a prospective study using histopathology as reference standard. LA RADIOLOGIA MEDICA 2024:10.1007/s11547-024-01863-2. [PMID: 39106024 DOI: 10.1007/s11547-024-01863-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 07/25/2024] [Indexed: 08/07/2024]
Abstract
PURPOSE There is an unmet clinical need for non-invasive imaging biomarkers that could replace liver biopsy in the management of patients with autoimmune hepatitis (AIH). In this study, we sought to evaluate the diagnostic accuracy of a simple uncorrected, non-contrast T1 mapping for detecting fibrosis and inflammation in AIH patients using histopathology as a reference standard. MATERIAL AND METHODS Over 3 years, 33 patients with AIH were prospectively studied using a multiparametric liver MRI protocol which included T1 mapping. Biopsies were performed up to 3 months before imaging, and a standardized histopathological score for fibrosis (F0-F4) and inflammatory activity (PPA0-4) was used as a reference. Statistical analysis included independent t test, Mann-Whitney U-test, and ROC (receiver operating characteristic) analysis. RESULTS T1 mapping values were significantly higher in patients with advanced fibrosis (F0-2 vs. F3-4; p < 0.015), significant fibrosis (F0-1 vs. F2-4; p < 0.005), and significant inflammatory activity (PPA 0-1 vs. PPA 2-4 p = 0.048). Moreover, the technique demonstrated a good diagnostic performance in detecting significant (AUC 0.856) and advanced fibrosis (AUC 0.835), as well as significant inflammatory activity (AUC 0.763). CONCLUSION A rapid, simple, uncorrected, non-contrast T1 mapping sequence showed satisfactory diagnostic performance in comparison with histopathology for detecting significant tissue inflammation and fibrosis in AIH patients, being a potential non-invasive imaging biomarker for monitoring disease activity in such individuals.
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Affiliation(s)
- Natália B N Gomes
- Grupo Fleury, São Paulo, Brazil.
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino Rua Napoleão de Barros, 800, São Paulo, SP, 04024-000, Brazil.
| | - Ulysses S Torres
- Grupo Fleury, São Paulo, Brazil
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino Rua Napoleão de Barros, 800, São Paulo, SP, 04024-000, Brazil
| | | | - Patricia S Fucuta
- Hospital de Base, Faculdade de Medicina de São José do Rio Preto (FAMERP), São Paulo, Brazil
| | - Maria Lucia C G Ferraz
- Department of Gastroenterology, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Giuseppe D'Ippolito
- Grupo Fleury, São Paulo, Brazil
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino Rua Napoleão de Barros, 800, São Paulo, SP, 04024-000, Brazil
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Simon TG, Wilechansky RM, Stoyanova S, Grossman A, Dichtel LE, Lauer GM, Miller KK, Hoshida Y, Corey KE, Loomba R, Chung RT, Chan AT. Aspirin for Metabolic Dysfunction-Associated Steatotic Liver Disease Without Cirrhosis: A Randomized Clinical Trial. JAMA 2024; 331:920-929. [PMID: 38502074 PMCID: PMC10951738 DOI: 10.1001/jama.2024.1215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/26/2024] [Indexed: 03/20/2024]
Abstract
Importance Aspirin may reduce severity of metabolic dysfunction-associated steatotic liver disease (MASLD) and lower the incidence of end-stage liver disease and hepatocellular carcinoma, in patients with MASLD. However, the effect of aspirin on MASLD is unknown. Objective To test whether low-dose aspirin reduces liver fat content, compared with placebo, in adults with MASLD. Design, Setting, and Participants This 6-month, phase 2, randomized, double-blind, placebo-controlled clinical trial was conducted at a single hospital in Boston, Massachusetts. Participants were aged 18 to 70 years with established MASLD without cirrhosis. Enrollment occurred between August 20, 2019, and July 19, 2022, with final follow-up on February 23, 2023. Interventions Participants were randomized (1:1) to receive either once-daily aspirin, 81 mg (n = 40) or identical placebo pills (n = 40) for 6 months. Main Outcomes and Measures The primary end point was mean absolute change in hepatic fat content, measured by proton magnetic resonance spectroscopy (MRS) at 6-month follow-up. The 4 key secondary outcomes included mean percentage change in hepatic fat content by MRS, the proportion achieving at least 30% reduction in hepatic fat, and the mean absolute and relative reductions in hepatic fat content, measured by magnetic resonance imaging proton density fat fraction (MRI-PDFF). Analyses adjusted for the baseline value of the corresponding outcome. Minimal clinically important differences for study outcomes were not prespecified. Results Among 80 randomized participants (mean age, 48 years; 44 [55%] women; mean hepatic fat content, 35% [indicating moderate steatosis]), 71 (89%) completed 6-month follow-up. The mean absolute change in hepatic fat content by MRS was -6.6% with aspirin vs 3.6% with placebo (difference, -10.2% [95% CI, -27.7% to -2.6%]; P = .009). Compared with placebo, aspirin treatment significantly reduced relative hepatic fat content (-8.8 vs 30.0 percentage points; mean difference, -38.8 percentage points [95% CI, -66.7 to -10.8]; P = .007), increased the proportion of patients with 30% or greater relative reduction in hepatic fat (42.5% vs 12.5%; mean difference, 30.0% [95% CI, 11.6% to 48.4%]; P = .006), reduced absolute hepatic fat content by MRI-PDFF (-2.7% vs 0.9%; mean difference, -3.7% [95% CI, -6.1% to -1.2%]; P = .004]), and reduced relative hepatic fat content by MRI-PDFF (-11.7 vs 15.7 percentage points; mean difference, -27.3 percentage points [95% CI, -45.2 to -9.4]; P = .003). Thirteen participants (32.5%) in each group experienced an adverse event, most commonly upper respiratory tract infections (10.0% in each group) or arthralgias (5.0% for aspirin vs 7.5% for placebo). One participant randomized to aspirin (2.5%) experienced drug-related heartburn. Conclusions and Relevance In this preliminary randomized clinical trial of patients with MASLD, 6 months of daily low-dose aspirin significantly reduced hepatic fat quantity compared with placebo. Further study in a larger sample size is necessary to confirm these findings. Trial Registration ClinicalTrials.gov Identifier: NCT04031729.
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Affiliation(s)
- Tracey G. Simon
- Clinical and Translational Epidemiology Unit (CTEU), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Robert M. Wilechansky
- Clinical and Translational Epidemiology Unit (CTEU), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of Gastroenterology and Hepatology, Department of Medicine, Massachusetts General Hospital, Boston
| | - Stefania Stoyanova
- Division of Gastroenterology and Hepatology, Department of Medicine, Massachusetts General Hospital, Boston
| | - Alessandra Grossman
- Division of Gastroenterology and Hepatology, Department of Medicine, Massachusetts General Hospital, Boston
| | - Laura E. Dichtel
- Harvard Medical School, Boston, Massachusetts
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston
| | - Georg M. Lauer
- Harvard Medical School, Boston, Massachusetts
- Division of Gastroenterology and Hepatology, Department of Medicine, Massachusetts General Hospital, Boston
| | - Karen K. Miller
- Harvard Medical School, Boston, Massachusetts
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston
| | - Yujin Hoshida
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Kathleen E. Corey
- Clinical and Translational Epidemiology Unit (CTEU), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of Gastroenterology and Hepatology, Department of Medicine, Massachusetts General Hospital, Boston
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla
| | - Raymond T. Chung
- Clinical and Translational Epidemiology Unit (CTEU), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of Gastroenterology and Hepatology, Department of Medicine, Massachusetts General Hospital, Boston
| | - Andrew T. Chan
- Clinical and Translational Epidemiology Unit (CTEU), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of Gastroenterology and Hepatology, Department of Medicine, Massachusetts General Hospital, Boston
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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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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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Armstrong T, Zhong X, Shih SF, Felker E, Lu DS, Dale BM, Wu HH. Free-breathing 3D stack-of-radial MRI quantification of liver fat and R 2* in adults with fatty liver disease. Magn Reson Imaging 2021; 85:141-152. [PMID: 34662702 DOI: 10.1016/j.mri.2021.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 10/07/2021] [Accepted: 10/12/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To investigate the agreement, intra-session repeatability, and inter-reader agreement of liver proton-density fat fraction (PDFF) and R2* quantification using free-breathing 3D stack-of-radial MRI, with and without self-gated motion compensation, compared to reference breath-hold techniques in subjects with fatty liver disease (FLD). METHODS In this institutional review board-approved prospective study, thirty-eight adults with FLD and/or iron overload (24 male, 58 ± 12 years) were imaged at 3T using free-breathing stack-of-radial MRI, breath-hold 3D Cartesian MRI, and breath-hold single-voxel MR spectroscopy (SVS). Each sequence was acquired twice in random order. To assess agreement compared to reference breath-hold techniques, the dependency of liver PDFF and/or R2* quantification on the sequence, radial sampling factor, and radial self-gating temporal resolution was assessed by calculating the Bayesian mean difference (MDB) of the posteriors. Intra-session repeatability and inter-reader agreement (two independent readers) were assessed by the coefficient of repeatability (CR) and intraclass correlation coefficient (ICC), respectively. RESULTS Thirty-five participants (21 male, 57 ± 12 years) were included for analysis. Both free-breathing radial MRI techniques (with and without self-gating) achieved ICC ≥ 0.92 for quantifying PDFF and R2*, and quantified PDFF with MDB < 1.2% compared to breath-hold techniques. Free-breathing radial MRI required self-gating to accurately quantify R2* (MDB < 10s-1 with self-gating; MDB < 50s-1 without self-gating). The radial sampling factor affected PDFF and R2* quantification while the radial self-gating temporal resolution only affected R2* quantification. Repeated self-gated free-breathing radial MRI scans achieved CR < 3% and CR < 27 s-1 for PDFF and R2*, respectively. CONCLUSION A free-breathing stack-of-radial MRI technique with self-gating demonstrated agreement, repeatability, and inter-reader agreement compared to reference breath-hold techniques for quantification of liver PDFF and R2* in adults with FLD.
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Affiliation(s)
- Tess Armstrong
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Xiaodong Zhong
- MR R&D Collaborations, Siemens Medical Solutions USA, Inc., Los Angeles, CA, United States
| | - Shu-Fu Shih
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States; Department of Bioengineering, University of California Los Angeles, Los Angeles, CA, United States
| | - Ely Felker
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - David S Lu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Brian M Dale
- MR R&D Collaborations, Siemens Medical Solutions USA, Inc., Cary, NC, United States
| | - Holden H Wu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States; Department of Bioengineering, University of California Los Angeles, Los Angeles, CA, United States.
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Lăpădat AM, Florescu LM, Manea NC, Gheonea DI, Pirici D, Tudoraşcu DR, Ene R, Gheonea IA. MR spectroscopy of the liver - a reliable non-invasive alternative for evaluating non-alcoholic fatty liver disease. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 61:73-80. [PMID: 32747897 PMCID: PMC7728118 DOI: 10.47162/rjme.61.1.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is one of the most common conditions worldwide that targets the liver parenchyma. NAFLD represents an intrahepatic triglyceride accumulation in the absence of excessive alcohol consumption and other diseases that affect the liver parenchyma. The current "gold standard" for evaluating the amount of intrahepatic fat is represented by liver biopsy, but many patients are reluctant and hardly accept undergoing this procedure due to its invasive nature. The current study addresses this aspect by evaluating the reliability of liver magnetic resonance spectroscopy (MRS) in diagnosing NAFLD, compared to the traditional invasive liver biopsy. The present study included a total of 38 patients based on several well-defined inclusion and exclusion criteria. We used the same NAFLD grading system for both liver MRS and liver biopsy: grade 0: <5% hepatocytes are affected; grade I: 5-33% hepatocytes are affected; grade II: 34-66% hepatocytes are affected; grade III: >66% hepatocytes are affected. Regarding the NAFLD grade, over three-quarters of patients were classified as grade I and grade II, with a strong predilection for men. The current results indicated a significant association between the NAFLD grade indicated by liver MRS and the NAFLD grade indicated by liver biopsy. At the end of our study, we recommend using liver MRS for evaluating and grading NAFLD in association with other parameters like serum triglycerides and body mass index grade as this protocol can enhance early detection and provide an accurate grading that will lead to a proper management of this disease.
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Affiliation(s)
- Alina Maria Lăpădat
- Department of Radiology and Medical Imaging, Department of Medical Informatics, University of Medicine and Pharmacy of Craiova, Romania; ,
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Virarkar M, Szklaruk J, Jensen CT, Taggart MW, Bhosale P. What's New in Hepatic Steatosis. Semin Ultrasound CT MR 2021; 42:405-415. [PMID: 34130852 DOI: 10.1053/j.sult.2021.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hepatic steatosis can lead to liver cancer, cirrhosis, and portal hypertension. There are two main types, non-alcoholic fatty liver disease (NAFLD) and alcoholic liver disease. The detection and quantification of hepatic steatosis with lifestyle changes can slow the evolution from NAFLD to steatohepatitis. Currently, the gold standard for the quantification of fat in the liver is biopsy, has some limitations. Hepatic steatosis is frequently detected during cross sectional imaging. Ultrasound (US), Computed Tomography (CT), and Magnetic Resonance Imaging (MRI) provide noninvasive assessment of liver parenchyma and can detect fat infiltration in the liver. However, the non-invasive quantification of hepatic steatosis by imaging has been challenging. Recent MRI techniques show great promise in the detection and quantification of liver fat. The aim of this article is to review the utilization of non-invasive imaging modalities for the detection and quantification of hepatic steatosis, to evaluate their advantages and limitations.
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Affiliation(s)
- Mayur Virarkar
- Department of Neuroradiology, The University of Texas Health Science Center, Houston, TX.
| | - Janio Szklaruk
- Department of Abdominal Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Corey T Jensen
- Department of Abdominal Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Melissa W Taggart
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Priya Bhosale
- Department of Abdominal Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Assessment of Intramyocardial Fat Content Using Computed Tomography: Is There a Relationship With Obesity? J Thorac Imaging 2020; 36:162-165. [PMID: 33875630 DOI: 10.1097/rti.0000000000000571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fat deposition in the liver and the skeletal muscle are linked to cardiovascular risk factors. Fat content in tissues can be estimated by measuring attenuation on noncontrast computed tomography (CT). Quantifying intramyocardial fat content is of interest as it may be related to myocardial dysfunction or development of heart failure. We hypothesized that myocardial fat content would correlate with severity of obesity, liver fat, and components of the metabolic syndrome. METHODS We measured attenuation values on 121 noncontrast CT scans from the spleen, liver, erector spinae muscle, and myocardial septum. A chart review was performed for patient demographics and clinical characteristics. We tested for correlations between attenuation values in each of the tissues and various clinical parameters. RESULTS We studied 78 females and 43 males, with a mean age of 54.5±11.2 years. Weak, but significant inverse Spearman correlation between body mass index and attenuation values were found in the liver (ρ=-0.228, P=0.012), spleen (ρ=-0.225, P=0.017), and erector spinae muscle (ρ=-0.211, P=0.022) but not in the myocardial septum (ρ=0.012, P=0.897). Mean attenuation in the nonobese group versus obese group (body mass index >30 kg/m2) were 41.1±5.0 versus 42.3±6.9 (P=0.270) in myocardial septum, 56.1±8.7 versus 51.7±10.9 (P=0.016) in the liver, 43.9±8.9 versus 40.1±10.4 (P=0.043) in the spleen, and 41.7±8.3 versus 39.0±8.8 (P=0.087) in the erector spinae muscle. CONCLUSIONS Although CT is a theoretically appealing modality to assess fat content of the myocardium, we did not find a relationship between myocardial CT attenuation and obesity, or other cardiovascular risk factors. These findings suggest that the degree of myocardial fat accumulation in obesity or metabolic syndrome is too small to be detected with this modality.
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Altay C, Seçil M, Adıyaman SC, Özgen Saydam B, Demir T, Akıncı G, Simsir IY, Eren E, Temeloğlu Keskin E, Demir L, Onay H, Topaloğlu H, Sarer Yürekli B, Özdemir Kutbay N, Gen R, Akıncı B. Magnetic resonance spectroscopy to assess hepatic steatosis in patients with lipodystrophy. TURKISH JOURNAL OF GASTROENTEROLOGY 2020; 31:588-595. [PMID: 32915147 DOI: 10.5152/tjg.2020.19114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS Lipodystrophy is a rare metabolic disorder characterized by near total or partial lack of subcutaneous adipose tissue and associated with insulin resistance. We aimed to evaluate the efficacy of magnetic resonance spectroscopy imaging (MRS) to explore the fat content of the liver in patients with lipodystrophy and to determine the relationship between the liver fat accumulation and clinical presentations of lipodystrophy. MATERIALS AND METHODS Between July 2014 and February 2016, 34 patients with lipodystrophy were assessed by MRS for quantification of hepatic steatosis. All patients had metabolic abnormalities associated with insulin resistance. Metabolic parameters and the MRS findings were analyzed to identify potential correlations between the liver fat content and disease severity. RESULTS The MRS fat ratios (MRS-FR) were markedly higher, indicating severe hepatic steatosis in lipodystrophy. Patients with generalized and partial lipodystrophy had comparable levels of MRS-FRs, although patients with generalized lipodystrophy were significantly younger. Patients with genetically based lipodystrophy had elevated MRS-FR compared to those with acquired lipodystrophy (p=0.042). The MRS-FR was positively correlated with liver enzyme alanine aminotransferase (p=0.028) and serum adiponectin (p=0.043). CONCLUSION Our data suggest that MRS might be an effective, noninvasive imaging method to quantify hepatic fat content in patients with lipodystrophy. Further studies are needed to validate the technique and threshold values which would allow accurate comparison of data acquired by different machines and centers.
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Affiliation(s)
- Canan Altay
- Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Mustafa Seçil
- Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | | | - Başak Özgen Saydam
- Division of Endocrinology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Tevfik Demir
- Division of Endocrinology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Gülçin Akıncı
- Division of Pediatric Neurology, Dr. Behçet Uz Childrens' Hospital, İzmir, Turkey
| | | | - Erdal Eren
- Division of Pediatric Endocrinology, Uludağ University School of Medicine, Bursa, Turkey
| | - Ela Temeloğlu Keskin
- Division of Endocrinology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Leyla Demir
- Department of Biochemistry, Atatürk Training Hospital, İzmir, Turkey
| | - Hüseyin Onay
- Department of Medical Genetics, Ege University School of Medicine, İzmir, Turkey
| | - Haluk Topaloğlu
- Division of Pediatric Neurology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Banu Sarer Yürekli
- Division of Endocrinology, Ege University School of Medicine, İzmir, Turkey
| | | | - Ramazan Gen
- Division of Endocrinology, Mersin University School of Medicine, Mersin, Turkey
| | - Barış Akıncı
- Division of Endocrinology, Dokuz Eylül University School of Medicine, İzmir, Turkey
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Paul J. Recent advances in non-invasive diagnosis and medical management of non-alcoholic fatty liver disease in adult. EGYPTIAN LIVER JOURNAL 2020. [DOI: 10.1186/s43066-020-00043-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Abstract
Background
Number of non-alcoholic fatty liver disease (NAFLD) cases is increasing over time due to alteration of food habit, increase incidence of metabolic syndrome, and lack of exercise. Liver biopsy is the test for diagnosis and staging of NAFLD, but nowadays several biochemical markers, scoring systems, and imaging studies are available to diagnose and stage NAFLD which is linked to end-stage liver disease, hepatocellular cancer, and elevated cardiovascular- and cancer-related morbidity and mortality. Therefore urgent diagnosis and management are required to avoid complications related to NAFLD. This review summarizes recent advances in diagnosis and medical management of non-alcoholic fatty liver disease.
Main text
Recently published studies from PubMed, Red Cross, Copernicus, and also various previous studies were reviewed. We have discussed various non-invasive methods for detection of non-alcoholic fatty liver disease, non-alcoholic steatohepatitis (NASH), and hepatic fibrosis. Non pharmacological therapies for NAFLD, indications, and approved medications for NAFLD and other commonly used non-approved medications have been discussed in this review article.
Conclusions
Multiple non-invasive tests are available for diagnosis of NAFLD, and its different stages however gold standard test is liver biopsy. NALFD without NASH and significant fibrosis is treated by lifestyle modifications which include moderate to vigorous exercise and diet modification. To improve hepatic steatosis, minimum of 3–5% of body weight loss is necessary, but > 7–10% weight reductions is required for histological improvement in NASH and fibrosis. Pharmacotherapy is indicated when patient is having NASH with significant fibrosis.
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Jin M, Niu X, Liu Y, Zhang D, Yuan D, Shen H. Effect of glucagon-like peptide-1 receptor agonists on adipokine level of nonalcoholic fatty liver disease in rats fed high-fat diet. Open Med (Wars) 2020; 15:689-696. [PMID: 33336025 PMCID: PMC7712363 DOI: 10.1515/med-2020-0212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/30/2020] [Accepted: 06/16/2020] [Indexed: 12/19/2022] Open
Abstract
Background Nonalcoholic fatty liver disease (NAFLD) is the leading cause of liver disease worldwide, and no effective treatment exists until now. Glucagon-like peptide-1 receptor agonists are becoming the preferred therapeutic option for the management of obesity and are becoming the preferred treatment options for the management of both NAFLD and type 2 diabetes mellitus, but the molecular mechanisms are still unclear. Methods Forty-five healthy male Wistar rats were divided into three groups: normal control, high-fat diet (HFD) group, HFD + liraglutide (100 mg/kg body weight) group. Biochemical parameters and adipokine levels were examined in the serum of rats. In order to judge the degree of steatosis of NAFLD, the magnetic resonance imaging and histopathology of the liver were also studied. Results and conclusion Liraglutide caused a significant decrease in the serum fasting glucose and improved the insulin resistance, dyslipidemia, and liver enzymes. It reduced the adipokine level, and alleviated the histopathology of liver of rats in the steatosis, ballooning, and lobular inflammation when compared to the HFD group. Thus, liraglutide demonstrated amelioration of NAFLD by decreasing the adipokine levels in this animal model and seems to be a promising molecule for the management of NAFLD.
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Affiliation(s)
- Miaomiao Jin
- Department of Endocrinology, The Heji Affiliated Hospital of Changzhi Medical College, 271 Taihang East Street, Luzhou District, Changzhi 046011, Shanxi, China
| | - Xiaohong Niu
- Department of Endocrinology, The Heji Affiliated Hospital of Changzhi Medical College, 271 Taihang East Street, Luzhou District, Changzhi 046011, Shanxi, China
| | - Yan Liu
- Department of Physiology, Changzhi Medical College, Changzhi 046000, Shanxi, China
| | - Dong Zhang
- Department of Radiology, The Heji Affiliated Hospital of Changzhi Medical College, Changzhi 046011, Shanxi, China
| | - Danni Yuan
- Department of Pathology, The Heji Affiliated Hospital of Changzhi Medical College, Changzhi 046011, Shanxi, China
| | - Huimin Shen
- Department of Laboratory, The Heji Affiliated Hospital of Changzhi Medical College, Changzhi 046011, Shanxi, China
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12
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Stanley TL, Fourman LT, Feldpausch MN, Purdy J, Zheng I, Pan CS, Aepfelbacher J, Buckless C, Tsao A, Kellogg A, Branch K, Lee H, Liu CY, Corey KE, Chung RT, Torriani M, Kleiner DE, Hadigan CM, Grinspoon SK. Effects of tesamorelin on non-alcoholic fatty liver disease in HIV: a randomised, double-blind, multicentre trial. Lancet HIV 2019; 6:e821-e830. [PMID: 31611038 PMCID: PMC6981288 DOI: 10.1016/s2352-3018(19)30338-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is a substantial cause of comorbidity in people with HIV and there are no proven pharmacological treatments for the disease in this population. We assessed the effects of tesamorelin on liver fat and histology in people with HIV and NAFLD. METHODS This randomised, double-blind, multicentre study with identical placebo as a comparator was done in a hospital and a medical research centre in the USA. People with HIV infection and a hepatic fat fraction (HFF) of 5% or more by proton magnetic resonance spectroscopy were eligible. Participants were randomly assigned (1:1) to receive either tesamorelin 2 mg once daily or placebo once daily for 12 months, followed by a 6-month open-label phase during which all participants received tesamorelin 2 mg daily. The randomisation list was prepared by the study statistician using a permuted block algorithm within each stratum with randomly varying block sizes. The primary endpoint was change in HFF between baseline and 12 months. The primary safety endpoint was glucose. Analysis was by intention to treat using all available data. This trial is registered with ClinicalTrials.gov, number NCT02196831. FINDINGS 61 patients were enrolled between Aug 20, 2015, and Jan 16, 2019, of whom 30 received tesamorelin and 30 received placebo. Patients receiving tesamorelin had a greater reduction of HFF than did patients receiving placebo, with an absolute effect size of -4·1% (95% CI -7·6 to -0·7, p=0·018), corresponding to a -37% (95% CI -67 to -7, p=0·016) relative reduction from baseline. After 12 months, 35% of individuals receiving tesamorelin and 4% receiving placebo had a HFF of less than 5% (p=0·0069). Changes in fasting glucose and glycated haemoglobin were not different between groups at 12 months. Individuals in the tesamorelin group experienced more localised injection site complaints than those in the placebo group, though none were judged to be serious. INTERPRETATION Tesamorelin might be beneficial in people with HIV and NAFLD. Further studies are needed to determine the long-term effects of tesamorelin on liver histology. FUNDING National Institutes of Health and National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
- Takara L Stanley
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Lindsay T Fourman
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Meghan N Feldpausch
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Julia Purdy
- National Institute of Allergy and Infectious Diseases, National Institutes of Health and University of Maryland, Bethesda, MD, USA
| | - Isabel Zheng
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Chelsea S Pan
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Julia Aepfelbacher
- National Institute of Allergy and Infectious Diseases, National Institutes of Health and University of Maryland, Bethesda, MD, USA
| | - Colleen Buckless
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrew Tsao
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Anela Kellogg
- National Institute of Allergy and Infectious Diseases, National Institutes of Health and University of Maryland, Bethesda, MD, USA; Frederick National Laboratory for Cancer Research, Frederick, MA, USA
| | - Karen Branch
- Massachusetts General Hospital Clinical Research Center, Boston, MA, USA
| | - Hang Lee
- Massachusetts General Hospital Biostatistics Center, Boston, MA, USA
| | - Chia-Ying Liu
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Kathleen E Corey
- Liver Center, Gastroenterology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Raymond T Chung
- Liver Center, Gastroenterology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Martin Torriani
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - David E Kleiner
- Laboratory of Pathology, National Cancer Institute, Bethesda, MD, USA
| | - Colleen M Hadigan
- National Institute of Allergy and Infectious Diseases, National Institutes of Health and University of Maryland, Bethesda, MD, USA
| | - Steven K Grinspoon
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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13
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Lee SJ, Kim SU. Noninvasive monitoring of hepatic steatosis: controlled attenuation parameter and magnetic resonance imaging-proton density fat fraction in patients with nonalcoholic fatty liver disease. Expert Rev Gastroenterol Hepatol 2019; 13:523-530. [PMID: 31018719 DOI: 10.1080/17474124.2019.1608820] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
With an increase in the worldwide prevalence of obesity, the incidence of non-alcoholic fatty liver disease (NAFLD) has been on the rise, such that it has been recently considered to be a major public health concern. Traditional interventions, such as lifestyle modifications, regular exercise, and healthy diet, have been significant in improving NAFLD with reduction of liver fat. Areas covered: Although liver biopsy is still the gold standard for diagnosis of NAFLD, there is a need for non-invasive, quantitative assessments of hepatic steatosis, especially in clinical trials of anti-steatotic medications or in the follow-up of patients undergoing lifestyle modifications. Liver biopsy has various shortcomings, such as invasive nature, risk of complications and possibility of sampling error. Therefore, it is impractical to use liver biopsy routinely in patients with NAFLD, clearly indicating the need for non-invasive and accurate diagnostic methods. Recently, controlled attenuation parameter (CAP) and magnetic resonance imaging-proton density fat fraction (MRI-PDFF) have been employed in various studies to monitor the dynamic changes of hepatic steatosis in response to treatment in patients with NAFLD. Expert commentary: Although further validations are required, CAP and MRI-PDFF could be used as potential diagnostic and monitoring tools in clinical setting.
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Affiliation(s)
- Sol Jae Lee
- a Department of Internal Medicine , Yonsei University College of Medicine , Seoul , South Korea.,b Yonsei Liver Center , Severance Hospital , Seoul , South Korea
| | - Seung Up Kim
- a Department of Internal Medicine , Yonsei University College of Medicine , Seoul , South Korea.,b Yonsei Liver Center , Severance Hospital , Seoul , South Korea.,c Institute of Gastroenterology , Yonsei University College of Medicine , Seoul , South Korea
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14
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Jennison E, Patel J, Scorletti E, Byrne CD. Diagnosis and management of non-alcoholic fatty liver disease. Postgrad Med J 2019; 95:314-322. [PMID: 31085617 DOI: 10.1136/postgradmedj-2018-136316] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/08/2019] [Accepted: 04/14/2019] [Indexed: 02/06/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in Western industrialised countries. The prevalence of NAFLD is increasing in parallel with the global rise in obesity and type 2 diabetes mellitus. NAFLD represents a spectrum of liver disease severity. NAFLD begins with accumulation of triacylglycerols in the liver (steatosis), and is defined by hepatic fatty infiltration amounting to greater than 5% by liver weight or the presence of over 5% of hepatocytes loaded with large fat vacuoles. In almost a quarter of affected individuals, steatosis progresses with the development of liver inflammation to non-alcoholic steatohepatitis (NASH). NASH is a potentially progressive liver condition and with ongoing liver injury and cell death can result in fibrosis. Progressive liver fibrosis may lead to the development of cirrhosis in a small proportion of patients. With the growing prevalence of NAFLD, there is an increasing need for a robust, accurate and non-invasive approach to diagnosing the different stages of this condition. This review will focus on (1) the biochemical tests and imaging techniques used to diagnose the different stages of NAFLD; and (2) a selection of the current management approaches focusing on lifestyle interventions and pharmacological therapies for NAFLD.
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Affiliation(s)
- Erica Jennison
- Chemical Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Janisha Patel
- Hepatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Eleonora Scorletti
- Human Development and Health, University of Southampton, Southampton, UK
| | - Christopher D Byrne
- The Institute of Developmental Sciences, University of Southampton, Southampton, UK
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15
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Braun LR, Feldpausch MN, Czerwonka N, Weiss J, Branch K, Lee H, Martinez-Salazar EL, Torriani M, Sponseller CA, Grinspoon SK, Stanley TL. Effects of Pitavastatin on Insulin Sensitivity and Liver Fat: A Randomized Clinical Trial. J Clin Endocrinol Metab 2018; 103:4176-4186. [PMID: 30239757 PMCID: PMC6194811 DOI: 10.1210/jc.2018-01446] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/12/2018] [Indexed: 02/06/2023]
Abstract
Context 3-Hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitors (statins) are widely prescribed. Statins may have important metabolic effects on insulin sensitivity and liver fat, but limited studies have assessed these effects by using euglycemic hyperinsulinemic clamp, stable isotopes, and 1H magnetic resonance spectroscopy (MRS) for liver fat quantification. Objective To study the effects of pitavastatin on hepatic fat and insulin sensitivity. Design Six-month, double-blind, randomized, placebo-controlled trial. Setting Academic clinical research center in Boston, Massachusetts. Participants Overweight, insulin-resistant men aged 40 to 65 years who had not received statin therapy for ≥1 year. Interventions Pitavastatin 4 mg or placebo daily. Outcome The primary endpoints were changes in insulin sensitivity measured by euglycemic hyperinsulinemic clamp and liver fat measured by 1H MRS. Results Pitavastatin showed no effect on endogenous glucose production (ΔRa glucose 0.07 ± 0.07 vs 0.04 ± 0.07 mg/kg/min, pitavastatin vs placebo, P = 0.76) or insulin-stimulated glucose uptake during "low dose" (ΔM 0.1 ± 0.1 vs -0.3 ± 0.2 mg/kg/min, P = 0.11) and "high dose" (ΔM -0.5 ± 0.3 vs -0.7 ± 0.4 mg/kg/min, P = 0.70) euglycemic hyperinsulinemic clamps. There was also no effect of pitavastatin on fasting glucose, HbA1c, and 2-hour glucose after 75-g glucose challenge. There was also no change in liver fat fraction (-1 ± 1 vs -0 ± 1%, P = 0.56). Conclusion Compared with placebo, pitavastatin did not affect hepatic or whole-body insulin sensitivity, and it did not reduce liver fat.
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Affiliation(s)
- Laurie R Braun
- Program in Nutritional Metabolism and Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Meghan N Feldpausch
- Program in Nutritional Metabolism and Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Natalia Czerwonka
- Program in Nutritional Metabolism and Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Julian Weiss
- Program in Nutritional Metabolism and Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Karen Branch
- Clinical Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Edgar L Martinez-Salazar
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Martin Torriani
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Steven K Grinspoon
- Program in Nutritional Metabolism and Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Takara L Stanley
- Program in Nutritional Metabolism and Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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16
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Free-breathing quantification of hepatic fat in healthy children and children with nonalcoholic fatty liver disease using a multi-echo 3-D stack-of-radial MRI technique. Pediatr Radiol 2018; 48:941-953. [PMID: 29728744 DOI: 10.1007/s00247-018-4127-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/07/2018] [Accepted: 03/25/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND In adults, noninvasive chemical shift encoded Cartesian magnetic resonance imaging (MRI) and single-voxel magnetic resonance (MR) spectroscopy (SVS) accurately quantify hepatic steatosis but require breath-holding. In children, especially young and sick children, breath-holding is often limited or not feasible. Sedation can facilitate breath-holding but is highly undesirable. For these reasons, there is a need to develop free-breathing MRI technology that accurately quantifies steatosis in all children. OBJECTIVE This study aimed to compare non-sedated free-breathing multi-echo 3-D stack-of-radial (radial) MRI versus standard breath-holding MRI and SVS techniques in a group of children for fat quantification with respect to image quality, accuracy and repeatability. MATERIALS AND METHODS Healthy children (n=10, median age [±interquartile range]: 10.9 [±3.3] years) and overweight children with nonalcoholic fatty liver disease (NAFLD) (n=9, median age: 15.2 [±3.2] years) were imaged at 3 Tesla using free-breathing radial MRI, breath-holding Cartesian MRI and breath-holding SVS. Acquisitions were performed twice to assess repeatability (within-subject mean difference, MDwithin). Images and hepatic proton-density fat fraction (PDFF) maps were scored for image quality. Free-breathing and breath-holding PDFF were compared using linear regression (correlation coefficient, r and concordance correlation coefficient, ρc) and Bland-Altman analysis (mean difference). P<0.05 was considered significant. RESULTS In patients with NAFLD, free-breathing radial MRI demonstrated significantly less motion artifacts compared to breath-holding Cartesian (P<0.05). Free-breathing radial PDFF demonstrated a linear relationship (P<0.001) versus breath-holding SVS PDFF and breath-holding Cartesian PDFF with r=0.996 and ρc=0.994, and r=0.997 and ρc=0.995, respectively. The mean difference in PDFF between free-breathing radial MRI, breath-holding Cartesian MRI and breath-holding SVS was <0.7%. Repeated free-breathing radial MRI had MDwithin=0.25% for PDFF. CONCLUSION In this pediatric study, non-sedated free-breathing radial MRI provided accurate and repeatable hepatic PDFF measurements and improved image quality, compared to standard breath-holding MR techniques.
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17
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Lv S, Jiang S, Liu S, Dong Q, Xin Y, Xuan S. Noninvasive Quantitative Detection Methods of Liver Fat Content in Nonalcoholic Fatty Liver Disease. J Clin Transl Hepatol 2018; 6:217-221. [PMID: 29951367 PMCID: PMC6018305 DOI: 10.14218/jcth.2018.00021] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/22/2018] [Accepted: 06/14/2018] [Indexed: 12/19/2022] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) ranges from simple steatosis to NAFLD-related liver cirrhosis and is a main cause of chronic liver diseases. Patients with nonalcoholic steatohepatitis and fibrosis are at a great risk of the progression to cirrhosis or hepatocellular carcinoma, both of which are tightly associated with liver-related mortality. Liver biopsy is still the gold standard for the diagnosis of NAFLD, but some defects, such as serious complications, sampling error and variability in histologic evaluation among pathologists, remain problematic. Therefore, noninvasive, repeatable and accurate diagnostic methods are urgently needed. Ultrasonography is a well-established and lower-cost imaging technique for the diagnosis of hepatic steatosis, especially suitable for population census, but limited by its low sensitivity to diagnose mild steatosis and being highly operator-dependent. Computed tomography also lacks the sensitivity to detect mild steatosis and small changes in fat content, and presents a potential radiation hazard. Controlled attenuation parameter based on the FibroScan® technology is a promising tool for noninvasive semiquantitative assessment of liver fat content, but the accuracy rate depends on the operator's expertise and is affected by age, width of the intercostal space, skin capsular distance and body mass index. Magnetic resonance imaging and magnetic resonance spectroscopy are regarded as the most accurate quantitative methods for measuring liver fat content in clinical practice, especially for longitudinal follow up of NAFLD patients. In this review, we mainly introduce the current imaging methods that are in use for evaluation of liver fat content and we discuss the advantages and disadvantages of each method.
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Affiliation(s)
- Shujing Lv
- Medical College of Qingdao University, Qingdao, Shandong, China
| | - Sushan Jiang
- Medical College of Qingdao University, Qingdao, Shandong, China
| | - Shousheng Liu
- Digestive Disease Key Laboratory of Qingdao, Qingdao, Shandong, China
- Central Laboratories, Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - Quanjiang Dong
- Central Laboratories, Qingdao Municipal Hospital, Qingdao, Shandong, China
- Department of Gastroenterology, Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - Yongning Xin
- Medical College of Qingdao University, Qingdao, Shandong, China
- Digestive Disease Key Laboratory of Qingdao, Qingdao, Shandong, China
- Department of Gastroenterology, Qingdao Municipal Hospital, Qingdao, Shandong, China
- Department of Infectious Disease, Qingdao Municipal Hospital, Qingdao, Shandong, China
- *Correspondence to: Shiying Xuan, Department of Gastroenterology, Qingdao Municipal Hospital, 1 Jiaozhou Road, Qingdao 266011, China. Tel: +86-532-88905508, Fax: +86-532-88905293, E-mail: ; Yongning Xin, Department of Gastroenterology, Qingdao Municipal Hospital, 1 Jiaozhou Road, Qingdao 266011, Shandong, China. Tel: +86-532-82789463, Fax: +86-532-85968434, E-mail:
| | - Shiying Xuan
- Medical College of Qingdao University, Qingdao, Shandong, China
- Digestive Disease Key Laboratory of Qingdao, Qingdao, Shandong, China
- Department of Gastroenterology, Qingdao Municipal Hospital, Qingdao, Shandong, China
- *Correspondence to: Shiying Xuan, Department of Gastroenterology, Qingdao Municipal Hospital, 1 Jiaozhou Road, Qingdao 266011, China. Tel: +86-532-88905508, Fax: +86-532-88905293, E-mail: ; Yongning Xin, Department of Gastroenterology, Qingdao Municipal Hospital, 1 Jiaozhou Road, Qingdao 266011, Shandong, China. Tel: +86-532-82789463, Fax: +86-532-85968434, E-mail:
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18
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Braun LR, Feldpausch MN, Czerwonka N, Torriani M, Grinspoon SK, Stanley TL. Fibroblast growth factor 21 decreases after liver fat reduction via growth hormone augmentation. Growth Horm IGF Res 2017; 37:1-6. [PMID: 29031905 PMCID: PMC5705434 DOI: 10.1016/j.ghir.2017.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 08/31/2017] [Accepted: 10/06/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Fibroblast growth factor 21 (FGF21) ameliorates steatohepatitis but is increased in humans with fatty liver, potentially due to compensatory mechanisms and/or FGF21 resistance. Further, animal models suggest that GH increases serum FGF21. Tesamorelin, a growth hormone releasing hormone agonist, reduces liver fat in HIV-infected individuals. The objectives of this study were to investigate changes in FGF21 during tesamorelin treatment, to elucide the interplay between FGF21, GH augmentation, and liver fat reduction in humans. METHODS 50 HIV-infected men and women with increased abdominal adiposity participated in this randomized, placebo-controlled trial of tesamorelin, 2mg vs. identical placebo daily for six months. Fasting laboratory measures, liver fat by 1H-magnetic resonance spectroscopy, and visceral adipose tissue (VAT) by computed tomography were obtained. Euglycemic hyperinsulinemic clamp was performed in a randomly selected subset. RESULTS At baseline, serum log10 FGF21 was significantly associated with log10 liver fat (r=0.32, p=0.03). Log10 FGF21 tended to decrease in the tesamorelin group compared to placebo (p=0.06). Among the entire cohort, reductions in FGF21 were significantly associated with reductions in liver fat (ρ=0.41, p=0.01), log10 gamma glutamyl tran speptidase (GGT, r=0.40, p=0.009), and FIB4 index (r=0.37, p=0.02). CONCLUSIONS In HIV-infected individuals, FGF21 is significantly positively associated with liver fat. FGF21 decreases in association with reductions in liver fat, GGT, and FIB4, suggesting that FGF21 is upregulated in the context of steatosis and steatohepatitis and is reduced when these conditions improve. Moreover, these data suggest that tesamorelin improves liver fat via pathways other than increasing serum FGF21. TRIAL REGISTRATION clinicaltrials.govNCT01263717.
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Affiliation(s)
- Laurie R Braun
- Program in Nutritional Metabolism and Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Meghan N Feldpausch
- Program in Nutritional Metabolism and Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Natalia Czerwonka
- Program in Nutritional Metabolism and Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Martin Torriani
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Steven K Grinspoon
- Program in Nutritional Metabolism and Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Takara L Stanley
- Program in Nutritional Metabolism and Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
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19
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Guber RD, Takyar V, Kokkinis A, Fox DA, Alao H, Kats I, Bakar D, Remaley AT, Hewitt SM, Kleiner DE, Liu CY, Hadigan C, Fischbeck KH, Rotman Y, Grunseich C. Nonalcoholic fatty liver disease in spinal and bulbar muscular atrophy. Neurology 2017; 89:2481-2490. [PMID: 29142082 PMCID: PMC5729799 DOI: 10.1212/wnl.0000000000004748] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 09/19/2017] [Indexed: 12/27/2022] Open
Abstract
Objective: To determine the prevalence and features of fatty liver disease in spinal and bulbar muscular atrophy (SBMA). Methods: Two groups of participants with SBMA were evaluated. In the first group, 22 participants with SBMA underwent laboratory analysis and liver imaging. In the second group, 14 participants with SBMA were compared to 13 female carriers and 23 controls. Liver biopsies were done in 4 participants with SBMA. Results: Evidence of fatty liver disease was detected by magnetic resonance spectroscopy in all participants with SBMA in the first group, with an average dome intrahepatic triacylglycerol of 27% (range 6%–66%, ref ≤5.5%). Liver dome magnetic resonance spectroscopy measurements were significantly increased in participants with SBMA in the second group relative to age- and sex-matched controls, with average disease and male control measurements of 17% and 3%, respectively. Liver biopsies were consistent with simple steatosis in 2 participants and nonalcoholic steatohepatitis in 2 others. Conclusions: We observed evidence of nonalcoholic liver disease in nearly all of the participants with SBMA evaluated. These observations expand the phenotypic spectrum of the disease and provide a potential biomarker that can be monitored in future studies.
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Affiliation(s)
- Robert D Guber
- From the Neurogenetics Branch (R.D.G., A.K., D.A.F., I.K., D.B., K.H.F., C.G.), National Institute of Neurological Disorders and Stroke; Liver Diseases Branch (V.T., H.A., Y.R.), National Institute of Diabetes and Digestive and Kidney Diseases; Cardiovascular and Pulmonary Branch (A.T.R.), National Heart Lung & Blood Institute; Laboratory of Pathology (S.M.H., D.E.K.), National Cancer Institute; Radiology and Imaging Sciences (C.-Y.L.), Clinical Center, National Institute of Allergy and Infectious Diseases; and NIH (C.H.), Bethesda, MD
| | - Varun Takyar
- From the Neurogenetics Branch (R.D.G., A.K., D.A.F., I.K., D.B., K.H.F., C.G.), National Institute of Neurological Disorders and Stroke; Liver Diseases Branch (V.T., H.A., Y.R.), National Institute of Diabetes and Digestive and Kidney Diseases; Cardiovascular and Pulmonary Branch (A.T.R.), National Heart Lung & Blood Institute; Laboratory of Pathology (S.M.H., D.E.K.), National Cancer Institute; Radiology and Imaging Sciences (C.-Y.L.), Clinical Center, National Institute of Allergy and Infectious Diseases; and NIH (C.H.), Bethesda, MD
| | - Angela Kokkinis
- From the Neurogenetics Branch (R.D.G., A.K., D.A.F., I.K., D.B., K.H.F., C.G.), National Institute of Neurological Disorders and Stroke; Liver Diseases Branch (V.T., H.A., Y.R.), National Institute of Diabetes and Digestive and Kidney Diseases; Cardiovascular and Pulmonary Branch (A.T.R.), National Heart Lung & Blood Institute; Laboratory of Pathology (S.M.H., D.E.K.), National Cancer Institute; Radiology and Imaging Sciences (C.-Y.L.), Clinical Center, National Institute of Allergy and Infectious Diseases; and NIH (C.H.), Bethesda, MD
| | - Derrick A Fox
- From the Neurogenetics Branch (R.D.G., A.K., D.A.F., I.K., D.B., K.H.F., C.G.), National Institute of Neurological Disorders and Stroke; Liver Diseases Branch (V.T., H.A., Y.R.), National Institute of Diabetes and Digestive and Kidney Diseases; Cardiovascular and Pulmonary Branch (A.T.R.), National Heart Lung & Blood Institute; Laboratory of Pathology (S.M.H., D.E.K.), National Cancer Institute; Radiology and Imaging Sciences (C.-Y.L.), Clinical Center, National Institute of Allergy and Infectious Diseases; and NIH (C.H.), Bethesda, MD
| | - Hawwa Alao
- From the Neurogenetics Branch (R.D.G., A.K., D.A.F., I.K., D.B., K.H.F., C.G.), National Institute of Neurological Disorders and Stroke; Liver Diseases Branch (V.T., H.A., Y.R.), National Institute of Diabetes and Digestive and Kidney Diseases; Cardiovascular and Pulmonary Branch (A.T.R.), National Heart Lung & Blood Institute; Laboratory of Pathology (S.M.H., D.E.K.), National Cancer Institute; Radiology and Imaging Sciences (C.-Y.L.), Clinical Center, National Institute of Allergy and Infectious Diseases; and NIH (C.H.), Bethesda, MD
| | - Ilona Kats
- From the Neurogenetics Branch (R.D.G., A.K., D.A.F., I.K., D.B., K.H.F., C.G.), National Institute of Neurological Disorders and Stroke; Liver Diseases Branch (V.T., H.A., Y.R.), National Institute of Diabetes and Digestive and Kidney Diseases; Cardiovascular and Pulmonary Branch (A.T.R.), National Heart Lung & Blood Institute; Laboratory of Pathology (S.M.H., D.E.K.), National Cancer Institute; Radiology and Imaging Sciences (C.-Y.L.), Clinical Center, National Institute of Allergy and Infectious Diseases; and NIH (C.H.), Bethesda, MD
| | - Dara Bakar
- From the Neurogenetics Branch (R.D.G., A.K., D.A.F., I.K., D.B., K.H.F., C.G.), National Institute of Neurological Disorders and Stroke; Liver Diseases Branch (V.T., H.A., Y.R.), National Institute of Diabetes and Digestive and Kidney Diseases; Cardiovascular and Pulmonary Branch (A.T.R.), National Heart Lung & Blood Institute; Laboratory of Pathology (S.M.H., D.E.K.), National Cancer Institute; Radiology and Imaging Sciences (C.-Y.L.), Clinical Center, National Institute of Allergy and Infectious Diseases; and NIH (C.H.), Bethesda, MD
| | - Alan T Remaley
- From the Neurogenetics Branch (R.D.G., A.K., D.A.F., I.K., D.B., K.H.F., C.G.), National Institute of Neurological Disorders and Stroke; Liver Diseases Branch (V.T., H.A., Y.R.), National Institute of Diabetes and Digestive and Kidney Diseases; Cardiovascular and Pulmonary Branch (A.T.R.), National Heart Lung & Blood Institute; Laboratory of Pathology (S.M.H., D.E.K.), National Cancer Institute; Radiology and Imaging Sciences (C.-Y.L.), Clinical Center, National Institute of Allergy and Infectious Diseases; and NIH (C.H.), Bethesda, MD
| | - Stephen M Hewitt
- From the Neurogenetics Branch (R.D.G., A.K., D.A.F., I.K., D.B., K.H.F., C.G.), National Institute of Neurological Disorders and Stroke; Liver Diseases Branch (V.T., H.A., Y.R.), National Institute of Diabetes and Digestive and Kidney Diseases; Cardiovascular and Pulmonary Branch (A.T.R.), National Heart Lung & Blood Institute; Laboratory of Pathology (S.M.H., D.E.K.), National Cancer Institute; Radiology and Imaging Sciences (C.-Y.L.), Clinical Center, National Institute of Allergy and Infectious Diseases; and NIH (C.H.), Bethesda, MD
| | - David E Kleiner
- From the Neurogenetics Branch (R.D.G., A.K., D.A.F., I.K., D.B., K.H.F., C.G.), National Institute of Neurological Disorders and Stroke; Liver Diseases Branch (V.T., H.A., Y.R.), National Institute of Diabetes and Digestive and Kidney Diseases; Cardiovascular and Pulmonary Branch (A.T.R.), National Heart Lung & Blood Institute; Laboratory of Pathology (S.M.H., D.E.K.), National Cancer Institute; Radiology and Imaging Sciences (C.-Y.L.), Clinical Center, National Institute of Allergy and Infectious Diseases; and NIH (C.H.), Bethesda, MD
| | - Chia-Ying Liu
- From the Neurogenetics Branch (R.D.G., A.K., D.A.F., I.K., D.B., K.H.F., C.G.), National Institute of Neurological Disorders and Stroke; Liver Diseases Branch (V.T., H.A., Y.R.), National Institute of Diabetes and Digestive and Kidney Diseases; Cardiovascular and Pulmonary Branch (A.T.R.), National Heart Lung & Blood Institute; Laboratory of Pathology (S.M.H., D.E.K.), National Cancer Institute; Radiology and Imaging Sciences (C.-Y.L.), Clinical Center, National Institute of Allergy and Infectious Diseases; and NIH (C.H.), Bethesda, MD
| | - Colleen Hadigan
- From the Neurogenetics Branch (R.D.G., A.K., D.A.F., I.K., D.B., K.H.F., C.G.), National Institute of Neurological Disorders and Stroke; Liver Diseases Branch (V.T., H.A., Y.R.), National Institute of Diabetes and Digestive and Kidney Diseases; Cardiovascular and Pulmonary Branch (A.T.R.), National Heart Lung & Blood Institute; Laboratory of Pathology (S.M.H., D.E.K.), National Cancer Institute; Radiology and Imaging Sciences (C.-Y.L.), Clinical Center, National Institute of Allergy and Infectious Diseases; and NIH (C.H.), Bethesda, MD
| | - Kenneth H Fischbeck
- From the Neurogenetics Branch (R.D.G., A.K., D.A.F., I.K., D.B., K.H.F., C.G.), National Institute of Neurological Disorders and Stroke; Liver Diseases Branch (V.T., H.A., Y.R.), National Institute of Diabetes and Digestive and Kidney Diseases; Cardiovascular and Pulmonary Branch (A.T.R.), National Heart Lung & Blood Institute; Laboratory of Pathology (S.M.H., D.E.K.), National Cancer Institute; Radiology and Imaging Sciences (C.-Y.L.), Clinical Center, National Institute of Allergy and Infectious Diseases; and NIH (C.H.), Bethesda, MD
| | - Yaron Rotman
- From the Neurogenetics Branch (R.D.G., A.K., D.A.F., I.K., D.B., K.H.F., C.G.), National Institute of Neurological Disorders and Stroke; Liver Diseases Branch (V.T., H.A., Y.R.), National Institute of Diabetes and Digestive and Kidney Diseases; Cardiovascular and Pulmonary Branch (A.T.R.), National Heart Lung & Blood Institute; Laboratory of Pathology (S.M.H., D.E.K.), National Cancer Institute; Radiology and Imaging Sciences (C.-Y.L.), Clinical Center, National Institute of Allergy and Infectious Diseases; and NIH (C.H.), Bethesda, MD
| | - Christopher Grunseich
- From the Neurogenetics Branch (R.D.G., A.K., D.A.F., I.K., D.B., K.H.F., C.G.), National Institute of Neurological Disorders and Stroke; Liver Diseases Branch (V.T., H.A., Y.R.), National Institute of Diabetes and Digestive and Kidney Diseases; Cardiovascular and Pulmonary Branch (A.T.R.), National Heart Lung & Blood Institute; Laboratory of Pathology (S.M.H., D.E.K.), National Cancer Institute; Radiology and Imaging Sciences (C.-Y.L.), Clinical Center, National Institute of Allergy and Infectious Diseases; and NIH (C.H.), Bethesda, MD.
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Magnetic Resonance Spectroscopy and its Clinical Applications: A Review. J Med Imaging Radiat Sci 2017; 48:233-253. [PMID: 31047406 DOI: 10.1016/j.jmir.2017.06.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 04/30/2017] [Accepted: 06/22/2017] [Indexed: 12/25/2022]
Abstract
In vivo NMR spectroscopy is known as magnetic resonance spectroscopy (MRS). MRS has been applied as both a research and a clinical tool in order to detect visible or nonvisible abnormalities. The adaptability of MRS allows a technique that can probe a wide variety of metabolic uses across different tissues. Although MRS is mostly applied for brain tissue, it can be used for detection, localization, staging, tumour aggressiveness evaluation, and tumour response assessment of breast, prostate, hepatic, and other cancers. In this article, the medical applications of MRS in the brain, including tumours, neural and psychiatric disorder studies, breast, prostate, hepatic, gastrointestinal, and genitourinary investigations have been reviewed.
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Kise Y, Chikui T, Yamashita Y, Kobayashi K, Yoshiura K. Clinical usefulness of the mDIXON Quant the method for estimation of the salivary gland fat fraction: comparison with MR spectroscopy. Br J Radiol 2017; 90:20160704. [PMID: 28707990 DOI: 10.1259/bjr.20160704] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To estimate the fat fraction (FF) in the salivary glands (SGs) by the mDIXON method and the 1H-MR spectroscopy (MRS) method, and to compare the results. METHODS 16 healthy volunteers were enrolled. mDIXON Quant and MRS (point-resolved spectroscopy: PRESS) with a single TE were employed to measure the FF in the parotid gland (PG) and submandibular gland (SMG). Multiple TEs were applied in 10 volunteers to correct for T2 decay. In addition, we assumed that the 1.3 ppm peak accounted for 60% of the total fat peak and estimated the FF (MRS all) as a gold standard. On mDIXON Quant images, volumes of interest were set on the bilateral SGs and we obtained the FF (mDIXON) of each volume of interest. RESULTS There was a strong correlation between the results of the mDIXON Quant method and the MRS (single TE) method (R2 = 0.960, slope = 0.900). Using PRESS with multiple TEs, there was also a strong correlation between FF (mDIXON) and FF (MRS all) (R2 = 0.963, slope = 1.18). FF (MRS all) was 24.9±12.7% in the PG and 4.5±3.0% in the SMG, while FF (mDIXON) was 29.4±16.2% in the PG and 6.4±4.7% in the SMG. There were no significant differences between the two methods, but the Bland-Altman plot showed that FF (mDIXON) was slightly larger than FF (MRS all) for small FF areas. CONCLUSION The mDIXON Quant method could be clinically useful for evaluating the FF of SGs, but the absolute values need careful interpretation. Advance in knowledge: This study suggested the potential clinical usefulness of the mDIXON Quant method for the SGs.
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Affiliation(s)
- Yoshitaka Kise
- 1 Department of Oral and Maxillofacial Radiology, Faculty of Dental Science, Kyushu University, Fukuoka, Japan.,2 Department of Oral and Maxillofacial Radiology, School of Dentistry, Aichi Gakuin University, Nisshin, Japan
| | - Toru Chikui
- 1 Department of Oral and Maxillofacial Radiology, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Yasuo Yamashita
- 3 Department of Medical Technology, Kyushu University Hospital, Fukuoka, Japan
| | - Koji Kobayashi
- 3 Department of Medical Technology, Kyushu University Hospital, Fukuoka, Japan
| | - Kazunori Yoshiura
- 1 Department of Oral and Maxillofacial Radiology, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
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22
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How to Perform Selective Liver Biopsy in Living Liver Donors Using Plain Computed Tomography. Transplantation 2017; 100:2398-2403. [PMID: 27495764 DOI: 10.1097/tp.0000000000001412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Preoperative donor liver biopsy is the criterion standard to verify the quality of a liver. However, it can cause some complications, thus this study was designed to know whether selective liver biopsy is possible or not, and to find a subgroup that does not require preoperative biopsy. METHODS We reviewed preoperative images and postoperative outcome in 118 donors from September 2013 to January 2014. Visual grading of steatosis on plain computed tomography (CT) was performed and compared steatosis on preoperative liver biopsy was done within 7 days from the CT scan. RESULTS Visual grades of plain CT were 1 (n = 50, 42.4%), 2 (n = 47, 39.8%), 3 (n = 13, 11.0%), 4 (n = 7, 5.9%), and 1 (n = 1, 0.8%). Macrovesicular steatosis on liver biopsy according to visual grades were 1 (0.67 ± 1.3%), 2 (1.67 ± 1.8%), 3 (6.23 ± 6.4%), 4 (14.7 ± 16.6), and 5 (30%). Right liver grafts including right lobe, modified right lobe, and extended right lobe were procured in 106 (89.9%) donors, and 16% (17/106) of the donors were visual grades 3, 4, and 5. Eleven donors (64.7%) were accepted for right liver donation after liver biopsy, whereas 6 (35.3%) donors were deemed possible to donate right liver after weight reduction and reevaluation of steatosis. Transient hepatic dysfunction after right hepatectomy was significantly increased according to the increment of visual grade. CONCLUSIONS Preoperative liver biopsy may not be necessary in visual grade 1 or 2 donors, but should be performed for grade 3 and 4 donors based on recipient's urgency so as to decide whether to proceed with right hepatectomy or not.
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23
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France M, Kwok S, Soran H, Williams S, Ho JH, Adam S, Canoy D, Liu Y, Durrington PN. Liver Fat Measured by MR Spectroscopy: Estimate of Imprecision and Relationship with Serum Glycerol, Caeruloplasmin and Non-Esterified Fatty Acids. Int J Mol Sci 2016; 17:ijms17071089. [PMID: 27399690 PMCID: PMC4964465 DOI: 10.3390/ijms17071089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 06/28/2016] [Accepted: 06/30/2016] [Indexed: 12/27/2022] Open
Abstract
Magnetic resonance spectroscopy (MRS) is a non-invasive method for quantitative estimation of liver fat. Knowledge of its imprecision, which comprises biological variability and measurement error, is required to design therapeutic trials with measurement of change. The role of adipocyte lipolysis in ectopic fat accumulation remains unclear. We examined the relationship between liver fat content and indices of lipolysis, and determine whether lipolysis reflects insulin resistance or metabolic liver disease. Imprecision of measurement of liver fat was estimated from duplicate measurements by MRS at one month intervals. Patients provided fasting blood samples and we examined the correlation of liver fat with indices of insulin resistance, lipolysis and metabolic liver disease using Kendall Tau statistics. The coefficient of variation of liver fat content was 14.8%. Liver fat was positively related to serum insulin (T = 0.48, p = 0.042), homeostasis model assessment (HOMA)-B% (T = -0.48, p = 0.042), and body mass index (BMI) (T = 0.59, p = 0.012); and inversely related to HOMA-S% (T = -0.48, p = 0.042), serum glycerol (T = -0.59, p = 0.014), and serum caeruloplasmin (T = 0.055, p = 0.047). Our estimate of total variability in liver fat content (14.8%) is nearly twice that of the reported procedural variability (8.5%). We found that liver fat content was significantly inversely related to serum glycerol but not to non-esterified fatty acids (NEFA), suggesting progressive suppression of lipolysis. Reduction of caeruloplasmin with increasing liver fat may be a consequence or a cause of hepatic steatosis.
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Affiliation(s)
- Michael France
- Department of Clinical Biochemistry, Cobbett House, Central Manchester Foundation Trust, Oxford Road, Manchester M13 9WL, UK.
| | - See Kwok
- Cardiovascular Trials Unit, The Old St Mary's Hospital, Hathersage Road, Oxford Road, Manchester M13 9WL, UK.
| | - Handrean Soran
- Department of Medicine, Central Manchester Foundation Trust, Oxford Road, Manchester M13 9WL, UK.
| | - Steve Williams
- Department of Imaging Science, University of Manchester, Oxford Road, Manchester M13 9PT, UK.
| | - Jan Hoong Ho
- Department of Medicine, Central Manchester Foundation Trust, Oxford Road, Manchester M13 9WL, UK.
| | - Safwaan Adam
- Department of Imaging Science, University of Manchester, Oxford Road, Manchester M13 9PT, UK.
| | - Dexter Canoy
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK.
| | - Yifen Liu
- School of Biomedicine, 3rd floor, Core Technology Facility, 46 Grafton Street, Manchester M13 9NT, UK.
| | - Paul N Durrington
- School of Biomedicine, 3rd floor, Core Technology Facility, 46 Grafton Street, Manchester M13 9NT, UK.
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Uthaya S, Liu X, Babalis D, Doré CJ, Warwick J, Bell J, Thomas L, Ashby D, Durighel G, Ederies A, Yanez-Lopez M, Modi N. Nutritional Evaluation and Optimisation in Neonates: a randomized, double-blind controlled trial of amino acid regimen and intravenous lipid composition in preterm parenteral nutrition. Am J Clin Nutr 2016; 103:1443-52. [PMID: 27099248 PMCID: PMC4880995 DOI: 10.3945/ajcn.115.125138] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 03/24/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Parenteral nutrition is central to the care of very immature infants. Current international recommendations favor higher amino acid intakes and fish oil-containing lipid emulsions. OBJECTIVE The aim of this trial was to compare 1) the effects of high [immediate recommended daily intake (Imm-RDI)] and low [incremental introduction of amino acids (Inc-AAs)] parenteral amino acid delivery within 24 h of birth on body composition and 2) the effect of a multicomponent lipid emulsion containing 30% soybean oil, 30% medium-chain triglycerides, 25% olive oil, and 15% fish oil (SMOF) with that of soybean oil (SO)-based lipid emulsion on intrahepatocellular lipid (IHCL) content. DESIGN We conducted a 2-by-2 factorial, double-blind, multicenter randomized controlled trial. RESULTS We randomly assigned 168 infants born at <31 wk of gestation. We evaluated outcomes at term in 133 infants. There were no significant differences between Imm-RDI and Inc-AA groups for nonadipose mass [adjusted mean difference: 1.0 g (95% CI: -108, 111 g; P = 0.98)] or between SMOF and SO groups for IHCL [adjusted mean SMOF:SO ratio: 1.1 (95% CI: 0.8, 1.6; P = 0.58]. SMOF does not affect IHCL content. There was a significant interaction (P = 0.05) between the 2 interventions for nonadipose mass. There were no significant interactions between group differences for either primary outcome measure after adjusting for additional confounders. Imm-RDI infants were more likely than Inc-AA infants to have blood urea nitrogen concentrations >7 mmol/L or >10 mmol/L, respectively (75% compared with 49%, P < 0.01; 49% compared with 18%, P < 0.01). Head circumference at term was smaller in the Imm-RDI group [mean difference: -0.8 cm (95% CI: -1.5, -0.1 cm; P = 0.02)]. There were no significant differences in any prespecified secondary outcomes, including adiposity, liver function tests, incidence of conjugated hyperbilirubinemia, weight, length, mortality, and brain volumes. CONCLUSION Imm-RDI of parenteral amino acids does not benefit body composition or growth to term and may be harmful. This trial was registered at www.isrctn.com as ISRCTN29665319 and at eudract.ema.europa.eu as EudraCT 2009-016731-34.
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Affiliation(s)
- Sabita Uthaya
- Chelsea and Westminster National Health Service Foundation Trust, London, United Kingdom; Section of Neonatal Medicine, Department of Medicine, Imperial College London,
| | - Xinxue Liu
- Imperial Clinical Trials Unit, School of Public Health, and
| | - Daphne Babalis
- Imperial Clinical Trials Unit, School of Public Health, and Clinical Trials and Evaluation Unit, Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Caroline J Doré
- Comprehensive Clinical Trials Unit, University College London, London, United Kingdom
| | - Jane Warwick
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom; and
| | - Jimmy Bell
- Institute of Clinical Sciences, Imperial College London and Medical Research Council Clinical Sciences Centre, Hammersmith Hospital, London, United Kingdom; Department of Life Sciences, University of Westminster, London, United Kingdom
| | - Louise Thomas
- Institute of Clinical Sciences, Imperial College London and Medical Research Council Clinical Sciences Centre, Hammersmith Hospital, London, United Kingdom; Department of Life Sciences, University of Westminster, London, United Kingdom
| | - Deborah Ashby
- Imperial Clinical Trials Unit, School of Public Health, and
| | - Giuliana Durighel
- Institute of Clinical Sciences, Imperial College London and Medical Research Council Clinical Sciences Centre, Hammersmith Hospital, London, United Kingdom
| | - Ash Ederies
- Institute of Clinical Sciences, Imperial College London and Medical Research Council Clinical Sciences Centre, Hammersmith Hospital, London, United Kingdom
| | - Monica Yanez-Lopez
- Institute of Clinical Sciences, Imperial College London and Medical Research Council Clinical Sciences Centre, Hammersmith Hospital, London, United Kingdom
| | - Neena Modi
- Chelsea and Westminster National Health Service Foundation Trust, London, United Kingdom; Section of Neonatal Medicine, Department of Medicine, Imperial College London
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Gaber A, Attiya G, Hamdy A, Elsayed T. Recognition of diffuse liver cirrhosis based on image analysis. THE IMAGING SCIENCE JOURNAL 2016. [DOI: 10.1080/13682199.2016.1157944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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26
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Krishan S, Jain D, Bathina Y, Kale A, Saraf N, Saigal S, Choudhary N, Baijal S, Soin A. Non-invasive quantification of hepatic steatosis in living, related liver donors using dual-echo Dixon imaging and single-voxel proton spectroscopy. Clin Radiol 2016; 71:58-63. [DOI: 10.1016/j.crad.2015.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 09/30/2015] [Accepted: 10/05/2015] [Indexed: 01/01/2023]
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27
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Vitamin D deficiency in non-alcoholic fatty liver disease: The chicken or the egg? Clin Nutr 2015; 36:191-197. [PMID: 26615912 DOI: 10.1016/j.clnu.2015.10.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 10/24/2015] [Accepted: 10/27/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Serum vitamin D concentration is reduced in patients with non-alcoholic fatty liver disease (NAFLD). Although the mechanism of vitamin D deficiency in liver disease is not fully understood, a few reports have suggested the beneficial effects of vitamin D supplements. The present study investigated changes in serum 25-hydroxy vitamin D level and clinical parameters after total calorie restriction with vitamin D intake reduction in NAFLD patients. METHODS Newly diagnosed NAFLD patients with elevated aminotransferase levels were chosen for a calorie restriction and weight-reduction program. A total of 82 patients received nutritional education from nutritionists every 2 weeks for 2 months. Serum 25-hydroxy vitamin D level, amount of vitamin D intake, and physical activity were thoroughly investigated. RESULTS The mean serum 25-hydroxy vitamin D concentration was 13.0 ng/ml. Twenty-nine patients (35.4%) had severe vitamin D deficiency. Patients with a 25-hydroxy vitamin D concentration <10 ng/ml had an increased risk of abdominal obesity (72.4% vs. 47.2%, P = 0.023) and a higher prevalence of metabolic syndrome (69% vs. 42.2%, P = 0.015) compared with patients with 25-hydroxy vitamin D levels >10 ng/ml. Although total energy and vitamin D intake were reduced during the program, serum 25-hydroxy vitamin D levels increased in patients with NAFLD (P < 0.001). Liver enzymes and metabolic parameters also improved, even as vitamin D intake decreased. Serum vitamin D concentration increased with body weight and intrahepatic fat reduction, independent of decreases in vitamin D intake. CONCLUSIONS Weight loss per increased serum vitamin D level without vitamin D supplementation and improved metabolic parameters in NAFLD.
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Gajdošík M, Chadzynski GL, Hangel G, Mlynárik V, Chmelík M, Valkovič L, Bogner W, Pohmann R, Scheffler K, Trattnig S, Krššák M. Ultrashort-TE stimulated echo acquisition mode (STEAM) improves the quantification of lipids and fatty acid chain unsaturation in the human liver at 7 T. NMR IN BIOMEDICINE 2015; 28:1283-1293. [PMID: 26313737 DOI: 10.1002/nbm.3382] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/15/2015] [Accepted: 07/24/2015] [Indexed: 06/04/2023]
Abstract
Ultrahigh-field, whole-body MR systems increase the signal-to-noise ratio (SNR) and improve the spectral resolution. Sequences with a short TE allow fast signal acquisition with low signal loss as a result of spin-spin relaxation. This is of particular importance in the liver for the precise quantification of the hepatocellular content of lipids (HCL). In this study, we introduce a spoiler Gradient-switching Ultrashort STimulated Echo AcqUisition (GUSTEAU) sequence, which is a modified version of a stimulated echo acquisition mode (STEAM) sequence, with a minimum TE of 6 ms. With the high spectral resolution at 7 T, the efficient elimination of water sidebands and the post-processing suppression of the water signal, we estimated the composition of fatty acids (FAs) via the detection of the olefinic lipid resonance and calculated the unsaturation index (UI) of hepatic FAs. The performance of the GUSTEAU sequence for the assessment of UI was validated against oil samples and provided excellent results in agreement with the data reported in the literature. When measuring HCL with GUSTEAU in 10 healthy volunteers, there was a high correlation between the results obtained at 7 and 3 T (R(2) = 0.961). The test-retest measurements yielded low coefficients of variation for HCL (4 ± 3%) and UI (11 ± 8%) when measured with the GUSTEAU sequence at 7 T. A negative correlation was found between UI and HCL (n = 10; p < 0.033). The ultrashort TE MRS sequence (GUSTEAU; TE = 6 ms) provided high repeatability for the assessment of HCL. The improved spectral resolution at 7 T with the elimination of water sidebands and the offline water subtraction also enabled an assessment of the unsaturation of FAs. This all highlights the potential use of this MRS acquisition scheme for studies of hepatic lipid composition in vivo.
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Affiliation(s)
- Martin Gajdošík
- High-Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Clinical Molecular MR Imaging, Vienna, Austria
| | - Grzegorz L Chadzynski
- Department of Biomedical Magnetic Resonance, University of Tübingen, Tübingen, Germany
- High-Field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Gilbert Hangel
- High-Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Vladimír Mlynárik
- High-Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Marek Chmelík
- High-Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Ladislav Valkovič
- High-Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Imaging Methods, Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Wolfgang Bogner
- High-Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Rolf Pohmann
- High-Field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Klaus Scheffler
- Department of Biomedical Magnetic Resonance, University of Tübingen, Tübingen, Germany
- High-Field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Siegfried Trattnig
- High-Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Clinical Molecular MR Imaging, Vienna, Austria
| | - Martin Krššák
- High-Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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Matthews L, Kleiner DE, Chairez C, McManus M, Nettles MJ, Zemanick K, Morse CG, Benator D, Kovacs JA, Hadigan C. Pioglitazone for Hepatic Steatosis in HIV/Hepatitis C Virus Coinfection. AIDS Res Hum Retroviruses 2015. [PMID: 26214341 DOI: 10.1089/aid.2015.0093] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Chronic hepatitis C infection frequently coexists with human immunodeficiency virus (HIV) and together are associated with increased hepatic steatosis. Steatosis is a risk factor for progression of liver disease and may persist despite a sustained virologic response to hepatitis C treatment. Therefore, therapies to target hepatic steatosis are important for individuals with HIV and hepatitis C virus (HCV) coinfection. We completed a 48-week, randomized, double-blind, placebo-controlled trial of pioglitazone (45 mg/day) in 13 subjects with HIV/HCV coinfection. The primary outcome variable was hepatic fat content, measured by magnetic resonance spectroscopy (MRS) imaging. Individuals randomized to pioglitazone had a significant decrease in hepatic fat content measured by MRS from baseline (15.1 ± 7.0%) to week 48 (7.6 ± 3.9%), with a mean difference of -7.4% (p = 0.02, n = 5). There was no significant change in hepatic fat content with placebo. Glycemic control as measured by oral glucose challenge improved significantly with pioglitazone (p = 0.047). Though not statistically significant, there were trends toward improved alanine aminotransferase (ALT) and histopathologic grade of steatosis in subjects who received pioglitazone. Pioglitazone was well tolerated and no one discontinued due to side effects. This study demonstrates that 48 weeks of pioglitazone therapy, and not placebo, results in significant reductions in hepatic fat content as measured by MRS in subjects with HIV and HCV coinfection and hepatic steatosis. This small study shows that pioglitazone helps ameliorate steatosis in the context of HIV/HCV coinfection.
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Affiliation(s)
- Lindsay Matthews
- Critical Care Medicine Department, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - David E. Kleiner
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Cheryl Chairez
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Maryellen McManus
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc. (formerly SAIC-Frederick, Inc.), Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Mary Jane Nettles
- Infectious Diseases Section, Medical Service, Veterans Affairs Medical Center, Washington, District of Columbia
| | - Kira Zemanick
- NIH Clinical Center Nursing Department, National Institutes of Health, Bethesda, Maryland
| | - Caryn Gee Morse
- Critical Care Medicine Department, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Debra Benator
- Infectious Diseases Section, Medical Service, Veterans Affairs Medical Center, Washington, District of Columbia
- Division of Infectious Diseases, The George Washington University Medical Center, Washington, District of Columbia
| | - Joseph A. Kovacs
- Critical Care Medicine Department, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Colleen Hadigan
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
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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: 150] [Impact Index Per Article: 16.7] [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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Fonvig CE, Chabanova E, Andersson EA, Ohrt JD, Pedersen O, Hansen T, Thomsen HS, Holm JC. 1H-MRS Measured Ectopic Fat in Liver and Muscle in Danish Lean and Obese Children and Adolescents. PLoS One 2015; 10:e0135018. [PMID: 26252778 PMCID: PMC4529156 DOI: 10.1371/journal.pone.0135018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 07/16/2015] [Indexed: 01/14/2023] Open
Abstract
Objectives This cross sectional study aims to investigate the associations between ectopic lipid accumulation in liver and skeletal muscle and biochemical measures, estimates of insulin resistance, anthropometry, and blood pressure in lean and overweight/obese children. Methods Fasting plasma glucose, serum lipids, serum insulin, and expressions of insulin resistance, anthropometry, blood pressure, and magnetic resonance spectroscopy of liver and muscle fat were obtained in 327 Danish children and adolescents aged 8–18 years. Results In 287 overweight/obese children, the prevalences of hepatic and muscular steatosis were 31% and 68%, respectively, whereas the prevalences in 40 lean children were 3% and 10%, respectively. A multiple regression analysis adjusted for age, sex, body mass index z-score (BMI SDS), and pubertal development showed that the OR of exhibiting dyslipidemia was 4.2 (95%CI: [1.8; 10.2], p = 0.0009) when hepatic steatosis was present. Comparing the simultaneous presence of hepatic and muscular steatosis with no presence of steatosis, the OR of exhibiting dyslipidemia was 5.8 (95%CI: [2.0; 18.6], p = 0.002). No significant associations between muscle fat and dyslipidemia, impaired fasting glucose, or blood pressure were observed. Liver and muscle fat, adjusted for age, sex, BMI SDS, and pubertal development, associated to BMI SDS and glycosylated hemoglobin, while only liver fat associated to visceral and subcutaneous adipose tissue and intramyocellular lipid associated inversely to high density lipoprotein cholesterol. Conclusion Hepatic steatosis is associated with dyslipidemia and liver and muscle fat depositions are linked to obesity-related metabolic dysfunctions, especially glycosylated hemoglobin, in children and adolescents, which suggest an increased cardiovascular disease risk.
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Affiliation(s)
- Cilius Esmann Fonvig
- The Children’s Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen Ø, Denmark
- * E-mail:
| | - Elizaveta Chabanova
- Department of Diagnostic Radiology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Ehm Astrid Andersson
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen Ø, Denmark
| | - Johanne Dam Ohrt
- The Children’s Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark
| | - Oluf Pedersen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen Ø, Denmark
| | - Torben Hansen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen Ø, Denmark
- University of Southern Denmark, Faculty of Health Sciences, Odense, Denmark
| | - Henrik S. Thomsen
- Department of Diagnostic Radiology, Copenhagen University Hospital Herlev, Herlev, Denmark
- University of Copenhagen, Faculty of Medical and Health Sciences, Copenhagen N, Denmark
| | - Jens-Christian Holm
- The Children’s Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark
- University of Copenhagen, Faculty of Medical and Health Sciences, Copenhagen N, Denmark
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Ultrasound-based tissue characterization and classification of fatty liver disease: A screening and diagnostic paradigm. Knowl Based Syst 2015. [DOI: 10.1016/j.knosys.2014.11.021] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Trovato FM, Catalano D, Musumeci G, Trovato GM. 4Ps medicine of the fatty liver: the research model of predictive, preventive, personalized and participatory medicine-recommendations for facing obesity, fatty liver and fibrosis epidemics. EPMA J 2014; 5:21. [PMID: 25937854 PMCID: PMC4417534 DOI: 10.1186/1878-5085-5-21] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 11/24/2014] [Indexed: 12/13/2022]
Abstract
Relationship between adipose tissue and fatty liver, and its possible evolution in fibrosis, is supported by clinical and research experience. Given the multifactorial pathogenesis of non-alcoholic fatty liver disease (NAFLD), treatments for various contributory risk factors have been proposed; however, there is no single validated therapy or drug association recommended for all cases which can stand alone. Mechanisms, diagnostics, prevention and treatment of obesity, fatty liver and insulin resistance are displayed along with recommendations and position points. Evidences and practice can get sustainable and cost-benefit valuable outcomes by participatory interventions. These recommendations can be enhanced by comprehensive research projects, addressed to societal issues and innovation, market appeal and industry development, cultural acceptance and sustainability. The basis of participatory medicine is a greater widespread awareness of a condition which is both a disease and an easy documented and inclusive clue for associated diseases and unhealthy lifestyle. This model is suitable for addressing prevention and useful for monitoring improvement, worsening and adherence with non-invasive imaging tools which allow targeted approaches. The latter include health psychology and nutritional and physical exercise prescription expertise disseminated by continuous medical education but, more important, by concrete curricula for training undergraduate and postgraduate students. It is possible and recommended to do it by early formal teaching of ultrasound imaging procedures and of practical lifestyle intervention strategies, including approaches aimed to healthier fashion suggestions. Guidelines and requirements of research project funding calls should be addressed also to NAFLD and allied conditions and should encompass the goal of training by research and the inclusion of participatory medicine topics. A deeper awareness of ethics of competences in health professionals and the articulation of knowledge, expertise and skills of medical doctors, dieticians, health psychologists and sport and physical exercise graduates are the necessary strategy for detectin a suboptimal health status and achieving realistically beneficial lifestyle changes. “The devil has put a penalty on all things we enjoy in life. Either we suffer in health or we suffer in soul or we get fat” (Albert Einstein); the task of medical research and intervention is to make possible to enjoy life also without things that make sufferance in health and souls and which excessively increase body fat.
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Affiliation(s)
- Francesca Maria Trovato
- Department of Clinical and Experimental Medicine, Internal Medicine Division, School of Medicine, University of Catania, Via S. Sofia, 78-95123 Catania, Italy
| | - Daniela Catalano
- Department of Clinical and Experimental Medicine, Internal Medicine Division, School of Medicine, University of Catania, Via S. Sofia, 78-95123 Catania, Italy
| | - Giuseppe Musumeci
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Via S. Sofia, 87-95123 Catania, Italy
| | - Guglielmo M Trovato
- Department of Clinical and Experimental Medicine, Internal Medicine Division, School of Medicine, University of Catania, Via S. Sofia, 78-95123 Catania, Italy
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Stanley TL, Feldpausch MN, Oh J, Branch KL, Lee H, Torriani M, Grinspoon SK. Effect of tesamorelin on visceral fat and liver fat in HIV-infected patients with abdominal fat accumulation: a randomized clinical trial. JAMA 2014; 312:380-9. [PMID: 25038357 PMCID: PMC4363137 DOI: 10.1001/jama.2014.8334] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
IMPORTANCE Among patients infected with human immunodeficiency virus (HIV), visceral adiposity is associated with metabolic dysregulation and ectopic fat accumulation. Tesamorelin, a growth hormone-releasing hormone analog, specifically targets visceral fat reduction but its effects on liver fat are unknown. OBJECTIVE To investigate the effect of tesamorelin on visceral and liver fat. DESIGN, SETTING, AND PATIENTS Double-blind, randomized, placebo-controlled trial conducted among 50 antiretroviral-treated HIV-infected men and women with abdominal fat accumulation at Massachusetts General Hospital in Boston. The first patient was enrolled on January 10, 2011; for the final patient, the 6-month study visit was completed on September 6, 2013. INTERVENTIONS Participants were randomized to receive tesamorelin, 2 mg (n=28), or placebo (n=22), subcutaneously daily for 6 months. MAIN OUTCOMES AND MEASURES Primary end points were changes in visceral adipose tissue and liver fat. Secondary end points included glucose levels and other metabolic end points. RESULTS Forty-eight patients received treatment with study drug. Tesamorelin significantly reduced visceral adipose tissue (mean change, -34 cm2 [95% CI, -53 to -15 cm2] with tesamorelin vs 8 cm2 [95% CI, -14 to 30 cm2] with placebo; treatment effect, -42 cm2 [95% CI, -71 to -14 cm2]; P = .005) and liver fat (median change in lipid to water percentage, -2.0% [interquartile range {IQR}, -6.4% to 0.1%] with tesamorelin vs 0.9% [IQR, -0.6% to 3.7%] with placebo; P = .003) over 6 months, for a net treatment effect of -2.9% in lipid to water percentage. Fasting glucose increased in the tesamorelin group at 2 weeks (mean change, 9 mg/dL [95% CI, 5-13 mg/dL] vs 2 mg/dL [95% CI, -3 to 8 mg/dL] in the placebo group; treatment effect, 7 mg/dL [95% CI, 1-14 mg/dL]; P = .03), but changes at 6 months in fasting glucose (mean change, 4 mg/dL [95% CI, -2 to 10 mg/dL] with tesamorelin vs 2 mg/dL [95% CI, -4 to 7 mg/dL] with placebo; treatment effect, 2 mg/dL [95% CI, -6 to 10 mg/dL]; P = .72 overall across time points) and 2-hour glucose (mean change, -1 mg/dL [95% CI, -18 to 15 mg/dL] vs -8 mg/dL [95% CI, -24 to 8 mg/dL], respectively; treatment effect, 7 mg/dL [95% CI, -16 to 29 mg/dL]; P = .53 overall across time points) were not significant. CONCLUSIONS AND RELEVANCE In this preliminary study of HIV-infected patients with abdominal fat accumulation, tesamorelin administered for 6 months was associated with reductions in visceral fat and additionally with modest reductions in liver fat. Further studies are needed to determine the clinical importance and long-term consequences of these findings. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01263717.
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Affiliation(s)
- Takara L Stanley
- Program in Nutritional Metabolism and Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Meghan N Feldpausch
- Program in Nutritional Metabolism and Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jinhee Oh
- Program in Nutritional Metabolism and Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Karen L Branch
- Clinical Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Martin Torriani
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Steven K Grinspoon
- Program in Nutritional Metabolism and Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Abstract
Preoperative evaluation of donors for living-donor liver transplantation aims to select a suitable donor with optimal graft quality and to ensure donor safety. Hepatic steatosis, a common finding in living liver donors, not only influences the outcome of liver transplantation for the recipient but also affects the recovery of the living donor after partial hepatectomy. Histopathologic analysis is the reference standard to detect and quantify fat in the liver, but it is invasive, and results are vulnerable to sampling error. Imaging can be repeated regularly and allows assessment of the entire liver, thus avoiding sampling error. Selection of appropriate imaging methods demands understanding of their advantages and limitations and the suitable clinical setting. This article describes potential clinical applications for liver fat quantification of imaging methods for fat detection and quantification, with an emphasis on the advantages and limitations of ultrasonography, computed tomography, and magnetic resonance imaging for quantifying liver fat.
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Aron-Wisnewsky J, Gaborit B, Dutour A, Clement K. Gut microbiota and non-alcoholic fatty liver disease: new insights. Clin Microbiol Infect 2013; 19:338-48. [DOI: 10.1111/1469-0691.12140] [Citation(s) in RCA: 172] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 12/21/2012] [Indexed: 12/20/2022]
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37
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Yang HR. Noninvasive diagnosis of pediatric nonalcoholic fatty liver disease. KOREAN JOURNAL OF PEDIATRICS 2013; 56:45-51. [PMID: 23482433 PMCID: PMC3589590 DOI: 10.3345/kjp.2013.56.2.45] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Accepted: 10/02/2012] [Indexed: 12/21/2022]
Abstract
Because nonalcoholic steatohepatitis can progress towards cirrhosis even in children, early detection of hepatic fibrosis and accurate diagnosis of nonalcoholic fatty liver disease (NAFLD) are important. Although liver biopsy is regarded as the gold standard of diagnosis, its clinical application is somewhat limited in children due to its invasiveness. Noninvasive diagnostic methods, including imaging studies, biomarkers of inflammation, oxidative stress, hepatic apoptosis, hepatic fibrosis, and noninvasive hepatic fibrosis scores have recently been developed for diagnosing the spectrum of NAFLD, particularly the severity of hepatic fibrosis. Although data and validation are still lacking for these noninvasive modalities in the pediatric population, these methods may be applicable for pediatric NAFLD. Therefore, noninvasive imaging studies, biomarkers, and hepatic fibrosis scoring systems may be useful in the detection of hepatic steatosis and the prediction of hepatic fibrosis, even in children with NAFLD.
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Affiliation(s)
- Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Early nutritional determinants of intrahepatocellular lipid deposition in preterm infants at term age. Int J Obes (Lond) 2013; 37:500-4. [PMID: 23318718 DOI: 10.1038/ijo.2012.213] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We have previously shown that by term age, preterm infants have elevated intrahepatocellular lipid (IHCL) content and altered regional adiposity, both of which are risk factors for cardiometabolic illness in adult life. Preterm nutritional intake is a plausible determinant of these aberrant trajectories of development. OBJECTIVE We aimed to establish if macronutritional components of the preterm diet were determinants of IHCL deposition measured at term equivalent age, using (1)H Magnetic Resonance spectroscopy (MRS). METHODS Prospective observational case-control study in a single UK neonatal unit. (1)H MR spectra were acquired from 18 preterm infants (<32 weeks gestational age at birth) at term age and 31 healthy term infants, who acted as a control group. Neonatal nutritional information was collected from birth to 34(+6) weeks postmenstrual age. RESULTS IHCL (median, interquartile range) was significantly higher in preterm-at-term infants compared with term-born infants: 0.735, 0-1.46 versus 0.138, 0-0.58; P=0.003. In preterm infants, IHCL was positively correlated with lipid intake in the first week of life (r=0.52, P=0.04). CONCLUSIONS This study confirms our previous observation of elevated IHCL in preterm infants at term and suggests that early lipid intake may be a determinant. Future work is warranted to establish the clinical relevance and the role of nutritional intervention in attenuating or exacerbating this effect in preterm infants.
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