Accuracy of common proton density fat fraction thresholds for magnitude- and complex-based chemical shift-encoded MRI for assessing hepatic steatosis in patients with obesity

Cunha, Guilherme Moura; Thai, Tydus; Hamilton, Gavin; Covarrubias, Yesenia; Schlein, Alexandra; Middleton, Michael S.; Wiens, Curtis N.; McMillan, A.; Agni, Rashmi; Funk, Luke M.; Campos, Guilherme M.; Horgan, Santiago; Jacobson, Garth; Wolfson, Tanya; Gamst, Anthony; Schwimmer, Jeffrey B.; Reeder, Scott B.; Sirlin, Claude B.

doi:10.1007/s00261-019-02350-3

Cited by 21 publications

(17 citation statements)

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“…After removing inappropriate studies, the inclusion criteria were fulfilled in 24 studies 14‐16,18,25‐43 (Figure 1). Nine articles used MRI‐PDFF, 14,16,18,25‐27,29,30 and 13 articles used TE‐CAP 31‐43 . Two studies compared the diagnostic performance of MR and TE methods for the noninvasive detection of liver fibrosis and steatosis in patients with NAFLD 15,17 .…”

Section: Resultsmentioning

confidence: 99%

“…Data acquired at each echo are then passed to a fitting algorithm that estimates and corrects T2 effects, model the fat signal and measure the fat and water proton densities; the fat content is then calculated 13 . It has been reported that MRI‐PDFF accurately classifies grades and changes in HS, with 80.0%‐95.8% sensitivity and 83.6%‐100% specificity 14,15 . Compared with TE, MRI‐based techniques measure a larger area of the liver, which may reduce sampling variability secondary to heterogeneity of HS.…”

Section: Introductionmentioning

confidence: 99%

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A meta‐analysis on the diagnostic performance of magnetic resonance imaging and transient elastography in nonalcoholic fatty liver disease

Lai

et al. 2020

Eur J Clin Investigation

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Background Noninvasive methods have been used for the assessment of hepatic steatosis in patients with nonalcoholic fatty liver disease (NAFLD). The aim was to assess the efficacy and accuracy of both magnetic resonance imaging(MRI) and transient elastography(TE) for the evaluation of hepatic steatosis. Materials and Methods The PubMed, Cochrane Library, Embase, MEDLINE and Web of Science databases were searched to retrieve studies examining the accuracy of MRI‐proton density fat fraction(PDFF) and TE‐controlled attenuation parameter(CAP) for evaluating the grading of steatosis(S0‐S3) diagnosed by liver biopsy in NAFLD. We compared the sensitivity, specificity, hierarchical summary receiver operating characteristic curves(HSROC) and clinical utility of these methods. Results Twenty‐four articles with a total of 2979 patients with NAFLD were included. The steatosis distribution was 8.1%/35.1%/32.2%/24.6% for S0/S1/S2/S3. For the diagnostic accuracy of MRI‐PDFF, the HSROCs were 0.97 for ≥S1, 0.91 for ≥S2 and 0.90 for ≥S3. For the diagnostic accuracy of TE‐based CAP, the HSROCs were 0.85 for ≥S1, 0.83 for ≥S2 and 0.79 for ≥S3. Following a ‘positive’ measurement (over the threshold value) for ≥S1, the corresponding post‐test probabilities of PDFF and CAP for the presence of steatosis were 82% and 61%, respectively, when the pretest probability was 24%. If the values were below these thresholds (‘negative’ results), the post‐test probabilities were 3% and 7%. Conclusion MRI‐PDFF and TE‐CAP both provide highly accurate noninvasive approaches for quantifying and staging hepatic steatosis in NAFLD. Compared with TE‐CAP, MRI‐PDFF is significantly more accurate for evaluating dichotomized grades of steatosis.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A meta‐analysis on the diagnostic performance of magnetic resonance imaging and transient elastography in nonalcoholic fatty liver disease

Lai

et al. 2020

Eur J Clin Investigation

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“…PDFF is expressed in percentile as a non-invasive biomarker of liver steatosis (19). Liver steatosis was defined as PDFF >5.4% in accordance to reports investigating patients with obesity (20).…”

Section: Liver Proton Density Fat Fraction Measurementsmentioning

confidence: 99%

“…Magnetic resonance imaging (MRI) has been shown as an accurate method for measuring VAT and liver fat in clinical practice and in clinical trials (19)(20)(21). It also allows the estimation of liver stiffness, a non-invasive biomarker that correlates to liver inflammation and fibrosis (22,23).…”

Section: Introductionmentioning

confidence: 99%

Efficacy of a 2-Month Very Low-Calorie Ketogenic Diet (VLCKD) Compared to a Standard Low-Calorie Diet in Reducing Visceral and Liver Fat Accumulation in Patients With Obesity

Cunha

Guzmán²,

Mello

et al. 2020

Front. Endocrinol.

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Background: Currently the treatment of non-alcoholic fatty liver disease (NAFLD) is based on weight loss through lifestyle changes, such as exercise combined with calorie-restricted dieting. Objectives: To assess the effects of a commercially available weight loss program based on a very low-calorie ketogenic diet (VLCKD) on visceral adipose tissue (VAT) and liver fat content compared to a standard low-calorie (LC) diet. As a secondary aim, we evaluated the effect on liver stiffness measurements. Methods: Open, randomized controlled, prospective pilot study. Patients were randomized and treated either with an LC or a VLCKD and received orientation and encouragement to physical activity equally for both groups. VAT, liver fat fraction, and liver stiffness were measured at baseline and after 2 months of treatment using magnetic resonance imaging. Paired t-tests were used for comparison of continuous variables between visits and unpaired test between groups. Categorical variables were compared using the χ 2-test. Pearson correlation was used to assess the association between VAT, anthropometric measures, and hepatic fat fraction. A significance level of the results was established at p < 0.05. Results: Thirty-nine patients (20 with VLCKD and 19 with LC) were evaluated at baseline and 2 months of intervention. Relative weight loss at 2 months was −9.59 ± 2.87% in the VLCKD group and −1.87 ± 2.4% in the LC group (p < 0.001). Mean reductions in VAT were −32.0 cm 2 for VLCKD group and −12.58 cm 2 for LC group (p < 0.05). Reductions in liver fat fraction were significantly more pronounced in the VLCKD group than in the LC group (4.77 vs. 0.79%; p < 0.005). Cunha et al. VLCKD for Visceral Fat and NAFLD Conclusion: Patients undergoing a VLCKD achieved superior weight loss, with significant VAT and liver fat fraction reductions when compared to the standard LC diet. The weight loss and rapid mobilization of liver fat demonstrated with VLCKD could serve as an effective alternative for the treatment of NAFLD.

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“…In the Dallas Heart Study (106), a threshold of 5.56% was identified as the 95th percentile threshold in a cohort with no risk factors for liver disease. In a weight loss surgery study (107), 5% and 15% MRI PDFF thresholds have been proposed for detection and differentiation between none-to-mild and mild and/or moderate-to-severe steatosis, respectively. A recent study by Rehm et al (108) in adolescent girls identified an MRI PDFF threshold of 3.0% as predictive of metabolic syndrome.…”

Section: Setting Up Clinically Meaningful Pdff Thresholdsmentioning

confidence: 99%

Quantification of Liver Fat Content with CT and MRI: State of the Art

et al. 2021

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A bnormal accumulation of liver fat, or hepatic steatosis, is a pathologic condition that is increasing in prevalence, progressive in nature, and associated with hepatic and extrahepatic complications. Development of quantitative imaging methods over the past 2 decades has produced accurate, precise, and reproducible methods to assess the severity of hepatic steatosis. Herein, we review state-of-theart liver fat quantification using CT and MRI, including advantages and limitations, followed by a guide for their use in clinical practice. Burden of Hepatic Steatosis and Nonalcoholic Fatty Liver DiseaseIn hepatic steatosis, several lipid metabolites can accumulate in the liver, including triglycerides (the majority), free fatty acids, and cholesterol (1,2). In the absence of specific causes (eg, alcohol abuse, steatogenic medications, or viral infection), the term nonalcoholic fatty liver disease (NAFLD) is used (3). NAFLD is the most common chronic liver disease (4), with an estimated pooled overall global prevalence of 25%, as diagnosed with imaging (US and/or CT) (4). Areas most affected include the Middle East (32%), South and North America (30% and 24%, respectively), and Asia (27%) (4).NAFLD can occur at an early age (5) and may result in fibrosis or cirrhosis in childhood or early adulthood (5,6). The pooled mean prevalence of pediatric NAFLD is estimated to be 8% in the general population and 34% in children seen at obesity clinics (6). As for the early onset of NAFLD, additional considerations including race, ethnicity (7), and genetically inherited metabolic disorders should be considered (3,7,8). Pediatric NAFLD, however, remains generally underdiagnosed because of lack of awareness.NAFLD represents a spectrum of disease, with the majority at one end with only "isolated" hepatic steatosis or nonalcoholic fatty liver (3). A fraction of patients with NAFLD, estimated at 20% (projected to be 27% in 2030), will develop hepatocyte injury and inflammation, representing a more aggressive subset known as nonalcoholic steatohepatitis (NASH). We note that an Hepatic steatosis is defined as pathologically elevated liver fat content and has many underlying causes. Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide, with an increasing prevalence among adults and children. Abnormal liver fat accumulation has serious consequences, including cirrhosis, liver failure, and hepatocellular carcinoma. In addition, hepatic steatosis is increasingly recognized as an independent risk factor for the metabolic syndrome, type 2 diabetes, and, most important, cardiovascular mortality. During the past 2 decades, noninvasive imaging-based methods for the evaluation of hepatic steatosis have been developed and disseminated. Chemical shift-encoded MRI is now established as the most accurate and precise method for liver fat quantification. CT is important for the detection and quantification of incidental steatosis and may play an increasingly prominent role in risk stratification, particularly wi...

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Accuracy of common proton density fat fraction thresholds for magnitude- and complex-based chemical shift-encoded MRI for assessing hepatic steatosis in patients with obesity

Cited by 21 publications

References 35 publications

A meta‐analysis on the diagnostic performance of magnetic resonance imaging and transient elastography in nonalcoholic fatty liver disease

A meta‐analysis on the diagnostic performance of magnetic resonance imaging and transient elastography in nonalcoholic fatty liver disease

Efficacy of a 2-Month Very Low-Calorie Ketogenic Diet (VLCKD) Compared to a Standard Low-Calorie Diet in Reducing Visceral and Liver Fat Accumulation in Patients With Obesity

Quantification of Liver Fat Content with CT and MRI: State of the Art

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