Multiparametric MR Index for the Diagnosis of Non-Alcoholic Steatohepatitis in Patients with Non-Alcoholic Fatty Liver Disease

Abstract

Non-alcoholic steatohepatitis (NASH) is a complex disease consisting of various components including steatosis, lobular inflammation, and ballooning degeneration, with or without fibrosis. Therefore, it is difficult to diagnose NASH with only one imaging modality. This study was aimed to evaluate the feasibility of magnetic resonance imaging (MRI) for predicting NASH and to develop a non-invasive multiparametric MR index for the detection of NASH in non-alcoholic fatty liver disease (NAFLD) patients. This prospective study included 47 NAFLD patients who were scheduled to undergo or underwent ultrasound-guided liver biopsy within 2 months. Biopsy specimens were graded as NASH or non-NASH. All patients underwent non-enhanced MRI including MR spectroscopy (MRS), MR elastography (MRE), and T1 mapping. Diagnostic performances of MRS, MRE, and T1 mapping for grading steatosis, activity, and fibrosis were evaluated. A multiparametric MR index combining fat fraction (FF), liver stiffness (LS) value, and T1 relaxation time was developed using linear regression analysis. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of the newly devised MR index. Twenty NASH patients and 27 non-NASH patients were included. Using MRS, MRE, and T1 mapping, the mean areas under the curve (AUCs) for grading steatosis, fibrosis, and activity were 0.870, 0.951, and 0.664, respectively. The multiparametric MR index was determined as 0.037 × FF (%) + 1.4 × LS value (kPa) + 0.004 × T1 relaxation time (msec) −3.819. ROC curve analysis of the MR index revealed an AUC of 0.883. The cutoff value of 6 had a sensitivity of 80.0% and specificity of 85.2%. The multiparametric MR index combining FF, LS value, and T1 relaxation time showed high diagnostic performance for detecting NASH in NAFLD patients.

Risperidone Exacerbates Glucose Intolerance, Nonalcoholic Fatty Liver Disease, and Renal Impairment in Obese Mice

“…Triglycerides have been proposed to potentially be a major factor in IR pathogenesis—the main type 2 diabetes (T2D) predictor [ 24 ]. Moreover, hyperinsulinemia and glucose intolerance, which are commonly observed with IR, may cause intrahepatic triglyceride overproduction in patients with nonalcoholic fatty liver disease [ 25 , 26 ]. Studies have estimated that patients with medication-treated schizophrenia have an approximately threefold higher risk of metabolic syndrome compared with community and clinical samples from the general population and that the prevalence of metabolic syndrome among this population, including IR, rapid weight increase, diabetes, elevated cardiovascular risk, and dyslipidemia, is 14.7–68% [ 27 , 28 ].…”

Doxepin Exacerbates Renal Damage, Glucose Intolerance, Nonalcoholic Fatty Liver Disease, and Urinary Chromium Loss in Obese Mice

“…Many commonly used psychotropic medications, particularly antipsychotics, and antidepressants, have recently been independently associated with endocrine and metabolic factors such as insulin resistance (IR), obesity, and dyslipidemia [8,10]. Triglycerides possibly represent a major factor in the pathogenesis of IR, the most crucial type 2 diabetes mellitus (T2DM) predictor [11,12]. Moreover, nonalcoholic fatty liver disease (NAFLD) may lead to triglyceride overproduction in the liver due to hyperinsulinemia and glucose intolerance (both commonly observed along with IR) [13,14].…”

Steatosis/steatohepatitis: how sustainable is the non-invasive instrumental differential diagnosis in clinical practice?

“…So far, magnetic resonance imaging-derived proton density fat fraction remains the gold standard for the non-invasive measure of liver fat and MRI-elastography and multiparametric MRI technology provides a highly accurate fibrosis-inflammatory index for the non-invasive differential diagnosis between NAFLD and NASH. These methods demonstrated good specificity and sensitivity in detecting patients with steatohepatitis even in absence of fibrosis [49][50][51][52][53][54] . However, the poor availability and high costs of MRIs limit their use in the everyday clinical practice.…”