Noninvasive assessment of hepatic lipid composition: Advancing understanding and management of fatty liver disorders

Johnson, Nathan A.; Walton, David W.H.; Sachinwalla, Toos; Thompson, Campbell; Smith, Kate; Ruell, Patricia; Stannard, Stephen R.; George, Jacob

doi:10.1002/hep.22220

Cited by 154 publications

(218 citation statements)

References 37 publications

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“…Magnetic resonance (MR) spectroscopy is regarded by many as the noninvasive reference standard in the quantifi cation of hepatic triglyceride content (16)(17)(18)(19). However, MR spectroscopy re quires a substantial amount of…”

Section: Patientsmentioning

confidence: 99%

Quantification of Hepatic Steatosis with T1-independent, T2*-corrected MR Imaging with Spectral Modeling of Fat: Blinded Comparison with MR Spectroscopy

Meisamy

Hines²,

Hamilton³

et al. 2011

Radiology

353

412

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Purpose:To prospectively compare an investigational version of a complex-based chemical shift-based fat fraction magnetic resonance (MR) imaging method with MR spectroscopy for the quantifi cation of hepatic steatosis. Materials and Methods:This study was approved by the institutional review board and was HIPAA compliant. Written informed consent was obtained before all studies. Fifty-fi ve patients (31 women, 24 men; age range, 24-71 years) were prospectively imaged at 1.5 T with quantitative MR imaging and single-voxel MR spectroscopy, each within a single breath hold. The effects of T2* correction, spectral modeling of fat, and magnitude fi tting for eddy current correction on fat quantifi cation with MR imaging were investigated by reconstructing fat fraction images from the same source data with different combinations of error correction. Single-voxel T2-corrected MR spectroscopy was used to measure fat fraction and served as the reference standard. All MR spectroscopy data were postprocessed at a separate institution by an MR physicist who was blinded to MR imaging results. Fat fractions measured with MR imaging and MR spectroscopy were compared statistically to determine the correlation ( r 2 ), and the slope and intercept as measures of agreement between MR imaging and MR spectroscopy fat fraction measurements, to determine whether MR imaging can help quantify fat, and examine the importance of T2* correction, spectral modeling of fat, and eddy current correction. Two-sided t tests (signifi cance level, P = .05) were used to determine whether estimated slopes and intercepts were signifi cantly different from 1.0 and 0.0 , respectively. Sensitivity and specifi city for the classifi cation of clinically signifi cant steatosis were evaluated. Results:Overall, there was excellent correlation between MR imaging and MR spectroscopy for all reconstruction combinations. However, agreement was only achieved when T2* correction, spectral modeling of fat, and magnitude fi tting for eddy current correction were used ( r 2 = 0.99; slope 6 standard deviation = 1.00 6 0.01, P = .77; intercept 6 standard deviation = 0.2% 6 0.1, P = .19 ). Conclusion:T1-independent chemical shift-based water-fat separation MR imaging methods can accurately quantify fat over the entire liver, by using MR spectroscopy as the reference standard, when T2* correction, spectral modeling of fat, and eddy current correction methods are used.q RSNA, 2011

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Section: Patientsmentioning

confidence: 99%

Quantification of Hepatic Steatosis with T1-independent, T2*-corrected MR Imaging with Spectral Modeling of Fat: Blinded Comparison with MR Spectroscopy

Meisamy

Hines²,

Hamilton³

et al. 2011

Radiology

353

412

View full text Add to dashboard Cite

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“…Similar voxel placement was achieved between measures within individual, guided by image capture at baseline [24]. Fully automated high-order shimming was performed to ensure maximum field homogeneity.…”

Section: Assessmentsmentioning

confidence: 99%

“…Liver and pancreas water signal amplitudes were quantified using Hankel-Lanczos squares singular values decomposition [27][28][29], and a five resonance model was employed to fit the lipid peaks [24,27,30]. A liver fat concentration ≥5.5% was considered consistent with the presence of non-alcoholic fatty liver disease (NAFLD), as described by previous studies quantifying liver fat using 1 H-MRS [31,32].…”

Section: Assessmentsmentioning

confidence: 99%

Reversal of type 2 diabetes in youth who adhere to a very-low-energy diet: a pilot study

et al. 2016

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Aims/hypothesis The aim of the study was to investigate whether a very-low-energy diet (VLED) is a feasible and acceptable treatment option for type 2 diabetes in children and adolescents, and whether adherence can lead to rapid weight loss, reversal of type 2 diabetes and reduced liver fat as seen in adult studies. Methods Eight participants with type 2 diabetes and obesity, aged 7-16 years, non-medicated (n = 1) or treated with metformin (n = 7) and in some cases insulin (n = 3), followed a VLED (<3360 kJ/day) for 8 weeks, then transitioned to a hypocaloric diet (∼6300 kJ/day) that they followed to 34 weeks. HbA 1c , fasting glucose and 2 h post-glucose load plasma glucose (2hG) were determined from fasting blood and an OGTT. Liver fat concentration was quantified using proton magnetic resonance spectroscopy. Adherence was defined as ≥5% weight loss during the 8 week VLED. Results Adherers (n = 5) and non-adherers (n = 3) had median weight loss of 7.5% and 0.5%, respectively, at 8 weeks. Only three out of eight participants met non-alcoholic fatty liver disease (NAFLD) criteria (≥5.5%) at 8 weeks, compared with eight out of eight at baseline. The three participants on insulin therapy at baseline were able to cease therapy during the 8 week VLED. At 34 weeks, adherers (n = 5) achieved 12.3% weight loss, none met NAFLD criteria and four did not meet American Diabetes Association criteria for type 2 diabetes.

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“…In vivo, the technique has been used to assess the prevalence of NAFLD [7]; recently, more detailed information on lipid composition has been reported [8]. In vitro, MRS has been applied to the study of liver tissue extracts in obese rats [9] and urine and plasma from mice with features of NAFLD [10;11].…”

Section: Introductionmentioning

confidence: 99%

Phenotyping murine models of non-alcoholic fatty liver disease through metabolic profiling of intact liver tissue

et al. 2009

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Non-alcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease, associated with the metabolic syndrome. Effective techniques are needed to investigate the potential of animal models of NAFLD. This study aimed to characterise murine models of NAFLD by metabolic profiling of intact liver tissue.Mice of three strains (BALB/c, C3H and the novel mutant, Gena/263) were fed a control or high fat diet. Biometric, biochemical and histological analysis demonstrated a spectrum of NAFLD from normal liver to steatohepatitis. Metabolic profiling of intact liver tissue, using magic angle spinning proton magnetic resonance spectroscopy (MAS MRS), showed an increase in total lipid-to-water ratio, a decrease in polyunsaturation indices and a decrease in total choline with increasing disease severity. Principal components analysis and partial least squares discriminant analysis showed separation of each model from its control and of each model from the total dataset. Class membership from the whole dataset was predicted with 100% accuracy in 6 of 8 models. Those models with steatosis discriminated from those with steatohepatitis with 100% accuracy.The separation of histologically-defined steatohepatitis from simple steatosis is clinically important. Indices derived from 1 H MAS MRS studies may inform subsequent in vivo MRS studies at lower field strengths.2

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Noninvasive assessment of hepatic lipid composition: Advancing understanding and management of fatty liver disorders

Abstract: Nonalcoholic fatty liver is frequently observed in obese individuals, yet the factors that predict its development and progression to liver disease are poorly understood. We proposed that proton magnetic resonance spectroscopy (

Cited by 154 publications

References 37 publications

Quantification of Hepatic Steatosis with T1-independent, T2*-corrected MR Imaging with Spectral Modeling of Fat: Blinded Comparison with MR Spectroscopy

Quantification of Hepatic Steatosis with T1-independent, T2*-corrected MR Imaging with Spectral Modeling of Fat: Blinded Comparison with MR Spectroscopy

Reversal of type 2 diabetes in youth who adhere to a very-low-energy diet: a pilot study

Phenotyping murine models of non-alcoholic fatty liver disease through metabolic profiling of intact liver tissue

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