Postprandial hepatic stiffness changes on magnetic resonance elastography in healthy volunteers

Abstract

Magnetic resonance elastography (MRE) is a reliable noninvasive method for assessment of hepatic stiffness. Liver stiffness is known to be affected by elevated postprandial portal blood flow in patients with chronic liver disease. The goal of this study was to determine whether food intake affects liver stiffness in the absence of known liver disease. We evaluated 100 volunteers (35 men and 65 women) who met inclusion criteria. The subjects had two MRE examinations, first while fasting and then 30 min after a test meal. Fourteen subjects also had two additional MRE exams 1 h 30 min and 2 h 30 min after the meal. Liver stiffness was measured by placing the largest possible polygon ROIs on the four widest liver slices and calculated as a mean of stiffness values from each slice. The correlation of liver stiffness values before and after the meal was assessed using a paired t-test. To evaluate the relationship between the change in postprandial liver stiffness and fasting liver stiffness values, linear regression was performed. The liver stiffness values in the fasting state ranged from 1.84 to 2.82 kPa, with a mean of 2.30 ± 0.23 kPa (95% CI 2.25–2.34). At 30 min after the meal, liver stiffness values ranged from 2.12 to 3.50 kPa, with a mean of 2.70 ± 0.28 kPa (95% CI 2.64–2.75), demonstrating a systematic postprandial increase by 0.40 ± 0.23 kPa (17.7 ± 3.5%). Meal intake significantly increases liver stiffness in healthy individuals, which persists for at least 2 h 30 min. Patients should fast for 3–4 h before MRE examinations to avoid fibrosis overstaging due to postprandial liver stiffness augmentation.

On the relationship between metabolic capacities and in vivo viscoelastic properties of the liver

“…One may speculate whether the observed correlations indicate a causal relationship between liver biomechanics and metabolic function. However, it is important to note that short-term physiological changes such as prandial state or perfusion rate induce acute changes in the liver’s mechanical properties within seconds or minutes ( Yin et al, 2011 ; Jajamovich et al, 2014 ; Dittmann et al, 2017 ; Manduca et al, 2021 ; Obrzut et al, 2021 ). In contrast, alterations in metabolic capacities due to variable protein abundance represent long-term adaptations taking place over hours or days ( Berndt and Holzhutter, 2018 ).…”

“…Liver fibrosis increases liver stiffness through accumulation and cross-linking of matrix proteins ( Huwart et al, 2008 ; Singh et al, 2015 ; Reiter et al, 2020 ). However, beyond fibrosis, the liver’s biomechanical properties are also affected by non-fibrotic alterations such as prandial states ( Yin et al, 2011 ; Jajamovich et al, 2014 ; Petzold et al, 2019 ; Obrzut et al, 2021 ), hydration ( Ipek-Ugay et al, 2016 ; Dittmann et al, 2017 ), blood perfusion ( Ipek-Ugay et al, 2016 ; Meyer et al, 2022a ), cell hypertrophy ( Garczyńska et al, 2020 ), fat accumulation ( Hudert et al, 2019 ) or inflammation ( Qu et al, 2021 ; Selvaraj et al, 2021 ), making elastography unspecifically sensitive to a variety of pathophysiological processes that occur in the course of NAFLD. Only little is known about the correlation between liver biomechanical parameters and liver metabolism.…”

Rapid MR elastography of the liver for subsecond stiffness sampling

“…A rich body of literature reports MRE of the liver under various conditions of blood perfusion, fasting, and breathing. A marked postprandial increase in liver stiffness has been observed in both patients with chronic liver disease 45 and healthy volunteers 11 and has been shown to correlate with portal venous flow 46 . These findings have led to the recommendation that MRE should be performed in a controlled fasted state 9 .…”

“…Furthermore, measured liver stiffness varies during the respiratory cycle 5,6 and with blood perfusion. 7,8 For example, it is recommended to perform MRE in expiration and in a controlled state of fasting, [9][10][11] and to ask patients to abstain from fluid intake before the examination. 12,13 Today, MRE is considered the most precise method for measuring liver stiffness, outperforming ultrasound elastography.…”

Postprandial splenic stiffness changes on magnetic resonance elastography in a young healthy population

“…The same group of participants was used in a previously published study. 18 The study design consisted of two steps: a research venous blood draw and a series of MRE examinations. All participants were asked to provide information on their height and weight so that the body mass index (BMI) could be calculated.…”