Serum Scoring and Quantitative Magnetic Resonance Imaging in Intestinal Failure-Associated Liver Disease: A Feasibility Study

Abstract

(1) Background: Intestinal failure-associated liver disease (IFALD) in adults is characterized by steatosis with variable progression to fibrosis/cirrhosis. Reference standard liver biopsy is not feasible for all patients, but non-invasive serological and quantitative MRI markers for diagnosis/monitoring have not been previously validated. Here, we examine the potential of serum scores and feasibility of quantitative MRI used in non-IFALD liver diseases for the diagnosis of IFALD steatosis; (2) Methods: Clinical and biochemical parameters were used to calculate serum scores in patients on home parenteral nutrition (HPN) with/without IFALD steatosis. A sub-group underwent multiparameter quantitative MRI measurements of liver fat fraction, iron content, tissue T1, liver blood flow and small bowel motility; (3) Results: Compared to non-IFALD (n = 12), patients with IFALD steatosis (n = 8) demonstrated serum score elevations in Enhanced Liver Fibrosis (p = 0.032), Aspartate transaminase-to-Platelet Ratio Index (p < 0.001), Fibrosis-4 Index (p = 0.010), Forns Index (p = 0.001), Gamma-glutamyl transferase-to-Platelet Ratio Index (p = 0.002) and Fibrosis Index (p = 0.001). Quantitative MRI scanning was feasible in all 10 sub-group patients. Median liver fat fraction was higher in IFALD steatosis patients (10.9% vs 2.1%, p = 0.032); other parameter differences were non-significant; (4) Conclusion: Serum scores used for non-IFALD liver diseases may be useful in IFALD steatosis. Multiparameter MRI is feasible in patients on HPN.

Hepatic dysfunction in patients receiving intravenous lipid emulsions

“…Goldani et al found that in a cohort of 54 children on HPN (median age of initiation: 10 m), 24% had IFALD, defined as an alkaline phosphatase and gamma glutamyl transferase at least 1.5× the upper limit of normal and persisting for at least 6 weeks [6 ▪ ]. IFALD tends to manifest as cholestasis in newborns, whereas hepatic steatosis predominates in older children and adults [7–9]. In fact, in a recent study, liver biopsies were performed in 31 children at 3–8 months; that steatosis was present in 26% of liver biopsies whereas cholestasis without steatosis was present in 52% [10 ▪▪ ].…”

IFALD in children: What's new? A narrative review

“…TE has been considered a promising method for monitoring the liver injury in adults on long-term PN due to its correlation with biochemical scores ( 35 ). Biochemical scores such as aspartate transaminase to platelet ratio index, fibrosis-4 index, gamma-glutamyl transferase to platelet ratio index, and fibrosis index may be useful to assess liver steatosis in adults with IFALD ( 40 ).…”