Skip to main content
Top
Published in: Obesity Surgery 7/2017

01-07-2017 | Original Contributions

Evolution of Liver Steatosis Quantified by MR Imaging and MR Spectroscopy, in Morbidly Obese Patients Undergoing Sleeve Gastrectomy: Short-Term Outcomes

Authors: María Engracia Alsina, Jaime Ruiz-Tovar, Angela Bernabeu

Published in: Obesity Surgery | Issue 7/2017

Login to get access

Abstract

Background

Currently, the standard procedure used to evaluate hepatic steatosis is the liver biopsy. This is an invasive practice that presents inherent risks. Increasing evidence suggests that magnetic resonance imaging (MRI) and MR spectroscopy (MRS) may represent an accurate method to determine the hepatic lipid content. The aim of this study was to evaluate the effect of sleeve gastrectomy on liver steatosis, quantified by MRI and MRS.

Patients and Methods

A prospective observational study of patients undergoing laparoscopic sleeve gastrectomy was performed. All patients underwent a MRI and a MRS study 2 weeks before the intervention and 6 months after the surgery. Anthropometric, biochemical, and radiological parameters were analyzed.

Results

Twenty-three patients were included, 21 females and 2 males, with a mean age of 47.6 ± 10.6 years and mean pre-op BMI 47.6 ± 6.7 Kg/m2. Six months after surgery, mean BMI was 32.2 ± 5.1 Kg/m2, with a mean excess weight loss of 68.2 ± 18.6%. Mean preoperative hepatic volume was 1999.9 ± 436.2 ml and 6 months after surgery it decreased to 1568 ± 170.3 ml (p = 0.005). Mean preoperative percentage of lipid content was 14.2 ± 15.4% and 6 months after surgery, it decreased to 4.3 ± 3.2% (p = 0.007). A significant reduction of steatosis grade was observed, with disappearance of preoperative steatosis in 54.9% of the patients.

Conclusion

Six months after sleeve gastrectomy, a significant reduction of liver steatosis is observed, as demonstrated by reduction in the percentage of intrahepatocitary lipids and liver volume, determined by MRS and MRI. These imaging techniques can be considered as noninvasive, accurate methods for monitoring liver steatosis in morbidly obese patients undergoing bariatric surgery.
Literature
1.
go back to reference Wilkins T, Tadkod A, Hepburn I, et al. Nonalcoholic fatty liver disease: diagnosis and management. Am Fam Physician. 2013;88:35–42.PubMed Wilkins T, Tadkod A, Hepburn I, et al. Nonalcoholic fatty liver disease: diagnosis and management. Am Fam Physician. 2013;88:35–42.PubMed
2.
go back to reference Alves de Carvalho MS, Coelho Cabral P, Kruze Grande de Arruda I, et al. Risk factors associated with hepatic steatosis; a study in patients in the Northeast Brazil. Nutr Hosp. 2012;27:1344–50. Alves de Carvalho MS, Coelho Cabral P, Kruze Grande de Arruda I, et al. Risk factors associated with hepatic steatosis; a study in patients in the Northeast Brazil. Nutr Hosp. 2012;27:1344–50.
3.
go back to reference Clark JM, Brancati FL, Diehl AM. Nonalcoholic fatty liver disease. Gastroenterology. 2002;122:1649–57.CrossRefPubMed Clark JM, Brancati FL, Diehl AM. Nonalcoholic fatty liver disease. Gastroenterology. 2002;122:1649–57.CrossRefPubMed
4.
go back to reference Clark JM, Alkhuraishi AR, Solga SF, et al. Roux-en-Y gastric bypass improves liver histology in patients with non-alcoholic fatty liver disease. Obes Res. 2005;13:1180–6.CrossRefPubMed Clark JM, Alkhuraishi AR, Solga SF, et al. Roux-en-Y gastric bypass improves liver histology in patients with non-alcoholic fatty liver disease. Obes Res. 2005;13:1180–6.CrossRefPubMed
5.
go back to reference Pillai AA, RInella ME. Non-alcoholic fatty liver disease: is bariatric surgery the answer? Clin Liver Dis. 2009;13:689–710.CrossRefPubMed Pillai AA, RInella ME. Non-alcoholic fatty liver disease: is bariatric surgery the answer? Clin Liver Dis. 2009;13:689–710.CrossRefPubMed
6.
go back to reference Weiner RA. Surgical treatment of non-alcoholic steatohepatitis and non-alcoholic fatty liver disease. Dig Dis. 2010;28:274–9.CrossRefPubMed Weiner RA. Surgical treatment of non-alcoholic steatohepatitis and non-alcoholic fatty liver disease. Dig Dis. 2010;28:274–9.CrossRefPubMed
7.
go back to reference Johansson HE, Haenni A, Zethelius B. Platelet counts and liver enzymes after bariatric surgery. J Obes. 2013; Article ID 567984. Johansson HE, Haenni A, Zethelius B. Platelet counts and liver enzymes after bariatric surgery. J Obes. 2013; Article ID 567984.
8.
go back to reference Tai CM, Huang CK, Hwang JC, et al. Improvement of nonalcoholic fatty liver disease after bariatric surgery in morbidly obese Chinese patients. Obes Surg. 2012;22:1016–21.CrossRefPubMed Tai CM, Huang CK, Hwang JC, et al. Improvement of nonalcoholic fatty liver disease after bariatric surgery in morbidly obese Chinese patients. Obes Surg. 2012;22:1016–21.CrossRefPubMed
9.
go back to reference Sakçak M, Avsar MF, Hamamci EO, et al. Comparison of early and late changes in immunoglobulins and acute phase reactants after laparoscopic adjustable gastric banding in patients with morbid obesity. Obes Surg. 2010;20:610–5.CrossRefPubMed Sakçak M, Avsar MF, Hamamci EO, et al. Comparison of early and late changes in immunoglobulins and acute phase reactants after laparoscopic adjustable gastric banding in patients with morbid obesity. Obes Surg. 2010;20:610–5.CrossRefPubMed
10.
go back to reference Ratziu V, Charlotte F, Heurtier A, et al. Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology. 2005;128:1898–906.CrossRefPubMed Ratziu V, Charlotte F, Heurtier A, et al. Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology. 2005;128:1898–906.CrossRefPubMed
11.
go back to reference Guiu B, Petit JM, Loffreoy R, et al. Quantification of liver fat content: comparison of triple-echo chemical shift gradient-echo imaging and in vivo proton MR spectroscopy. Radiology. 2009;250:95–102.CrossRefPubMed Guiu B, Petit JM, Loffreoy R, et al. Quantification of liver fat content: comparison of triple-echo chemical shift gradient-echo imaging and in vivo proton MR spectroscopy. Radiology. 2009;250:95–102.CrossRefPubMed
12.
go back to reference Moreno-Pérez O, Portilla J, Escoín C, et al. Impact of vitamin D insufficiency on insulin homeostasis and beta cell function in nondiabetic male HIV-infected patients. HIV Med. 2013;14:540–8.CrossRefPubMed Moreno-Pérez O, Portilla J, Escoín C, et al. Impact of vitamin D insufficiency on insulin homeostasis and beta cell function in nondiabetic male HIV-infected patients. HIV Med. 2013;14:540–8.CrossRefPubMed
13.
go back to reference Ma X, Holalkere N-S, Kambadakone RA, et al. Imaging-based quantification of hepatic fat: methods and clinical applications. Radiographics. 2009;29:1253–77.CrossRefPubMed Ma X, Holalkere N-S, Kambadakone RA, et al. Imaging-based quantification of hepatic fat: methods and clinical applications. Radiographics. 2009;29:1253–77.CrossRefPubMed
14.
go back to reference Machann J, Thamer C, Schnoedt B, et al. Hepatic lipid accumulation in healthy subjects: a comparative study using spectral fat-selective MRI and volume-localized 1H-MR spectroscopy. Magn ResonMed. 2006;55:913–7.CrossRef Machann J, Thamer C, Schnoedt B, et al. Hepatic lipid accumulation in healthy subjects: a comparative study using spectral fat-selective MRI and volume-localized 1H-MR spectroscopy. Magn ResonMed. 2006;55:913–7.CrossRef
15.
go back to reference van Werven JR, Marsman HA, Nederveen AJ, et al. Assessment of hepatic steatosis in patients undergoing liver resection: comparison of US, CT, T1-weighted dual-echo MR imaging, and point-resolved 1H MR spectroscopy. Radiology. 2010;256:159–68.CrossRefPubMed van Werven JR, Marsman HA, Nederveen AJ, et al. Assessment of hepatic steatosis in patients undergoing liver resection: comparison of US, CT, T1-weighted dual-echo MR imaging, and point-resolved 1H MR spectroscopy. Radiology. 2010;256:159–68.CrossRefPubMed
16.
go back to reference Thomas EL, Hamilton G, Patel N, et al. Hepatic triglyceride content and its relation to body adiposity: a magnetic resonance imaging and proton magnetic resonance spectroscopy study. Gut. 2005;54:122–7.CrossRefPubMedPubMedCentral Thomas EL, Hamilton G, Patel N, et al. Hepatic triglyceride content and its relation to body adiposity: a magnetic resonance imaging and proton magnetic resonance spectroscopy study. Gut. 2005;54:122–7.CrossRefPubMedPubMedCentral
17.
go back to reference Subichin M, Clanton J, Makuszewski M, et al. Liver disease in the morbidly obese: a review of 1000 consecutive patients undergoing weight loss surgery. Surg Obes Relat Dis. 2015;11:137–41.CrossRefPubMed Subichin M, Clanton J, Makuszewski M, et al. Liver disease in the morbidly obese: a review of 1000 consecutive patients undergoing weight loss surgery. Surg Obes Relat Dis. 2015;11:137–41.CrossRefPubMed
18.
go back to reference Jimenez-Aguero R, Emparanza JI, Beguiristain A, et al. Novel equation to determine the hepatic triglyceride concentration in humans by MRI: diagnosis and monitoring of NAFLD in obese patients before and after bariatric surgery. BMC Medicine. 2014;12:137–51.CrossRefPubMedPubMedCentral Jimenez-Aguero R, Emparanza JI, Beguiristain A, et al. Novel equation to determine the hepatic triglyceride concentration in humans by MRI: diagnosis and monitoring of NAFLD in obese patients before and after bariatric surgery. BMC Medicine. 2014;12:137–51.CrossRefPubMedPubMedCentral
19.
go back to reference Younossi ZM, Gramlich T, Liu YC, et al. Nonalcoholic fatty liver disease: assessment of variability in pathologic interpretations. Mod Pathol. 1998;11:560–5.PubMed Younossi ZM, Gramlich T, Liu YC, et al. Nonalcoholic fatty liver disease: assessment of variability in pathologic interpretations. Mod Pathol. 1998;11:560–5.PubMed
20.
go back to reference Reeder SB, Cruite I, Hamilton G, et al. Quantitative assessment of liver fat with magnetic resonance imaging and spectroscopy. J Magn Reson Imaging. 2011;34:729–49.CrossRefPubMed Reeder SB, Cruite I, Hamilton G, et al. Quantitative assessment of liver fat with magnetic resonance imaging and spectroscopy. J Magn Reson Imaging. 2011;34:729–49.CrossRefPubMed
21.
go back to reference Tang A, Tan J, Sun M, et al. Nonalcoholic fatty liver disease: MR imaging of liver proton density fat fraction to assess hepatic steatosis. Radiology. 2013;267:422–31.CrossRefPubMedPubMedCentral Tang A, Tan J, Sun M, et al. Nonalcoholic fatty liver disease: MR imaging of liver proton density fat fraction to assess hepatic steatosis. Radiology. 2013;267:422–31.CrossRefPubMedPubMedCentral
22.
go back to reference Chan DC, Watts GF, Ng TWK, et al. Measurement of liver fat by magnetic resonance imaging: relationships with body fat distribution, insulin sensitivity and plasma lipids in healthy men. Diabetes Obes Metab. 2006;8:698–702.CrossRefPubMed Chan DC, Watts GF, Ng TWK, et al. Measurement of liver fat by magnetic resonance imaging: relationships with body fat distribution, insulin sensitivity and plasma lipids in healthy men. Diabetes Obes Metab. 2006;8:698–702.CrossRefPubMed
23.
go back to reference Ishii M, Yoshioka Y, Ishida W, et al. Liver fat content measured by magnetic resonance spectroscopy at 3.0 tesla independently correlates with plasminogen activator inhibitor-1 and body mass index in type 2 diabetic subjects. Tohoku J Exp Med. 2005;206:23–30.CrossRefPubMed Ishii M, Yoshioka Y, Ishida W, et al. Liver fat content measured by magnetic resonance spectroscopy at 3.0 tesla independently correlates with plasminogen activator inhibitor-1 and body mass index in type 2 diabetic subjects. Tohoku J Exp Med. 2005;206:23–30.CrossRefPubMed
24.
go back to reference Oliveira CPMS, Faintuch J, Rascovski A, et al. Lipid peroxidation in bariatric candidates with nonalcoholic fatty liver disease (NAFLD)—preliminary findings. Obes Surg. 2005;15:502–5.CrossRefPubMed Oliveira CPMS, Faintuch J, Rascovski A, et al. Lipid peroxidation in bariatric candidates with nonalcoholic fatty liver disease (NAFLD)—preliminary findings. Obes Surg. 2005;15:502–5.CrossRefPubMed
25.
go back to reference Frantzides CT, Carlson MA, Moore RE, et al. Effect of body mass index on nonalcoholic fatty liver disease in patients undergoing minimally invasive bariatric surgery. J Gastrointest Surg. 2004;8:849–55.CrossRefPubMed Frantzides CT, Carlson MA, Moore RE, et al. Effect of body mass index on nonalcoholic fatty liver disease in patients undergoing minimally invasive bariatric surgery. J Gastrointest Surg. 2004;8:849–55.CrossRefPubMed
26.
go back to reference Carbajo MA, Castro MJ, Kleinfinger S, et al. Effects of a balanced energy and high protein formula diet (Vegestart complet®) vs. low-calorie regular diet in morbid obese patients prior to bariatric surgery (laparoscopic single anastomosis gastric bypass): a prospective, double-blind randomized study. Nutr Hosp. 2010;25:939–48.PubMed Carbajo MA, Castro MJ, Kleinfinger S, et al. Effects of a balanced energy and high protein formula diet (Vegestart complet®) vs. low-calorie regular diet in morbid obese patients prior to bariatric surgery (laparoscopic single anastomosis gastric bypass): a prospective, double-blind randomized study. Nutr Hosp. 2010;25:939–48.PubMed
27.
go back to reference Lewis MC, Phillips ML, Slavotinek JP, et al. Change in liver size and fat content after treatment with Optifast very low calorie diet. Obes Surg. 2006;16:697–701.CrossRefPubMed Lewis MC, Phillips ML, Slavotinek JP, et al. Change in liver size and fat content after treatment with Optifast very low calorie diet. Obes Surg. 2006;16:697–701.CrossRefPubMed
28.
go back to reference Dixon JB, Bhathal PS, O’Brien PE. Weight loss and non-alcoholic fatty liver disease: falls in gamma-glutamyl transferase concentrations are associated with histologic improvement. Obes Surg. 2006;10:1278–86.CrossRef Dixon JB, Bhathal PS, O’Brien PE. Weight loss and non-alcoholic fatty liver disease: falls in gamma-glutamyl transferase concentrations are associated with histologic improvement. Obes Surg. 2006;10:1278–86.CrossRef
29.
go back to reference Campos GM, Bambha K, Vittinghoff E, et al. A clinical scoring system for predicting nonalcoholic steatohepatitis in morbidly obese patients. Hepatology. 2008;47:1916–23.CrossRefPubMed Campos GM, Bambha K, Vittinghoff E, et al. A clinical scoring system for predicting nonalcoholic steatohepatitis in morbidly obese patients. Hepatology. 2008;47:1916–23.CrossRefPubMed
30.
go back to reference Vargas V, Allende H, Lecube A, et al. Surgically induced weight loss by gastric bypass improves non alcoholic fatty liver disease in morbid obese patients. World J Hepatol. 2012;4:382–8.PubMedPubMedCentral Vargas V, Allende H, Lecube A, et al. Surgically induced weight loss by gastric bypass improves non alcoholic fatty liver disease in morbid obese patients. World J Hepatol. 2012;4:382–8.PubMedPubMedCentral
31.
go back to reference Pontiroli AE, Benetti A, Folini L, et al. Other aspects of bariatric surgery: liver steatosis, ferritin and cholesterol metabolism. Nutr Hosp. 2013;28:104–8.PubMed Pontiroli AE, Benetti A, Folini L, et al. Other aspects of bariatric surgery: liver steatosis, ferritin and cholesterol metabolism. Nutr Hosp. 2013;28:104–8.PubMed
32.
go back to reference Ruiz-Tovar J, Oller I, Tomas A, et al. Midterm impact of sleeve gastrectomy, calibrated with a 50-Fr bougie, on weight loss, glucose hemostasis, lipid profiles and comorbidities in morbidly obese patients. Am Surg. 2012;78:969–74.PubMed Ruiz-Tovar J, Oller I, Tomas A, et al. Midterm impact of sleeve gastrectomy, calibrated with a 50-Fr bougie, on weight loss, glucose hemostasis, lipid profiles and comorbidities in morbidly obese patients. Am Surg. 2012;78:969–74.PubMed
Metadata
Title
Evolution of Liver Steatosis Quantified by MR Imaging and MR Spectroscopy, in Morbidly Obese Patients Undergoing Sleeve Gastrectomy: Short-Term Outcomes
Authors
María Engracia Alsina
Jaime Ruiz-Tovar
Angela Bernabeu
Publication date
01-07-2017
Publisher
Springer US
Published in
Obesity Surgery / Issue 7/2017
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-016-2473-9

Other articles of this Issue 7/2017

Obesity Surgery 7/2017 Go to the issue