Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Medicine
Published in: BMC Medicine 1/2014

Open Access 01-12-2014 | Research article

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

Authors: Raúl Jiménez-Agüero, José I Emparanza, Adolfo Beguiristain, Luis Bujanda, José M Alustiza, Elisabeth García, Elizabeth Hijona, Lander Gallego, Javier Sánchez-González, María J Perugorria, José I Asensio, Santiago Larburu, Maddi Garmendia, Mikel Larzabal, María P Portillo, Leixuri Aguirre, Jesús M Banales

Published in: BMC Medicine | Issue 1/2014

Login to get access

Abstract

Background

Non-alcoholic fatty liver disease (NAFLD) is caused by abnormal accumulation of lipids within liver cells. Its prevalence is increasing in developed countries in association with obesity, and it represents a risk factor for non-alcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma. Since NAFLD is usually asymptomatic at diagnosis, new non-invasive approaches are needed to determine the hepatic lipid content in terms of diagnosis, treatment and control of disease progression. Here, we investigated the potential of magnetic resonance imaging (MRI) to quantitate and monitor the hepatic triglyceride concentration in humans.

Methods

A prospective study of diagnostic accuracy was conducted among 129 consecutive adult patients (97 obesity and 32 non-obese) to compare multi-echo MRI fat fraction, grade of steatosis estimated by histopathology, and biochemical measurement of hepatic triglyceride concentration (that is, Folch value).

Results

MRI fat fraction positively correlates with the grade of steatosis estimated on a 0 to 3 scale by histopathology. However, this correlation value was stronger when MRI fat fraction was linked to the Folch value, resulting in a novel equation to predict the hepatic triglyceride concentration (mg of triglycerides/g of liver tissue = 5.082 + (432.104 * multi-echo MRI fat fraction)). Validation of this formula in 31 additional patients (24 obese and 7 controls) resulted in robust correlation between the measured and estimated Folch values. Multivariate analysis showed that none of the variables investigated improves the Folch prediction capacity of the equation. Obese patients show increased steatosis compared to controls using MRI fat fraction and Folch value. Bariatric surgery improved MRI fat fraction values and the Folch value estimated in obese patients one year after surgery.

Conclusions

Multi-echo MRI is an accurate approach to determine the hepatic lipid concentration by using our novel equation, representing an economic non-invasive method to diagnose and monitor steatosis in humans.
Appendix
Available only for authorised users
Literature
1.
Idilman IS, Aniktar H, Idilman R, Kabacam G, Savas B, Elhan A, Celik A, Bahar K, Karcaaltincaba M: Hepatic steatosis: quantification by proton density fat fraction with MR imaging versus liver biopsy. Radiology. 2013, 267: 767-775. 10.1148/radiol.13121360.CrossRefPubMed
2.
Vernon G, Baranova A, Younossi ZM: Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther. 2011, 34: 274-285. 10.1111/j.1365-2036.2011.04724.x.CrossRefPubMed
3.
Adams LA, Lindor KD: Nonalcoholic fatty liver disease. Ann Epidemiol. 2007, 17: 863-869. 10.1016/j.annepidem.2007.05.013.CrossRefPubMed
4.
Kawamitsu H, Kaji Y, Ohara T, Sugimura K: Feasibility of quantitative intrahepatic lipid imaging applied to the magnetic resonance dual gradient echo sequence. Magn Reson Med Sci. 2003, 2: 47-50. 10.2463/mrms.2.47.CrossRefPubMed
5.
Ratziu V, Charlotte F, Heurtier A, Gombert S, Giral P, Bruckert E, Grimaldi A, Capron F, Poynard T: Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology. 2005, 128: 1898-1906. 10.1053/j.gastro.2005.03.084.CrossRefPubMed
6.
Younossi ZM, Gramlich T, Liu YC, Matteoni C, Petrelli M, Goldblum J, Rybicki L, McCullough AJ: Nonalcoholic fatty liver disease: assessment of variability in pathologic interpretations. Mod Pathol. 1998, 11: 560-565.PubMed
7.
Marsman H, Matsushita T, Dierkhising R, Kremers W, Rosen C, Burgart L, Nyberg SL: Assessment of donor liver steatosis: pathologist or automated software?. Hum Pathol. 2004, 35: 430-435. 10.1016/j.humpath.2003.10.029.CrossRefPubMed
8.
Zaitoun AM, Al Mardini H, Awad S, Ukabam S, Makadisi S, Record CO: Quantitative assessment of fibrosis and steatosis in liver biopsies from patients with chronic hepatitis C. J Clin Pathol. 2001, 54: 461-465. 10.1136/jcp.54.6.461.CrossRefPubMedPubMedCentral
9.
Reeder SB, Cruite I, Hamilton G, Sirlin CB: Quantitative assessment of liver fat with magnetic resonance imaging and spectroscopy. J Magn Reson Imaging. 2011, 34: 729-749. 10.1002/jmri.22580.CrossRefPubMed
10.
Tang A, Tan J, Sun M, Hamilton G, Bydder M, Wolfson T, Gamst AC, Middleton M, Brunt EM, Loomba R, Lavine JE, Schwimmer JB, Sirlin CB: Nonalcoholic fatty liver disease: MR imaging of liver proton density fat fraction to assess hepatic steatosis. Radiology. 2013, 267: 422-431. 10.1148/radiol.12120896.CrossRefPubMedPubMedCentral
11.
O’Regan DP, Callaghan MF, Wylezinska-Arridge M, Fitzpatrick J, Naoumova RP, Hajnal JV, Schmitz SA: Liver fat content and T2*: simultaneous measurement by using breath-hold multiecho MR imaging at 3.0 T-feasibility. Radiology. 2008, 247: 550-557. 10.1148/radiol.2472070880.CrossRefPubMed
12.
Obesity: preventing and managing the global epidemic. Report of a WHO Consultation. WHO Technical Report Series 894. 2000, World Health Organization, Geneva
13.
Brunt EM, Janney CG, Di Bisceglie AM, Neuschwander-Tetri BA, Bacon BR: Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol. 1999, 94: 2467-2474. 10.1111/j.1572-0241.1999.01377.x.CrossRefPubMed
14.
Folch J, Lees M, Sloane Stanley GH: A simple method for the isolation and purification of total lipides from animal tissues. J Biol Chem. 1957, 226: 497-509.PubMed
15.
Iverson S, Lang S, Cooper M: Comparison of the Bligh and Dyer and Folch methods for total lipid determination in a broad range of marine tissue. Lipids. 2001, 11: 1283-1287. 10.1007/s11745-001-0843-0.CrossRef
16.
Hijona E, Sanchez-Gonzalez J, Alustiza JM, Hijona L, Arenas J, Garcia E, Rojas N, Portillo MP, Jimenez R, Aldazabal P, Bujanda L: Accurate fat fraction quantification by multiecho gradient-recalled-echo magnetic resonance at 1.5 T in rats with nonalcoholic fatty liver disease. Eur J Radiol. 2012, 81: 1122-1127. 10.1016/j.ejrad.2011.02.065.CrossRefPubMed
17.
Kim SH, Lee JM, Han JK, Lee JY, Lee KH, Han CJ, Jo JY, Yi NJ, Suh KS, Shin KS, Jo SY, Choi BI: Hepatic macrosteatosis: predicting appropriateness of liver donation by using MR imaging-correlation with histopathologic findings. Radiology. 2006, 240: 116-129. 10.1148/radiol.2393042218.CrossRefPubMed
18.
Guiu B, Petit JM, Loffroy R, Ben Salem D, Aho S, Masson D, Hillon P, Krause D, Cercueil JP: 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. 10.1148/radiol.2493080217.CrossRefPubMed
19.
Yokoo T, Bydder M, Hamilton G, Middleton MS, Gamst AC, Wolfson T, Hassanein T, Patton HM, Lavine JE, Schwimmer JB, Sirling CB: Nonalcoholic fatty liver disease: diagnostic and fat-grading accuracy of low-flip-angle multiecho gradient-recalled-echo MR imaging at 1.5 T. Radiology. 2009, 251: 67-76. 10.1148/radiol.2511080666.CrossRefPubMedPubMedCentral
20.
Guiu B, Petit JM, Loffroy R, Aho S, Ben Salem D, Masson D, Robin I, Verges B, Hillon P, Cercueil JP, Krausé D: Liver methylene fraction by dual- and triple-echo gradient-echo imaging at 3.0 T: correlation with proton MR spectroscopy and estimation of robustness after SPIO administration. J Magn Reson Imaging. 2011, 33: 119-127. 10.1002/jmri.22390.CrossRefPubMed
21.
Cesbron-Metivier E, Roullier V, Boursier J, Cavaro-Menard C, Lebigot J, Michalak S, Cales P, Aube C: Noninvasive liver steatosis quantification using MRI techniques combined with blood markers. Eur J Gastroenterol Hepatol. 2010, 22: 973-982. 10.1097/MEG.0b013e32833775fb.CrossRefPubMed
22.
Guaraldi G, Besutti G, Stentarelli C, Zona S, Nocetti L, Loria P, Ballestri S, Losi L, Torricelli P, Ligabue G: Magnetic resonance for quantitative assessment of liver steatosis: a new potential tool to monitor antiretroviral-drug-related toxicities. Antivir Ther. 2012, 17: 965-971. 10.3851/IMP2228.CrossRefPubMed
23.
Permutt Z, Le TA, Peterson MR, Seki E, Brenner DA, Sirlin C, Loomba R: Correlation between liver histology and novel magnetic resonance imaging in adult patients with non-alcoholic fatty liver disease - MRI accurately quantifies hepatic steatosis in NAFLD. Aliment Pharmacol Ther. 2012, 36: 22-29. 10.1111/j.1365-2036.2012.05121.x.CrossRefPubMedPubMedCentral
24.
Iverson SJ, Lang SL, Cooper MH: Comparison of the Bligh and Dyer and Folch methods for total lipid determination in a broad range of marine tissue. Lipids. 2001, 36: 1283-1287. 10.1007/s11745-001-0843-0.CrossRefPubMed
25.
Hines CD, Yu H, Shimakawa A, McKenzie CA, Warner TF, Brittain JH, Reeder SB: Quantification of hepatic steatosis with 3-T MR imaging: validation in ob/ob mice. Radiology. 2010, 254: 119-128. 10.1148/radiol.09090131.CrossRefPubMed
26.
Korkusuz H, Keese D, Raschidi BA, Hubner F, Namgaladze D, Hintereder G, Hammerstingl R, Korkusuz Y, Monch C, Vogl TJ: Detection of a fatty liver after binge drinking: correlation of MR-spectroscopy, DECT, biochemistry and histology in a rat model. Acad Radiol. 2011, 18: 1349-1357. 10.1016/j.acra.2011.07.009.CrossRefPubMed
27.
Raptis DA, Fischer MA, Graf R, Nanz D, Weber A, Moritz W, Tian Y, Oberkofler CE, Clavien PA: MRI: the new reference standard in quantifying hepatic steatosis?. Gut. 2012, 61: 117-127. 10.1136/gutjnl-2011-300155.CrossRefPubMed
28.
Roldan-Valadez E, Favila R, Martinez-Lopez M, Uribe M, Rios C, Mendez-Sanchez N: In vivo 3 T spectroscopic quantification of liver fat content in nonalcoholic fatty liver disease: correlation with biochemical method and morphometry. J Hepatol. 2010, 53: 732-737. 10.1016/j.jhep.2010.04.018.CrossRefPubMed
Metadata
Title
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
Authors
Raúl Jiménez-Agüero
José I Emparanza
Adolfo Beguiristain
Luis Bujanda
José M Alustiza
Elisabeth García
Elizabeth Hijona
Lander Gallego
Javier Sánchez-González
María J Perugorria
José I Asensio
Santiago Larburu
Maddi Garmendia
Mikel Larzabal
María P Portillo
Leixuri Aguirre
Jesús M Banales
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2014
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-014-0137-y

Other articles of this Issue 1/2014

BMC Medicine 1/2014 Go to the issue

Commentary

Early start and stop of biologics: has the time come?

Research article

Diagnostic utility of zinc protoporphyrin to detect iron deficiency in Kenyan pregnant women

Research article

Standard laboratory tests to identify older adults at increased risk of death

Research article

FTOrs9939609 polymorphism is associated with metabolic disturbances and response to HCV therapy in HIV/HCV-coinfected patients

Research article

The burden of disease in Spain: results from the global burden of disease study 2010

Research article

Local versus general anesthesia for transcatheter aortic valve implantation (TAVR) – systematic review and meta-analysis