Kalra N, Duseja A, Das A, Virmani V, Krishan DR, Chawla Y, Singh P, Khandelwal N

Language: Spanish
References: 30
Page: 21-25
PDF size: 136.79 Kb.

Text Extraction

Background & Aim: Imaging modalities have a role in the diagnosis of patients with nonalcoholic fatty liver disease. Aim of the present study was to evaluate the role of chemical shift magnetic resonance imaging in assessing hepatic steatosis and fibrosis in patients with nonalcoholic fatty liver disease. Methods: Chemical shift magnetic resonance imaging was done in 10 biopsy proven patients (7 females, mean age 41 ± 9.2 years) with nonalcoholic fatty liver disease. Objective measurements of signal intensity (SI) were done and a ratio was calculated (SI out-of- phase liver/ SI out-of- phase kidney)/ (SI in- phase liver/ SI in-phase kidney). A lower ratio indicated a higher signal drop and hence higher fat content. The ratio was correlated with hepatic steatosis on histology (‹ 33% and › 33%). Patients were classified as having histological NASH or no NASH and MRI was assessed in diagnosing hepatic fibrosis as seen on liver histology. Results: Six patients had › 33% hepatic steatosis on histology. Five patients (50%) had evidence of histological NASH. MRI was not helpful in differentiating patients with and without histological NASH. One patient amongst NASH patients did not have fibrosis, one had stage 1, 2 had stage 2 and one had stage 4 fibrosis. SI ratio ranged between 0.35-0.69 in 6 patients with steatosis› 33% and was in the range of 0.69-1.20 in four patients with steatosis ‹33% on histology. Fibrotic changes seen in 4 patients on biopsy were not detected on MRI. Conclusion: Chemical shift MRI provides objective data on fat infiltration in patients with NAFLD without giving information about hepatic fibrosis.

REFERENCES

1. Falck-Ytter Y, Younossi ZM, Marchesini G, Mc Cullough AJ. Clinical features and natural history of nonalcoholic steatosis syndromes. Semin Liver Dis 2001; 21: 17-26.

2. Ludwig J, Viggiano TR, McGill DB, Oh BJ. Nonalcoholic steatohepatitis. Mayo Clinic experience with a hitherto unnamed disease. Mayo Clin Proc 1980; 55: 434-8.

3. Talwalkar JA. Motion - all patients with NASH need to have a liver biopsy: arguments for the motion. Can J Gastroenterol 2002; 16: 718-21.

4. Laurin J. Motion - all patients with NASH need to have a liver biopsy: arguments against the motion. Can J Gastroenterol 2002; 16: 722-6

5. Saadeh S, Younossi ZM, Remer EM, et al. The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterology 2002; 123: 745-50.

6. Steering Committee of the Western Pacific region of the World Health Organization. The International Association for the study of Obesity and the International Study Task Force. The Asia-Pacific perspective; redefining obesity and its treatment, 8-56. Australia: Health Communications; 2000.

7. Dhiman RK, Duseja A, Chawla Y. Asians need different criteria for defining overweight and obesity. Arch Intern Med 2005; 165: 1069-70.

8. World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications – Part 1: Diagnosis and classification of diabetes mellitus, 31-3. Geneva: World Health Organization; 1999.

9. Expert panel on detection evaluation and treatment of high cholesterol in adults. Executive summary of the third report of the national Cholesterol Education Program (NCEP) expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment panel III). JAMA 2001; 285: 2486-97.

10. Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ. Non-alcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology 1999; 16: 1413-9.

11. 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: 2467-74.

12. Chitturi S, Abeygunasekera S, Farrell GC, et al. NASH and insulin resistance: Insulin hypersecretion and specific association with the insulin resistance syndrome. Hepatology 2002; 35: 373-9.

13. Duseja A, Das A, Das R, et al. Clinicopathological profile of Indian patients with nonalcoholic fatty liver disease is different from the west. Dig Dis Sci 2007; 52: 2368-74.

14. Duseja A, Das A, Dhiman RK, et al. Metformin is effective in achieving biochemical response in patients with nonalcoholic fatty liver disease (NAFLD) not responding to lifestyle interventions. Ann Hepatol 2007; 6: 222-6.

15. Duseja A, Thumburu KK, Das A, et al. Insulin tolerance test is comparable to homeostasis model assessment for insulin resistance in patients with nonalcoholic fatty liver disease. Indian J Gastroenterol 2007; 26: 170-3.

16. Saverymuttu SH, Joseph AE, Maxwell JD. Ultrasound scanning in the detection of hepatic fibrosis and steatosis. BMJ 1986; 292: 13-5.

17. Dixon WT. Simple proton spectroscopic imaging. Radiology 1984; 153: 189-94.

18. Ratziu V, Giral P, Chalotte F, et al. Liver fibrosis in overweight patients. Gastroenterology 2000; 118: 1117-23.

19. Dixon JB, Bhathal PS, O’Brian PE. Non-alcoholic fatty liver disease predictors of non-alcoholic steatohepatitis and liver fibrosis in the severely obese. Gastroenterology 2001; 121: 91-100.

20. Ratziu V, Lecalvez S, Imbert Bismut F, et al. Diagnostic value of bio-chemical markers (fibrotest) for the prediction of liver fibrosis in patients with non-alcoholic fatty liver disease. Hepatology 2003; 38: S510A.

21. Graif M, Yanuka M, Baraz M, et al. Quantitative estimation of attenuation in ultrasound video images; correlation with histology in diffuse liver disease. Invest Radiol 2000; 35: 319-24.

22. Yoneda M, Yoneda M, Mawatari H, et al. Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with nonalcoholic fatty liver disease (NAFLD). Dig Liver Dis 2008; 40: 371-8.

23. Jacobs JE, Birnbaum BA, Shapiro MA, et al. Diagnostic criteria for fatty infiltration of the liver on contrast enhanced helical CT AJR. Am J Roentgenol 1998; 171: 659-64.

24. Levenson H, Greensite F, Hoefs J, et al. Fatty infiltration of the liver: quantification with phase-contrast MR imaging at 1.5T vs biopsy. AJR Am J Roentgenol 1991; 156: 307-12.

25. Fishbein MH, Gardner KG, Potter CJ, Schmalbrock P, Smith MA. Introduction of fast MR imaging in the assessment of hepatic steatosis. Magn Reson Imaging 1997; 15: 287-93.

26. Fishbein MH, Stevens WR. Rapid MRI using a modified Dixon technique: a non-invasive and effective method for detection and monitoring of fatty metamorphosis of the liver. Pediatr Radiol 2001; 31: 806-9.

27. Hussain HK, Chenevert TL, Londy FJ, et al. Hepatic fat fraction: MR imaging for quantitative measurement and display- early experience. Radiology 2005; 237: 1048-55.

28. Fishbein M, Castro F, Cheruku S, et al. Hepatic MRI for fat quantification. Its relationship to fat morphology, diagnosis, and ultrasound. J Clin Gastroenterol 2005; 39: 619-25.

29. Radetti G, Kleon W, Stuefer J, Pittschieler K. Non-alcoholic fatty liver disease in obese children evaluated by magnetic resonance imaging. Acta Paediatr 2006; 95: 833-7.

30. Browning JD, Szczepaniak LS, Dobbins R, et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology 2004; 40: 1387-95.