Macroscopic heterogeneity of liver fat: an MR-based study in type-2 diabetic patients (original) (raw)

Abstract

Objective

To assess the heterogeneity of liver fat deposition with MR of the liver in type-2 diabetic (T2D) patients.

Methods

We enrolled 121 consecutive T2D patients. The reference standard was 3.0-T 1H-MR spectroscopy. Hepatic steatosis was defined as liver fat content (LFC) ≥5.56 %. A triple-echo gradient-echo sequence corrected for T1 recovery and T2* decay was used to calculate LFC in left and right livers and hepatic segments. Analyses were performed using a linear mixed model.

Results

Fifty-nine (48.8 %) patients had liver steatosis, whereas 62 (51.2 %) did not. Steatosis was greater in the right than in the left liver (P < 0.0001) [mean difference: 1.32 % (range: 0.01–8.75 %)]. In seven patients (5.8 %), LFC was <5.56 % in one side of the liver, whereas it was ≥5.56 % in the other.

Steatosis of the left and right liver was heterogeneous at the segmental level in both non-steatotic (P < 0.001 and P < 0.0001 respectively) and steatotic (P < 0.0001 and P = 0.0002 respectively) patients [mean maximum difference: 3.98 % (range: 0.74–19.32 %)]. In 23 patients (19 %), LFC was <5.56 % in one segment, whereas it was ≥5.56 % in at least one other.

Conclusion

Overall, the mean segmental/lobar variability of steatosis is low. However, segmental variability can sometimes lead to a misdiagnosis.

Key Points

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References

  1. Browning JD, Szczepaniak LS, Dobbins R et al (2004) Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology 40:1387–1395
    Article PubMed Google Scholar
  2. Kleiner DE, Brunt EM, Van Natta M et al (2005) Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 41:1313–1321
    Article PubMed Google Scholar
  3. Merriman RB, Ferrell LD, Patti MG et al (2006) Correlation of paired liver biopsies in morbidly obese patients with suspected nonalcoholic fatty liver disease. Hepatology 44:874–880
    Article PubMed Google Scholar
  4. Ratziu V, Charlotte F, Heurtier A et al (2005) Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology 128:1898–1906
    Article PubMed Google Scholar
  5. Johnson NA, Walton DW, Sachinwalla T et al (2008) Noninvasive assessment of hepatic lipid composition: Advancing understanding and management of fatty liver disorders. Hepatology 47:1513–1523
    Article PubMed CAS Google Scholar
  6. van Werven JR, Marsman HA, Nederveen AJ et al (2010) 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 256:159–168
    Article PubMed Google Scholar
  7. Guiu B, Petit JM, Loffroy R et al (2009) Quantification of liver fat sontent: somparison of triple-echo chemical shift gradient-echo imaging and in vivo proton MR spectroscopy. Radiology 250:95–102
    Article PubMed Google Scholar
  8. Yoshimitsu K, Honda H, Kuroiwa T et al (2001) Unusual hemodynamics and pseudolesions of the noncirrhotic liver at CT. Radiographics 21:S81–S96
    PubMed Google Scholar
  9. Pineda N, Sharma P, Xu Q, Hu X, Vos M, Martin DR (2009) Measurement of hepatic lipid: high-speed T2-corrected multiecho acquisition at 1H MR spectroscopy–a rapid and accurate technique. Radiology 252:568–576
    Article PubMed Google Scholar
  10. Yokoo T, Bydder M, Hamilton G et al (2009) Nonalcoholic fatty liver disease: diagnostic and fat-grading accuracy of low-flip-angle multiecho gradient-recalled-echo MR imaging at 1.5 T. Radiology 251:67–76
    Article PubMed Google Scholar
  11. Guiu B, Loffroy R, Petit JM et al (2009) Mapping of liver fat with triple-echo gradient echo imaging: validation against 3.0-T proton MR spectroscopy. Eur Radiol 19:1786–1793
    Article PubMed Google Scholar
  12. Targher G, Bertolini L, Rodella S et al (2007) Nonalcoholic fatty liver disease is independently associated with an increased incidence of cardiovascular events in type 2 diabetic patients. Diabetes Care 30:2119–2121
    Article PubMed CAS Google Scholar
  13. Naressi A, Couturier C, Devos JM et al (2001) Java-based graphical user interface for the MRUI quantitation package. MAGMA 12:141–152
    Article PubMed CAS Google Scholar
  14. Szczepaniak LS, Nurenberg P, Leonard D et al (2005) Magnetic resonance spectroscopy to measure hepatic triglyceride content: prevalence of hepatic steatosis in the general population. Am J Physiol Endocrinol Metab 288:E462–E468
    Article PubMed CAS Google Scholar
  15. Kotronen A, Peltonen M, Hakkarainen A et al (2009) Prediction of non-alcoholic fatty liver disease and liver fat using metabolic and genetic factors. Gastroenterology 137:865–872
    Article PubMed CAS Google Scholar
  16. Hussain HK, Chenevert TL, Londy FJ et al (2005) Hepatic fat fraction: MR imaging for quantitative measurement and display–early experience. Radiology 237:1048–1055
    Article PubMed Google Scholar
  17. Irwan R, Edens MA, Sijens PE (2008) Assessment of the variations in fat content in normal liver using a fast MR imaging method in comparison with results obtained by spectroscopic imaging. Eur Radiol 18:806–813
    Article PubMed Google Scholar
  18. Lin LI (1989) A concordance correlation coefficient to evaluate reproducibility. Biometrics 45:255–268
    Article PubMed CAS Google Scholar
  19. Wieckowska A, McCullough AJ, Feldstein AE (2007) Noninvasive diagnosis and monitoring of nonalcoholic steatohepatitis: present and future. Hepatology 46:582–589
    Article PubMed CAS Google Scholar
  20. Brunt EM, Tiniakos DG (2010) Histopathology of nonalcoholic fatty liver disease. World J Gastroenterol 16:5286–5296
    Article PubMed Google Scholar
  21. El-Badry AM, Breitenstein S, Jochum W et al (2009) Assessment of hepatic steatosis by expert pathologists: the end of a gold standard. Ann Surg 250:691–697
    Article PubMed Google Scholar
  22. Fiorini RN, Kirtz J, Periyasamy B et al (2004) Development of an unbiased method for the estimation of liver steatosis. Clin Transplant 18:700–706
    Article PubMed Google Scholar
  23. Marsman H, Matsushita T, Dierkhising R et al (2004) Assessment of donor liver steatosis: pathologist or automated software? Hum Pathol 35:430–435
    Article PubMed CAS Google Scholar
  24. Raptis DA, Fischer MA, Graf R et al (2011) MRI: the new reference standard in quantifying hepatic steatosis? Gut 61:117–127, Epub 2011 Oct 13
    Article PubMed Google Scholar
  25. Brunt EM (2008) Do you see what I see? The role of quality histopathology in scientific study. Hepatology 47:771–774
    Article PubMed Google Scholar
  26. Guiu B, Petit JM, Loffroy R et al (2011) 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 33:119–127
    Article PubMed Google Scholar
  27. Barbaro B, Palazzoni G, Prudenzano R, Cina A, Manfredi R, Marano P (1999) Doppler sonographic assessment of functional response of the right and left portal venous branches to a meal. J Clin Ultrasound 27:75–80
    Article PubMed CAS Google Scholar
  28. Gates GF, Dore EK (1973) Streamline flow in the human portal vein. J Nucl Med 14:79–83
    PubMed CAS Google Scholar
  29. Yamagami T, Arai Y, Matsueda K, Inaba Y, Sueyoshi S, Takeuchi Y (1999) The cause of nontumorous defects of portal perfusion in the hepatic hilum revealed by CT during arterial portography. AJR Am J Roentgenol 172:397–402
    PubMed CAS Google Scholar
  30. Couinaud C (1988) The parabiliary venous system. Surg Radiol Anat 10:311–316
    Article PubMed CAS Google Scholar
  31. Chalasani N (2009) Nonalcoholic fatty liver disease liver fat score and fat equation to predict and quantitate hepatic steatosis: promising but not prime time! Gastroenterology 137:772–775
    Article PubMed CAS Google Scholar

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Acknowledgements

We would like to thank Philip Bastable for revision of the English language.

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Authors and Affiliations

  1. Department of Radiology, CHU (University Hospital), 14 rue Paul Gaffarel, BP 77908, 21079, Dijon, France
    Violaine Capitan, Pierre-Henri Lefevre, Sylvain Favelier, Romaric Loffroy, Denis Krausé, Jean-Pierre Cercueil & Boris Guiu
  2. Department of Endocrinology, Diabetology, and Metabolic Diseases, CHU (University Hospital), BP 77908, 21079, Dijon, France
    Jean-Michel Petit
  3. Department of Biostatistics and Medical Informatics, CHU (University Hospital), BP 77908, 21079, Dijon, France
    Serge Aho
  4. University of Burgundy, INSERM U866, BP 87900, 21079, Dijon, France
    Patrick Hillon, Jean-Pierre Cercueil & Boris Guiu
  5. Department of Hepatology, CHU (University Hospital), BP 77908, 21079, Dijon, France
    Patrick Hillon
  6. CHU (University Hospital), BP 77908, 21079, Dijon, France
    Violaine Capitan, Jean-Michel Petit, Serge Aho, Pierre-Henri Lefevre, Sylvain Favelier, Romaric Loffroy, Patrick Hillon, Denis Krausé, Jean-Pierre Cercueil & Boris Guiu

Authors

  1. Violaine Capitan
  2. Jean-Michel Petit
  3. Serge Aho
  4. Pierre-Henri Lefevre
  5. Sylvain Favelier
  6. Romaric Loffroy
  7. Patrick Hillon
  8. Denis Krausé
  9. Jean-Pierre Cercueil
  10. Boris Guiu

Corresponding authors

Correspondence toViolaine Capitan or Boris Guiu.

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Capitan, V., Petit, JM., Aho, S. et al. Macroscopic heterogeneity of liver fat: an MR-based study in type-2 diabetic patients.Eur Radiol 22, 2161–2168 (2012). https://doi.org/10.1007/s00330-012-2468-4

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