nach oben

Erschienen in:

01.10.2012 | Hepatobiliary-Pancreas

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

verfasst von: Violaine Capitan, Jean-Michel Petit, Serge Aho, Pierre-Henri Lefevre, Sylvain Favelier, Romaric Loffroy, Patrick Hillon, Denis Krausé, Jean-Pierre Cercueil, Boris Guiu

Erschienen in: European Radiology | Ausgabe 10/2012

Einloggen, um Zugang zu erhalten

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

There is a need for methods quantifying steatosis over a large region.
Steatosis is usually greater in the right than left lobe of the liver.
Steatosis within both left and right hepatic lobes is segmentally heterogeneous.
Segmental variability of steatosis can result in misdiagnosis.

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 40:1387–1395PubMedCrossRef

Kleiner DE, Brunt EM, Van Natta M et al (2005) Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 41:1313–1321PubMedCrossRef

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 44:874–880PubMedCrossRef

Ratziu V, Charlotte F, Heurtier A et al (2005) Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology 128:1898–1906PubMedCrossRef

Johnson NA, Walton DW, Sachinwalla T et al (2008) Noninvasive assessment of hepatic lipid composition: Advancing understanding and management of fatty liver disorders. Hepatology 47:1513–1523PubMedCrossRef

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 256:159–168PubMedCrossRef

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 250:95–102PubMedCrossRef

Yoshimitsu K, Honda H, Kuroiwa T et al (2001) Unusual hemodynamics and pseudolesions of the noncirrhotic liver at CT. Radiographics 21:S81–S96PubMed

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 252:568–576PubMedCrossRef

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 251:67–76PubMedCrossRef

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 19:1786–1793PubMedCrossRef

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 30:2119–2121PubMedCrossRef

13.

Naressi A, Couturier C, Devos JM et al (2001) Java-based graphical user interface for the MRUI quantitation package. MAGMA 12:141–152PubMedCrossRef

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–E468PubMedCrossRef

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 137:865–872PubMedCrossRef

16.

Hussain HK, Chenevert TL, Londy FJ et al (2005) Hepatic fat fraction: MR imaging for quantitative measurement and display–early experience. Radiology 237:1048–1055PubMedCrossRef

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 18:806–813PubMedCrossRef

18.

Lin LI (1989) A concordance correlation coefficient to evaluate reproducibility. Biometrics 45:255–268PubMedCrossRef

19.

Wieckowska A, McCullough AJ, Feldstein AE (2007) Noninvasive diagnosis and monitoring of nonalcoholic steatohepatitis: present and future. Hepatology 46:582–589PubMedCrossRef

20.

Brunt EM, Tiniakos DG (2010) Histopathology of nonalcoholic fatty liver disease. World J Gastroenterol 16:5286–5296PubMedCrossRef

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 250:691–697PubMedCrossRef

22.

Fiorini RN, Kirtz J, Periyasamy B et al (2004) Development of an unbiased method for the estimation of liver steatosis. Clin Transplant 18:700–706PubMedCrossRef

23.

Marsman H, Matsushita T, Dierkhising R et al (2004) Assessment of donor liver steatosis: pathologist or automated software? Hum Pathol 35:430–435PubMedCrossRef

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 13PubMedCrossRef

25.

Brunt EM (2008) Do you see what I see? The role of quality histopathology in scientific study. Hepatology 47:771–774PubMedCrossRef

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 33:119–127PubMedCrossRef

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 27:75–80PubMedCrossRef

28.

Gates GF, Dore EK (1973) Streamline flow in the human portal vein. J Nucl Med 14:79–83PubMed

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 172:397–402PubMed

30.

Couinaud C (1988) The parabiliary venous system. Surg Radiol Anat 10:311–316PubMedCrossRef

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 137:772–775PubMedCrossRef

Titel: Macroscopic heterogeneity of liver fat: an MR-based study in type-2 diabetic patients
verfasst von: Violaine Capitan
Jean-Michel Petit
Serge Aho
Pierre-Henri Lefevre
Sylvain Favelier
Romaric Loffroy
Patrick Hillon
Denis Krausé
Jean-Pierre Cercueil
Boris Guiu
Publikationsdatum: 01.10.2012
Verlag: Springer-Verlag
Erschienen in: European Radiology / Ausgabe 10/2012
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-012-2468-4

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

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