Hepatic MRI for Fat Quantitation: Its Relationship to Fat Morphology, Diagnosis, and Ultrasound

Purpose: The value of MRI and ultrasound in quantifying hepatic steatosis is assessed and the results compared with those obtained by liver biopsies. Methods: A total of 38 patients undergoing hepatic biopsy for a variety of liver diseases were recruited for this study. Hepatic fat morphology and severity were assessed visually in each biopsy specimen. Steatosis pattern included macrovesicular, microvesicular, or mixed. The severity of hepatic steatosis was assessed by MRI through chemical shift imaging (n = 38) and by ultrasound through echogenicity (n = 31). Results: MRI had a better correlation than ultrasound for microscopic fat content (r = 0.77, P < 0.001 vs. r = 0.41, P < 0.05). In macrovesicular steatosis, MRI and ultrasound both correlated well with microscopic fat content (r = 0.92, P < 0.001 vs. r = 0.90, P < 0.001). In nonalcoholic fatty liver disease, ultrasound revealed severe steatosis in all instances, but MRI fat content ranged greatly (19%-40%). In diagnoses excluding nonalcoholic fatty liver disease, increasing ultrasound severity did not correspond to advanced MRI fat content. Conclusion: Hepatic MRI and ultrasound are both useful in identifying heavy fat accumulation associated with nonalcoholic fatty liver disease. MRI is superior to ultrasound in detecting and quantifying minor degrees of fatty metamorphosis in the liver.

[1]  A. Burt,et al.  Diagnosis and interpretation of steatosis and steatohepatitis. , 1998, Seminars in diagnostic pathology.

[2]  B. Bacon,et al.  Orlistat in the Treatment of NASH: A Case Series , 2003, American Journal of Gastroenterology.

[3]  M. Zencir,et al.  Correlation of abdominal fat accumulation and liver steatosis: importance of ultrasonographic and anthropometric measurements. , 2001, European journal of ultrasound : official journal of the European Federation of Societies for Ultrasound in Medicine and Biology.

[4]  P. Hayashi,et al.  Vitamin E and vitamin C treatment improves fibrosis in patients with nonalcoholic steatohepatitis , 2003, American Journal of Gastroenterology.

[5]  R. Fisher,et al.  Clinical and histologic spectrum of nonalcoholic fatty liver disease associated with normal ALT values , 2003, Hepatology.

[6]  K. Batts,et al.  Chronic hepatitis. An update on terminology and reporting. , 1995, The American journal of surgical pathology.

[7]  A. Zanella,et al.  Updated Definitions of Healthy Ranges for Serum Alanine Aminotransferase Levels , 2002, Annals of Internal Medicine.

[8]  F. Schaffner,et al.  Nonalcoholic fatty liver disease. , 1986, Progress in liver diseases.

[9]  M. Fishbein,et al.  The Spectrum of Fatty Liver in Obese Children and The Relationship of Serum Aminotransferases to Severity of Steatosis , 2003, Journal of pediatric gastroenterology and nutrition.

[10]  J. Maxwell,et al.  Ultrasound scanning in the detection of hepatic fibrosis and steatosis. , 1986, British medical journal.

[11]  E K Outwater,et al.  Detection of lipid in abdominal tissues with opposed-phase gradient-echo images at 1.5 T: techniques and diagnostic importance. , 1998, Radiographics : a review publication of the Radiological Society of North America, Inc.

[12]  W. T. Dixon.  Simple proton spectroscopic imaging. , 1984, Radiology.

[13]  B. Goldberg,et al.  Sonography of diffuse benign liver disease: accuracy of pattern recognition and grading. , 1986, AJR. American journal of roentgenology.

[14]  M. Fishbein,et al.  A rapid MRI technique for the assessment of hepatic steatosis in a subject with medium-chain acyl-coenzyme A dehydrogenase (MCAD) deficiency. , 1998, Journal of pediatric gastroenterology and nutrition.

[15]  Jeanne M Clark,et al.  Nonalcoholic fatty liver disease: an underrecognized cause of cryptogenic cirrhosis. , 2003, JAMA.

[16]  A. Joseph,et al.  Comparison of liver histology with ultrasonography in assessing diffuse parenchymal liver disease. , 1991, Clinical radiology.

[17]  J. Heiken,et al.  Fatty infiltration of the liver: evaluation by proton spectroscopic imaging. , 1985, Radiology.

[18]  M. Fishbein,et al.  Rapid MRI using a modified Dixon technique: a non-invasive and effective method for detection and monitoring of fatty metamorphosis of the liver , 2001, Pediatric Radiology.

[19]  R. Buxton,et al.  Fatty infiltration of the liver: quantification with phase-contrast MR imaging at 1.5 T vs biopsy. , 1991, AJR. American journal of roentgenology.

[20]  W A Murphy,et al.  Fatty infiltration of the liver: demonstration by proton spectroscopic imaging. Preliminary observations. , 1984, Radiology.

[21]  R. E. Hendrick,et al.  Diagnosis of fatty infiltration of the liver on contrast enhanced CT: limitations of liver-minus-spleen attenuation difference measurements , 1998, Abdominal Imaging.

[22]  B. Neuschwander‐Tetri,et al.  Improved nonalcoholic steatohepatitis after 48 weeks of treatment with the PPAR‐γ ligand rosiglitazone , 2003, Hepatology.

[23]  G Bodemar,et al.  Increased liver echogenicity at ultrasound examination reflects degree of steatosis but not of fibrosis in asymptomatic patients with mild/moderate abnormalities of liver transaminases. , 2002, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[24]  P. Schmalbrock,et al.  Introduction of fast MR imaging in the assessment of hepatic steatosis. , 1995, Magnetic resonance imaging.

[25]  R. Semelka,et al.  Imaging the fatty liver. , 2002, Magnetic resonance imaging clinics of North America.

[26]  C. Langlotz,et al.  Diagnostic criteria for fatty infiltration of the liver on contrast-enhanced helical CT. , 1998, AJR. American journal of roentgenology.

[27]  M. Rosen,et al.  Imaging of Hepatic Steatosis , 2001, Seminars in liver disease.

[28]  J. Hoofnagle,et al.  A pilot study of pioglitazone treatment for nonalcoholic steatohepatitis , 2004, Hepatology.