Comparative Study of Quantitative Diagnosis of Hepatic Fat Content by MRI and Patholgy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHAO Liming ^1,2 , SONG Bin ¹ , CHEN Guangwen ² , YUAN Fang ¹

1.Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;;
2.Department of Radiology, Sichuan Academy of Medical Sciences &;
Sichuan Provincial People’s Hospital, Chengdu 610072, Sichuan Province, China;

Corresponding author：

Keywords：

Hepatic steatosis; 1H magnetic resonance spectroscopy; Gradient-echo chemical shift MRI; Spectral saturation inversion recovery; Quantitative analysis

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ObjectiveTo investigate the diagnostic value of spectral saturation inversion recovery, gradient-echo chemical shift MRI， and proton magnetic resonance spectroscopy in quantifying hepatic fat content. MethodsConventional T1-weighted and T2-weighted scanning (without fat saturation and with fat saturation)， gradient-echo T1W in-phase （IP） and opposedphase （OP） images and 1H-MRS were performed in 31 healthy volunteers and 22 patients who were candidates for liver surgery. Signal intensities of T1WI amp; T1WIFS (SInonfat1, SIfat1), T2WI amp; T2WI-FS (SInonfat2, SIfat2), and IP amp; OP (SIin, SIout) were measured respectively, the relative signal intensity one (RSI1), relative signal intensity two (RSI2)， and fat index (FI) were calculated. Peak values and the area under peak of 1H-MRS were measured, and the relative lipid content of liver cells (RLC ) were calculated. Twenty-two patients accepted liver resection and histological examination after MRI scanning, the proportion of fatty degenerative cells were calculated by image analysis software. Results①Hepatic steatosis group showed higher average values of RSI1, FI， and RLC to non-hepatic steatosis group (P lt;0.05), while there was no significant difference in RSI2 between two groups (P gt;0.05). ②There was a statistical significant difference in RLC among different histopathological grades of hepatic steatosis, and RLC increased in parallel with histopathological grade (P lt;0.05).There was no significant difference in RSI2, RSI1, and FI among different histopathological grades, although the latter two had a tendency of increasing concomitant with histopathological grade (P gt;0.05). ③The values of FI and RLC were positively correlated with the PFDC （r=0468, P=0.027； r＝0771， P lt;0.000 1）, while they were not in RSI1 and RSI2 (r=0.411, P=0.057； r=0.191, P=0.392). ConclusionsSPIR, Gradient-echo chemical shift MRI and 1H-MRS can help to differentiate patients with hepatic steatosis from normal persons, the latter also can help to classify hepatic steatosis. In quantifying hepatic fat content, 1H-MRS is superior to gradient-echo chemical shift MRI, while SPIR’s role is limited.

Citation： ZHAO Liming ,SONG Bin,CHEN Guangwen,YUAN Fang. Comparative Study of Quantitative Diagnosis of Hepatic Fat Content by MRI and Patholgy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(6): 666-671. doi: Copy

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11.	范建高, 曾民德. 脂肪肝的研究进展 [J]. 胃肠病学和肝病学杂志, 1999， 8 (2)∶ 149156.
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13.	Rinella ME， McCarthy R， Thakrar K， et al． Dualecho，chemical shift gradientecho magnetic resonance imaging to quantify hepatic steatosis： implications for living liver donation [J]． Liver Transpl， 2003， 9(8): 851856.
14.	Machann J， Thamer C， Schnoedt B， et al． Hepatic lipid accumulation in healthy subjects： a comparative study using spectral fatselective MRI and volumelocalized 1HMR spectroscopy [J]． Magn Reson Med， 2006， 55（4）： 913917.
15.	Limanond P， Raman SS， Lassman C， et al． Macrovesicular hepatic steatosis in living related liver donors： correlation between CT and histologic findings [J]． Radiology， 2004， 230（1）： 276280．.
16.	Cotler SJ, Guzman G, LaydenAlmerJ， et al. Measurement of liver fat content using selective saturation at 3.0 T [J]. Magnetic Resonance imaging， 2007， 25(4)：743748．.
17.	Dixon WT. Simple proton spectroscopic imaging [J]. Radiology， 1984， 153(1): 189194.
18.	林江, 陈祖望, 周康容, 等. 梯度回波化学位移成像用于诊断腹腔含脂病变的价值 [J]. 中华放射学杂志， 2001， 35(2): 139141.
19.	Hussain HK, Chenevert Tl, Londy FJ， et al. Hepatic fat fraction: MR imaging for quantitative measurement and displayearly experience [J]. Radiology， 2005， 237(3): 10481055.
20.	Szczepaniak LS, Lidia S, Evelyn E, et al. Measurement of intracellular triglyceride stores by 1H spectroscopy: validation in vivo [J]. Am J Physiol， 1999， 276（5）: E977E989.
21.	Mitchell DG, Kim I, Chang TS, et al. Chemical shift phase2difference and suppression magnetic resonance imaging techniques in animals, phantoms, and humans [J] . Investigative Radiology, 1991, 26 (12): 10411052.
22.	Rofsky NM, Fleishaker H. CT and MRI of diffuse liver disease (review) [J]. Semin Ultrasound CT MR, 1995, 16 (1): 1633.
23.	Saadeh S， Younossi ZM， Remer EM， et al． The utility of radiological imaging in nonalcoholic fatty liver disease [J]． Gastroenterology， 2002， 123（3）： 745750.
24.	Xu HB， Kong XQ， Xiong Y， et al． Hepatic fatty infiltration: MR findings and choice of MR sequences [J]． Radiol Practice， 2001， 16（1）： 4850.
25.	Thomas EL， Hamilton G， Patel N， et al． hepatic triglyceride content and its relation to body adiposity： a magnetic resonance imaging and proton magnetic resonance spectroscopy study [J]． Gut， 2005， 54（1）：122127．.
26.	苏中振, 单鸿, 何炳钧, 等. STEAM和 PRESS序列在脂肪肝定量诊断中应用价值的对比研究 [J]. 中国介入影像与治疗学, 2008， 5(2): 9598.
27.	梁长虹, 刘于宝, 张中林, 等. 脂肪肝MR氢质子波谱成像定量分析的初步研究 [J]. 中华放射学杂志， 2007， 41（1）： 4346.
28.	范明霞，田建明，陆建平，等．活体1H磁共振波谱分析在大鼠脂肪肝中应用价值的初步研究 [J]．中国影像技术， 2004， 20（10）： 15031505.
29.	Vuppalanchi R， Cummings OW， Saxena R, et al. Relationship among histoligic, radiologic, and biochemical assessments of hepatic steatosis: a study of human liver sample [J]. J Clin Gastroenterol， 2007， 41(2): 206210.

1. Marrero JA, Fontana RJ, Su GL, et al. NAFLD may be a common underlying liver disease in patients with hepatocellular carcinoma in the United States [J]. Hepatology, 2002, 36（6）: 13491354.
2. Bugianesi E, Leone N, Vanni E, et al. Expanding the natural history of nonalcoholic steatohepatitis: from cryptogenic cirrhosis to hepatocellular carcinoma [J]. Gastroenterology, 2002, 123（1）: 134140.
3. Kawamitsu H， Kaji Y， Ohara T， et al． Feasibility of quantitative intrahepatic lipid imaging applied to the magnetic resonance dual gradient echo sequence [J]． Magn Reson Med， 2003， 2（1）： 4750．.
4. 中华肝脏病学会脂肪肝和酒精性肝病学组．非酒精性肝病诊断标准 [J]．中华肝脏病杂志， 2003， 11（2）：7171.
5. 中华肝脏病学会脂肪肝和酒精性肝病学组．酒精性脂肪性肝病诊断标准 [J]．中华肝脏病杂志， 2003， 11（2）： 7272.
6. 徐芸, 王振豫, 宋燕, 等. CT 图像的面罩式覆盖法对脂肪肝脂肪浸润的定量分析及临床意义 [J]. 中华消化杂志, 2000, 20(6): 422423.
7. Ricci C, Longo R, Gioulis E, et al . Noninvasive in vivo quantitative assessment of fat content in human liver [J ] . J Hepatol， 1997， 27 (1): 108113.
8. 李文政, 彭光春, 汤恢焕, 等. 脂肪肝CT、MRI 定量诊断的对照实验研究 [J]. 医学影像学杂志, 2005， 15 (4)∶ 294297.
9. 刘军, 高鑫, 陈刚, 等. CT 定量评价脂肪肝 [J ]. 上海医学影像杂志, 2002， 11 (3)∶ 170172.
10. Qayyum A, Goh JS, Kakar S, et al . Accuracy of liver fat quantification at MR imaging : comparison of outofphase gradient echo and fatsaturated fast spinecho techniques——initial experience [J ]. Radiology, 2005， 237(2): 509511.
11. 范建高, 曾民德. 脂肪肝的研究进展 [J]. 胃肠病学和肝病学杂志, 1999， 8 (2)∶ 149156.
12. Gholam PM, Kotler DP, Flancbaum LJ. Liver pathology in morbidly obesepatient s undergoing RouxenY gastric bypass surgery [J]. Obes Surg, 2002, 12 (1) : 4951.
13. Rinella ME， McCarthy R， Thakrar K， et al． Dualecho，chemical shift gradientecho magnetic resonance imaging to quantify hepatic steatosis： implications for living liver donation [J]． Liver Transpl， 2003， 9(8): 851856.
14. Machann J， Thamer C， Schnoedt B， et al． Hepatic lipid accumulation in healthy subjects： a comparative study using spectral fatselective MRI and volumelocalized 1HMR spectroscopy [J]． Magn Reson Med， 2006， 55（4）： 913917.
15. Limanond P， Raman SS， Lassman C， et al． Macrovesicular hepatic steatosis in living related liver donors： correlation between CT and histologic findings [J]． Radiology， 2004， 230（1）： 276280．.
16. Cotler SJ, Guzman G, LaydenAlmerJ， et al. Measurement of liver fat content using selective saturation at 3.0 T [J]. Magnetic Resonance imaging， 2007， 25(4)：743748．.
17. Dixon WT. Simple proton spectroscopic imaging [J]. Radiology， 1984， 153(1): 189194.
18. 林江, 陈祖望, 周康容, 等. 梯度回波化学位移成像用于诊断腹腔含脂病变的价值 [J]. 中华放射学杂志， 2001， 35(2): 139141.
19. Hussain HK, Chenevert Tl, Londy FJ， et al. Hepatic fat fraction: MR imaging for quantitative measurement and displayearly experience [J]. Radiology， 2005， 237(3): 10481055.
20. Szczepaniak LS, Lidia S, Evelyn E, et al. Measurement of intracellular triglyceride stores by 1H spectroscopy: validation in vivo [J]. Am J Physiol， 1999， 276（5）: E977E989.
21. Mitchell DG, Kim I, Chang TS, et al. Chemical shift phase2difference and suppression magnetic resonance imaging techniques in animals, phantoms, and humans [J] . Investigative Radiology, 1991, 26 (12): 10411052.
22. Rofsky NM, Fleishaker H. CT and MRI of diffuse liver disease (review) [J]. Semin Ultrasound CT MR, 1995, 16 (1): 1633.
23. Saadeh S， Younossi ZM， Remer EM， et al． The utility of radiological imaging in nonalcoholic fatty liver disease [J]． Gastroenterology， 2002， 123（3）： 745750.
24. Xu HB， Kong XQ， Xiong Y， et al． Hepatic fatty infiltration: MR findings and choice of MR sequences [J]． Radiol Practice， 2001， 16（1）： 4850.
25. Thomas EL， Hamilton G， Patel N， et al． hepatic triglyceride content and its relation to body adiposity： a magnetic resonance imaging and proton magnetic resonance spectroscopy study [J]． Gut， 2005， 54（1）：122127．.
26. 苏中振, 单鸿, 何炳钧, 等. STEAM和 PRESS序列在脂肪肝定量诊断中应用价值的对比研究 [J]. 中国介入影像与治疗学, 2008， 5(2): 9598.
27. 梁长虹, 刘于宝, 张中林, 等. 脂肪肝MR氢质子波谱成像定量分析的初步研究 [J]. 中华放射学杂志， 2007， 41（1）： 4346.
28. 范明霞，田建明，陆建平，等．活体1H磁共振波谱分析在大鼠脂肪肝中应用价值的初步研究 [J]．中国影像技术， 2004， 20（10）： 15031505.
29. Vuppalanchi R， Cummings OW， Saxena R, et al. Relationship among histoligic, radiologic, and biochemical assessments of hepatic steatosis: a study of human liver sample [J]. J Clin Gastroenterol， 2007， 41(2): 206210.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparative Study of Quantitative Diagnosis of Hepatic Fat Content by MRI and Patholgy

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