Abstract
The reference diagnostic test of fibrosis, steatosis, and hepatic iron overload is liver biopsy, a clear invasive procedure. The main objective of this work was to propose HSA, or human serum albumin, as a biomarker for the assessment of fibrosis and to study non-invasive biomarkers for the assessment of steatosis and hepatic iron overload by means of an MR image acquisition protocol. It was performed on a set of eight subjects to determine fibrosis, steatosis, and hepatic iron overload with four different MRI sequences. We calibrated longitudinal relaxation times (T1 [ms]) with seven human serum albumin (HSA [%]) phantoms, and we studied the relationship between them as this protein is synthesized by the liver, and its concentration decreases in advanced fibrosis. Steatosis was calculated by means of the fat fraction (FF [%]) between fat and water liver signals in “fat-only images” (the subtraction of in-phase [IP] images and out-of-phase [OOP] images) and in “water-only images” (the addition of IP and OOP images). Liver iron concentration (LIC [µmol/g]) was obtained by the transverse relaxation time (T2* [ms]) using Gandon’s method with multiple echo times (TE) in T2-weighted IP and OOP images. The preliminary results showed that there is an inverse relationship (r = −0.9662) between the T1 relaxation times (ms) and HSA concentrations (%). Steatosis was determined with FF > 6.4% and when the liver signal was greater than the paravertebral muscles signal, and thus, the liver appeared hyperintense in fat-only images. Hepatic iron overload was detected with LIC > 36 µmol/g, and in these cases, the liver signal was smaller than the paravertebral muscles signal, and thus, the liver behaved as hypointense in IP images.
Highlights
Liver diseases have an annual mortality rate of 2 million people globally [1]
The results showed that the liver signal is greater than the paravertebral muscles signal when there is steatosis, and this ratio between both signals increases progressively as the grade of steatosis increases
(2) The SIR method between the liver signal and the paravertebral muscles signal that increased in steatosis and decreased in hepatic iron overload
Summary
Liver fibrosis and steatosis are some of the most common hepatic diseases that consist of the accumulation of connective tissue and fat in the liver, respectively These two liver diseases are related to non-alcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease (ALD), whose most common risk factors are obesity, diabetes, and alcohol consumption [2]. Both diseases can evolve to steatosis, non-alcoholic steatohepatitis (NASH) with or without liver fibrosis, cirrhosis, and end in hepatocarcinoma, which are the 11th and 16th leading causes of death in the world [1,3]. Another common liver disease is hepatic iron overload, or hemochromatosis, which is mainly genetic in origin and if it is not treated in time it can progress to other liver diseases, such as cirrhosis [4].
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