Evaluation of a Whole-Liver Dixon-Based MRI Approach for Quantification of Liver Fat in Patients with Type 2 Diabetes Treated with Two Isocaloric Different Diets.

Valentina Brancato,Carlo Cavaliere,Lutgarda Bozzetto,Serena Monti,Marilena Vitale,Giuseppe Della Pepa,Angela Albarosa Rivellese,Giovanni Annuzzi,Luca Basso,Marco Salvatore

doi:10.3390/diagnostics12020514

Abstract

Dixon-based methods for the detection of fatty liver have the advantage of being non-invasive, easy to perform and analyze, and to provide a whole-liver coverage during the acquisition. The aim of the study was to assess the feasibility of a whole-liver Dixon-based approach for liver fat quantification in type 2 diabetes (T2D) patients who underwent two different isocaloric dietary treatments: a diet rich in monosaturated fatty acids (MUFA) and a multifactorial diet. Thirty-nine T2D patients were randomly assigned to MUFA diet (n = 21) and multifactorial diet (n = 18). The mean values of the proton density fat fraction (PDFF) over the whole liver and over the ROI corresponding to that chosen for MRS were compared to MRS-PDFF using Spearman’s correlation (ρ). Before–after changes in percentage of liver volume corresponding to MRI-PDFF above thresholds associated with hepatic steatosis (LV%TH, with TH = 5.56%, 7.97% and 8.8%) were considered to assess the proposed approach and compared between diets using Wilcoxon rank-sum test. Statistical significance set at p < 0.05. A strong linear relationship was found between MRS-PDFF and MRI-PDFFs (ρ = 0.85, p < 0.0001). Changes in LV%TH% were significantly higher (p < 0.05) in the multifactorial diet than in MUFA diet (25% vs. 9%, 35% vs. 12%, and 38% vs. 13% decrease, respectively, for TH = 5.56%, 7.97%, and 8.8%) and this was reproducible compared to results obtained using the standard liver fat analysis. A volumetric approach based on Dixon method could be an effective, non-invasive technique that could be used for the quantitative analysis of hepatic steatosis in T2D patients.

Highlights

Non-alcoholic fatty liver disease (NAFLD) refers to a condition encompassing multiple progressive liver disorders, ranging from simple hepatic steatosis, often called non-alcoholic fatty liver (NAFL), to nonalcoholic steatohepatitis (NASH)
Bland– Altman analysis revealed a systematic error in the Dixon based fat-signal fraction, which showed a prevailing overestimation of Dixon-based with respect to magnetic resonance spectroscopy (MRS) with few outliers
We investigated the use of a volumetric approach based on Dixon method for quantification of liver fat in patients with type 2 diabetes (T2D) treated with two different isocaloric dietary approaches, namely an isocaloric multifactorial diet rich in fiber, monosaturated fatty acids (MUFA), n-6 and n-3 polyunsaturated fatty acids, polyphenols, and vitamins D, E, and C, and an isocaloric diet rich in MUFA already shown to be effective in reducing liver fat in patients with T2D [24]

Summary

Introduction

Non-alcoholic fatty liver disease (NAFLD) refers to a condition encompassing multiple progressive liver disorders, ranging from simple hepatic steatosis, often called non-alcoholic fatty liver (NAFL), to nonalcoholic steatohepatitis (NASH). Treatment options for NAFLD in patients with T2D are still a debated topic. In these patients, dietary treatments able to reduce hepatic fat content and improve liver histology are highly warranted. Open topics are related to the techniques able to measure liver fat and detect fatty liver. The most reliable method for the detection of fatty liver is hepatic needle biopsy [3], which is currently the gold standard procedure in the diagnosis of fatty liver disease. A biopsy is an invasive technique, limited to the sample taken, and it may lead to misdiagnosis [4,5]

Objectives

Methods

Results

Conclusion