The value of <sup>1</sup>H-MRS, gradient dual-echo, and triple-echo sequences in the quantitative evaluation of treatment effect of fatty liver at 3.0T MR_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHAO Liming ¹ ,  SONG Bin ² , WANG Yishuang ¹ , LU Tao ¹ , CHEN Guangwen ¹

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

Corresponding author：

SONG Bin, Email: cjr.songbin@vip.163.com

Keywords：

fatty liver; proton magnetic resonance spectroscopy; magnetic resonance imaging; gradient echo; treatment effect; quantitative analysis

DOI：

10.7507/1007-9424.201905063

Video：

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Objective To investigate the value of proton magnetic resonance spectroscopy (¹H-MRS), gradient dual-echo, and triple-echo sequences in the quantitative evaluation of treatment effect of fatty liver at 3.0T MR.Methods Thirty patients with fatty liver diagnosed by CT or ultrasound who admitted in Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital between August 2017 and May 2018, were enrolled and undergone gradient dual-echo, triple-echo, and ¹H-MRS examination before and 3 months after treatment. The fat index (FI) and relative lipid content (RLC) were measured. Fatty liver index (FLI) was calculated from blood biochemical indicators, waist circumference, and BMI at the same time. With the reference standard of FLI, the results before and after treatment measured from MRI were analyzed.Results There were significantly differences of FLI, FI_dual, FI_triple, and RLC before and after treatment (t=5.281, P<0.001; Z=–3.651, P<0.001; Z=–3.630, P<0.001; Z=–4.762, P<0.001), all indexes decreased after treatment. FI_dual and FI_triple were positively correlated with FLI before (r_s=0.413, P=0.023; r_s=0.396, P=0.030) and after treatment (r_s=0.395, P=0.031; r_s=0.519, P=0.003), the highest correlation factor was FI_triple to FLI after treatment. There were no significant correlation between RLC and FLI before and after treatment (P>0.05).Conclusions It is feasible to quantitatively evaluate the treatment effect of fatty liver by using ¹H-MRS, gradient dual-echo, and triple-echo sequences. Gradient triple-echo sequences has better accuracy, which is technically easy to implement and more suitable for clinical development.

Citation： ZHAO Liming, SONG Bin, WANG Yishuang, LU Tao, CHEN Guangwen. The value of ¹H-MRS, gradient dual-echo, and triple-echo sequences in the quantitative evaluation of treatment effect of fatty liver at 3.0T MR. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(8): 992-996. doi: 10.7507/1007-9424.201905063 Copy

1.	Dhamija E, Paul SB, Kedia S. Non-alcoholic fatty liver disease associated with hepatocellular carcinoma: an increasing concern. Indian J Med Res, 2019, 149(1): 9-17.
2.	Weiß J, Rau M, Geier A. Non-alcoholic fatty liver disease: epidemiology, clinical course, investigation, and treatment. Dtsch Arztebl Int, 2014, 111(26): 447-452.
3.	Rinella ME. Nonalcoholic fatty liver disease: a systematic review. JAMA, 2015, 313(22): 2263-2273.
4.	Bedogni G, Bellentani S, Miglioli L, et al. The fatty liver index: a simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterol, 2006, 6(1): 33-37.
5.	李晓姣, 赵建农, 唐茁月, 等. 3.0T ¹H-MRS 与超声在非酒精性脂肪肝随访价值的对比研究. 临床放射学杂志, 2015, 34(9): 1427-1431.
6.	Guiu B, Petit JM, Loffroy R, et al. Quantification of liver fat content: comparison of triple-echo chemical shift gradient-echo imaging and in vivo proton MR spectroscopy. Radiology, 2009, 250(1): 95-102.
7.	张羲娥, 黄子星, 袁放, 等. 3.0T ¹H-MRS 联合梯度回波化学位移技术定量分析评估脂肪肝治疗效果. 放射学实践, 2012, 27(6): 641-644.
8.	Barrera F, George J. The role of diet and nutritional intervention for the management of patients with NAFLD. Clin Liver Dis, 2014, 18(1): 91-112.
9.	Leite NC, Villela-Nogueira CA, Pannain VL, et al. Histo-pathological stages of nonalcoholic fatty liver disease in type 2 diabetes: prevalences and correlated factors. Liver Int, 2011, 31(5): 700-706.
10.	Dharmalingam M, Yamasandhi PG. Nonalcoholic fatty liver disease and type 2 diabetes mellitus. Indian J Endocrinol Metab, 2018, 22(3): 421-428.
11.	范建高, 庄辉. 中国脂肪肝防治指南 (科普版). 上海: 上海科学技术出版社, 2015: 18-19.
12.	Lee DH. Imaging evaluation of non-alcoholic fatty liver disease: focused on quantification. Clin Mol Hepatol, 2017, 23(4): 290-301.
13.	王敏, 亓开, 贾守强, 等. 一种新的评价非酒精性脂肪肝的影像学指标. 临床放射学杂志, 2018, 37(6): 954-956.
14.	Hussain HK, Chenevert TL, Londy FJ, et al. Hepatic fat fraction: MR imaging for quantitative measurement and display–early experience. Radiology, 2005, 237(3): 1048-1055.
15.	Yokoo T, Bydder M, Hamilton G, et al. Nonalcoholic fatty liver disease: diagnostic and fat-grading accuracy of low-flip-angle multiecho gradient-recalled-echo MR imaging at 1.5 T. Radiology, 2009, 251(1): 67-76.
16.	韩海伟, 韩成坤, 汪敬群, 等. 三回波梯度回波序列与¹H-MRS 在大鼠肝内脂肪含量测定中的应用. 临床放射学杂志, 2014, 33(6): 929-932.
17.	袁放, 宋彬, 徐缨龙, 等. 梯度双回波和三回波技术定量分析肝脏脂肪含量的可行性研究. 放射学实践, 2012, 27(2): 128-131.
18.	韩成坤, 韩海伟, 陈识, 等. MR 三回波序列在大鼠非酒精性脂肪肝模型中的应用. 中国医学影像技术, 2014, 30(2): 189-193.
19.	Zabihzadeh M, Gharibvand MM, Motamedfar A, et al. Noninvasive quantification of liver fat content by different gradient echo magnetic resonance imaging sequences in patients with nonalcoholic fatty liver disease. J Med Signals Sens, 2018, 8(4): 244-252.
20.	Lee SJ, Yu SM. Effectiveness evaluation of the fat percentage determination in multi-echo T2-corrected single-voxel spectroscopy by comparing the 3-point dixon and the 6-point interference dixon techniques. Applied Magnetic Resonance, 2014, 45(12): 1333-1342.
21.	Di Costanzo A, D’Erasmo L, Polimeni L, et al. Non-alcoholic fatty liver disease and subclinical atherosclerosis: a comparison of metabolically-versus genetically-driven excess fat hepatic storage. Atherosclerosis, 2017, 257: 232-239.
22.	Radmard AR, Rahmanian MS, Abrishami A, et al. Assessment of abdominal fat distribution in non-alcoholic fatty liver disease by magnetic resonance imaging: a population-based study. Arch Iran Med, 2016, 19(10): 693-699.
23.	瞿欢佳, 王磊, 金沛桦, 等. 氢质子磁共振波谱在脂肪性肝病肝脏甘油三酯含量测定中的价值及其影响因素. 中华肝脏病杂志, 2017, 25(11): 858-863.
24.	张羲娥, 刘曦娇, 黄子星, 等. 3.0T ¹H-MRS 定量分析评估脂肪肝治疗效果的初步研究. 中国普外基础与临床杂志, 2011, 18(12): 1330-1333.
25.	黄梦月, 程敬亮, 吕晓婷, 等. IDEAL-IQ 与 MRS 定量测量肝脏脂肪含量的可行性及相关性. 放射学实践, 2017, 32(5): 447-450.

1. Dhamija E, Paul SB, Kedia S. Non-alcoholic fatty liver disease associated with hepatocellular carcinoma: an increasing concern. Indian J Med Res, 2019, 149(1): 9-17.
2. Weiß J, Rau M, Geier A. Non-alcoholic fatty liver disease: epidemiology, clinical course, investigation, and treatment. Dtsch Arztebl Int, 2014, 111(26): 447-452.
3. Rinella ME. Nonalcoholic fatty liver disease: a systematic review. JAMA, 2015, 313(22): 2263-2273.
4. Bedogni G, Bellentani S, Miglioli L, et al. The fatty liver index: a simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterol, 2006, 6(1): 33-37.
5. 李晓姣, 赵建农, 唐茁月, 等. 3.0T ¹H-MRS 与超声在非酒精性脂肪肝随访价值的对比研究. 临床放射学杂志, 2015, 34(9): 1427-1431.
6. Guiu B, Petit JM, Loffroy R, et al. Quantification of liver fat content: comparison of triple-echo chemical shift gradient-echo imaging and in vivo proton MR spectroscopy. Radiology, 2009, 250(1): 95-102.
7. 张羲娥, 黄子星, 袁放, 等. 3.0T ¹H-MRS 联合梯度回波化学位移技术定量分析评估脂肪肝治疗效果. 放射学实践, 2012, 27(6): 641-644.
8. Barrera F, George J. The role of diet and nutritional intervention for the management of patients with NAFLD. Clin Liver Dis, 2014, 18(1): 91-112.
9. Leite NC, Villela-Nogueira CA, Pannain VL, et al. Histo-pathological stages of nonalcoholic fatty liver disease in type 2 diabetes: prevalences and correlated factors. Liver Int, 2011, 31(5): 700-706.
10. Dharmalingam M, Yamasandhi PG. Nonalcoholic fatty liver disease and type 2 diabetes mellitus. Indian J Endocrinol Metab, 2018, 22(3): 421-428.
11. 范建高, 庄辉. 中国脂肪肝防治指南 (科普版). 上海: 上海科学技术出版社, 2015: 18-19.
12. Lee DH. Imaging evaluation of non-alcoholic fatty liver disease: focused on quantification. Clin Mol Hepatol, 2017, 23(4): 290-301.
13. 王敏, 亓开, 贾守强, 等. 一种新的评价非酒精性脂肪肝的影像学指标. 临床放射学杂志, 2018, 37(6): 954-956.
14. Hussain HK, Chenevert TL, Londy FJ, et al. Hepatic fat fraction: MR imaging for quantitative measurement and display–early experience. Radiology, 2005, 237(3): 1048-1055.
15. Yokoo T, Bydder M, Hamilton G, et al. Nonalcoholic fatty liver disease: diagnostic and fat-grading accuracy of low-flip-angle multiecho gradient-recalled-echo MR imaging at 1.5 T. Radiology, 2009, 251(1): 67-76.
16. 韩海伟, 韩成坤, 汪敬群, 等. 三回波梯度回波序列与¹H-MRS 在大鼠肝内脂肪含量测定中的应用. 临床放射学杂志, 2014, 33(6): 929-932.
17. 袁放, 宋彬, 徐缨龙, 等. 梯度双回波和三回波技术定量分析肝脏脂肪含量的可行性研究. 放射学实践, 2012, 27(2): 128-131.
18. 韩成坤, 韩海伟, 陈识, 等. MR 三回波序列在大鼠非酒精性脂肪肝模型中的应用. 中国医学影像技术, 2014, 30(2): 189-193.
19. Zabihzadeh M, Gharibvand MM, Motamedfar A, et al. Noninvasive quantification of liver fat content by different gradient echo magnetic resonance imaging sequences in patients with nonalcoholic fatty liver disease. J Med Signals Sens, 2018, 8(4): 244-252.
20. Lee SJ, Yu SM. Effectiveness evaluation of the fat percentage determination in multi-echo T2-corrected single-voxel spectroscopy by comparing the 3-point dixon and the 6-point interference dixon techniques. Applied Magnetic Resonance, 2014, 45(12): 1333-1342.
21. Di Costanzo A, D’Erasmo L, Polimeni L, et al. Non-alcoholic fatty liver disease and subclinical atherosclerosis: a comparison of metabolically-versus genetically-driven excess fat hepatic storage. Atherosclerosis, 2017, 257: 232-239.
22. Radmard AR, Rahmanian MS, Abrishami A, et al. Assessment of abdominal fat distribution in non-alcoholic fatty liver disease by magnetic resonance imaging: a population-based study. Arch Iran Med, 2016, 19(10): 693-699.
23. 瞿欢佳, 王磊, 金沛桦, 等. 氢质子磁共振波谱在脂肪性肝病肝脏甘油三酯含量测定中的价值及其影响因素. 中华肝脏病杂志, 2017, 25(11): 858-863.
24. 张羲娥, 刘曦娇, 黄子星, 等. 3.0T ¹H-MRS 定量分析评估脂肪肝治疗效果的初步研究. 中国普外基础与临床杂志, 2011, 18(12): 1330-1333.
25. 黄梦月, 程敬亮, 吕晓婷, 等. IDEAL-IQ 与 MRS 定量测量肝脏脂肪含量的可行性及相关性. 放射学实践, 2017, 32(5): 447-450.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The value of ¹H-MRS, gradient dual-echo, and triple-echo sequences in the quantitative evaluation of treatment effect of fatty liver at 3.0T MR

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The value of 1H-MRS, gradient dual-echo, and triple-echo sequences in the quantitative evaluation of treatment effect of fatty liver at 3.0T MR

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The value of ¹H-MRS, gradient dual-echo, and triple-echo sequences in the quantitative evaluation of treatment effect of fatty liver at 3.0T MR