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. 2020;61(1):73-80.
doi: 10.47162/RJME.61.1.08.

MR spectroscopy of the liver - a reliable non-invasive alternative for evaluating non-alcoholic fatty liver disease

Alina Maria Lăpădat  1 , Lucian Mihai Florescu, Nicolae Cătălin Manea, Dan Ionuţ Gheonea, Daniel Pirici, Diana Rodica Tudoraşcu, Răzvan Ene, Ioana Andreea Gheonea
Affiliations

MR spectroscopy of the liver - a reliable non-invasive alternative for evaluating non-alcoholic fatty liver disease

Alina Maria Lăpădat et al. Rom J Morphol Embryol. 2020.

Abstract

Non-alcoholic fatty liver disease (NAFLD) is one of the most common conditions worldwide that targets the liver parenchyma. NAFLD represents an intrahepatic triglyceride accumulation in the absence of excessive alcohol consumption and other diseases that affect the liver parenchyma. The current "gold standard" for evaluating the amount of intrahepatic fat is represented by liver biopsy, but many patients are reluctant and hardly accept undergoing this procedure due to its invasive nature. The current study addresses this aspect by evaluating the reliability of liver magnetic resonance spectroscopy (MRS) in diagnosing NAFLD, compared to the traditional invasive liver biopsy. The present study included a total of 38 patients based on several well-defined inclusion and exclusion criteria. We used the same NAFLD grading system for both liver MRS and liver biopsy: grade 0: <5% hepatocytes are affected; grade I: 5-33% hepatocytes are affected; grade II: 34-66% hepatocytes are affected; grade III: >66% hepatocytes are affected. Regarding the NAFLD grade, over three-quarters of patients were classified as grade I and grade II, with a strong predilection for men. The current results indicated a significant association between the NAFLD grade indicated by liver MRS and the NAFLD grade indicated by liver biopsy. At the end of our study, we recommend using liver MRS for evaluating and grading NAFLD in association with other parameters like serum triglycerides and body mass index grade as this protocol can enhance early detection and provide an accurate grading that will lead to a proper management of this disease.

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Conflict of interest statement

The authors declare that they have no conflict of interests.

Figures

Figure 1 – (A–C)
Figure 1 – (A–C)
The figure illustrates how the ROI inside the liver parenchyma was selected on MRS. ROI: Region of interest; MRS: Magnetic resonance spectroscopy
Figure 2
Figure 2
The HE stained slides (A–D, ×100) indicated generalized periportal and centrolobular stasis and the presence of panlobular steatosis in less than 5% of hepatocytes corresponding to grade 0 NAFLD. HE: Hematoxylin–Eosin; NAFLD: Non-alcoholic fatty liver disease
Figure 3
Figure 3
The HE stained slides (A–D, ×100) indicated the presence of stasis, moderate fibrosis in the periportal space and steatosis in 5–33% of hepatocytes corresponding to grade I NAFLD. HE: Hematoxylin–Eosin; NAFLD: Non-alcoholic fatty liver disease
Figure 4
Figure 4
The HE stained slides (A and B, ×100) indicated the presence of stasis, moderate fibrosis in the periportal space and steatosis in 34–66% of hepatocytes corresponding to grade II NAFLD. HE: Hematoxylin–Eosin; NAFLD: Non-alcoholic fatty liver disease
Figure 5
Figure 5
Liver MRS aspect of various degrees of NAFLD: (A) Grade 0 – fat content in less than 5% of hepatocytes; (B) Grade I – fat content in 5–33% of hepatocytes; (C) Grade II – fat content in 34–66% of hepatocytes. MRS: Magnetic resonance spectroscopy; NAFLD: Non-alcoholic fatty liver disease
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