Learning objectives
Understand the epidemiology of chronic liver disease and clinical management of iron and fat hepatic overload and hepatic fibrosis.
Recognize the qualitative and quantitative methods on magnetic resonance (MR) to assess iron,
fat and fibrosis on liver.
Recognize the advantages and disadvantages of each method.
Background
Chronic liver diseases,
regardless their etiologies,culminate in a final common pathway of progressive fibrosis and,eventually,
cirrhosis(Fig.2).[1]There are several causes of chronic liver disease including viral infection,
alcohol abuse,
nonalcoholic fatty liver disease,
biliary disease,
autoimmune disease,
genetic causes,
and metabolic disorders.
Fat,
iron and fibrosis are hallmarks of chronic liver disease and very commonly they coexist in the same patient (Fig.
3).
Iron overload is associated with disease severity and development of fibrosis in patients with fatty liver disease; and fat,
is an important cofactor...
Findings and procedure details
QUALITATIVE MRI METHODS TO ASSESS FAT ON LIVER
Inversion-Recovery Imaging (STIR)
Concepts:
Based on short T1 of FAT
Fat has a shorter T1 thanalmost all other materials in the body.
This technique takes advantage of this difference to suppress the fat signal.
No signal from the lipid protons,
but there is signal from other tissues with different T1 values.[4]
Protocols:
180° pulse (inverts longitudinal magnetization).
90° excitation pulse after a specific inversion time (TI),
when the recovery magnetization of fat protons exactly crosses the null...
Conclusion
The pandemic ofnonalcoholic fatty liver disease on the development of chronic liver disease reinforces the validation of MR imaging-based biomarkers.
Further,
detection and quantification of hepaticironis essential in patients with hereditary hemochromatosis and transfusional hemosiderosis.
Accurate staging of the degree of fibrosis is essential in the management and determination of the prognosis of patients with chronic liver disease.
Therefore,
beyond the qualitative methods,
a multiparametric quantitative MR Imaging protocol that includes assessment of fat,
iron and fibrosis is the ideal evaluation of a patient with...
Personal information
Contact details:
Dr.
Júlia Miranda Department of Radiology,
Hospital Sírio-Libanês,
São Paulo,
Brazil.
Email:
[email protected]
References
1.
Srinivasa Babu A,
Wells ML,
Teytelboym OM,
Mackey JE,
Miller FH,
Yeh BM,
et al.
Elastography in Chronic Liver Disease: Modalities,
Techniques,
Limitations,
and Future Directions.
RadioGraphics.
2016;36(2):1987–2006.
2.
Wells SA.
Quantification of hepatic fat and iron with magnetic resonance imaging.
Magn Reson Imaging Clin N Am [Internet].
2014;22(3):397–416.
Available from: http://dx.doi.org/10.1016/j.mric.2014.04.010
3.
Gilbert G.
Liver Iron Quantification with MR Imaging : A Primer for Radiologists 1.
2018;392–412.
4.
Pokharel SS,
Macura KJ,
Ihab R.
Current MR Imaging Lipid Detection Techniques for Diagnosis of...