Current and Future Magnetic Resonance Technologies for Assessing Liver Disease in Clinical and Experimental Medicine

Abstract

Background: In the past decades, a number of non-invasive methods have emerged for detecting and estimating liver fibrosis; these include both serum-based panels and imaging-based technology. Some of these methods are now being incorporated in clinical practice. However, the limitations of the current techniques include lack of organ specificity, sampling errors and limited ability to reflect the efficacy of interventions. Key Messages: Novel magnetic resonance (MR)-based techniques provide an opportunity to bring about further changes in the investigations and management of patients with liver diseases. Multimodal quantitative MR techniques enable the estimation of fat, iron accumulation, degree of liver injury/inflammation and fibrosis within the whole liver without the need for administering contrast agents. Architectural changes within the liver can be evaluated concurrently with portal haemodynamic changes allowing non-invasive assessment of portal hypertension and effects of interventions. A combination ultra-high field (7T) provides greater sensitivity with a potential to distinguish inflammation from fibrosis on imaging and determine specific types of fats (saturated vs. unsaturated) present within the liver using MR spectroscopy. ¹³C MR spectroscopy can estimate glutathione flux and rate of beta oxidation in-vivo providing novel tools for experimental studies that evaluate the efficacy of interventions as well as underlying mechanisms. Conclusions: Translational research should focus on converting the potentials of these innovative methodologies into clinical applications for the benefit of patients.

Drug Development for Nonalcoholic Fatty Liver Disease: Landscape and Challenges

“…This is of particular relevance to the study of hepatic and whole-body insulin resistance, given the ability to simultaneously quantify lipid and glucose metabolism as well as energy homeostasis in the liver and skeletal muscle, the major insulin target tissues, using 1 H-MRS, 13 C MRS, and 31 P-MRS, respectively. 27,28 Novel MRS methodologies developed recently could bring about a step change in experimental medicine studies. In a study involving two animal models, investigators used labeled intravenous glycine together with 13 C MRS to estimate glutathione flux in vivo.…”

“…A combination of the slow nature of disease progression in NAFLD, heterogeneity of therapeutic targets, and well- 37 MRI and MRS, vibration controlled transient elastography, and MR elastography (MRE) can map hepatic anatomy, chemical composition, and stiffness, directly and accurately. 28 Indeed, MRI and MRE were used as surrogate endpoints in a recent phase 2 trial evaluating the ASK-1 inhibitor selonsertib in patients with noncirrhotic NAFLD. 34…”

Effects of sprint interval training on ectopic lipids and tissue-specific insulin sensitivity in men with non-alcoholic fatty liver disease

“…MR measurements were performed on a Philips Achieva 3T system with 32 channel XL-Torso coil. IHTG was measured from a 20x20x20 mm voxel within the right lobe of the liver using 1 H-MRS with Stimulated Echo Acquisition Mode (STEAM) localization (repetition time = 2046 ms) (Stephenson et al 2013;Bawden et al 2017). VAT and ScAT were assessed using a two-point modified Dixon technique (Philips) (Nakai et al 2010) and an in-house algorithm to generate fat boundaries of visceral and subcutaneous regions.…”

The effect of exercise training on intrahepatic triglyceride and hepatic insulin sensitivity: a systematic review and meta‐analysis

“…Ultrasound and computed tomography are also limited by a lack of sensitivity to detect mild‐to‐moderate accumulation of IHTG and to quantify subtle changes resulting from experimental interventions . 1 H‐MRS has much greater precision , making it a more suitable method for experimental research, while the necessity to characterize histological features beyond steatosis makes liver biopsy the standard tool in clinical practice .…”