Abstract
Background:
Bariatric surgery and lifestyle modification are important treatments for obesity, a risk factor for metabolic dysfunction-associated steatohepatitis (MASH). Studies have related weight reduction with changes in MASH, however, few have used imaging to investigate effects on liver health. We evaluated differences in liver response to obesity treatment using disease activity iron corrected T1 (cT1) and proton density fat fraction (PDFF) in patients with both obesity and metabolic dysfunction-associated steatotic liver disease (MASLD).
Methods:
34 patients with obesity and MASLD were recruited between March 2019 to February 2022 from tertiary hospital in this longitudinal study; 13 underwent laparoscopic sleeve gastrectomy (LSG) alongside intraoperative liver biopsy, and 21 underwent a 4-month lifestyle-modification program (LMP). All patients had multi-parametric MRI at baseline and 4-months. Diagnostic accuracy to identify MASH was assessed using the area under receiver operating characteristic curve.
Results
4 (31%) of patients in the LSG group had metabolic dysfunction-associated steatohepatitis (NAS activity score ≥4) on liver biopsy. Proton density fat fraction and iron corrected T1 correlated with the NAS activity score (r=0.81, 95% CI 0.453-0.943, P<0.001) and (r=0.70, 95% CI 0.228-0.907, P=0.008, respectively). There was good area under receiver operating characteristic curve (AUROC) for iron corrected T1 (0.89, 95% CI 0.67-1.00, P=0.031) and Proton density fat fraction (0.83, 95% CI 0.57-1.00, P=0.064) to identify metabolic dysfunction-associated steatohepatitis. At follow-up, weight reduction -22.8% (P=0.013) vs. -1.3% (P=0.262) resulted in iron corrected T1 reduction of -8.04% (864ms, P=0.025) vs. -3.87% (907ms, P=0.083) in the LSG vs. LMP group, respectively. Significant differences between interventions were observed for percentage proton density fat fraction decrease (-64.52% vs. -29.16%, P=0.001). Both biomarkers were significantly reduced in the LSG group (cT1 by -8.04%, P=0.025, PDFF by -64.52%, P=0.012), while only PDFF (-29.16%, P=0.012) was significantly reduced in the LMP group.
Conclusions
MRI biomarkers may have some utility to monitor MASH following intervention in patients with obesity allowing objective comparison between intervention strategies. Compared to LMP, LSG was more effective in improving liver health.
Bariatric surgery and lifestyle modification are important treatments for obesity, a risk factor for metabolic dysfunction-associated steatohepatitis (MASH). Studies have related weight reduction with changes in MASH, however, few have used imaging to investigate effects on liver health. We evaluated differences in liver response to obesity treatment using disease activity iron corrected T1 (cT1) and proton density fat fraction (PDFF) in patients with both obesity and metabolic dysfunction-associated steatotic liver disease (MASLD).
Methods:
34 patients with obesity and MASLD were recruited between March 2019 to February 2022 from tertiary hospital in this longitudinal study; 13 underwent laparoscopic sleeve gastrectomy (LSG) alongside intraoperative liver biopsy, and 21 underwent a 4-month lifestyle-modification program (LMP). All patients had multi-parametric MRI at baseline and 4-months. Diagnostic accuracy to identify MASH was assessed using the area under receiver operating characteristic curve.
Results
4 (31%) of patients in the LSG group had metabolic dysfunction-associated steatohepatitis (NAS activity score ≥4) on liver biopsy. Proton density fat fraction and iron corrected T1 correlated with the NAS activity score (r=0.81, 95% CI 0.453-0.943, P<0.001) and (r=0.70, 95% CI 0.228-0.907, P=0.008, respectively). There was good area under receiver operating characteristic curve (AUROC) for iron corrected T1 (0.89, 95% CI 0.67-1.00, P=0.031) and Proton density fat fraction (0.83, 95% CI 0.57-1.00, P=0.064) to identify metabolic dysfunction-associated steatohepatitis. At follow-up, weight reduction -22.8% (P=0.013) vs. -1.3% (P=0.262) resulted in iron corrected T1 reduction of -8.04% (864ms, P=0.025) vs. -3.87% (907ms, P=0.083) in the LSG vs. LMP group, respectively. Significant differences between interventions were observed for percentage proton density fat fraction decrease (-64.52% vs. -29.16%, P=0.001). Both biomarkers were significantly reduced in the LSG group (cT1 by -8.04%, P=0.025, PDFF by -64.52%, P=0.012), while only PDFF (-29.16%, P=0.012) was significantly reduced in the LMP group.
Conclusions
MRI biomarkers may have some utility to monitor MASH following intervention in patients with obesity allowing objective comparison between intervention strategies. Compared to LMP, LSG was more effective in improving liver health.
| Original language | English |
|---|---|
| Pages (from-to) | 4659-4674 |
| Number of pages | 16 |
| Journal | Quantitative Imaging in Medicine and Surgery |
| Volume | 14 |
| Issue number | 7 |
| Publication status | Published - 24 May 2024 |