Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 7, 2015; 21(33): 9741-9748
Published online Sep 7, 2015. doi: 10.3748/wjg.v21.i33.9741
Hepatic fat quantification magnetic resonance for monitoring treatment response in pediatric nonalcoholic steatohepatitis
Hong Koh, Seung Kim, Myung-Joon Kim, Hyun Gi Kim, Hyun Joo Shin, Mi-Jung Lee
Hong Koh, Seung Kim, Department of Pediatrics, Severance Pediatric Liver Disease Research Group, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul 120-752, South Korea
Myung-Joon Kim, Hyun Gi Kim, Hyun Joo Shin, Mi-Jung Lee, Department of Radiology and Research Institute of Radiological Science, Severance Pediatric Liver Disease Research Group, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul 120-752, South Korea
Author contributions: Koh H and Lee MJ designed the research; Koh H, Kim MJ and Lee MJ performed the research; Kim S, Kim HG and Shin HJ contributed analytic tools; Koh H, Kim S and Lee MJ analyzed the data; Koh H and Lee MJ wrote the manuscript; Kim S, Kim MJ, Kim HG, Shin HJ and Lee MJ revised and approved the final version.
Supported by A new faculty research seed money grant of Yonsei University College of Medicine for 2013 (8-2013-0028).
Institutional review board statement: This study was reviewed and approved by the local ethics committee of the Severance Hospital, Yonsei University (register no. 1-2014-0007).
Informed consent statement: Because of the retrospective and anonymous character of this study, the need for informed consent was waived by the institutional review board.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mi-Jung Lee, MD, PhD, Department of Radiology and Research Institute of Radiological Science, Severance Pediatric Liver Disease Research Group, Severance Children’s Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea. mjl1213@yuhs.ac
Telephone: +82-2-22287400 Fax: +82-2-3933035
Received: February 27, 2015
Peer-review started: February 27, 2015
First decision: March 26, 2015
Revised: April 23, 2015
Accepted: July 8, 2015
Article in press: July 8, 2015
Published online: September 7, 2015
Processing time: 192 Days and 14.2 Hours
Abstract

AIM: To evaluate the possibility of treatment effect monitoring using hepatic fat quantification magnetic resonance (MR) in pediatric nonalcoholic steatohepatitis (NASH).

METHODS: We retrospectively reviewed the medical records of patients who received educational recommendations and vitamin E for NASH and underwent hepatic fat quantification MR from 2011 to 2013. Hepatic fat fraction (%) was measured using dual- and triple-echo gradient-recalled-echo sequences at 3T. The compliant and non-compliant groups were compared clinically, biochemically, and radiologically.

RESULTS: Twenty seven patients (M:F = 24:3; mean age: 12 ± 2.3 years) were included (compliant group = 22, non-compliant = 5). None of the baseline findings differed between the 2 groups, except for triglyceride level (compliant vs non-compliant, 167.7 mg/dL vs 74.2 mg/dL, P = 0.001). In the compliant group, high-density lipoprotein increased and all other parameters decreased after 1-year follow-up. However, there were various changes in the non-compliant group. Dual-echo fat fraction (-19.2% vs 4.6, P < 0.001), triple-echo fat fraction (-13.4% vs 3.5, P < 0.001), alanine aminotransferase (-110.7 IU/L vs -10.6 IU/L, P = 0.047), total cholesterol (-18.1 mg/dL vs 3.8 mg/dL, P = 0.016), and triglyceride levels (-61.3 mg/dL vs 11.2 mg/dL, P = 0.013) were significantly decreased only in the compliant group. The change in body mass index and dual-echo fat fraction showed a positive correlation (ρ = 0.418, P = 0.030).

CONCLUSION: Hepatic fat quantification MR can be a non-invasive, quantitative and useful tool for monitoring treatment effects in pediatric NASH.

Keywords: Nonalcoholic fatty liver disease; Steatohepatitis; Hepatic fat quantification magnetic resonance; Child; Monitoring

Core tip: Few noninvasive methods have been evaluated to accurately assess and monitor the progression of nonalcoholic steatohepatitis (NASH) in children. In this study, we used hepatic fat quantification magnetic resonance (MR) and compared the compliant and non-compliant groups for treatment of pediatric NASH. The compliant group showed not only laboratory improvement but also a decrease in the fat fraction in both dual- and triple-echo sequences after follow-up. Therefore, hepatic fat quantification MR can be a non-invasive, quantitative and useful tool for monitoring treatment effects in pediatric NASH.