Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
JPEN J Parenter Enteral Nutr. 2018 May;42(4):778-785. doi: 10.1177/0148607117711667. Epub 2017 Dec 19.
Intestinal failure-associated liver disease is a frequent complication in patients with chronic intestinal failure (CIF), with steatosis as a dominant feature in adults. Proton magnetic resonance spectroscopy (1H-MRS) is a noninvasive method to quantify liver fat content (LFC). In this study, LFC was assessed with 1H-MRS, taking into account the possible accumulation of paramagnetic components of home parenteral nutrition (HPN) that may disturb these measurements.
LFC was measured in 15 adult CIF patients who had been receiving HPN for >6 months. 1H-MR spectra were obtained with a 3 Tesla magnetic resonance (MR) system, with a method correcting for the presence of paramagnetic ions. Patients with low (<5%) versus high (≥5%, steatosis) LFC were compared with nonparametric statistical tests.
1H-MRS analysis revealed steatosis in 5 patients (median, 10.3%), while 10 patients had normal LFC (median, 0.9%). In all patients, the 1H-MRS results indicated the presence of various amounts of paramagnetic constituents in the liver. Patients with steatosis had higher alanine aminotransferase values than patients without steatosis (median, 60 vs 28 U/L). Unexpectedly, in the steatosis group, the frequency of HPN use was lower, with significant lower total HPN and carbohydrate calories. In 1 patient, MR spectra were of inferior quality, with broadened resonances after infusion with a ferric compound.
1H-MRS enables reliable noninvasive assessment of LFC in patients receiving long-term HPN, if correcting for possible accumulation of paramagnetic components in the liver. However, LFC determination by 1H-MRS is not recommended after a recent ferric compound infusion.
肠衰竭相关肝病是慢性肠衰竭（CIF）患者常见的并发症，成人以脂肪变性为主要特征。质子磁共振波谱（1H-MRS）是一种定量肝脂肪含量（LFC）的非侵入性方法。在这项研究中，考虑到可能会干扰这些测量的肠外营养（HPN）中顺磁成分的积累，我们使用 1H-MRS 评估了 LFC。
我们对 15 名接受 HPN 治疗>6 个月的成年 CIF 患者进行了 LFC 测量。使用 3T 磁共振（MR）系统获得 1H-MR 谱，并采用一种校正顺磁离子存在的方法。采用非参数统计检验比较 LFC 低值（<5%，脂肪变性）与高值（≥5%，脂肪变性）患者。
1H-MRS 分析显示 5 名患者（中位数，10.3%）存在脂肪变性，10 名患者 LFC 正常（中位数，0.9%）。在所有患者中，1H-MRS 结果表明肝脏中存在不同量的顺磁成分。有脂肪变性的患者的丙氨酸氨基转移酶值高于无脂肪变性的患者（中位数，60 与 28 U/L）。出乎意料的是，在脂肪变性组中，HPN 使用频率较低，总 HPN 和碳水化合物热量显著较低。在 1 名患者中，铁化合物输注后磁共振谱质量较差，共振变宽。
如果校正肝脏中可能积累的顺磁成分，1H-MRS 可用于可靠地评估长期接受 HPN 治疗的患者的 LFC。但是，不建议在最近输注铁化合物后使用 1H-MRS 测定 LFC。
