Pilot study to diagnose nonalcoholic steatohepatitis with dynamic 18 F-FDG PET

Research output: Contribution to journalArticle

Abstract

OBJECTIVE. Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are major causes of chronic liver disease characterized by steatosis, inflammation, and fibrosis. Diagnosis of inflammation is limited by the need for liver biopsy. Dynamic PET with the widely used radiotracer 18 F-FDG provides a novel method for evaluating spatial and temporal changes in liver inflammation. MATERIALS AND METHODS. Patients with NAFLD or NASH underwent dynamic FDG PET and MRI within 6 months of undergoing liver biopsy. Liver time-activity curves were extracted to estimate kinetic parameters representing various rate constants of FDG transport using tracer kinetic modeling. Liver biopsy specimens were scored on the basis of NASH Clinical Research Network criteria. RESULTS. This pilot study included 22 patients, 14 of whom were women. Patient age ranged from 18 to 70 years, and the mean body mass index (weight in kilograms divided by the square of height in meters) was 33.2 (range, 24–43.1). The K 1 value, which represents the rate of FDG transport from blood to hepatic tissue, was significantly correlated with inflammation (r = −0.7284; p = 0.0001) and the overall NAFLD activity score (NAS; r = −0.6750; p = 0.0006). K 1 values were inversely related to the hepatic inflammation score and NAS. Although heterogeneity in K 1 values across eight liver segments was noted, distinct segregation existed among segmental K 1 values dependent on the histologic inflammation score (p = 0.022) or NAS (p = 0.0091). K 1 had a strong association with both inflammation (ROC AUC value, 0.88) and the NAS (ROC AUC value, 0.89), with K 1 = 1.02 (mL/min/mL) corresponding to a sensitivity and specificity of 93% and 88%, respectively, for the NAS. CONCLUSION. Dynamic FDG PET with tracer kinetic modeling has the potential to determine liver inflammation in patients with NAFLD and NASH and can fill an essential gap in diagnosis.

Original languageEnglish (US)
Pages (from-to)529-537
Number of pages9
JournalAmerican Journal of Roentgenology
Volume212
Issue number3
DOIs
StatePublished - Mar 1 2019

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Inflammation
Liver
Biopsy
Area Under Curve
Non-alcoholic Fatty Liver Disease
Liver Diseases
Body Mass Index
Fibrosis
Chronic Disease
Weights and Measures
Sensitivity and Specificity
Research

Keywords

  • FDG
  • Liver inflammation
  • Nonalcoholic fatty liver disease
  • Nonalcoholic steatohepatitis
  • PET

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{eb753e36271a4c7dbd0d9f700e2e9949,
title = "Pilot study to diagnose nonalcoholic steatohepatitis with dynamic 18 F-FDG PET",
abstract = "OBJECTIVE. Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are major causes of chronic liver disease characterized by steatosis, inflammation, and fibrosis. Diagnosis of inflammation is limited by the need for liver biopsy. Dynamic PET with the widely used radiotracer 18 F-FDG provides a novel method for evaluating spatial and temporal changes in liver inflammation. MATERIALS AND METHODS. Patients with NAFLD or NASH underwent dynamic FDG PET and MRI within 6 months of undergoing liver biopsy. Liver time-activity curves were extracted to estimate kinetic parameters representing various rate constants of FDG transport using tracer kinetic modeling. Liver biopsy specimens were scored on the basis of NASH Clinical Research Network criteria. RESULTS. This pilot study included 22 patients, 14 of whom were women. Patient age ranged from 18 to 70 years, and the mean body mass index (weight in kilograms divided by the square of height in meters) was 33.2 (range, 24–43.1). The K 1 value, which represents the rate of FDG transport from blood to hepatic tissue, was significantly correlated with inflammation (r = −0.7284; p = 0.0001) and the overall NAFLD activity score (NAS; r = −0.6750; p = 0.0006). K 1 values were inversely related to the hepatic inflammation score and NAS. Although heterogeneity in K 1 values across eight liver segments was noted, distinct segregation existed among segmental K 1 values dependent on the histologic inflammation score (p = 0.022) or NAS (p = 0.0091). K 1 had a strong association with both inflammation (ROC AUC value, 0.88) and the NAS (ROC AUC value, 0.89), with K 1 = 1.02 (mL/min/mL) corresponding to a sensitivity and specificity of 93{\%} and 88{\%}, respectively, for the NAS. CONCLUSION. Dynamic FDG PET with tracer kinetic modeling has the potential to determine liver inflammation in patients with NAFLD and NASH and can fill an essential gap in diagnosis.",
keywords = "FDG, Liver inflammation, Nonalcoholic fatty liver disease, Nonalcoholic steatohepatitis, PET",
author = "Souvik Sarkar and Corwin, {Michael T} and Olson, {Kristin A} and Stewart, {Susan L} and Liu, {Chung Heng} and Badawi, {Ramsey D} and Guobao Wang",
year = "2019",
month = "3",
day = "1",
doi = "10.2214/AJR.18.20012",
language = "English (US)",
volume = "212",
pages = "529--537",
journal = "American Journal of Roentgenology",
issn = "0361-803X",
publisher = "American Roentgen Ray Society",
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TY - JOUR

T1 - Pilot study to diagnose nonalcoholic steatohepatitis with dynamic 18 F-FDG PET

AU - Sarkar, Souvik

AU - Corwin, Michael T

AU - Olson, Kristin A

AU - Stewart, Susan L

AU - Liu, Chung Heng

AU - Badawi, Ramsey D

AU - Wang, Guobao

PY - 2019/3/1

Y1 - 2019/3/1

N2 - OBJECTIVE. Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are major causes of chronic liver disease characterized by steatosis, inflammation, and fibrosis. Diagnosis of inflammation is limited by the need for liver biopsy. Dynamic PET with the widely used radiotracer 18 F-FDG provides a novel method for evaluating spatial and temporal changes in liver inflammation. MATERIALS AND METHODS. Patients with NAFLD or NASH underwent dynamic FDG PET and MRI within 6 months of undergoing liver biopsy. Liver time-activity curves were extracted to estimate kinetic parameters representing various rate constants of FDG transport using tracer kinetic modeling. Liver biopsy specimens were scored on the basis of NASH Clinical Research Network criteria. RESULTS. This pilot study included 22 patients, 14 of whom were women. Patient age ranged from 18 to 70 years, and the mean body mass index (weight in kilograms divided by the square of height in meters) was 33.2 (range, 24–43.1). The K 1 value, which represents the rate of FDG transport from blood to hepatic tissue, was significantly correlated with inflammation (r = −0.7284; p = 0.0001) and the overall NAFLD activity score (NAS; r = −0.6750; p = 0.0006). K 1 values were inversely related to the hepatic inflammation score and NAS. Although heterogeneity in K 1 values across eight liver segments was noted, distinct segregation existed among segmental K 1 values dependent on the histologic inflammation score (p = 0.022) or NAS (p = 0.0091). K 1 had a strong association with both inflammation (ROC AUC value, 0.88) and the NAS (ROC AUC value, 0.89), with K 1 = 1.02 (mL/min/mL) corresponding to a sensitivity and specificity of 93% and 88%, respectively, for the NAS. CONCLUSION. Dynamic FDG PET with tracer kinetic modeling has the potential to determine liver inflammation in patients with NAFLD and NASH and can fill an essential gap in diagnosis.

AB - OBJECTIVE. Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are major causes of chronic liver disease characterized by steatosis, inflammation, and fibrosis. Diagnosis of inflammation is limited by the need for liver biopsy. Dynamic PET with the widely used radiotracer 18 F-FDG provides a novel method for evaluating spatial and temporal changes in liver inflammation. MATERIALS AND METHODS. Patients with NAFLD or NASH underwent dynamic FDG PET and MRI within 6 months of undergoing liver biopsy. Liver time-activity curves were extracted to estimate kinetic parameters representing various rate constants of FDG transport using tracer kinetic modeling. Liver biopsy specimens were scored on the basis of NASH Clinical Research Network criteria. RESULTS. This pilot study included 22 patients, 14 of whom were women. Patient age ranged from 18 to 70 years, and the mean body mass index (weight in kilograms divided by the square of height in meters) was 33.2 (range, 24–43.1). The K 1 value, which represents the rate of FDG transport from blood to hepatic tissue, was significantly correlated with inflammation (r = −0.7284; p = 0.0001) and the overall NAFLD activity score (NAS; r = −0.6750; p = 0.0006). K 1 values were inversely related to the hepatic inflammation score and NAS. Although heterogeneity in K 1 values across eight liver segments was noted, distinct segregation existed among segmental K 1 values dependent on the histologic inflammation score (p = 0.022) or NAS (p = 0.0091). K 1 had a strong association with both inflammation (ROC AUC value, 0.88) and the NAS (ROC AUC value, 0.89), with K 1 = 1.02 (mL/min/mL) corresponding to a sensitivity and specificity of 93% and 88%, respectively, for the NAS. CONCLUSION. Dynamic FDG PET with tracer kinetic modeling has the potential to determine liver inflammation in patients with NAFLD and NASH and can fill an essential gap in diagnosis.

KW - FDG

KW - Liver inflammation

KW - Nonalcoholic fatty liver disease

KW - Nonalcoholic steatohepatitis

KW - PET

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