Yavuz METİN, Nurgül Orhan METİN, Süleyman KALCAN, Muhammed Kadri ÇOLAKOĞLU, Filiz TAŞÇI, Oğuzhan ÖZDEMİR, Ali KÜPELİ

Bariatrik Cerrahi Sonrası Viseral Organ Yağ İnfiltrasyon Değişikliklerini İzlemenin Etkili Yöntemi: İdeal IQ Sekansı

Amaç: Bariatrik cerrahinin karaciğer ve pankreas yağ infiltrasyonu üzerindeki etkilerinin saptanmasında non-invaziv görüntüleme yönteminin-MR proton dansite yağ fraksiyonu (PDFF); ideal IQ sekansı-etkinliğini göstermeyi amaçladık. Gereç ve Yöntem: Bu çalışmada Mayıs 2016 ile Nisan 2017 tarihleri arasında obezite cerrahisi geçiren 39 hasta (25 kadın, 14 erkek) retrospektif olarak incelendi. Tüm hastaların vücut kitle indeksi (VKİ) ve vücut ağırlığı (VA) değerleri bariatrik cerrahiden bir hafta önce ve bir ay sonra kaydedildi ve bu esnada kontrastsız üst abdomen MR görüntülemesi yapıldı. MR-PDFF ve T2 ağırlıklı görüntülerle karaciğer yağ fraksiyonu (KYF), pankreas yağ fraksiyonu (PYF), karaciğer hacmi (KV) ve karaciğer kraniyokaudal uzunluğu (KKU) ölçüldü. Ameliyat sonrası tüm parametrelerdeki değişiklikler kaydedildi ve bu değişikliklerin KYF’deki değişiklik ile korelasyonu analiz edildi. Bulgular: Bariatrik cerrahinin 1. ayının sonunda KYF ve PYF ortalama değerlerinde anlamlı azalma ile birlikte KV, KKU, VA ve VKİ’de azalma gözlendi (p

The Effective Method of Monitoring Visceral Organ Fatty Infiltration Changes After Bariatric Surgery: Ideal IQ Sequence

Aim: The aim of this study is to demonstrate the efficiency of non-invasive imaging method-MR proton density fat fraction (PDFF); ideal IQ sequence- on detecting the effects of bariatric surgery on liver and pancreatic fatty infiltration. Materials and Methods: Thirty-nine patients (25 females, 14 males) who underwent bariatric surgery between May 2016 and April 2017 were analyzed retrospectively in this study. Body mass index (BMI) and body weight (BW) values of all patients were noted one week before and one month after bariatric surgery, and meanwhile an unenhanced upper abdominal MR imaging was performed. Liver fat fraction (LFF), pancreas fat fraction (PFF), liver volume (LV) and craniocaudal length of liver (LL) were measured with MR-PDFF and T2 weighted images. Changes in all parameters after the surgery were recorded and the correlation of these changes with the change in LFF was analyzed.Results: At the end of first month of bariatric surgery, a significant decrease on mean values of LFF and PFF has been observed along with a decrease of LV, LL, BW and BMI (p

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1. McFarlane SI, Banerji M, Sowers JR. Insulin resistance and cardiovascular disease. J Clin Endocrinol Metab. 2001;86:713-8.
2. Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther. 2011;34:274-85.
3. Glen J, Floros L, Day C, Pryke R; Guideline Development Group. Non alcoholic fatty liver disease (NAFLD): summary of NICE guidance. BMJ. 2016;354:i4428.
4. Smits MM, van Geenen EJ. The clinical significance of pancreatic steatosis. Nat Rev Gastroenterol Hepatol. 2011;8:169-77.
5. Mathur A, Marine M, Lu D, Swartz-Basile DA, Saxena R, Zyromski NJ, et al. Nonalcoholic fatty pancreas disease. HPB (Oxford). 2007;9:312-8.
6. Ogilvie RF. The islands of langerhans in 19 cases of obesity. Journal Pathology and Bacteriology. 1933;37:473-81.
7. Martínez J, Johnson CD, Sánchez-Payá J, de Madaria E, Robles-Díaz G, Pérez Mateo M. Obesity is a definitive risk factor of severity and mortality in acute pancreatitis: an updated meta-analysis. Pancreatology. 2006;6:206-9.
8. Lee JS, Kim SH, Jun DW, Han JH, Jang EC, Park JY, et al. Clinical implications of fatty pancreas: correlations between fatty pancreas and metabolic syndrome. World J Gastroenterol. 2009;15:1869-75.
9. Nalbantoglu IL, Brunt EM. Role of liver biopsy in nonalcoholic fatty liver disease. World J Gastroenterol. 2014;20:9026-37.
10. Ratziu V, Charlotte F, Heurtier A, Gombert S, Giral P, Bruckert E, et al. Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology. 2005;128:1898-906.
11. Goceri E, Shah ZK, Layman R, Jiang X, Gurcan MN. Quantification of liver fat: A comprehensive review. Comput Biol Med. 2016;71:174-89.
12. Idilman IS, Keskin O, Celik A, Savas B, Elhan AH, Idilman R, et al. A comparison of liver fat content as determined by magnetic resonance imaging-proton density fat fraction and MRS versus liver histology in non-alcoholic fatty liver disease. Acta Radiol. 2016;57:271-8.
13. van Werven JR, Marsman HA, Nederveen AJ, Smits NJ, ten Kate FJ, van Gulik TM, et al. Assessment of hepatic steatosis in patients undergoing liver resection: comparison of US, CT, T1-weighted dual-echo MR imaging, and point-resolved 1H MR spectroscopy. Radiology. 2010;256:159-68.
14. Kramer H, Pickhardt PJ, Kliewer MA, Hernando D, Chen GH, Zagzebski JA, et al. Accuracy of Liver Fat Quantification With Advanced CT, MRI, and Ultrasound Techniques: Prospective Comparison With MR Spectroscopy. AJR Am J Roentgenol. 2017;208:92-100.
15. Guiu B, Petit JM, Loffroy R, Ben Salem D, Aho S, Masson D, et al. Quantification of liver fat content: comparison of triple-echo chemical shift gradient-echo imaging and in vivo proton MR spectroscopy. Radiology. 2009;250:95-102.
16. Vieira J, Amorim J, Martí-Bonmatí L, Alberich-Bayarri Á, França M. Quantifying steatosis in the liver and pancreas with MRI in patient with chronic liver disease. Radiologia (Engl Ed). 2020;62:222-8.
17. Yao WJ, Guo Z, Wang L, Li K, Saba L, Guglielmi G, et al. Pancreas fat quantification with quantitative CT: an MRI correlation analysis. Clin Radiol. 2020;75:397.e1-397.e6.
18. Idilman IS, Tuzun A, Savas B, Elhan AH, Celik A, Idilman R, et al. Quantification of liver, pancreas, kidney, and vertebral body MRI-PDFF in non-alcoholic fatty liver disease. Abdom Imaging. 2015;40:1512-9.
19. Pillai AA, Rinella ME. Non-alcoholic fatty liver disease: is bariatric surgery the answer? Clin Liver Dis. 2009;13:689-710.
20. Mummadi RR, Kasturi KS, Chennareddygari S, Sood GK. Effect of bariatric surgery on nonalcoholic fatty liver disease: systematic review and meta analysis. Clin Gastroenterol Hepatol. 2008;6:1396-402.
21. Lassailly G, Caiazzo R, Buob D, Pigeyre M, Verkindt H, Labreuche J, et al. Bariatric Surgery Reduces Features of Nonalcoholic Steatohepatitis in Morbidly Obese Patients. Gastroenterology. 2015;149:379-88; quiz e15-6.
22. Schwenzer NF, Springer F, Schraml C, Stefan N, Machann J, Schick F. Non invasive assessment and quantification of liver steatosis by ultrasound, computed tomography and magnetic resonance. J Hepatol. 2009;51:433- 45.
23. Ble M, Procopet B, Miquel R, Hernandez-Gea V, García-Pagán JC. Transjugular liver biopsy. Clin Liver Dis. 2014;18:767-78.
24. Hu HH, Kim HW, Nayak KS, Goran MI. Comparison of fat-water MRI and single-voxel MRS in the assessment of hepatic and pancreatic fat fractions in humans. Obesity (Silver Spring). 2010;18:841-7.
25. Idilman IS, Aniktar H, Idilman R, Kabacam G, Savas B, Elhan A, et al. Hepatic steatosis: quantification by proton density fat fraction with MR imaging versus liver biopsy. Radiology. 2013;267:767-75.
26. Tang A, Tan J, Sun M, Hamilton G, Bydder M, Wolfson T, et al. Nonalcoholic fatty liver disease: MR imaging of liver proton density fat fraction to assess hepatic steatosis. Radiology. 2013;267:422-31.
27. Luo RB, Suzuki T, Hooker JC, Covarrubias Y, Schlein A, Liu S, et al. How bariatric surgery affects liver volume and fat density in NAFLD patients. Surg Endosc. 2018;32:1675-82.
28. Hedderich DM, Hasenberg T, Haneder S, Schoenberg SO, Kücükoglu Ö, Canbay A, et al. Effects of Bariatric Surgery on Non-alcoholic Fatty Liver Disease: Magnetic Resonance Imaging Is an Effective, Non-invasive Method to Evaluate Changes in the Liver Fat Fraction. Obes Surg. 2017;27:1755-62.
29. Hui SCN, Wong SKH, Ai Q, Yeung DKW, Ng EKW, Chu WCW. Observed changes in brown, white, hepatic and pancreatic fat after bariatric surgery: Evaluation with MRI. Eur Radiol. 2019;29:849-56.
30. Covarrubias Y, Fowler KJ, Mamidipalli A, Hamilton G, Wolfson T, Leinhard OD, et al. Pilot study on longitudinal change in pancreatic proton density fat fraction during a weight-loss surgery program in adults with obesity. J Magn Reson Imaging. 2019;50:1092-102.
31. Pooler BD, Wiens CN, McMillan A, Artz NS, Schlein A, Covarrubias Y, et al. Monitoring Fatty Liver Disease with MRI Following Bariatric Surgery: A Prospective, Dual-Center Study. Radiology. 2019;290:682-90.