New method for diagnosing fatty liver – without any surgical intervention
(Vienna, 20th March 2014) Normally, a liver biopsy is required to diagnose and track the progression of non-alcohol-induced steatohepatitis, and this can be associated with complications and considerable failure quota. A team of radiologists from the MedUni Vienna, led by Ahmed Ba-Ssalamah, has now, in collaboration with the Clinical Department of Gastroenterology and Hepatology, for the first time demonstrated that it may be possible in future to carry out the procedure non-invasively, using functional magnetic resonance imaging (fMRI). This discovery highlights the high esteem that Vienna’s Radiology department enjoys among the international scientific community.
“We’ve demonstrated for the first time that a specialist contrast medium and fMRI can be used to diagnose fatty liver (steatosis) and inflamed forms of the condition (steatohepatitis), but also to investigate and illustrate the function of the liver,” says the senior author of the study, Ahmed Ba-Ssalamah from the University Department of Radiology and Nuclear Medicine. The contrast medium is gadoxetic acid, which is injected into the veins and excreted via the bile ducts.
The take-up of the contrast medium by the cells in a fatty liver is poor or non-existent, due to the inflammation, fibrosis and associated increase in volume of liver cells (“ballooning”). Says Ba-Ssalamah: “Their function is markedly impaired.” On the other hand, the contrast medium is highly visible in healthy liver cells. This difference was made appreciable using functional MRI.
Following on from this study, which has now been published in the highly respected journal “Radiology”, the results are now being verified in a multi-centre study so that the method can in future also replace liver biopsies to establish an initial diagnosis, say the MedUni Vienna researchers. “Progression monitoring with fMRI is already possible,” says Ba-Ssalamah.
40 per cent of people affected by non-alcoholic fatty liver
Fatty liver is a condition that is becoming more and more prevalent among affluent society. It is a condition in which fatty deposits (triglycerides) accumulate in liver cells. If alcohol is ruled out as the cause of the inflammation of the fatty liver, the condition is termed “non-alcoholic liver disease” (NASH).
Already around 40 per cent of the population are affected by non-alcoholic liver disease, says Michael Trauner, Head of the Department of Gastroenterology and Hepatology at the MedUni Vienna. This condition is strongly linked to diabetes, obesity or metabolic syndrome, but also to genetic processes and changes in the intestinal microbiome. The term “non-alcoholic fatty liver” was also coined by the Viennese hepatologist Heribert Thaler (a student of Hans Popper) in the 1960s and later picked up by American researchers.
Interdisciplinary collaboration in the MedUni Vienna research clusters
The current study is based on interdisciplinary cooperation between the University Departments of Radiology and Nuclear Medicine (headed up by Christian Herold) and Gastroenterology and Hepatology (headed up by Michael Trauner) at the MedUni Vienna. As a result, this collaboration falls under the Medical Imaging research cluster. There are five such research clusters at the MedUni Vienna. These specialist areas are increasingly focusing on fundamental and clinical research at the MedUni Vienna. The other three research clusters are Immunology, Cancer Research / Oncology and Medical Neurosciences.
“Noninvasive Differentiation of Simple Steatosis and Steatohepatitis by Using Gadoxetic Acid-enhanced MR Imaging in Patients with Nonalcoholic Fatty Liver Disease: A Proof-of-Concept Study.” N. Bastati, D. Feier, A. Wibmer, S. Traussnigg, C. Balassy, D. Tamandl, H. Einspieler, F. Wrba, M. Trauner, C. Herold, A. Ba-Ssalahmah. Radiology, 2014 Feb 27; 131890.