Multiparametric Magnetic Resonance Imaging and Magnetic Resonance Elastography to Evaluate the Early Effects of Bariatric Surgery on Nonalcoholic Fatty Liver Disease
Hong Chang Tan, Elizabeth Shumbayawonda, Cayden Beyer, Lionel Tim‐Ee Cheng, Albert Low, Chin Hong Lim, Alvin Eng, Weng Hoong Chan, Phong Ching Lee, Mei Fang Tay, Stella Kin, Pik‐Eu Chang, Yong Mong Bee, George Boon‐Bee Goh
Abstract
Background. Bariatric surgery is the most effective treatment for morbid obesity and reduces the severity of nonalcoholic fatty liver disease (NAFLD) in the long term. Less is known about the effects of bariatric surgery on liver fat, inflammation, and fibrosis during the early stages following bariatric surgery. Aims. This exploratory study utilises advanced imaging methods to investigate NAFLD and fibrosis changes during the early metabolic transitional period following bariatric surgery. Methods. Nine participants with morbid obesity underwent sleeve gastrectomy. Multiparametric MRI (mpMRI) and magnetic resonance elastography (MRE) were performed at baseline, during the immediate (1 month), and late (6 months) postsurgery period. Liver fat was measured using proton density fat fraction (PDFF), disease activity using iron-correct T1 (cT1), and liver stiffness using MRE. Repeated measured ANOVA was used to assess longitudinal changes and Dunnett’s method for multiple comparisons. Results. All participants (Age <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mn>45.1</a:mn> <a:mo>±</a:mo> <a:mn>9.0</a:mn> </a:math> years, BMI <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mn>39.7</c:mn> <c:mo>±</c:mo> <c:mn>5.3</c:mn> <c:mtext> </c:mtext> <c:mtext>kg</c:mtext> <c:mo>/</c:mo> <c:msup> <c:mrow> <c:mtext>m</c:mtext> </c:mrow> <c:mrow> <c:mn>2</c:mn> </c:mrow> </c:msup> </c:math> ) had elevated hepatic steatosis at baseline (PDFF >5%). In the immediate postsurgery period, PDFF decreased significantly from <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mn>14.1</e:mn> <e:mo>±</e:mo> <e:mn>7.4</e:mn> <e:mi>%</e:mi> </e:math> to 8 <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:mn>.9</g:mn> <g:mo>±</g:mo> <g:mn>4.4</g:mn> <g:mi>%</g:mi> </g:math> ( <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"> <i:mi>p</i:mi> <i:mo>=</i:mo> <i:mn>0.016</i:mn> </i:math> ) and cT1 from <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M6"> <k:mn>826.9</k:mn> <k:mo>±</k:mo> <k:mn>80.6</k:mn> <k:mtext> </k:mtext> <k:mtext>ms</k:mtext> </k:math> to <m:math xmlns:m="http://www.w3.org/1998/Math/MathML" id="M7"> <m:mn>768.4</m:mn> <m:mo>±</m:mo> <m:mn>50.9</m:mn> <m:mtext> </m:mtext> <m:mtext>ms</m:mtext> </m:math> ( <o:math xmlns:o="http://www.w3.org/1998/Math/MathML" id="M8"> <o:mi>p</o:mi> <o:mo>=</o:mo> <o:mn>0.047</o:mn> </o:math> ). These improvements continued to the later postsurgery period. Bariatric surgery did not reduce liver stiffness measurements. Conclusion. Our findings support using MRI as a noninvasive tool to monitor NAFLD in patient with morbid obesity during the early stages following bariatric surgery.