Metabolic Imaging in Non-Alcoholic Fatty Liver Disease: Applications of Magnetic Resonance Spectroscopy

Thiagarajan, Prarthana; Bawden, Stephen J.; Aithal, Guruprasad P.

Abstract

Non-alcoholic fatty liver disease (NAFLD) is poised to dominate the landscape of clinical hepatology in the 21st century. Its complex, interdependent aetiologies, non-linear disease progression and uncertain natural history have presented great challenges to the development of effective therapies. Progress will require an integrated approach to uncover molecular mediators, key pathogenic milestones and response to intervention at the metabolic level. The advent of precision imaging has yielded unprecedented insights into these processes. Quantitative imaging biomarkers such as magnetic resonance imaging (MRI), spectroscopy (MRS) and elastography (MRE) present robust, powerful tools with which to probe NAFLD metabolism and fibrogenesis non-invasively,in real time. Specific advantages of MRS include the ability to quantify static metabolite concentrations as well as dynamic substrate fluxin vivo. Thus, a vast range of key metabolic events inthe natural history of NAFLD can be explored using MRS. Here, we provide an overview of MRS for the clinician, as well as key pathways exploitable by MRS in vivo. Development, optimisation and validation of multinuclear MRS, in combination with other quantitative imaging techniques, may ultimately provide a robust, non-invasive alternative to liver biopsy for observational and longitudinal studies. Through enabling deeper insight into inflammatory and fibrogenic cascades, MRS may facilitate identification of novel therapeutic targets and clinically meaningful endpoints in NAFLD. Its widespread use in future could conceivably accelerate study design, data acquisition and availability of disease-modifying therapies at a population level

Citation

Thiagarajan, P., Bawden, S. J., & Aithal, G. P. (2021). Metabolic Imaging in Non-Alcoholic Fatty Liver Disease: Applications of Magnetic Resonance Spectroscopy. Journal of Clinical Medicine, 10(4), Article 632. https://doi.org/10.3390/jcm10040632

• Journal Article Type: Article
• Acceptance Date: Jan 26, 2021
• Online Publication Date: Feb 7, 2021
• Publication Date: Feb 7, 2021
• Deposit Date: Feb 8, 2021
• Publicly Available Date: Feb 11, 2021
• Journal: Journal of Clinical Medicine
• Electronic ISSN: 2077-0383
• Publisher: MDPI
• Peer Reviewed: Peer Reviewed
• Volume: 10
• Issue: 4
• Article Number: 632
• DOI: https://doi.org/10.3390/jcm10040632
• Keywords: NAFLD; metabolic liver disease; magnetic resonance; spectroscopy
• Public URL: https://nottingham-repository.worktribe.com/output/5311282
• Publisher URL: https://www.mdpi.com/2077-0383/10/4/632