Losing weight and maintaining a healthy lifestyle are common goals, but it's important to approach these endeavors with accurate information and evidence-based strategies. While this article doesn't directly address Deborah Ann Gaetano's specific weight loss journey, it provides valuable insights into related health aspects, specifically focusing on the role of quantitative imaging biomarkers in managing conditions like chronic liver disease (CLD), which can be influenced by weight and lifestyle choices. It also include some tips for weight loss.
The Role of Quantitative Imaging Biomarkers in Liver Health
Quantitative imaging biomarkers, measured using MRI and ultrasound (US), are becoming increasingly important tools in the clinical management of patients with chronic liver disease (CLD). These techniques offer high accuracy and are non-invasive, which has led to them replacing liver biopsies in many cases for diagnosis, staging, and monitoring treatment.
Common Imaging Biomarkers
The most commonly evaluated imaging biomarkers are surrogates for liver fibrosis, fat, and iron.
Liver Fibrosis: MR elastography (MRE) is routinely used to evaluate liver fibrosis, often combined with MRI-based liver fat and iron quantification. US elastography is also widely used for liver fibrosis assessment, offering the advantage of lower equipment costs and greater availability compared to MRI.
Liver Fat: MRI is used for liver fat quantification. Emerging US fat quantification methods can be performed along with US elastography.
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Liver Iron: MRI is used for iron quantification.
Advantages Over Liver Biopsy
Historically, liver biopsies were the primary method for diagnosing and staging liver fibrosis, fat, and iron levels. However, liver biopsies have several limitations:
- Sampling error
- Cost
- Invasiveness
- Morbidity
- Pathologist inter-reader reporting variability
- Low patient acceptance
Biopsies sample only a small portion of the liver, which may not accurately reflect overall liver involvement, especially when there is heterogeneous distribution in the liver.
MRI and US biomarker technologies have become more available and have successfully replaced liver biopsy in many patient care settings due to their availability, repeatability, and improved patient acceptance.
Causes and Epidemiology of CLD
The most common causes of CLD are non-alcoholic fatty liver disease (NAFLD), chronic viral hepatitis B and C infections, and alcohol-related liver disease. The epidemiology of CLD has shifted over the last decade due to effective antiviral regimens and an increased prevalence of NAFLD, resulting from the global obesity epidemic.
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MR Elastography (MRE) for Fibrosis Detection
For fibrosis detection and staging, MR elastography (MRE) is now routinely performed in many radiology practices. In most centers, MRE is combined with MRI-based fat and iron quantification to provide a comprehensive liver biomarker panel. Dedicated liver US shear wave elastography (SWE) and fat quantification can be easily added to a standard abdominal US examination. The greater availability and lower equipment cost of US compared with MRI makes US more convenient in routine clinical care.
MRE Setup and Procedure
MRE can be performed by adding hardware and software to existing or new 1.5-T and 3-T MRI scanners. The clinical liver MRE setup consists of an active driver placed outside the MRI scanner room connected to a passive driver via a plastic tube through a waveguide in the wall. The passive driver is placed over the right hepatic lobe using the midclavicular line and xiphisternum as landmarks and held in place with an elastic strap.
It is generally recommended that all acquisitions are performed with the patient at end expiration to ensure reproducible positioning of the diaphragm and liver. The passive driver delivers acoustic vibrations produced by the active driver and creates propagating shear waves that are imaged with the MRE sequence.
MRE Quality Control
Each MRE sequence performed must be reviewed for quality to ensure that any liver stiffness measurement (LSM) obtained will be valid and for troubleshooting. All liver MREs should be obtained at a fixed 60-Hz frequency, which is standardized across all scanners and field strengths.
A good-quality MRE examination has the following features:
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- Signal void in the abdominal wall
- Sections obtained through the mid liver
- Good shear wave propagation in the liver
- A large region of liver parenchyma available for LSM
For the most accurate LSM, the goal is to obtain high-quality elastograms with a large amount of liver parenchyma uncovered by the 95% confidence map available to make the LSM. However, occasionally elastograms are low quality, with only a small amount of liver available for LSM, or nondiagnostic, with no liver parenchyma available for measurement.
MRE Measurement Technique
Before LSM is performed, the wave images and color elastograms should be evaluated visually to determine if an elastogram likely depicts normal or elevated liver stiffness (LS). Normal livers typically have thin waves that are attenuated (darken) as they move toward the central portion of the liver and display blue or violet liver parenchyma on color elastograms. With elevated LS, wave images demonstrate thicker waves that are unattenuated, while color elastograms depict liver parenchyma in green through red.
When making the LSM, each elastogram is evaluated for ROI placement. ROI measurements can be performed manually or by using automated techniques. Manual ROI measurements can be performed at the MRI scanner, on a picture archiving and communication system (PACS), or on an independent workstation. ROI measurements should be made by using a freehand ROI tool, sampling the largest portion of liver on each elastogram.
When making ROI measurements, the following general principles apply:
- On magnitude images, which are best for evaluating liver anatomy, areas within 1 cm of the liver edge, large vessels, extrahepatic tissues, fissures, masses, and gallbladder fossa should be avoided.
- On wave images, areas with wave distortion, low-amplitude waves, and poor wave propagation should be avoided.
- On elastogram images, crosshatched regions on the 95% confidence map should be excluded.
- Liver “hot spots,” which usually result from shear wave interference, reflect artifact rather than actual stiffness and should be avoided.
For analysis of liver MRE examinations, ROIs are drawn on each image, and the mean LSMs (m) in kilopascals are recorded. The areas (a) of the ROIs are also recorded. The measurements are combined into an overall mean LSM. This can be done by calculating a simple average of the mean stiffness values on each image. However, calculating the weighted mean (ie, weighted arithmetic mean) corrects for the different sizes of the ROIs on each image and will avoid potential measurement bias if some ROIs are much smaller than others.
Weight Loss Tips
While the provided text focuses on liver health and imaging techniques, here are some general, evidence-based weight loss tips:
Balanced Diet: Focus on a diet rich in fruits, vegetables, lean proteins, and whole grains.
Portion Control: Be mindful of portion sizes to avoid overeating.
Regular Exercise: Aim for at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic activity per week, along with strength training exercises.
Hydration: Drink plenty of water throughout the day.
Limit Processed Foods: Reduce your intake of processed foods, sugary drinks, and unhealthy fats.
Mindful Eating: Pay attention to your body's hunger and fullness cues.
Sufficient Sleep: Aim for 7-9 hours of quality sleep per night.
Stress Management: Practice stress-reducing techniques like meditation or yoga.
Consult Professionals: Seek guidance from healthcare professionals or registered dietitians for personalized advice.