Looking for A “Silver Lining” - MRI Elastography

[LeiL]

I know I should be okay with these results but I’m not and I’m also not insensitive to the many that have much worst findings. But I just keep looking at the future and I don’t see a light just a dark cloud overcast on the rest of my life.

Being honest, my diet wasn’t the best since my MRE in January but at least my fitness level was strong. I didn’t over consume calories but did increase carbs, sweets, and had the occasional burgers and fries. I’ve been traveling this road since 2014 and wanted a break—-I wanted to be normal. I now know that is never going to happen due to surgical induced hypothyroidism. I think I now have metabolic syndrome with high LDL and a fasting glucose which is “in range” but high for me at 91.

Looking for any thoughts on how I can improve my health.

Study Result

Impression

IMPRESSION:

1. No hepatic fibrosis. Heterogenous liver stiffness, with focal area of mildly increased liver stiffness right hepatic lobe, segment 5, which may represent normal or inflamed liver parenchyma.

2. No hepatic steatosis.

3. No iron deposition in the liver.

Narrative

EXAM: MRI ELASTOGRAPHY

INDICATION: Nonalcoholic steatohepatitis.

Technique: In and Out of phase imaging, axial T2 HASTE fat suppressed, R2 star maps, and gradient echo MR Elastography were performed.

COMPARISON: MRI elastography on 1/6/2021

FINDINGS:

LIVER STIFFNESS (MR ELASTOGRAPHY):

Range of liver stiffness values throughout entire liver: 1.5 to 2.6 kPa.

Average liver stiffness throughout entire liver: 2.0 kPa, which is not compatible with fibrosis.

Are there areas of elevated liver stiffness that are at least the size of one hepatic segment Yes

If yes, describe location and stage of fibrosis: Focal area in segment 5, demonstrating mildly increased stiffness, with average liver stiffness of 2.6 kPa, which may represent normal or inflamed hepatic parenchyma (series 350, image 1).

Reference values:

= 2.5 kPa normal

>2.5-3 kPa normal or inflammation

>3-3.5 kPa stage 1-2 fibrosis

>3.5-4 kPa stage 2-3 fibrosis

>4-5 kPa stage 3-4 fibrosis

> 5 kPa stage 4 to cirrhosis

FAT QUANTIFICATION:

The average liver fat content percentage calculated using a two-point Dixon technique is: 4 %, which is not compatible with fatty liver.

Reference values:

=6% normal (Grade 0)

> 6-26% mild steatosis (Grade 1)

> 26-37% moderate steatosis (Grade 2)

> 37% severe steatosis (Grade 3)

IRON QUANTIFICATION:

The range of R2* values are: 42 to 47 Hz.

The average R2* frequency is 44 Hz, which is not consistent with iron deposition in the liver.

Reference values:

< 88 Hz normal

88 - 263 Hz mild iron deposition

263 - 555 Hz moderate iron deposition

> 555 Hz severe iron deposition

[nash2 Partner]

It's hard to know what to say to someone who has good tests but doesn't accept them. It is scary but it might be worth examining why you distrust your docs so much.

[LeiL in reply to nash2]

It’s the inflammation and knowing that this is for my entire life. Of course I’m grateful there is no fibrosis.

By the way these results track eith LiverFast.

[nash2 Partner]

Good to he aware of the risks and I think you are aware that one of the biggest drivers of inflammation is diet so you do have some tools to work with and time is one your side to manage things.

[Alterity]

Worry causes stress. Just know what your liver can take and what it can't. Your liver will rebel when given to much of a bad thing. You will know it. Try to stay stress free as much as possible. I have lived with it for 20 years at stage 4 when they told me I had 6 years to live. Yes, 99% of my food is chicken, turkey or fish. Once in a while I just have to have a hamburger. I stay away from a lot of carbs as well, but once in a while you just need the sweets and then I leave them alone. My liver usually tells me, enough. I get lots of rest. It is insane but yes sometimes 10 hours. The liver digest so much better at a quiet state. Live your life, but live it differently. My Dr. told me I could have a glass of wine one in a while but not often. I will only have one under stress so I can sleep but to be honest, I don't think I've had a glass in 3 months. when I do, it's only 1. True friends understand. This is a way for you to teach others because 1 out of every 4 have Nash and Don't know it. Be thankful you do, you will live longer than they will. Good Luck. Keep going.

[LeiL in reply to Alterity]

Are you still at Stage 4?