Observational study of clinical outcomes for testosterone treatment of pubertal delay in Duchenne muscular dystrophy.

BACKGROUND: Adolescents with DMD treated with chronic high dose GC therapy typically have profound pubertal delay. Testosterone, the main circulating androgen in men, promotes virilisation and growth with associated accrual of fat-free muscle mass and bone mineral content. Testosterone therapy is routinely used to mimic the normal stages of pubertal development in patients with hypogonadotrophic hypogonadism, androgen deficiency secondary to testicular disease and in constitutional delay of growth and puberty (CDGP). Improved life expectancy in DMD has meant that more adolescents are eligible for testosterone supplementation but there is little objective data regarding the impact of this treatment on muscle structure and function, bone integrity and overall well-being. METHODS: This is a single centre observational clinical trial (NCT02571205) that aims to follow the progress of 15 adolescents with Duchenne muscular dystrophy and delayed puberty as they are managed with incremental testosterone therapy to induce puberty. Subjects will all be treated with a steadily increasing dose of testosterone administered by injection every 4 weeks and data will be collected to help us determine the effectiveness and tolerability of the described treatment regimen. We will use the data to explore the effects of testosterone on pubertal development, growth, muscle strength and function, bone mineral density, body composition with a detailed record of any adverse events. We will also carry out interviews to explore the boys' views on the tolerability of the regimen. The study will last for 27 months in total for each participant. DISCUSSION: Our experience has indicated that testosterone treatment in adolescents with DMD is liked and well tolerated but we have not collected objective data on a specific treatment regimen and there is no current consensus. Testosterone supplementation is not part of the standard of care of pubertal delay in DMD but inclusion in future protocols may be appropriate depending on the results of this trial. TRIAL REGISTRATION: EudraCT Number: 2015-003195-68. Research Registry & References: Clinical trials.gov- NCT02571205 (registered 8/10/15).

Calorie restriction and not glucagon-like peptide-1 explains the acute improvement in glucose control after gastric bypass in Type 2 diabetes.

AIMS: To compare directly the impact of glucagon-like peptide-1 secretion on glucose metabolism in individuals with Type 2 diabetes listed for Roux-en-Y gastric bypass surgery, randomized to be studied before and 7 days after undergoing Roux-en-Y gastric bypass or after following a very-low-calorie diet. METHODS: A semi-solid meal test was used to investigate glucose, insulin and glucagon-like peptide-1 response. Insulin secretion in response to intravenous glucose and arginine stimulus was measured. Hepatic and pancreatic fat content was quantified using magnetic resonance imaging. RESULTS: The decrease in fat mass was almost identical in the Roux-en-Y gastric bypass and the very-low-calorie diet groups (3.0±0.3 and 3.0±0.7kg). The early rise in plasma glucose level and in acute insulin secretion were greater after Roux-en-Y gastric bypass than after a very-low-calorie diet; however, the early rise in glucagon-like peptide-1 was disproportionately greater (sevenfold) after Roux-en-Y gastric bypass than after a very-low-calorie diet. This did not translate into a greater improvement in fasting glucose level or area under the curve for glucose. The reduction in liver fat was greater after Roux-en-Y gastric bypass (29.8±3.7 vs 18.6±4.0%) and the relationships between weight loss and reduction in liver fat differed between the Roux-en-Y gastric bypass group and the very-low-calorie diet group. CONCLUSIONS: This study shows that gastroenterostomy increases the rate of nutrient absorption, bringing about a commensurately rapid rise in insulin level; however, there was no association with the large post-meal rise in glucagon-like peptide-1, and post-meal glucose homeostasis was similar in the Roux-en-Y gastric bypass and very-low-calorie diet groups. (Clinical trials registry number: ISRCTN11969319.).

Interfacial tension measurements using MRI drop shape analysis.

Accurate interfacial tension data for fluid systems such as hydrocarbons and water is essential to many applications such as reservoir oil and gas recovery predictions. Conventional interfacial tension measurement techniques typically use optical images to analyze droplet shapes but require that the continuous-phase fluid be optically transparent and that the fluids are not refractive index matched. Magnetic resonance images obtain contrast between fluids using other mechanisms such as magnetic relaxation weighting, so systems that are impossible to measure with optical methods may be analyzed. In this article, we present high-field (9.4 T) MRI images of various droplets analyzed with axisymmetric drop shape analysis. The resultant interfacial tension data show good agreement with literature data. The method is subsequently demonstrated using both opaque continuous phases and refractive-index-matched fluids. We conclude with a brief consideration of the potential to extrapolate the methodology to lower magnetic fields (0.3 T), featuring more accessible hardware; although droplet imaging is possible, resolution and stability do not currently permit accurate interfacial tension measurements.

Impaired cardiac function in chronic fatigue syndrome measured using magnetic resonance cardiac tagging.

OBJECTIVES: Impaired cardiac function has been confirmed in patients with chronic fatigue syndrome (CFS). Magnetic resonance cardiac tagging is a novel technique that assesses myocardial wall function in vivo. We hypothesized that patients with CFS may have impaired development and release of myocardial torsion and strain. METHODS: Cardiac morphology and function were assessed using magnetic resonance imaging and cardiac tagging methodology in 12 CFS patients (Fukuda) and 10 matched controls. RESULTS: Compared to controls, the CFS group had substantially reduced left ventricular mass (reduced by 23%), end-diastolic volume (30%), stroke volume (29%) and cardiac output (25%). Residual torsion at 150% of the end-systolic time was found to be significantly higher in the patients with CFS (5.3 ± 1.6°) compared to the control group (1.7 ± 0.7°, P = 0.0001). End-diastolic volume index correlated negatively with both torsion-to-endocardial-strain ratio (TSR) (r = -0.65, P = 0.02) and the residual torsion at 150% end-systolic time (r = -0.76, P = 0.004), so decreased end-diastolic volume is associated with raised TSR and torsion persisting longer into diastole. Reduced end-diastolic volume index also correlated significantly with increased radial thickening (r = -0.65, P = 0.03) and impaired diastolic function represented by the ratio of early to late ventricular filling velocity (E/A ratio, r = 0.71, P = 0.009) and early filling percentage (r = 0.73, P = 0.008). CONCLUSION: Patients with CFS have markedly reduced cardiac mass and blood pool volumes, particularly end-diastolic volume: this results in significant impairments in stroke volume and cardiac output compared to controls. The CFS group appeared to have a delay in the release of torsion.

Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol.

AIMS/HYPOTHESIS: Type 2 diabetes is regarded as inevitably progressive, with irreversible beta cell failure. The hypothesis was tested that both beta cell failure and insulin resistance can be reversed by dietary restriction of energy intake. METHODS: Eleven people with type 2 diabetes (49.5 ± 2.5 years, BMI 33.6 ± 1.2 kg/m(2), nine male and two female) were studied before and after 1, 4 and 8 weeks of a 2.5 MJ (600 kcal)/day diet. Basal hepatic glucose output, hepatic and peripheral insulin sensitivity and beta cell function were measured. Pancreas and liver triacylglycerol content was measured using three-point Dixon magnetic resonance imaging. An age-, sex- and weight-matched group of eight non-diabetic participants was studied. RESULTS: After 1 week of restricted energy intake, fasting plasma glucose normalised in the diabetic group (from 9.2 ± 0.4 to 5.9 ± 0.4 mmol/l; p = 0.003). Insulin suppression of hepatic glucose output improved from 43 ± 4% to 74 ± 5% (p = 0.003 vs baseline; controls 68 ± 5%). Hepatic triacylglycerol content fell from 12.8 ± 2.4% in the diabetic group to 2.9 ± 0.2% by week 8 (p = 0.003). The first-phase insulin response increased during the study period (0.19 ± 0.02 to 0.46 ± 0.07 nmol min(-1) m(-2); p < 0.001) and approached control values (0.62 ± 0.15 nmol min(-1) m(-2); p = 0.42). Maximal insulin response became supranormal at 8 weeks (1.37 ± 0.27 vs controls 1.15 ± 0.18 nmol min(-1) m(-2)). Pancreatic triacylglycerol decreased from 8.0 ± 1.6% to 6.2 ± 1.1% (p = 0.03). CONCLUSIONS/INTERPRETATION: Normalisation of both beta cell function and hepatic insulin sensitivity in type 2 diabetes was achieved by dietary energy restriction alone. This was associated with decreased pancreatic and liver triacylglycerol stores. The abnormalities underlying type 2 diabetes are reversible by reducing dietary energy intake.

Association between cardiac high-energy phosphate metabolism and whole body metabolism in healthy female adults.

Decline in cardiac high-energy phosphate metabolism [phosphocreatine-to-ATP (PCr/ATP) ratio] and whole body metabolism increase the risk of heart failure and metabolic diseases. The aim of the present study was to assess the relationship between PCr/ATP ratio and measures of body metabolic function. A total of 35 healthy women (56+/-14.0 years of age) underwent cardiac 31P magnetic resonance spectroscopy to assess PCr/ATP ratio - an index of cardiac high-energy phosphate metabolism. Fasting and 2-hour glucose levels were assessed using oral glucose tolerance test. Indirect calorimetry was performed to determine oxygen consumption and resting metabolic rate. There were no significant relationships between PCr/ATP ratio and resting metabolic rate (r=-0.09, p=0.62), oxygen consumption (r=-0.11, p=0.54), fasting glucose levels (r=-0.31, p=0.07), and 2-hour plasma glucose (r=-0.10, p=0.58). Adjusted analysis for covariates including age, body mass index, fat mass, and physical activity, had no significant influence on the relationship between PCr/ATP ratio and body metabolism. In conclusion, the lack of relationship between cardiac PCr/ATP ratio, glucose control and metabolic rate may suggest that overall metabolic function does not influence cardiac high-energy phosphate metabolism.

Abnormalities in pH handling by peripheral muscle and potential regulation by the autonomic nervous system in chronic fatigue syndrome.

OBJECTIVES: To examine muscle acid handling following exercise in chronic fatigue syndrome (CFS/ME) and the relationship with autonomic dysfunction. DESIGN: Observational study. SETTING: Regional fatigue service. SUBJECTS & INTERVENTIONS: Chronic fatigue syndrome (n = 16) and age and sex matched normal controls (n = 8) underwent phosphorus magnetic resonance spectroscopy (MRS) to evaluate pH handling during exercise. Subjects performed plantar flexion at fixed 35% load maximum voluntary contraction. Heart rate variability was performed during 10 min supine rest using digital photophlethysmography as a measure of autonomic function. RESULTS: Compared to normal controls, the CFS/ME group had significant suppression of proton efflux both immediately postexercise (CFS: 1.1 +/- 0.5 mmol L(-1) min(-1) vs. normal: 3.6 +/- 1.5 mmol L(-1) min(-1), P < 0.001) and maximally (CFS: 2.7 +/- 3.4 mmol L(-1) min(-1) vs. control: 3.8 +/- 1.6 mmol L(-1) min(-1), P < 0.05). Furthermore, the time taken to reach maximum proton efflux was significantly prolonged in patients (CFS: 25.6 +/- 36.1 s vs. normal: 3.8 +/- 5.2 s, P < 0.05). In controls the rate of maximum proton efflux showed a strong inverse correlation with nadir muscle pH following exercise (r(2) = 0.6; P < 0.01). In CFS patients, in contrast, this significant normal relationship was lost (r(2) = 0.003; P = ns). In normal individuals, the maximum proton efflux following exercise were closely correlated with total heart rate variability (r(2) = 0.7; P = 0.007) this relationship was lost in CFS/ME patients (r(2) < 0.001; P = ns). CONCLUSION: Patients with CFS/ME have abnormalities in recovery of intramuscular pH following standardised exercise degree of which is related to autonomic dysfunction. This study identifies a novel biological abnormality in patients with CFS/ME which is potentially open to modification.

Mitochondrial respiratory chain function and content are preserved in the skeletal muscle of active very old men and women.

INTRODUCTION: The loss of mitochondrial function and content have been implicated in sarcopenia although they have been little studied in the very old, the group in which sarcopenia is most common. In this pilot study, our aim was to determine if mitochondrial respiratory chain function and content are preserved among healthy 85-year-olds. METHODS: We recruited 19 participants (11 female) through their general practitioner and assessed their medical history, functional status and self-reported physical activity. We identified sarcopenia using grip strength, Timed Up-and-Go and bioimpedance analysis. We assessed mitochondrial respiratory chain function using phosphorous magnetic resonance spectroscopy, estimating τ1/2 PCr, the recovery half-time of phosphocreatine in the calf muscles following a bout of aerobic exercise. We performed a biopsy of the vastus lateralis muscle and assessed mitochondrial respiratory chain content by measuring levels of subunits of complex I and IV of the respiratory chain, expressed as Z-scores relative to that in young controls. RESULTS: Participants had a median (IQR) of 2 (1,3) long-term conditions, reported regular aerobic physical activity, and one participant (5.3%) had sarcopenia. Sixteen participants completed the magnetic resonance protocol and the mean (SD) τ1/2 PCr of 35.6 (11.3) seconds was in keeping with preserved mitochondrial function. Seven participants underwent muscle biopsy and the mean fibre Z-scores were -0.7 (0.7) and -0.2 (0.4) for complexes I and IV, respectively, suggesting preserved content of mitochondrial respiratory chain enzymes. CONCLUSION: Muscle mitochondrial respiratory chain function and content are preserved in a sample of active, well-functioning 85-year-olds, among whom sarcopenia was uncommon. The results from this study will help inform future work examining the association between muscle mitochondrial deficiency and sarcopenia.

Droplet migration in emulsion systems measured using MR methods.

The migration of emulsion droplets under shear flow remains a largely unexplored area of study, despite the existence of an extensive literature on the analogous problem of solid particle migration. A novel methodology is presented to track the shear-induced migration of emulsion droplets based on magnetic resonance imaging (MRI). The work is in three parts: first, single droplets of one Newtonian fluid are suspended in a second Newtonian fluid (water in silicone oil (PDMS)) and are tracked as they migrate within a Couette cell; second, the migration of emulsion droplets in Poiseuille flow is considered; third, water-in-silicone oil emulsions are sheared in a Couette cell. The effect of (a) rotational speed of the Couette, (b) the continuous phase viscosity, and (c) the droplet phase concentration are considered. The equilibrium extent of migration and rate of migration increase with rotational speed for two different emulsion systems and increased continuous phase viscosity, leads to a greater equilibrium extent of migration. The relationship between the droplet phase concentration and migration is however complex. These results for semi-concentrated emulsion systems and wide-gap Couette cells are not well described by existing models of emulsion droplet migration.

Spatially resolved emulsion droplet sizing using inverse Abel transforms.

Pulsed field gradient (PFG) nuclear magnetic resonance (NMR) is well established as a tool for determining emulsion droplet-size distributions via measurement of restricted self-diffusion. Most measurements made to date have not been spatially resolved, but have measured an average size distribution for a certain volume of emulsion. This paper demonstrates a rapid method of performing spatially resolved, restricted diffusion measurements, which enables emulsion droplet sizing to be spatially resolved as a function of radius in cylindrical geometries or pipes. This is achieved by the use of an Abel transform. The technique is demonstrated in various annular systems containing two emulsions, with different droplet-size distributions, and/or a pure fluid. It is also shown that by modifying the pulse sequence by the inclusion of flow-compensating magnetic field gradients, the technique can measure spatially resolved droplet-size distributions in flowing emulsions, with potential applications in spatially resolved on-line droplet-size analysis.

Development and application of rotationally compensated RARE.

In this paper we describe a new extension to the RARE rapid imaging technique--ROTACOR--which compensates for constant sample rotational motion by rotating the direction of the gradient coordinate system (read and phase directions) between each refocusing RF pulse and therefore between each acquisition of a line of k-space in the read direction. In the laboratory frame this corresponds to an irregularly sampled k-space raster; for a sample rotating at the predefined rotation rate this will correspond to the sampling of a rectilinear k-space raster. This technique is applied to two rotating systems. First, to demonstrate the technique, a rotating mixing paddle in water is imaged using conventional RARE and then using the ROTACOR sequence, demonstrating the improvement of image quality produced by ROTACOR. Second, ROTACOR is used to image the deformation of water droplets in silicone oil, being sheared in a wide-gap Couette cell. Accurate imaging of the droplet shape as a function of shear rate, permits determination of the interfacial tension between the two fluids concerned; the results compare favourably with reported literature values.

Applications of fast diffusion measurement using Difftrain.

Novel applications of fast self-diffusion measurement are presented. Difftrain (Diffusion train), which uses successive stimulated echoes from a single excitation pulse where a portion of the available magnetisation is recovered for each echo, is used to measure self-diffusion by varying the observation time. It is applied to produce the droplet size distribution of an oil-in-water emulsion in less than 4s. This is verified by comparison with the droplet size distribution produced by a standard pulsed field gradient (PFG) technique. Difftrain is also extended to enable the application of incremental gradients, in addition to varying the observation time. This is used to produce propagators or displacement probabilities of water flowing through a packed bed for a range of 16 observation times in under 10 min. Again verification is provided by acquisition of the same propagators using a conventional PFG technique.

Measurement of emulsion droplet sizes using PFG NMR and regularization methods.

The droplet size distributions of emulsions have been measured using pulsed field gradient (PFG) nuclear magnetic resonance (NMR) for many years. This technique finds particular application with emulsions that are concentrated and/or opaque, since such emulsion systems are difficult to characterize by other methods. Most studies employing PFG techniques assume a lognormal form when extracting the droplet size distribution from the experimental data. It is clearly desirable to retrieve a droplet size distribution from the experimental data without assuming such a functional form. This is achieved for the first time using regularization techniques. Regularization based on the distribution area and on its second derivative are compared and assessed along with the following techniques for selecting the optimal regularization parameter: the L-curve method, generalized cross validation (GCV), and the discrepancy principle. Regularization is applied to both simulated data sets and experimental data. It is found that when the experimental error can be estimated accurately, the discrepancy principle with area regularization is the best approach. When the error is not known the GCV method, with second derivative regularization and allowing only nonnegative values, is most effective.

Fast emulsion droplet sizing using NMR self-diffusion measurements.

Emulsion droplet sizing using pulsed field gradient (PFG) nuclear magnetic resonance (NMR) is a well-established technique. Traditionally these measurements require total acquisition times of typically 5-20 min per sample, which severely limits our ability to use this method to study dynamic processes. Here we present the application and verification of an NMR pulse sequence, Difftrain, which enables emulsion droplet size distributions to be measured in 3-10 s. We have previously introduced applications of Difftrain (C. Buckley, K.G. Hollingsworth, A.J. Sederman, D.J. Holland, M.L. Johns, L.F. Gladden, J. Magn. Reson. 161 (2003) 112-117), including the droplet sizing of a single unimodal emulsion sample. In this paper, several model emulsions containing different oils are measured and the results compared directly with sizing provided by laser scattering. In this manner, the Difftrain method is verified and its possibilities and limitations are explored. Guidelines are proposed for the range of droplet sizes for which accurate results can be produced. The Difftrain technique opens up the possibility of studying non-equilibrium emulsions; a study of the in situ emulsification of a 21% v/v water-in-silicone oil emulsion is presented.

An NMR study of the freezing of emulsion-containing drops.

Various nuclear magnetic resonance (NMR) techniques were used to monitor the freezing behaviour of suspended 2-mm-diameter drops. The drops were composed of hydrocarbon oils emulsified in either water or water/sucrose mixtures. As such they were good model systems for the study of spray freezing, sharing structural similarities with potential products such as ice cream. In particular, simple 1H NMR spectroscopy was used to monitor and individually quantify the freezing or solidification behaviour of the various constituent species of the drops. In addition, the effect of freezing on the emulsion droplet size distribution (and hence emulsion stability) was also measured based on NMR self-diffusion measurements. The effect of freeze/thaw cycling was also similarly studied. The nucleation temperature of the emulsion droplets was found to depend on the emulsion droplet size distribution: the smaller the droplets, the lower the nucleation temperature. Emulsion droplet sizing indicated that oil-in-sucrose-solution emulsions were more stable, showing minimal coalescence, whereas oil-in-water emulsions showed significant coalescence during freezing and freeze/thaw cycling.

Muscle histology vs MRI in Duchenne muscular dystrophy.

OBJECTIVE: There are currently no effective treatments to halt the muscle breakdown in Duchenne muscular dystrophy (DMD), although genetic-based clinical trials are being piloted. Most of these trials have as an endpoint the restoration of dystrophin in muscle fibers, hence requiring sufficiently well-preserved muscle of recruited patients. The choice of the muscles to be studied and the role of noninvasive methods to assess muscle preservation therefore require further evaluation. METHODS: We studied the degree of muscle involvement in the lower leg muscles of 34 patients with DMD >8 years, using muscle MRI. In a subgroup of 15 patients we correlated the muscle MRI findings with the histology of open extensor digitorum brevis (EDB) muscle biopsies. Muscle MRI involvement was assigned using a scale 0-4 (normal-severe). RESULTS: In all patients we documented a gradient of involvement of the lower leg muscles: the posterior compartment (gastrocnemius > soleus) was most severely affected; the anterior compartment (tibialis anterior/posterior, popliteus, extensor digitorum longus) least affected. Muscle MRI showed EDB involvement that correlated with the patient's age (p = 0.055). We show a correlation between the MRI and EDB histopathologic changes, with MRI 3-4 grades associated with a more severe fibro-adipose tissue replacement. The EDB was sufficiently preserved for bulk and signal intensity in 18/22 wheelchair users aged 10-16.6 years. CONCLUSION: This study provides a detailed correlation between muscle histology and MRI changes in DMD and demonstrates the value of this imaging technique as a reliable tool for the selection of muscles in patients recruited into clinical trials.

MR sialography: the effect of a sialogogue and ductal occlusion in volunteers.

MR sialography using heavily T(2) weighted projection techniques relies upon saliva for image contrast, and the visualization of normal ducts is often limited. Methods used to increase the volume of intraductal saliva during imaging in order to improve duct visualization have not been previously evaluated. The effect of a sialogogue and passive ductal occlusion on the ability to visualize the main and intraglandular salivary gland ducts during MR sialography was investigated. Three-dimensional (3D) T(2) weighted MR sialograms were obtained from 12 healthy volunteers with and without the combined use of a sialogogue and passive ductal occlusion pad adjacent to the parotid duct orifice on one side. Two radiologists (in consensus) subjectively evaluated ductal visualization and image artefacts on the resulting blinded maximum intensity projections. The results demonstrate that main duct visualization was significantly improved (p<0.00001) by this technique, with no significant change seen in image artefacts. Although an improvement in intraglandular duct visualization was noted, this was not statistically significant (p = 0.05). Thus, the use of a sialogogue and passive ductal occlusion improves visualization of the main parotid duct in volunteers undergoing MR sialography. Further optimization and evaluation of this approach should lead to improvements in the MR sialography examination of patients.

Influence of perfusion on hepatic MR diffusion measurement.

Percutaneous liver biopsy is the current gold standard for the diagnosis and assessment of hepatic fibrosis: it is an uncomfortable procedure with associated risks of infection and internal bleeding. Diffusion-weighted MRI may be important as a non-invasive measure of the grade of hepatic fibrosis, owing to the morphological and physiological changes in hepatic tissues as fibrosis develops. The factors that influence hepatic diffusion measurements are complex and are thought to include hepatic perfusion. This study assesses whether hepatic diffusion measurements are influenced by hepatic perfusion changes as this could be an important variable when investigating the relationship between diffusion measurements and grade of hepatic fibrosis. Hepatic apparent diffusion coefficients (ADCs) were measured in 10 healthy volunteers after an 8-h fast and 1-h after a standard meal (which increases portal vein flow and hepatic sinusoidal perfusion) using a breath-hold technique at b-values of 750, 500 and 200 s/mm(2). ADC measurements using b = 750 and 500 s/mm(2) in the posterior right lobe were unaffected by the perfusion changes (P = 0.15 and 0.14, respectively) whereas the results from the anterior right lobe significantly increased post-prandially (P = 0.03 and 0.008, respectively): inter-subject variability was low ( approximately 5%) for these b-values. Portal perfusion had a significant effect in both the posterior and anterior segments of the right lobe when using a b-value of 200 s/mm(2) (P = 0.01 and 0.00001 respectively): inter-subject variability was found to be high ( approximately 25%). The most reproducible measurements of the ADC can be made in the posterior right lobe and the effect of perfusion is minimised at the higher b-values (b = 500 and 750 s/mm(2)).

Low-carbohydrate diet induced reduction of hepatic lipid content observed with a rapid non-invasive MRI technique.

Low carbohydrate diets are currently fashionable for inducing weight loss, but the metabolic effects at organ level are not well understood, especially the effect on liver fat storage. Such studies require serial hepatic fat measurements, for which liver biopsy is impractical. In 10 healthy volunteers we demonstrate the use of rapid (total 2 min acquisition time, 10 min magnet room time), non-invasive, quantitative MRI to serially measure hepatic fat changes induced by following a low carbohydrate diet for 10 days. A significant (p<0.01) reduction in hepatic fat after 3 days of dieting was observed in 5 subjects. All subjects demonstrated significant (p<0.01) reductions in hepatic fat by day 10. A strong correlation (kappa = 0.81) existed between the initial fat content and the percentage fat content reduction in the first 3 days of the diet. All subjects lost weight (average 1.7 kg at day 3 and 3.0 kg at day 10), but this was not correlated with hepatic fat loss after 3 days or 10 days of dieting. The results presented illustrate the potential value of MR hepatic fat quantification in longitudinal studies of hepatic fat content.