Fatty Liver on MRI: Results & Risks (USA)

Magnetic Resonance Imaging (MRI), a non-invasive diagnostic tool, plays a crucial role in the assessment of hepatic steatosis, commonly known as fatty liver, with many medical facilities across the United States (USA) now utilizing advanced MRI techniques to improve diagnostic accuracy. Radiologists, specialists in interpreting medical images, analyze MRI scans to identify and quantify the presence of fat within the liver, helping differentiate between varying degrees of fatty liver disease. The American Association for the Study of Liver Diseases (AASLD) provides guidelines for the diagnosis and management of this condition, emphasizing the importance of early detection through methods like fatty liver on MRI to mitigate potential risks. The results obtained from an MRI, including the Proton Density Fat Fraction (PDFF), are essential for determining the severity of steatosis and guiding subsequent treatment strategies.

Fatty Liver Disease: A Looming Public Health Challenge

Fatty Liver Disease (FLD) is increasingly recognized as a significant and growing public health concern. It's not a single disease, but rather an umbrella term that encompasses a spectrum of liver conditions characterized by the accumulation of excess fat in the liver.

This broad category primarily includes Non-Alcoholic Fatty Liver Disease (NAFLD) and Alcoholic Fatty Liver Disease (AFLD), each with distinct causes but potentially overlapping consequences.

Understanding the Scope of the Problem

NAFLD, as the name suggests, develops in individuals who do not consume excessive amounts of alcohol. AFLD, conversely, is directly linked to chronic and excessive alcohol consumption.

While the causes differ, both conditions can lead to serious liver damage if left unmanaged.

The Rising Tide of FLD: A Call to Action

The prevalence of FLD is alarmingly high and continues to rise globally. Factors contributing to this increase include:

• The obesity epidemic
• The rise in type 2 diabetes
• Sedentary lifestyles
• Poor dietary habits

This escalating prevalence necessitates a proactive approach focused on early detection and intervention.

Why Early Detection Matters

Early stages of FLD are often asymptomatic, meaning individuals may not experience any noticeable symptoms. This makes early detection through screening and awareness programs crucial.

Without timely intervention, FLD can progress to more severe liver conditions such as:

• Non-Alcoholic Steatohepatitis (NASH)
• Fibrosis
• Cirrhosis
• Hepatocellular carcinoma (liver cancer)

These advanced stages can lead to liver failure, the need for liver transplantation, and increased mortality. Therefore, early detection and intervention are paramount in preventing the progression of FLD and improving patient outcomes.

Understanding the FLD Spectrum: NAFLD, NASH, and AFLD

The landscape of Fatty Liver Disease (FLD) is complex, marked by varied etiologies and disease trajectories. Differentiating between the subtypes—Non-Alcoholic Fatty Liver Disease (NAFLD), Non-Alcoholic Steatohepatitis (NASH), and Alcoholic Fatty Liver Disease (AFLD)—is crucial for targeted management and improved patient outcomes. This section aims to clarify these distinctions, highlighting the underlying mechanisms and potential consequences of each condition.

NAFLD: The Metabolic Culprit

NAFLD is characterized by the accumulation of excess fat in the liver of individuals who consume little to no alcohol. While seemingly benign in its initial stages, NAFLD is often a manifestation of underlying metabolic dysfunction.

It is strongly associated with Metabolic Syndrome, a cluster of conditions that include obesity, type 2 diabetes, high cholesterol, high triglycerides, and hypertension. The convergence of these factors creates a perfect storm, disrupting lipid metabolism and promoting hepatic steatosis.

The Progression to NASH

A critical aspect of NAFLD is its potential to progress to NASH. While simple steatosis may remain relatively stable, the development of inflammation transforms the disease into a more aggressive form. This progression is driven by various factors, including oxidative stress, insulin resistance, and the release of inflammatory cytokines.

NASH: Inflammation and the Threat of Fibrosis

NASH is defined by the presence of steatohepatitis, which is inflammation in addition to fat accumulation. This inflammatory process is a key determinant of disease severity, as it triggers hepatocyte damage and initiates the fibrotic cascade.

The chronic inflammation in NASH leads to the deposition of collagen and other extracellular matrix components, resulting in fibrosis, or scarring of the liver. This fibrosis is a critical turning point, as it can ultimately lead to cirrhosis, a severe and irreversible form of liver damage. Cirrhosis significantly increases the risk of liver failure and hepatocellular carcinoma (HCC).

AFLD: The Impact of Alcohol Abuse

AFLD is caused by excessive alcohol consumption. The liver metabolizes alcohol, and in doing so, generates toxic byproducts that damage hepatocytes and promote inflammation.

The Parallels with NAFLD

AFLD shares several similarities with NAFLD in terms of its progression. Like NAFLD, AFLD can start with simple steatosis and progress to steatohepatitis, fibrosis, and cirrhosis. However, the underlying cause is different. AFLD can be effectively treated by stopping alcohol consumption and thus improving or even stopping progression.

Continued alcohol abuse accelerates the progression of AFLD, increasing the risk of severe liver damage and related complications. Abstinence from alcohol is crucial for halting disease progression and improving patient outcomes.

From Steatosis to Cirrhosis: Mapping the Progression of FLD

The landscape of Fatty Liver Disease (FLD) is complex, marked by varied etiologies and disease trajectories. Differentiating between the subtypes—Non-Alcoholic Fatty Liver Disease (NAFLD), Non-Alcoholic Steatohepatitis (NASH), and Alcoholic Fatty Liver Disease (AFLD)—is crucial for targeted management. Central to understanding FLD is appreciating its stepwise progression, a continuum spanning from initial fat accumulation to irreversible liver failure and its dire consequences.

Hepatic Steatosis: The First Domino

Hepatic steatosis, characterized by the excessive accumulation of fat within liver cells (hepatocytes), represents the initial stage in both NAFLD and AFLD. This seemingly benign condition sets the stage for more severe liver damage.

While the liver normally contains some fat, steatosis is defined as fat comprising more than 5% of the liver's weight. This excess fat disrupts normal liver function.

Several factors can trigger steatosis, including insulin resistance, dietary imbalances, and alcohol abuse. The exact mechanisms are still under investigation.

Fibrosis: The Scarring Process

If the underlying causes of steatosis are not addressed, the liver initiates a repair process that leads to fibrosis, the formation of scar tissue. Fibrosis is the liver's attempt to heal itself from chronic injury.

However, this scarring progressively impairs liver function. Fibrosis can develop directly from steatosis, or, more commonly, from steatohepatitis (inflammation associated with fat accumulation).

The progression of fibrosis is not linear and can be influenced by a multitude of factors, including genetics, lifestyle, and the presence of other medical conditions. Monitoring fibrosis progression is crucial in FLD management.

Cirrhosis: The Point of No Return?

Cirrhosis represents the end-stage of chronic liver disease. It involves extensive scarring that distorts the liver's normal architecture, hindering its ability to function properly.

The liver becomes nodular and hardened, impeding blood flow and leading to a cascade of complications. Once cirrhosis develops, the damage is often irreversible.

Cirrhosis significantly increases the risk of liver failure and hepatocellular carcinoma (HCC), a type of liver cancer. While a liver transplant can be a life-saving option in some cases, it is not a cure, and many patients may not be eligible.

Hepatocellular Carcinoma (HCC)

Hepatocellular carcinoma is the most common type of primary liver cancer. It often arises in the context of cirrhosis.

The risk of HCC increases exponentially with the severity of underlying liver disease. Regular screening for HCC is recommended in individuals with cirrhosis.

Early detection and treatment can improve outcomes. However, HCC is often diagnosed at an advanced stage, making treatment challenging.

Understanding the progression from steatosis to cirrhosis is crucial for early detection and timely intervention. Lifestyle modifications and medical management can slow or even halt the progression of FLD, preventing the development of irreversible liver damage and improving patient outcomes.

Diagnosing FLD: A Multi-Modal Approach

From Steatosis to Cirrhosis: Mapping the Progression of FLD The landscape of Fatty Liver Disease (FLD) is complex, marked by varied etiologies and disease trajectories. Differentiating between the subtypes—Non-Alcoholic Fatty Liver Disease (NAFLD), Non-Alcoholic Steatohepatitis (NASH), and Alcoholic Fatty Liver Disease (AFLD)—is crucial for targeted management. Accurate diagnosis is the cornerstone of effective intervention, requiring a sophisticated, multi-modal approach. This involves a combination of laboratory tests, advanced imaging techniques, and, in some cases, invasive procedures to fully characterize the extent and severity of liver damage.

The Role and Limitations of Liver Function Tests (LFTs)

Liver Function Tests (LFTs) are often the first step in evaluating liver health. These blood tests measure the levels of various liver enzymes, such as Alanine Aminotransferase (ALT) and Aspartate Aminotransferase (AST), as well as bilirubin and albumin.

Elevated levels can indicate liver damage or inflammation. However, it’s critical to understand the limitations of LFTs.

Many individuals with early-stage FLD may have normal LFTs, highlighting the need for more sensitive diagnostic tools.

LFTs can also be elevated due to a variety of other conditions unrelated to FLD, necessitating further investigation. They provide a preliminary assessment but cannot definitively diagnose or stage FLD.

Advanced Imaging: MRI as a Key Modality

Magnetic Resonance Imaging (MRI) has emerged as a powerful non-invasive tool for diagnosing and assessing FLD. MRI offers several advantages, including the ability to quantify liver fat content, detect inflammation, and evaluate the degree of fibrosis.

Quantifying Liver Fat: MRI-PDFF

MRI Proton Density Fat Fraction (MRI-PDFF) is considered the gold standard for non-invasive quantification of liver fat. This technique provides a precise measurement of the percentage of fat within the liver, enabling clinicians to accurately diagnose hepatic steatosis, even in mild cases.

The non-invasive nature of MRI-PDFF makes it ideal for monitoring disease progression and treatment response over time.

Assessing Inflammation and Fibrosis

Beyond fat quantification, MRI can also provide information about inflammation and fibrosis.

Chemical Shift Imaging (CSI) can detect changes associated with inflammation.

Elastography techniques, performed as part of the MRI exam (MR Elastography), can assess liver stiffness, which correlates with the degree of fibrosis.

Lesion Evaluation with Contrast-Enhanced MRI

Contrast-enhanced MRI is valuable for evaluating any focal lesions that may be present in the liver. This technique involves injecting a contrast agent intravenously, which enhances the visibility of tumors or other abnormalities.

It is especially useful in screening for Hepatocellular Carcinoma (HCC) in patients with cirrhosis.

Elastography: Assessing Liver Stiffness

Elastography is a non-invasive technique used to assess liver stiffness, which is a surrogate marker for fibrosis.

MR Elastography is performed using MRI and provides a quantitative assessment of liver stiffness. Shear Wave Elastography can be performed using ultrasound and offers a more readily accessible alternative.

Both techniques are valuable for staging fibrosis and monitoring disease progression.

Liver Biopsy: The Gold Standard and Its Limitations

Liver biopsy remains the gold standard for diagnosing and staging liver disease.

This invasive procedure involves obtaining a small sample of liver tissue for microscopic examination.

Biopsy allows for direct assessment of steatosis, inflammation, and fibrosis, as well as the identification of other potential causes of liver disease.

However, liver biopsy is not without its limitations. It is an invasive procedure associated with risks such as bleeding, infection, and pain. Sampling error can also occur, as the biopsy may not be representative of the entire liver.

Due to its invasiveness and risks, liver biopsy is typically reserved for cases where non-invasive tests are inconclusive or when a definitive diagnosis is needed to guide treatment decisions.

In conclusion, the diagnosis of FLD requires a comprehensive approach, integrating clinical assessment, laboratory tests, and advanced imaging techniques. Each modality plays a crucial role in accurately diagnosing and staging the disease, ultimately guiding appropriate management strategies.

Diagnosing FLD: A Multi-Modal Approach From Steatosis to Cirrhosis: Mapping the Progression of FLD

The landscape of Fatty Liver Disease (FLD) is complex, marked by varied etiologies and disease trajectories. Differentiating between the subtypes—Non-Alcoholic Fatty Liver Disease (NAFLD), Non-Alcoholic Steatohepatitis (NASH), and Alcoholic Fatty Liver Disease (AFLD)—is crucial for tailoring effective management and treatment strategies. Here, we delve into the established and emerging approaches to mitigate FLD progression and improve patient outcomes.

Management and Treatment Strategies for FLD

The cornerstone of FLD management rests on a multifaceted approach, prioritizing lifestyle modifications, pharmacotherapy for associated conditions, and in advanced cases, considering liver transplantation. Effective strategies depend heavily on the stage and etiology of the disease, necessitating individualized treatment plans.

Lifestyle Modifications: The Primary Intervention

Lifestyle adjustments, particularly dietary changes and regular exercise, form the bedrock of FLD treatment, especially for NAFLD. These interventions directly address the underlying metabolic dysfunction driving fat accumulation in the liver.

Dietary Interventions

Dietary recommendations emphasize a balanced, calorie-controlled diet rich in fruits, vegetables, and whole grains. Limiting the intake of processed foods, sugary beverages, and saturated fats is paramount.

The Mediterranean diet, with its emphasis on healthy fats, lean protein, and complex carbohydrates, is frequently recommended due to its proven benefits in improving metabolic profiles and reducing liver fat.

The Role of Registered Dietitians (RDs)

Registered Dietitians (RDs) play a crucial role in translating general dietary guidelines into personalized meal plans that align with individual needs and preferences.

RDs can provide ongoing support and education, helping patients navigate dietary changes and maintain long-term adherence. Their expertise ensures that nutritional interventions are both effective and sustainable.

Exercise and Physical Activity

Regular physical activity complements dietary changes, enhancing weight loss and improving insulin sensitivity.

Both aerobic exercise and resistance training have demonstrated benefits in reducing liver fat and improving overall metabolic health.

Aim for at least 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous-intensity exercise per week, combined with strength training exercises targeting all major muscle groups.

Pharmacological Interventions: Addressing Underlying Conditions

While no specific medications are universally approved for directly treating NAFLD, pharmacotherapy plays a vital role in managing associated conditions that contribute to FLD progression.

Managing Type 2 Diabetes

Effective control of blood sugar levels is crucial for patients with NAFLD and Type 2 Diabetes.

Medications like metformin, SGLT2 inhibitors, and GLP-1 receptor agonists can improve insulin sensitivity, reduce hepatic steatosis, and mitigate liver inflammation.

Addressing Hyperlipidemia

Hyperlipidemia, characterized by elevated cholesterol and triglyceride levels, is a common comorbidity in NAFLD.

Statins, fibrates, and other lipid-lowering agents can help reduce cardiovascular risk and potentially improve liver health by reducing fat accumulation and inflammation.

Advanced Interventions: Liver Transplantation

In cases of advanced cirrhosis and liver failure resulting from FLD, liver transplantation may be the only viable treatment option.

Considerations for Transplantation

Liver transplantation is a complex and resource-intensive procedure, reserved for patients with end-stage liver disease who meet specific eligibility criteria.

Patients undergoing liver transplantation require lifelong immunosuppression to prevent organ rejection, which carries its own set of risks and potential complications.

The Future of FLD Therapies

While lifestyle modifications and management of comorbidities remain the primary strategies, ongoing research is exploring novel therapeutic targets for FLD.

Emerging therapies, including FXR agonists, PPAR agonists, and antifibrotic agents, hold promise for directly targeting liver inflammation, fibrosis, and steatosis.

The Collaborative Care Team: Medical Professionals Involved in FLD Management

The landscape of Fatty Liver Disease (FLD) is complex, marked by varied etiologies and disease trajectories. Differentiating between the subtypes—Non-Alcoholic Fatty Liver Disease (NAFLD), Non-Alcoholic Steatohepatitis (NASH), and Alcoholic Fatty Liver Disease (AFLD)—necessitates a multidisciplinary approach. This collaborative effort involves a diverse team of medical professionals, each contributing unique expertise to the diagnosis, treatment, and ongoing management of FLD. Understanding the roles of these specialists is crucial for both patients and healthcare providers.

Radiologists: Interpreting the Visual Narrative

Radiologists play a pivotal role in the diagnostic pathway of FLD. Their expertise lies in the interpretation of medical images, particularly those obtained through Magnetic Resonance Imaging (MRI). MRI scans are instrumental in quantifying liver fat, assessing inflammation, and detecting fibrosis, key indicators of FLD progression.

Specifically, radiologists analyze MRI sequences like MRI-PDFF (Proton Density Fat Fraction) to precisely measure the fat content within the liver. They also evaluate for the presence of steatohepatitis using specific imaging features.

Furthermore, they assess the degree of fibrosis using non-invasive techniques like MR Elastography, which measures liver stiffness. Their detailed reports provide crucial information that guides treatment decisions.

Hepatologists and Gastroenterologists: The Specialists

Hepatologists are specialists dedicated to the study and treatment of liver diseases. They possess in-depth knowledge of the pathophysiology of FLD, enabling them to develop comprehensive management plans tailored to individual patient needs. Hepatologists often manage complex cases of NASH and cirrhosis.

Gastroenterologists, while focusing on the entire digestive system, also possess significant expertise in liver disorders. They are often involved in the initial diagnosis and management of FLD, particularly in cases where the disease is less advanced. They can also perform liver biopsies when needed for definitive diagnosis and staging.

Both hepatologists and gastroenterologists may collaborate with other specialists, such as endocrinologists (for managing diabetes) and cardiologists (for managing cardiovascular risk factors), to address the multifaceted aspects of FLD.

Primary Care Physicians: The First Point of Contact

Primary Care Physicians (PCPs) are often the first point of contact for patients experiencing symptoms or risk factors associated with FLD. PCPs play a crucial role in screening for FLD, particularly in individuals with obesity, type 2 diabetes, or metabolic syndrome.

They can order initial liver function tests (LFTs) and imaging studies to assess liver health. If abnormalities are detected, they refer patients to specialists such as hepatologists or gastroenterologists for further evaluation and management.

PCPs also play a vital role in educating patients about lifestyle modifications, including diet and exercise, which are foundational to FLD management.

MRI Technologists: The Operators

MRI technologists are essential members of the healthcare team, responsible for operating the sophisticated MRI equipment. They ensure the acquisition of high-quality images that are crucial for accurate diagnosis.

Their expertise in positioning patients, optimizing imaging parameters, and ensuring patient safety is paramount. MRI technologists work closely with radiologists to ensure that the appropriate imaging protocols are followed, and the images obtained are of diagnostic quality.

The Importance of Interdisciplinary Communication

Effective management of FLD requires seamless communication and collaboration among all members of the healthcare team. Regular communication ensures that treatment plans are coordinated, and patients receive consistent and comprehensive care. This interdisciplinary approach optimizes patient outcomes and improves the overall management of FLD.

Screening and Prevention: Taking Proactive Steps Against FLD

The landscape of Fatty Liver Disease (FLD) is complex, marked by varied etiologies and disease trajectories. Differentiating between the subtypes—Non-Alcoholic Fatty Liver Disease (NAFLD), Non-Alcoholic Steatohepatitis (NASH), and Alcoholic Fatty Liver Disease (AFLD)—necessitates careful assessment of risk factors, lifestyle considerations, and clinical indicators. This section emphasizes the critical role of proactive screening and preventative measures in mitigating the impact of FLD.

The Imperative of Screening

For individuals harboring specific risk factors, screening for FLD is not merely advisable; it is imperative. Obesity, particularly central adiposity, and Type 2 Diabetes Mellitus are strongly associated with NAFLD and its progression to NASH.

Early detection allows for timely interventions, potentially halting or reversing disease progression before irreversible damage occurs. Screening protocols should be tailored to individual risk profiles, incorporating a combination of non-invasive assessments and, when necessary, more definitive diagnostic procedures.

Who Should Be Screened?

While universal screening for FLD in the general population is not currently recommended, certain high-risk groups warrant prioritized attention. These include:

• Individuals with Obesity or Metabolic Syndrome: Given the strong correlation between metabolic dysfunction and NAFLD, screening is essential.
• Patients with Type 2 Diabetes: Diabetes significantly elevates the risk of NAFLD and accelerates its progression to NASH and cirrhosis.
• Individuals with Elevated Liver Enzymes: Persistent elevations in alanine aminotransferase (ALT) or aspartate aminotransferase (AST) should prompt further investigation for underlying liver disease, including FLD.
• Those with a Family History of Liver Disease: Genetic predisposition can play a role in FLD development.

Preventative Measures: A Multifaceted Approach

Prevention of FLD hinges on a holistic approach encompassing lifestyle modifications and targeted interventions.

Dietary Modifications

A cornerstone of FLD prevention is adopting a balanced, liver-friendly diet. This involves:

• Limiting intake of saturated and trans fats.
• Reducing consumption of processed foods and sugary beverages.
• Increasing fiber intake through fruits, vegetables, and whole grains.
• Prioritizing lean protein sources.

Regular Physical Activity

Engaging in regular physical activity is crucial for improving insulin sensitivity, reducing liver fat, and promoting overall metabolic health. Aim for at least 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous-intensity exercise per week.

Weight Management

For individuals who are overweight or obese, even modest weight loss (5-10% of body weight) can significantly reduce liver fat and improve liver function.

Moderation of Alcohol Consumption

For AFLD prevention, strict abstinence from alcohol is paramount. Even moderate alcohol consumption can exacerbate liver damage in individuals with pre-existing liver conditions.

Managing Underlying Conditions

Effective management of underlying conditions such as Type 2 Diabetes, hyperlipidemia, and hypertension is essential for preventing and controlling FLD. Adherence to prescribed medications and lifestyle modifications is crucial.

The Role of Education

Public awareness campaigns and educational initiatives play a vital role in promoting FLD prevention. Empowering individuals with knowledge about risk factors, preventative strategies, and the importance of early detection can drive positive behavior change and reduce the burden of FLD.

Resources and Support: Relevant Organizations for FLD

The landscape of Fatty Liver Disease (FLD) is complex, marked by varied etiologies and disease trajectories. Differentiating between the subtypes—Non-Alcoholic Fatty Liver Disease (NAFLD), Non-Alcoholic Steatohepatitis (NASH), and Alcoholic Fatty Liver Disease (AFLD)—necessitates careful attention to diagnostic criteria and a nuanced understanding of disease progression. This complexity underscores the vital importance of readily accessible, reliable resources and robust support networks for both patients and healthcare professionals navigating the challenges of FLD.

Key Professional Organizations

Several prominent organizations play a crucial role in advancing research, education, and clinical practice related to liver diseases, including FLD.

The American Association for the Study of Liver Diseases (AASLD)

The AASLD stands as a leading authority in hepatology, providing a wealth of resources for professionals and patients alike. Its mission centers on preventing and curing liver disease, reflected in its comprehensive research initiatives, evidence-based guidelines, and educational programs. AASLD’s publications, including its flagship journal, Hepatology, are invaluable for staying abreast of the latest advancements in FLD management.

The American Gastroenterological Association (AGA)

While encompassing a broader scope of digestive disorders, the AGA recognizes the significance of liver health. The AGA contributes substantially to FLD research, offers continuing medical education opportunities for gastroenterologists, and publishes influential clinical guidelines. Their journal, Gastroenterology, frequently features articles on FLD, providing insights into its pathogenesis, diagnosis, and treatment.

The American Liver Foundation (ALF)

The ALF distinguishes itself through its unwavering commitment to patient advocacy and public awareness. Through educational campaigns, support groups, and resource centers, the ALF empowers individuals affected by liver diseases to navigate their condition and connect with others facing similar challenges. The ALF is an exceptional resource for patients seeking information and emotional support.

Navigating the Resource Landscape: A Critical Perspective

While these organizations offer invaluable resources, it's crucial to approach information critically. Always verify the credibility of sources, particularly when seeking health advice online. Consider the following points:

• Evidence-Based Information: Prioritize information grounded in scientific evidence and peer-reviewed research. Be wary of unsubstantiated claims or anecdotal evidence.

• Expert Consultation: Information obtained online or from support groups should supplement, not replace, consultation with qualified healthcare professionals.

• Individualized Approach: Remember that FLD management is highly individualized. The best course of action should be determined in consultation with your physician, taking into account your specific circumstances and health history.

The Value of Support Networks

Beyond professional organizations, informal support networks can provide crucial emotional and practical assistance. Patient support groups, both online and in-person, offer a safe space to share experiences, ask questions, and connect with others who understand the challenges of living with FLD. These networks can foster a sense of community and empower individuals to actively participate in their care.

Accessing reliable resources and leveraging supportive networks is essential for effectively managing FLD. By empowering patients and healthcare professionals with knowledge and support, we can collectively work towards improved outcomes and a better quality of life for those affected by this increasingly prevalent condition.

So, that's the lowdown on fatty liver on MRI! Hopefully, this has helped clear up any questions you had about what to expect from the scan, what the results might mean, and what potential (though usually minimal) risks are involved. If you're still concerned or have more personalized questions, definitely chat with your doctor – they're the best resource for your specific health situation.