Accurate simultaneous quantification of liver steatosis and iron overload in diffuse liver diseases with MRI
- 620 Downloads
To evaluate the diagnostic performances of 3 Tesla multi-echo chemical shift-encoded gradient echo magnetic resonance (MECSE-MR) imaging to simultaneously quantify liver steatosis and iron overload in a wide spectrum of diffuse liver diseases having biopsy as reference standard.
MECSE-MR-acquired images were used to calculate fat fraction and iron content in a single breath-hold in 109 adult patients. Proton density fat fraction (PDFF) was prospectively estimated using complex-based data reconstruction with multipeak fat modeling. Water R2* was used to estimate iron content. Biopsy was obtained in all cases, grading liver steatosis, siderosis, inflammation, and fibrosis. Differences in PDFF and R2* values across histopathological grades were analyzed, and ROC curves analyses evaluated the MR diagnostic performance.
Calculated fat fraction measurements showed significant differences (p < 0.001) among steatosis grades, being unaffected by the presence of inflammation or fibrosis (p ≥ 0.05). A strong correlation was found between fat fraction and steatosis grade (R S = 0.718, p < 0.001). Iron deposits did not affect fat fraction quantitation (p ≥ 0.05), except in cases with severe iron overload (grade 4). A strong positive correlation was also observed between R2* measurements and iron grades (R S = 0.704, p < 0.001). Calculated R2* values were not different across grades of steatosis, inflammation, and fibrosis (p ≥ 0.05).
A MECSE-MR sequence simultaneously quantifies liver steatosis and siderosis, regardless coexisting liver inflammation or fibrosis, with high accuracy in a wide spectrum of diffuse liver disorders. This sequence can be acquired within a single breath-hold and can be implemented in the routine MR evaluation of the liver.
KeywordsFat quantification Iron overload R2* measurement Chronic liver diseases Quantitative imaging biomarkers
Compliance with ethical standards
This work was partially funded by a research grant from the Teaching and Research Department of Centro Hospitalar do Porto (DEFI:309/12(213-DEFI/251-CES)) and from a Spanish Ministry of Health and Carlos III Health Institute funding grant (PI12/01262). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Conflict of interest
Javier Sanchez Gonzalez is employee at Philips Healthcare Iberia. Angel Alberich Bayarri and Luis Martí-Bonmatí are co-founders of QUIBIM SME. The other authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 15.Hines CDG, Frydrychowicz A, Hamilton G, et al. (2011) T1 independent, T2* corrected chemical shift based fat-water separation with multi-peak fat spectral modeling is an accurate and precise measure of hepatic steatosis. J Magn Reson Imaging 33:873–881. doi: 10.1002/jmri.22514 CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Permutt Z, Le T-A, Peterson MR, et al. (2012) Correlation between liver histology and novel magnetic resonance imaging in adult patients with non-alcoholic fatty liver disease—MRI accurately quantifies hepatic steatosis in NAFLD. Aliment Pharmacol Ther 36:22–29. doi: 10.1111/j.1365-2036.2012.05121.x CrossRefPubMedPubMedCentralGoogle Scholar
- 28.Kang B-K, Yu ES, Lee SS, et al. (2012) Hepatic fat quantification: a prospective comparison of magnetic resonance spectroscopy and analysis methods for chemical-shift gradient echo magnetic resonance imaging with histologic assessment as the reference standard. Invest Radiol 47:368–375. doi: 10.1097/RLI.0b013e31824baff3 CrossRefPubMedGoogle Scholar
- 37.Heba ER, Desai A, Zand KA, et al. (2016) Accuracy and the effect of possible subject-based confounders of magnitude-based MRI for estimating hepatic proton density fat fraction in adults, using MR spectroscopy as reference. J Magn Reson Imaging 43:398–406. doi: 10.1002/jmri.25006 CrossRefPubMedGoogle Scholar
- 41.Tyagi A, Yeganeh O, Levin Y, et al. (2015) Intra- and inter-examination repeatability of magnetic resonance spectroscopy, magnitude-based MRI, and complex-based MRI for estimation of hepatic proton density fat fraction in overweight and obese children and adults. Abdom Imaging 40:3070–3077. doi: 10.1007/s00261-015-0542-5 CrossRefPubMedPubMedCentralGoogle Scholar