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European Radiology

, Volume 28, Issue 11, pp 4479–4487 | Cite as

Feasibility of balanced steady-state free precession sequence at 1.5T for the evaluation of hepatic steatosis in obese children and adolescents

  • Hong-xi Zhang
  • Jun-fen Fu
  • Can Lai
  • Feng-yu Tian
  • Xiao-li Su
  • Ke Huang
Magnetic Resonance
  • 100 Downloads

Abstract

Objectives

To determine the feasibility of balanced steady-state free precession (b-SSFP) imaging for measuring hepatic steatosis in obese children and adolescents, using proton magnetic resonance spectroscopy (1H MRS) as reference standard.

Methods

182 obese Chinese paediatric patients underwent conventional T1-weighted dual echo MRI, 1H MRS and b-SSFP imaging for non-invasive assessment of hepatic steatosis.

Results

There was a strong positive correlation between liver fat fraction (FF) on T1-weighted dual echo MRI and 1H MRS-determined liver fat content (LFC) (r = 0.964, p < .001), and a strong negative correlation between the ratio of liver signal intensity (SI) to spleen SI (L/S) on b-SSFP and LFC (r = −0.896, p < .001). ROC curve analysis based on a diagnostic threshold of 1H MRS-determined LFC >50 mg/g (>5 % by wet weight) showed areas under the curves for FF and L/S at 0.989 (0.976–1.000) and 0.926 (0.888–0.964), respectively. Optimal FF and L/S cut-off values identified patients with hepatic steatosis with 97.9 % and 86.5 % sensitivity and 93.4 % and 93.4 % specificity, respectively.

Conclusions

Following further validation, b-SSFP at 1.5T has potential as a feasible technique for evaluation of hepatic steatosis in obese paediatric patients with limited breath-holding capacity.

Key Points

• L/S on b-SSFP images closely correlated with 1 H MRS-determined LFC.

• b-SSFP has high diagnostic accuracy for hepatic steatosis in obese children.

• 100% of obese paediatric subjects are imaged successfully using b-SSFP sequence.

• b-SSFP has potential to evaluate hepatic steatosis in children with poor breath-hold.

Keywords

Children Diagnosis Fatty liver Magnetic resonance imaging Magnetic resonance spectroscopy 

Abbreviations and acronyms

1H MRS

Proton magnetic resonance spectroscopy

2D

Two dimensional

AUC

Area under the curve

b-SSFP

Balanced steady-state free precession

BMI

Body mass index

FF

Fat fraction

GRE

Gradient recalled echo

HOMA-IR

Homeostasis model assessment of insulin resistance

IP

In phase

L/S

Liver signal intensity (SI) to spleen SI

LFC

Liver fat content

MRI

Magnetic resonance imaging

NAFLD

Non-alcoholic fatty liver disease

OP

Out-of-phase

ROC

Receiver operating characteristic

ROI

Regions of interest

SI

Signal intensity

TE

Echo time

TR

Repetition time

Notes

Acknowledgements

The authors thank Prof. Jun-fen Fu as the scientific guarantor, and Prof. Yun-xian Yu from the Department of Epidemiology and Health Statistics School of Public Health, Zhejiang University, for his data analysis and assistance with statistics.

Funding

This study has received funding by the National Natural Science Foundations of China (Grant No. 81270938 and NO. 81570759), Zhejiang provincial key disciplines of medicine (Innovation discipline, 11-CX24), and Scientific Research Fund of Zhejiang Provincial Education Department (N20140120).

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Prof. Jun-fen Fu.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Prof. Yun-xian Yu from the Department of Epidemiology and Health Statistics School of Public Health, Zhejiang University, for his data analysis and assistance with statistics.

Informed consent

Written informed consent was obtained from all children and adolescents and/or their guardians in this study.

Ethical approval

Ethical approval for this study was obtained from the Medical Committee of the Children's Hospital Zhejiang University School of Medicine, China.

Methodology

• prospective

• cross sectional study / diagnostic or prognostic study

• performed at one institution

Supplementary material

330_2018_5344_MOESM1_ESM.docx (26 kb)
ESM 1 (DOCX 26 kb)

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of RadiologyChildren’s Hospital of Zhejiang University School of MedicineHangzhouChina
  2. 2.Department of EndocrinologyChildren’s Hospital of Zhejiang University School of MedicineHangzhouChina

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