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 FuEmail author
  • Can Lai
  • Feng-yu Tian
  • Xiao-li Su
  • Ke Huang
Magnetic Resonance



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.


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.


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.


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.


Children Diagnosis Fatty liver Magnetic resonance imaging Magnetic resonance spectroscopy 

Abbreviations and acronyms


Proton magnetic resonance spectroscopy


Two dimensional


Area under the curve


Balanced steady-state free precession


Body mass index


Fat fraction


Gradient recalled echo


Homeostasis model assessment of insulin resistance


In phase


Liver signal intensity (SI) to spleen SI


Liver fat content


Magnetic resonance imaging


Non-alcoholic fatty liver disease




Receiver operating characteristic


Regions of interest


Signal intensity


Echo time


Repetition time



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.


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


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.


• 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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