Feasibility of balanced steady-state free precession sequence at 1.5T for the evaluation of hepatic steatosis in obese children and adolescents
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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.
• 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.
KeywordsChildren Diagnosis Fatty liver Magnetic resonance imaging Magnetic resonance spectroscopy
Abbreviations and acronyms
- 1H MRS
Proton magnetic resonance spectroscopy
Area under the curve
Balanced steady-state free precession
Body mass index
Gradient recalled echo
Homeostasis model assessment of insulin resistance
Liver signal intensity (SI) to spleen SI
Liver fat content
Magnetic resonance imaging
Non-alcoholic fatty liver disease
Receiver operating characteristic
Regions of interest
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.
Written informed consent was obtained from all children and adolescents and/or their guardians in this study.
Ethical approval for this study was obtained from the Medical Committee of the Children's Hospital Zhejiang University School of Medicine, China.
• cross sectional study / diagnostic or prognostic study
• performed at one institution
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