Abdominal Radiology

, Volume 43, Issue 5, pp 1168–1179 | Cite as

Quantitative MRI of fatty liver disease in a large pediatric cohort: correlation between liver fat fraction, stiffness, volume, and patient-specific factors

  • Madalsa Joshi
  • Jonathan R. Dillman
  • Kamalpreet Singh
  • Suraj D. Serai
  • Alexander J. Towbin
  • Stavra Xanthakos
  • Bin Zhang
  • Weizhe Su
  • Andrew T. Trout



Magnetic resonance imaging (MRI) techniques are increasingly used to quantify and monitor liver tissue characteristics including fat fraction, stiffness, and liver volume. The purpose of this study was to assess the inter-relationships between multiple quantitative liver metrics and patient-specific factors in a large pediatric cohort with known or suspected fatty liver disease.

Materials and methods

In this IRB-approved, HIPAA-compliant study, we retrospectively reviewed patient data and quantitative liver MRI results in children with known/suspected fatty liver disease. Relationships between liver MRI tissue characteristics and patient variables [sex, age, body mass index (BMI), diabetic status (no diabetes mellitus, insulin resistance/“prediabetes” diagnosis, or confirmed diabetes mellitus), and serum alanine transaminase (ALT)] were assessed using linear mixed models.


294 quantitative liver MRI examinations were performed in 202 patients [128/202 (63.4%) boys], with a mean age of 13.4 ± 2.9 years. Based on linear mixed models, liver fat fraction was influenced by age (−0.71%/+1 year, p = 0.0002), liver volume (+0.006%/+1 mL, p < 0.0001), liver stiffness (−2.80%/+1 kPa, p = 0.0006), and serum ALT (+0.02%/+1 U/L, p = 0.0019). Liver stiffness was influenced by liver volume (+0.0003 kPa/+1 mL, p = 0.001), fat fraction (−0.02 kPa/+1% fat, p = 0.0006), and ALT (0.002 kPa/+1 U/L, p = 0.0002). Liver volume was influenced by sex (−262.1 mL for girls, p = 0.0003), age (+51.8 mL/+1 year, p = 0.0001), BMI (+49.1 mL/+1 kg/m2, p < 0.0001), fat fraction (+30.5 mL/+1% fat, p < 0.0001), stiffness (+192.6 mL/+1 kPa, p = 0.001), and diabetic status (+518.94 mL for diabetics, p = 0.0009).


Liver volume, fat fraction, and stiffness are inter-related and associated with multiple patient-specific factors. These relationships warrant further study as MRI is increasingly used as a non-invasive biomarker for fatty liver disease diagnosis and monitoring.


MRI Children Steatosis Fibrosis Quantitative Multiparameteric 


Compliance with ethical standards



Conflict of interest

Joshi—none, Dillman—unrelated grant funding (Siemens Medical Solutions USA, Toshiba America Medical Systems, Guerbet Group), Singh—none, Serai—None, Towbin—unrelated grant funding (Siemens Medical Solutions USA, Guerbet Group), consultant (Applied Radiology), and royalties (Elsevier), Xanthakos—none, Zhang—none, Shu—none, Trout—unrelated grant funding (Siemens Medical Solutions USA, Toshiba America Medical Systems), consultant (American College of Radiology), and royalties (Elsevier).

Ethical approval

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. As this study was retrospective and involved analysis of existing data, the requirement for informed consent was waived by our institutional review board.


  1. 1.
    Kramer H, Pickhardt PJ, Kliewer MA, et al. (2017) Accuracy of liver fat quantification with advanced CT, MRI, and ultrasound techniques: prospective comparison with MR spectroscopy. AJR Am J Roentgenol. 208(1):92–100CrossRefPubMedGoogle Scholar
  2. 2.
    Petitclerc L, Sebastiani G, Gilbert G, et al. (2017) Liver fibrosis: review of current imaging and MRI quantification techniques. J Magn Reson Imaging. 45(5):1276–1295CrossRefPubMedGoogle Scholar
  3. 3.
    Srinivasa Babu A, Wells ML, Teytelboym OM, et al. (2016) Elastography in chronic liver disease: modalities, techniques, limitations, and future directions. Radiographics. 36(7):1987–2006CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Yin M, Glaser KJ, Talwalkar JA, et al. (2016) Hepatic MR elastography: clinical performance in a series of 1377 consecutive examinations. Radiology. 278(1):114–124CrossRefPubMedGoogle Scholar
  5. 5.
    Towbin AJ, Serai SD, Podberesky DJ (2013) Magnetic resonance imaging of the pediatric liver: imaging of steatosis, iron deposition, and fibrosis. Magn Reson Imaging Clin N Am. 21(4):669–680CrossRefPubMedGoogle Scholar
  6. 6.
    Trout AT, Serai S, Mahley AD, et al. (2016) Liver stiffness Measurements with MR elastography: agreement and repeatability across imaging systems, field strengths, and pulse sequences. Radiology. 281(3):793–804CrossRefPubMedGoogle Scholar
  7. 7.
    Manduca A, Oliphant TE, Dresner MA, et al. (2001) Magnetic resonance elastography: non-invasive mapping of tissue elasticity. Med Image Anal. 5(4):237–254CrossRefPubMedGoogle Scholar
  8. 8.
    Pavlides M, Banerjee R, Tunnicliffe EM, et al. (2016) Multi-parametric magnetic resonance imaging for the assessment of non-alcoholic fatty liver disease severity. Liver Int. 37(7):1065–1073CrossRefGoogle Scholar
  9. 9.
    Leitao HS, Doblas S, Garteiser P, et al. (2017) Hepatic fibrosis, inflammation, and steatosis: influence on the MR viscoelastic and diffusion parameters in patients with chronic liver disease. Radiology. 283(1):98–107CrossRefPubMedGoogle Scholar
  10. 10.
    Loomba R, Wolfson T, Ang B, et al. (2014) Magnetic resonance elastography predicts advanced fibrosis in patients with nonalcoholic fatty liver disease: a prospective study. Hepatology. 60(6):1920–1928CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Chen J, Talwalkar JA, Yin M, et al. (2011) Early detection of nonalcoholic steatohepatitis in patients with nonalcoholic fatty liver disease by using MR elastography. Radiology. 259(3):749–756CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Patel NS, Hooker J, Gonzalez M, et al. (2017) Weight loss decreases magnetic resonance elastography estimated liver stiffness in nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 15(3):463–464CrossRefPubMedGoogle Scholar
  13. 13.
    Patel NS, Doycheva I, Peterson MR, et al. (2015) Effect of weight loss on magnetic resonance imaging estimation of liver fat and volume in patients with nonalcoholic steatohepatitis. Clin Gastroenterol Hepatol. 13(3):561–568CrossRefPubMedGoogle Scholar
  14. 14.
    Macaluso FS, Maida M, Camma C, et al. (2014) Steatosis affects the performance of liver stiffness measurement for fibrosis assessment in patients with genotype 1 chronic hepatitis C. J Hepatol. 61(3):523–529CrossRefPubMedGoogle Scholar
  15. 15.
    Petta S, Maida M, Macaluso FS, et al. (2015) The severity of steatosis influences liver stiffness measurement in patients with nonalcoholic fatty liver disease. Hepatology. 62(4):1101–1110CrossRefPubMedGoogle Scholar
  16. 16.
    Conti F, Vukotic R, Foschi FG, et al. (2016) Transient elastography in healthy subjects and factors influencing liver stiffness in non-alcoholic fatty liver disease: an Italian community-based population study. Dig Liver Dis. 48(11):1357–1363CrossRefPubMedGoogle Scholar
  17. 17.
    Guo Y, Dong C, Lin H, et al. (2017) Ex vivo study of acoustic radiation force impulse imaging elastography for evaluation of rat liver with steatosis. Ultrasonics. 74:161–166CrossRefPubMedGoogle Scholar
  18. 18.
    Kang BK, Lee SS, Cheong H, et al. (2015) Shear wave elastography for assessment of steatohepatitis and hepatic fibrosis in rat models of non-alcoholic fatty liver disease. Ultrasound Med Biol. 41(12):3205–3215CrossRefPubMedGoogle Scholar
  19. 19.
    Silva M, Marques M, Cardoso H, et al. (2016) Glycogenic hepatopathy in young adults: a case series. Rev Esp Enferm Dig. 108(10):673–676PubMedGoogle Scholar
  20. 20.
    DiPaola FW, Schumacher KR, Goldberg CS, et al. (2017) Effect of Fontan operation on liver stiffness in children with single ventricle physiology. Eur Radiol. 27(6):2434–2442CrossRefPubMedGoogle Scholar
  21. 21.
    Serai SD, Dillman JR, Trout AT (2017) Proton density fat fraction measurements at 1.5- and 3-T hepatic MR imaging: same-day agreement among readers and across two imager manufacturers. Radiology. 284(1):244–254. doi: 10.1148/radiol.2017161786 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Madalsa Joshi
    • 1
  • Jonathan R. Dillman
    • 1
  • Kamalpreet Singh
    • 2
  • Suraj D. Serai
    • 1
  • Alexander J. Towbin
    • 1
  • Stavra Xanthakos
    • 3
  • Bin Zhang
    • 4
  • Weizhe Su
    • 5
  • Andrew T. Trout
    • 1
  1. 1.Department of RadiologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  2. 2.Department of RadiologyAllegheny General HospitalPittsburghUSA
  3. 3.Division of Gastroenterology, Hepatology and Nutrition, Department of PediatricsCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  4. 4.Division of Biostatistics and EpidemiologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  5. 5.Department of Mathematical SciencesUniversity of CincinnatiCincinnatiUSA

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