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

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

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.

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Abbreviations

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

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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).

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Authors and Affiliations

  1. Department of Radiology, Children’s Hospital of Zhejiang University School of Medicine, 57 Zhugan Avenue, Hangzhou, Zhejiang Province, China

    Hong-xi Zhang, Can Lai, Feng-yu Tian & Xiao-li Su

  2. Department of Endocrinology, Children’s Hospital of Zhejiang University School of Medicine, 57 Zhugan Avenue, Hangzhou, Zhejiang Province, China

    Jun-fen Fu & Ke Huang

Authors
  1. Hong-xi Zhang
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  2. Jun-fen Fu
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  3. Can Lai
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  6. Ke Huang
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Corresponding author

Correspondence to Jun-fen Fu.

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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

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Zhang, Hx., Fu, Jf., Lai, C. et al. Feasibility of balanced steady-state free precession sequence at 1.5T for the evaluation of hepatic steatosis in obese children and adolescents. Eur Radiol 28, 4479–4487 (2018). https://doi.org/10.1007/s00330-018-5344-z

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  • DOI: https://doi.org/10.1007/s00330-018-5344-z

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