Accuracy of Multi-echo Dixon Sequence in Quantification of Hepatic Steatosis

Abstract

ObjectiveToday, a biopsy is the gold standard in the diagnosis of non-alcoholic fatty liver. However, a biopsy is an invasive technique, limited to the sample taken, and it may lead to misdiagnosis. Therefore, novel noninvasive options are needed. The objective of this study was to investigate the accuracy of magnetic resonance (MR) Dixon sequence and elastography using magnetic resonance spectroscopy (MRS) as a reference in the quantification of hepatic steatosis. MethodsA total of 60 patients were included in the study. All patients underwent magnetic resonance imaging (MRI), MRS, and elastography in order to quantify hepatosteatosis. MRI and MRS imaging studies were performed using MR Dixon and high-speed T2-corrected multiple-echo 1H-MRS sequence (HISTO) sequences, respectively, in order to calculate proton density fat fraction (PDFF) values. ResultsThe mean MRI-PDFF value with the MRS region of interest (ROI) was found as 9.4% ± 12.1%. The mean MRS-PDFF was found as 8.9% ± 11.3%. No statistically significant difference was found between MRS-PDFF and MRI-PDFF values measured in ROI (p < 0.005). The correlation between MRS-PDFF and MRI-PDFF was examined with Spearman's correlation analysis. Accordingly, there was an excellent correlation between MRS and MRI values measured in ROI (r ≥ 0.8, p < 0.001). Sensitivity, specificity, positive predictive value, and negative predictive value were calculated as 96%, 100%, 89.5%, and 92.6%, respectively, for MRI-PDFF in predicting hepatic steatosis for the same ROI localization with MRS. The optimum cut-off value of MRS-PDFF in predicting hepatic steatosis was found as 5.3% using the same ROI localization with MRS. ConclusionThe results of this study indicated an excellent correlation between MRI-PDFF and MRS-PDFF. The multi-echo Dixon MRI technique seems a promising alternative method in the detection of non-alcoholic fatty liver disease.

Evaluation of a Whole-Liver Dixon-Based MRI Approach for Quantification of Liver Fat in Patients with Type 2 Diabetes Treated with Two Isocaloric Different Diets

“…Interestingly, the strong correlation found between MRS-PDFF and MRI-PDFF was in line with findings by a large number of previous studies investigating the accuracy of Dixon-based methods for liver fat estimation in different hepatic diseases, assuming MRS as reference standard [ 9 , 10 , 20 , 22 ].…”

“…To our knowledge, this is the first study aiming at investigating a MRI-based whole-liver approach for liver fat estimation that aims to go beyond both the standard MRS analysis of liver fat and the commonly used MRI approach for liver fat estimation based on average measurement of PDFF in regions of interest covering part of the liver or the whole-liver coverage [ 10 , 22 , 29 , 30 ].…”

“…This is mainly because this value was derived from a large study. Moreover, other thresholds arising from MRS or MRI were derived from smaller studies or established based on MRI-PDFF methods with different settings and characteristics [ 10 , 22 , 36 , 37 ].…”

“…MRS has been found to demonstrate excellent diagnostic performance for liver applications and showed close correlation with histological results [ 18 , 19 , 20 ]. Then, several studies were performed using Dixon-based techniques to quantify liver fat content with MRS as reference standard and demonstrated equivalent accuracy to MRS and a strong correlation with MRS, as well as with histology, for different applications involving NAFLD patients [ 9 , 20 , 21 , 22 ].…”

High‐Speed T2‐Corrected Multiecho Magnetic Resonance Spectroscopy for Quantitatively Detecting Skeletal Muscle Fatty Infiltration and Predicting the Loss of Ambulation in Patients With Duchenne Muscular Dystrophy

“…13,14 Traditionally, MRS has been performed with multiple acquisitions under free-breathing conditions to achieve a high signal-to-noise ratio, 15 which commonly leads to line broadening and erroneous data acquisition due to motion and long acquisition times. [16][17][18] Recently, high-speed T 2 -corrected multiecho (HISTO) MRS was developed to assess lipids by using multiple short-echo times to correct T 2 bias and using long repetition times to correct T 1 bias by enabling the simultaneous acquisition of multiple echoes, 19,20 which is faster and more accurate in acquiring and measuring lipid components than traditional MRS. [21][22][23] Previous studies have shown the benefit of HISTO-MRS for the precise quantitative assessment of fatty deposition in the liver. 23,24 However, only one study has examined the utilization and feasibility of HISTO-MRS as a rapid and noninvasive MRS technique for quantifying the fat infiltration of skeleton muscles in children with confirmed DMD, 25 Meanwhile, the relationship between muscle fat infiltration measured by HISTO-MRS and clinical motor functional ability remains unknown.…”