Feasibility of a three-step magnetic resonance imaging approach for the assessment of hepatic steatosis in an asymptomatic study population

• Published in: European radiology Vol. 26; no. 6; pp. 1895 - 1904
• Main Authors: Hetterich, Holger, Bayerl, Christian, Peters, Annette, Heier, Margit, Linkohr, Birgit, Meisinger, Christa, Auweter, Sigrid, Kannengießer, Stephan A. R., Kramer, Harald, Ertl-Wagner, Birgit, Bamberg, Fabian
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2016; Springer Nature B.V
• Subjects: Adult; Aged; Asymptomatic; Asymptomatic Diseases; Cardiovascular disease; Consent; Diagnostic Radiology; Fatty Liver - diagnosis; Feasibility Studies; Female; Heart attacks; Hospitals; Humans; Imaging; Internal Medicine; Interventional Radiology; Liver - diagnostic imaging; Liver diseases; Magnetic Resonance; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medical research; Medicine; Medicine & Public Health; Metabolism; Middle Aged; Mortality; Neuroradiology; Prospective Studies; Radiology; Reproducibility of Results; Spectrum analysis; Ultrasound; Germany; Magnetic resonance spectroscopy; Dual-echo Dixon; Multi-echo Dixon; Magnetic resonance imaging; Non-alcoholic fatty liver disease
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-015-3966-y

Objectives To determine the feasibility of a multi-step magnetic resonance imaging (MRI) approach for comprehensive assessment of hepatic steatosis defined as liver fat content of ≥5 % in an asymptomatic population. Methods The study was approved by the institutional review board and written informed consent of all participants was obtained. Participants of a population-based study cohort underwent a three-step 3-T MRI-based assessment of liver fat. A dual-echo Dixon sequence was performed to identify subjects with hepatic steatosis, followed by a multi-echo Dixon sequence with proton density fat fraction estimation. Finally, single-voxel T2-corrected multi-echo spectroscopy was performed. Results A total of 215 participants completed the MRI protocol (56.3 % male, average age 57.2 ± 9.4 years). The prevalence of hepatic steatosis was 55 %. Mean liver proton density fat fraction was 9.2 ± 8.5 % by multi-echo Dixon and 9.3 ± 8.6 % by multi-echo spectroscopy ( p  = 0.51). Dual-echo Dixon overestimated liver fat fraction by 1.4 ± 2.0 % ( p  < 0.0001). All measurements showed excellent correlations ( r  ≥ 0.9, p  < 0.001). Dual-echo Dixon was highly sensitive for the detection of hepatic steatosis (sensitivity 0.97, NPV 0.96) with good specificity and PPV (0.75 and 0.81, respectively). Conclusions A multi-step MRI approach may enable rapid and accurate identification of subjects with hepatic steatosis in an asymptomatic population. Key Points • Dual-echo Dixon can rapidly and reliably exclude hepatic steatosis without complex post-processing. • Multi-echo Dixon and multi-echo spectroscopy yield similar results regarding hepatic fat quantification. • Each sequence can be performed in one breath-hold. • These sequences can be implemented in routine abdominal MRI protocols. • Thus hepatic fat can be evaluated without relevant increase in scan time.