Proton density fat-fraction is an accurate biomarker of hepatic steatosis in adolescent girls and young women

• Published in: European radiology Vol. 25; no. 10; pp. 2921 - 2930
• Main Authors: Rehm, Jennifer L., Wolfgram, Peter M., Hernando, Diego, Eickhoff, Jens C., Allen, David B., Reeder, Scott B.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2015; Springer Nature B.V
• Subjects: Adolescent; Alanine Transaminase - metabolism; Anniversaries; Biomarkers - metabolism; Body Mass Index; Child; Cross-Sectional Studies; Diagnostic Radiology; Fatty Liver - diagnosis; Female; Healthy Volunteers; Humans; Imaging; Insulin resistance; Internal Medicine; Interventional Radiology; Linear Models; Magnetic Resonance; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Magnetic Resonance Spectroscopy - methods; Medicine; Medicine & Public Health; Neuroradiology; Overweight - physiopathology; Prospective Studies; Protons; Radiology; Sensitivity and Specificity; Teenagers; Triglycerides - metabolism; Ultrasound; Waist Circumference; Young Adult; United States > US; Magnetic resonance spectroscopy; Obesity; Fatty liver; Magnetic resonance imaging; Paediatrics
• ISSN: 0938-7994; 1432-1084; 1432-1084
• DOI: 10.1007/s00330-015-3724-1

Objectives To compare complex quantitative magnetic resonance imaging (MRI) with MR spectroscopy (MRS) for quantification of hepatic steatosis (HS) and determine clinically significant MRI-based thresholds of HS in female youths. Methods This prospective, cross-sectional study was conducted in 132 healthy females (11–22 years, mean 13.3 ± 2). Proton density fat-fraction (PDFF) was measured using complex quantitative MRI and MRS. Body mass index (BMI), fasting labs [glucose, insulin, alanine aminotransferase (ALT), and other metabolic markers] were obtained. Outcomes were measured using regression analysis, Spearman-rank correlation, and receiver operator characteristics (ROC) analysis. HS was defined as MRI-PDFF >5.6 %. Results HS was detected by MRI-PDFF in 15 % of all subjects. Linear regression demonstrated excellent correlation and agreement [r 2  = 0.96, slope = 0.97 (95 %CI: 0.94–1.00), intercept = 0.78 % (95 %CI: 0.58–0.98 %)] between MRI-PDFF and MRS-PDFF. MRI-PDFF had a sensitivity of 100 % (95 %CI: 0.79–1.00), specificity of 96.6 % (95 %CI: 0.91–0.99), and a kappa index of 87 % (95 %CI: 0.75–0.99) for identifying HS. In overweight subjects with HS, MRI-PDFF correlated with ALT (r = 0.84, p  < 0.0001) and insulin (r = 0.833, p  < 0.001), but not with BMI or WC. ROC analysis ascertained an optimal MRI-PDFF threshold of 3.5 % for predicting metabolic syndrome (sensitivity = 76 %, specificity = 83 %). Conclusion Complex quantitative MRI demonstrates strong correlation and agreement with MRS to quantify hepatic triglyceride content in adolescent girls and young women. A low PDFF threshold is predictive of metabolic syndrome in this population. Key points • Confounder-corrected quantitative MRI (ccqMRI) effectively measures hepatic triglyceride content in adolescent girls. • MRS and ccqMRI strongly correlate in liver proton density fat-fraction (PDFF) detection. • A PDFF threshold of 3.5 % may be predictive of paediatric metabolic syndrome.