title: Accuracy of liver fat quantification at MR imaging: comparison of out-of-phase gradient-echo and fat-saturated fast spin-echo techniques--initial experience.
abstract: OBJECTIVE
  To retrospectively determine the relative accuracy of liver fat quantification with out-of-phase gradient-echo magnetic resonance (MR) imaging and fat-saturated fast spin-echo MR imaging in patients with and without cirrhosis, with histologic analysis as the reference standard.
  
  
  METHODS
  Committee on Human Research approval was obtained. Patient consent was not required. Data collection ended before HIPAA regulations were implemented, but patient anonymity was maintained. Twenty-seven patients, 16 with cirrhosis, were retrospectively identified who underwent MR imaging before histopathologic evaluation of liver fat at biopsy or surgery. The patient population consisted of 15 male and 12 female patients (mean age, 55 years; range, 16-75 years). One radiologist blinded to the histopathologic results recorded mean signal intensity derived from three regions of interest placed in the right and left lobes of the liver on three sections and signal intensity of the spleen from one region of interest within the same section. Liver fat was quantified with the relative loss of signal intensity on out-of-phase images compared with that on in-phase T1-weighted gradient-echo images and with relative loss of signal intensity on T2-weighted fast spin-echo MR images obtained with fat saturation compared with those obtained without fat saturation. Hotelling t test was used to compare correlation coefficients between relative signal intensity differences and histopathologically determined percentage of fat.
  
  
  RESULTS
  In patients without cirrhosis, liver fat quantification with fat-saturated fast spin-echo MR imaging was significantly better than it was with out-of-phase gradient-echo MR imaging (r = 0.92 vs 0.69, P < .01). In patients with cirrhosis, liver fat quantification was correlated only with fat-saturated fast spin-echo MR imaging (r = 0.76, P < .01); the relative signal intensity loss on out-of-phase gradient-echo MR images was not correlated with histopathologically determined percentage of fat (r = 0.25, P = .36).
  
  
  CONCLUSIONS
  Preliminary results suggest liver fat may be more accurately quantified with fat-saturated fast spin-echo MR imaging than with out-of-phase gradient-echo MR imaging, especially in patients with cirrhosis.
authors.affiliation: Department of Radiology, University of California San Francisco, CA 94143-0628, USA. Aliya.Qayyum@radiology.ucsf.edu
authors.forename: Aliya
authors.initials: A
authors.lastname: Qayyum
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Goh
authors.forename: Sanjay
authors.initials: S
authors.lastname: Kakar
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Yeh
authors.forename: Raphael B
authors.initials: RB
authors.lastname: Merriman
authors.forename: Fergus V
authors.initials: FV
authors.lastname: Coakley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005234:Fatty Liver / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D016014:Linear Models; D008103:Liver Cirrhosis / Q000150:complications; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity