title: Nonalcoholic fatty liver disease: rapid evaluation of liver fat content with in-phase and out-of-phase MR imaging.
abstract: OBJECTIVE
  To evaluate in-phase and out-of-phase magnetic resonance (MR) imaging in the estimation of liver fat content (LFC) in patients with nonalcoholic fatty liver disease (NAFLD), with hydrogen ((1)H) MR spectroscopy as the reference standard.
  
  
  METHODS
  Written informed consent was obtained from all subjects, and the local ethics committee approved this prospective study protocol. A total of 33 patients with type 2 diabetes mellitus who were at high risk for NAFLD (23 men, 10 women; overall mean age, 62.8 years +/- 8.3 [standard deviation]; age range, 48-77 years) underwent 1.5-T MR imaging with (1)H MR spectroscopy and in-phase and out-of-phase imaging of the liver. Three fat indexes were calculated from the signal intensity (SI) measured on the images. Two radiologists independently graded SI changes between in-phase and out-of-phase images by means of visual inspection. The Pearson correlation coefficient was used to study the relationship between the obtained parameters of SI change and LFC measured with (1)H MR spectroscopy.
  
  
  RESULTS
  Fat indexes calculated from in-phase and out-of-phase images correlated linearly with LFC measured with (1)H MR spectroscopy (P < .001, r = 0.94-0.96) and were superior (P = .004) to visual estimates (P < .001, r = 0.88). The simple difference in SI between in-phase and out-of-phase images was used to calculate the fat index. An intercept of the regression line with the x-axis was observed at 5.1%, discriminating between normal and elevated LFC with high sensitivity (95%) and specificity (98%).
  
  
  CONCLUSIONS
  In-phase and out-of-phase imaging can be used to rapidly estimate the LFC in patients with NAFLD. The cutoff value of 5.1% enables objective rapid and reliable discrimination of normal LFC from elevated LFC.
authors.affiliation: Medical Imaging Centre of Southwest Finland, Turku University Hospital, Kiinamyllynkatu 4-8, PO Box 52, 20521 Turku, Finland. Ronald.Borra@tyks.fi
authors.forename: Ronald J H
authors.initials: RJ
authors.lastname: Borra
authors.forename: Sakari
authors.initials: S
authors.lastname: Salo
authors.forename: Kirsti
authors.initials: K
authors.lastname: Dean
authors.forename: Riikka
authors.initials: R
authors.lastname: Lautamäki
authors.forename: Pirjo
authors.initials: P
authors.lastname: Nuutila
authors.forename: Markku
authors.initials: M
authors.lastname: Komu
authors.forename: Riitta
authors.initials: R
authors.lastname: Parkkola
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000473:pathology; D005234:Fatty Liver / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008099:Liver / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012015:Reference Standards; D012680:Sensitivity and Specificity; D012984:Software