title: Liver-vessel cancellation artifact on in-phase and out-of-phase MRI imaging: a sign of ultra-high liver fat content.
abstract: OBJECTIVE
  To describe a new MRI sign, the liver-vessel cancellation artifact, on In-Phase and Out-of-Phase gradient-echo sequences related to ultra-high liver fat content (>90%) by qualitative histology.
  
  
  METHODS
  Institutional review board approval was obtained for this retrospective HIPAA-compliant study with waived informed consent. Patients with liver steatosis were searched in MRI (n = 195) and pathology (n = 116) databases between January 1, 2008, and June 20, 2010. Two readers blindly reviewed all MR images for the presence of the liver-vessel cancellation sign. Cross-reference of patients with biopsy-proven steatosis and MRI within one month was performed (n = 54; 25 males, 29 females; mean age 41.0 ± 18.9), with a population of 6 patients with ultra-high liver fat content (1 male, 5 females; mean age 15.5 ± 11.2). Performance diagnostic tests, including sensitivity and specificity, were performed.
  
  
  RESULTS
  Liver-vessel cancellation sign was present in all patients with ultra-high liver fat content but in none of the remaining patients. Calculated sensitivity and specificity for the detection of ultra-high liver fat content with this sign were 100% (95% confidence interval [CI]: 69.1-100%) and 100% (95% CI: 98.4-100%), respectively.
  
  
  CONCLUSIONS
  The presence of liver-vessel cancellation artifact around intra-hepatic vessels is a feature of ultra-high liver fat content.
authors.affiliation: Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Vasco
authors.initials: V
authors.lastname: Herédia
authors.forename: Miguel
authors.initials: M
authors.lastname: Ramalho
authors.forename: Rafael O P
authors.initials: RO
authors.lastname: de Campos
authors.forename: Brian
authors.initials: B
authors.lastname: Dale
authors.forename: Rafael
authors.initials: R
authors.lastname: Azevedo
authors.forename: John T
authors.initials: JT
authors.lastname: Woosley
authors.forename: Richard C
authors.initials: RC
authors.lastname: Semelka
mesh_terms: D000293:Adolescent; D000328:Adult; D016477:Artifacts; D005234:Fatty Liver / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008099:Liver / Q000098:blood supply / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D012680:Sensitivity and Specificity