Quantification of hepatic steatosis: a comparison of the accuracy among multiple magnetic resonance techniques.
OBJECTIVE
Magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) are important diagnostic tools for the non-invasive assessment of hepatic steatosis (HS). This study was conducted to compare different magnetic resonance (MR) techniques and correlate the MR findings with histological and intracellular lipid density findings.


METHODS
In this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant prospective study, 60 patients scheduled for liver resection were included in this study. Fat fraction in the non-tumorous liver parenchyma was estimated using double-echo MRI, triple-echo MRI (TE-MRI), and MRS. HS was defined by the histologic steatosis percentage (HSP), and intrahepatocellular triglyceride density (IHTGD) of the surgical specimen used as the reference standard. Imaging quantification results were evaluated using Pearson's correlation. Lin's concordance coefficient and Bland-Altman 95% limits of agreement were used to evaluate the concordance of IHTGDs estimated by the three MR techniques. The diagnostic performance was compared using receiver operating characteristic curve analysis.


RESULTS
HS assessed by TE-MRI and MRS had a stronger relationship with HS assessed by HSP and IHTGD. The TE-MRI method had the highest concordance correlation coefficients (ρ = 0.881) and percentage (95%, 57/60) within the Bland-Altman 95% limits of agreement. Receiver operating characteristic curve analysis for diagnosing > 5% HSP showed significantly larger area under the curve (0.9783) for TE-MRI than for double-echo MRI (0.8773, P = 0.0121).


CONCLUSIONS
Among the three MR techniques, TE-MRI and MRS may be the preferred techniques for non-invasive assessment of HS.
Department of Medical Imaging, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan; Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.
Chih-Horng
CH
Wu
Ming-Chih
MC
Ho
Yung-Ming
YM
Jeng
Chao-Yu
CY
Hsu
Po-Chin
PC
Liang
Rey-Heng
RH
Hu
Hong-Shiee
HS
Lai
Tiffany Ting-Fang
TT
Shih
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005234:Fatty Liver / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology*; D005260:Female; D006801:Humans; D008099:Liver / Q000378:metabolism / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014280:Triglycerides / Q000032:analysis; D055815:Young Adult
D014280:Triglycerides
fatty liver; hepatic steatosis; magnetic resonance imaging; magnetic resonance spectroscopy