title: Accurate simultaneous quantification of liver steatosis and iron overload in diffuse liver diseases with MRI.
abstract: To evaluate the diagnostic performances of 3 Tesla multi-echo chemical shift-encoded gradient echo magnetic resonance (MECSE-MR) imaging to simultaneously quantify liver steatosis and iron overload in a wide spectrum of diffuse liver diseases having biopsy as reference standard.
  
  
  
  MECSE-MR-acquired images were used to calculate fat fraction and iron content in a single breath-hold in 109 adult patients. Proton density fat fraction (PDFF) was prospectively estimated using complex-based data reconstruction with multipeak fat modeling. Water R2* was used to estimate iron content. Biopsy was obtained in all cases, grading liver steatosis, siderosis, inflammation, and fibrosis. Differences in PDFF and R2* values across histopathological grades were analyzed, and ROC curves analyses evaluated the MR diagnostic performance.
  
  
  
  Calculated fat fraction measurements showed significant differences (p < 0.001) among steatosis grades, being unaffected by the presence of inflammation or fibrosis (p ≥ 0.05). A strong correlation was found between fat fraction and steatosis grade (RS= 0.718, p < 0.001). Iron deposits did not affect fat fraction quantitation (p ≥ 0.05), except in cases with severe iron overload (grade 4). A strong positive correlation was also observed between R2* measurements and iron grades (RS= 0.704, p < 0.001). Calculated R2* values were not different across grades of steatosis, inflammation, and fibrosis (p ≥ 0.05).
  
  
  
  A MECSE-MR sequence simultaneously quantifies liver steatosis and siderosis, regardless coexisting liver inflammation or fibrosis, with high accuracy in a wide spectrum of diffuse liver disorders. This sequence can be acquired within a single breath-hold and can be implemented in the routine MR evaluation of the liver.
authors.affiliation: Imaging Department, Centro Hospitalar do Porto, Largo Prof Abel Salazar, 4099-001, Porto, Portugal. mariamanuela.franca@gmail.com.
authors.forename: Manuela
authors.identifier: http://orcid.org/0000-0003-1068-8577
authors.initials: M
authors.lastname: França
authors.affiliation: Radiology Department, Hospital Universitario y Politécnico La Fe and Biomedical Imaging Research Group (GIBI230), Valencia, Spain.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Alberich-Bayarri
authors.affiliation: Radiology Department, Hospital Universitario y Politécnico La Fe and Biomedical Imaging Research Group (GIBI230), Valencia, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Martí-Bonmatí
authors.affiliation: Population Studies Department, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal.|Epidemiology Research Unit (EPIUnit), Institute of Public Health of the University of Porto, Porto, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Oliveira
authors.affiliation: Pathology Department, Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: Francisca Emanuel
authors.initials: FE
authors.lastname: Costa
authors.affiliation: Hematology Department, Centro Hospitalar do Porto, Porto, Portugal.|I3S, Instituto de Investigação e Inovação em Saúde, Porto, Portugal.|IBMC, Institute for Molecular and Cell Biology, Porto, Portugal.
authors.forename: Graça
authors.initials: G
authors.lastname: Porto
authors.affiliation: Pathology Department, Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: José Ramón
authors.initials: JR
authors.lastname: Vizcaíno
authors.affiliation: MR Clinical Science, Philips Healthcare, Madrid, Spain.
authors.forename: Javier Sanchez
authors.initials: JS
authors.lastname: Gonzalez
authors.affiliation: Imaging Department, Centro Hospitalar do Porto, Largo Prof Abel Salazar, 4099-001, Porto, Portugal.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Ribeiro
authors.affiliation: Imaging Department, Centro Hospitalar do Porto, Largo Prof Abel Salazar, 4099-001, Porto, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Oliveira
authors.affiliation: Epidemiology Research Unit (EPIUnit), Institute of Public Health of the University of Porto, Porto, Portugal.|Liver and Pancreas Transplantation Unit and Medicine Department, Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: Helena
authors.initials: H
authors.lastname: Pessegueiro Miranda
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D005234:Fatty Liver / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D019190:Iron Overload / Q000000981:diagnostic imaging* / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
keywords: Chronic liver diseases; Fat quantification; Iron overload; Quantitative imaging biomarkers; R2* measurement