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Published in: European Radiology 11/2020

01-11-2020 | Magnetic Resonance Imaging | Magnetic Resonance

Evaluation of liver iron overload with R2* relaxometry with versus without fat suppression: both are clinically accurate but there are differences

Authors: M. Plaikner, C. Kremser, H. Zoller, W. Jaschke, M. Steurer, A. Viveiros, B. Henninger

Published in: European Radiology | Issue 11/2020

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Abstract

Objectives

To assess clinically relevant difference in hepatic iron quantification using R2* relaxometry with (FS) and without (non-FS) fat saturation for the evaluation of patients with suspected hepatic iron overload.

Methods

We prospectively enrolled 134 patients who underwent 1.5-T MRI R2* relaxometry with FS and non-FS gradient echo sequences (12 echoes, initial TE = 0.99 ms). Proton density fat fraction for the quantification of steatosis was assessed. Linear regression analyses and Bland-Altman plots including Lin’s concordance correlation coefficient were performed for correlation of FS R2* with non-FS R2*. Patients were grouped into 4 severity classes of iron overload (EASL based), and agreement was evaluated by contingency tables and the proportion of overall agreement.

Results

A total of 41.8% of patients showed hepatic iron overload; 67.9% had concomitant steatosis; and 58.2% revealed no iron overload of whom 60.3% had steatosis. The mean R2* value for all FS data was 102.86 1/s, for non-FS 108.16 1/s. Linear regression resulted in an R-squared value of 0.99 (p < 0.001); Bland-Altman plot showed a mean R2* difference of 5.26 1/s (SD 17.82). The concordance correlation coefficient was only slightly lower for patients with steatosis compared with non-steatosis (0.988 vs. 0.993). The overall agreement between FS and non-FS R2* measurements was 94.8% using either method to classify patients according to severity of iron storage. No correlation between R2* and proton density fat fraction was found for both methods.

Conclusion

R2* relaxometry showed an excellent overall agreement between FS and non-FS acquisition. Both variants can therefore be used in daily routine. However, clinically relevant differences might result when switching between the two methods or during patient follow-up, when fat content changes over time. We therefore recommend choosing a method and keeping it straight in the context of follow-up examinations.

Key Points

• Both variants of R2* relaxometry (FS and non-FS) may be used in daily routine.
• Clinically relevant differences might result when switching between the two methods or during patient follow-up, when fat content changes over time.
• It seems advisable choosing one method and keeping it straight in the context of follow-up examinations.
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Metadata
Title
Evaluation of liver iron overload with R2* relaxometry with versus without fat suppression: both are clinically accurate but there are differences
Authors
M. Plaikner
C. Kremser
H. Zoller
W. Jaschke
M. Steurer
A. Viveiros
B. Henninger
Publication date
01-11-2020
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 11/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-020-07010-5

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