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Pediatric Radiology

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01-11-2014 | Original Article

Quantitative MRI for hepatic fat fraction and T2* measurement in pediatric patients with non-alcoholic fatty liver disease

Authors: Jie Deng, Mark H. Fishbein, Cynthia K. Rigsby, Gang Zhang, Samantha E. Schoeneman, James S. Donaldson

Published in: Pediatric Radiology | Issue 11/2014

Abstract

Background

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in children. The gold standard for diagnosis is liver biopsy. MRI is a non-invasive imaging method to provide quantitative measurement of hepatic fat content. The methodology is particularly appealing for the pediatric population because of its rapidity and radiation-free imaging techniques.

Objective

To develop a multi-point Dixon MRI method with multi-interference models (multi-fat-peak modeling and bi-exponential T2* correction) for accurate hepatic fat fraction (FF) and T2* measurements in pediatric patients with NAFLD.

Materials and methods

A phantom study was first performed to validate the accuracy of the MRI fat fraction measurement by comparing it with the chemical fat composition of the ex-vivo pork liver-fat homogenate. The most accurate model determined from the phantom study was used for fat fraction and T2* measurements in 52 children and young adults referred from the pediatric hepatology clinic with suspected or identified NAFLD. Separate T2* values of water (T2*_W) and fat (T2*_F) components derived from the bi-exponential fitting were evaluated and plotted as a function of fat fraction. In ten patients undergoing liver biopsy, we compared histological analysis of liver fat fraction with MRI fat fraction.

Results

In the phantom study the 6-point Dixon with 5-fat-peak, bi-exponential T2* modeling demonstrated the best precision and accuracy in fat fraction measurements compared with other methods. This model was further calibrated with chemical fat fraction and applied in patients, where similar patterns were observed as in the phantom study that conventional 2-point and 3-point Dixon methods underestimated fat fraction compared to the calibrated 6-point 5-fat-peak bi-exponential model (P < 0.0001). With increasing fat fraction, T2*_W (27.9 ± 3.5 ms) decreased, whereas T2*_F (20.3 ± 5.5 ms) increased; and T2*_W and T2*_F became increasingly more similar when fat fraction was higher than 15–20%. Histological fat fraction measurements in ten patients were highly correlated with calibrated MRI fat fraction measurements (Pearson correlation coefficient r = 0.90 with P = 0.0004).

Conclusion

Liver MRI using multi-point Dixon with multi-fat-peak and bi-exponential T2* modeling provided accurate fat quantification in children and young adults with non-alcoholic fatty liver disease and may be used to screen at-risk or affected individuals and to monitor disease progress noninvasively.

Matthiessen J, Velsing Groth M, Fagt S et al (2008) Prevalence and trends in overweight and obesity among children and adolescents in Denmark. Scand J Public Health 36:153–160PubMedCrossRef

Ji CY, Cooperative Study on Childhood Obesity: Working Group on Obesity (2008) The prevalence of childhood overweight/obesity and the epidemic changes in 1985–2000 for Chinese school-age children and adolescents. Obes Rev 9:78–81PubMedCrossRef

Giorgio V, Prono F, Graziano F et al (2013) Pediatric non alcoholic fatty liver disease: old and new concepts on development, progression, metabolic insight and potential treatment targets. BMC Pediatr 13:40PubMedCrossRefPubMedCentral

Day CP (2011) Non-alcoholic fatty liver disease: a massive problem. Clin Med 11:176–178PubMedCrossRef

Ma X, Holalkere NS, Kambadakone RA et al (2009) Imaging-based quantification of hepatic fat: methods and clinical applications. Radiographics 29:1253–1277PubMedCrossRef

Fishbein M, Castro F, Cheruku S et al (2005) Hepatic MRI for fat quantitation: its relationship to fat morphology, diagnosis, and ultrasound. J Clin Gastroenterol 39:619–625PubMedCrossRef

Lee SS, Park SH, Kim HJ et al (2010) Non-invasive assessment of hepatic steatosis: prospective comparison of the accuracy of imaging examinations. J Hepatol 52:579–585PubMedCrossRef

Mottin CC, Moretto M, Padoin AV et al (2004) The role of ultrasound in the diagnosis of hepatic steatosis in morbidly obese patients. Obes Surg 14:635–637PubMedCrossRef

Park SH, Kim PN, Kim KW et al (2006) Macrovesicular hepatic steatosis in living liver donors: use of CT for quantitative and qualitative assessment. Radiology 239:105–112PubMedCrossRef

10.

Cassidy FH, Yokoo T, Aganovic L et al (2009) Fatty liver disease: MR imaging techniques for the detection and quantification of liver steatosis. Radiographics 29:231–260PubMedCrossRef

11.

Dixon WT (1984) Simple proton spectroscopic imaging. Radiology 153:189–194PubMedCrossRef

12.

Levenson H, Greensite F, Hoefs J et al (1991) Fatty infiltration of the liver: quantification with phase-contrast MR imaging at 1.5 T vs. biopsy. AJR Am J Roentgenol 156:307–312PubMedCrossRef

13.

Fishbein MH, Gardner KG, Potter CJ et al (1997) Introduction of fast MR imaging in the assessment of hepatic steatosis. Magn Reson Imaging 15:287–293PubMedCrossRef

14.

Yokoo T, Bydder M, Hamilton G et al (2009) Nonalcoholic fatty liver disease: diagnostic and fat-grading accuracy of low-flip-angle multiecho gradient-recalled-echo MR imaging at 1.5 T. Radiology 251:67–76PubMedCrossRefPubMedCentral

15.

Reeder SB, Pineda AR, Wen Z et al (2005) Iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL): application with fast spin-echo imaging. Magn Reson Med 54:636–644PubMedCrossRef

16.

Reeder SB, McKenzie CA, Pineda AR et al (2007) Water-fat separation with IDEAL gradient-echo imaging. J Magn Reson Imaging 25:644–652PubMedCrossRef

17.

Liu CY, McKenzie CA, Yu H et al (2007) Fat quantification with IDEAL gradient echo imaging: correction of bias from T(1) and noise. Magn Reson Med 58:354–364PubMedCrossRef

18.

Yokoo T, Shiehmorteza M, Hamilton G et al (2011) Estimation of hepatic proton-density fat fraction by using MR imaging at 3.0 T. Radiology 258:749–759PubMedCrossRefPubMedCentral

19.

Zhong X, Nickel M, Kannengiesser SAR et al (2013) Fat and iron quantification using a multi-step adaptive fitting approach with multi-echo GRE imaging. J Magn Reson Imaging. doi:10.1002/mrm.25054 PubMed

20.

Lee SS, Lee Y, Kim N et al (2011) Hepatic fat quantification using chemical shift MR imaging and MR spectroscopy in the presence of hepatic iron deposition: validation in phantoms and in patients with chronic liver disease. J Magn Reson Imaging 33:1390–1398PubMedCrossRef

21.

Permutt Z, Le TA, Peterson MR et al (2012) Correlation between liver histology and novel magnetic resonance imaging in adult patients with non-alcoholic fatty liver disease — MRI accurately quantifies hepatic steatosis in NAFLD. Aliment Pharmacol Ther 36:22–29

22.

Bydder M, Yokoo T, Hamilton G et al (2008) Relaxation effects in the quantification of fat using gradient echo imaging. Magn Reson Imaging 26:347–359PubMedCrossRefPubMedCentral

23.

Bydder M, Shiehmorteza M, Yokoo T et al (2010) Assessment of liver fat quantification in the presence of iron. Magn Reson Imaging 28:767–776PubMedCrossRefPubMedCentral

24.

Yu H, Shimakawa A, McKenzie CA et al (2008) Multiecho water-fat separation and simultaneous R2* estimation with multifrequency fat spectrum modeling. Magn Reson Med 60:1122–1134PubMedCrossRefPubMedCentral

Title: Quantitative MRI for hepatic fat fraction and T2* measurement in pediatric patients with non-alcoholic fatty liver disease
Authors: Jie Deng
Mark H. Fishbein
Cynthia K. Rigsby
Gang Zhang
Samantha E. Schoeneman
James S. Donaldson
Publication date: 01-11-2014
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Radiology / Issue 11/2014
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI: https://doi.org/10.1007/s00247-014-3024-y

At a glance: The STEP trials

Springer Medicine

Quantitative MRI for hepatic fat fraction and T2* measurement in pediatric patients with non-alcoholic fatty liver disease

Abstract

Background

Objective

Materials and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Objective

Materials and methods

Results

Conclusion

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