European Radiology

, Volume 19, Issue 8, pp 2033–2040

Noninvasive quantitation of human liver steatosis using magnetic resonance and bioassay methods

  • Gaspard d’Assignies
  • Martin Ruel
  • Abdesslem Khiat
  • Luigi Lepanto
  • Miguel Chagnon
  • Claude Kauffmann
  • An Tang
  • Louis Gaboury
  • Yvan Boulanger
Magnetic Resonance


The purpose was to evaluate the ability of three magnetic resonance (MR) techniques to detect liver steatosis and to determine which noninvasive technique (MR, bioassays) or combination of techniques is optimal for the quantification of hepatic fat using histopathology as a reference. Twenty patients with histopathologically proven steatosis and 24 control subjects underwent single-voxel proton MR spectroscopy (MRS; 3 voxels), dual-echo in phase/out of phase MR imaging (DEI) and diffusion-weighted MR imaging (DWI) examinations of the liver. Blood or urine bioassays were also performed for steatosis patients. Both MRS and DEI data allowed to detect steatosis with a high sensitivity (0.95 for MRS; 1 for DEI) and specificity (1 for MRS; 0.875 for DEI) but not DWI. Strong correlations were found between fat fraction (FF) measured by MRS, DEI and histopathology segmentation as well as with low density lipoprotein (LDL) and cholesterol concentrations. A Bland-Altman analysis showed a good agreement between the FF measured by MRS and DEI. Partial correlation analyses failed to improve the correlation with segmentation FF when MRS or DEI data were combined with bioassay results. Therefore, FF from MRS or DEI appear to be the best parameters to both detect steatosis and accurately quantify fat liver noninvasively.


Liver steatosis MRI Magnetic resonance spectroscopy Histopathology Fat quantitation 


  1. 1.
    Yan E, Durazo F, Tong M et al (2007) Nonalcoholic fatty liver disease: pathogenesis, identification, progression, and management. Nutr Rev 65:376–384PubMedCrossRefGoogle Scholar
  2. 2.
    Yeh MM, Brunt EM (2007) Pathology of nonalcoholic fatty liver disease. Am J Clin Pathol 128:837–847PubMedCrossRefGoogle Scholar
  3. 3.
    Schindhelm RK, Diamant M, Heine RJ (2007) Nonalcoholic fatty liver disease and cardiovascular disease risk. Curr Diab Rep 7:181–187PubMedCrossRefGoogle Scholar
  4. 4.
    Farrell GC, Larter CZ (2006) Nonalcoholic fatty liver disease: from steatosis to cirrhosis. Hepatology 43:S99–S112PubMedCrossRefGoogle Scholar
  5. 5.
    Angulo P (2002) Nonalcoholic fatty liver disease. N Engl J Med 346:1221–1231PubMedCrossRefGoogle Scholar
  6. 6.
    Castera L, Negre I, Samii K et al (1999) Pain experienced during percutaneous liver biopsy. Hepatology 30:1529–1530PubMedCrossRefGoogle Scholar
  7. 7.
    Joy D, Thava VR, Scott BB (2003) Diagnosis of fatty liver disease: is biopsy necessary? Eur J Gastroenterol Hepatol 15:539–543PubMedCrossRefGoogle Scholar
  8. 8.
    Ratziu V, Charlotte F, Heurtier A et al (2005) Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology 128:1898–1906PubMedCrossRefGoogle Scholar
  9. 9.
    Vos MB, McClain CJ (2008) Nutrition and nonalcoholic fatty liver disease in children. Curr Gastroenterol Rep 10:308–315PubMedCrossRefGoogle Scholar
  10. 10.
    Te Sligte K, Bourass I, Sels JP et al (2004) Non-alcoholic steatohepatitis: review of a growing medical problem. Eur J Intern Med 15:10–21PubMedCrossRefGoogle Scholar
  11. 11.
    Canbakan B, Senturk H, Tahan V et al (2007) Clinical, biochemical and histological correlations in a group of non-drinker subjects with non-alcoholic fatty liver disease. Acta Gastroenterol Belg 70:277–284PubMedGoogle Scholar
  12. 12.
    Zafrani ES (2004) Non-alcoholic fatty liver disease: an emerging pathological spectrum. Virchows Arch 444:3–12PubMedCrossRefGoogle Scholar
  13. 13.
    Charatcharoenwitthaya P, Lindor KD (2007) Role of radiologic modalities in the management of non-alcoholic steatohepatitis. Clin Liver Dis 11:37–54 viiiPubMedCrossRefGoogle Scholar
  14. 14.
    Szczepaniak LS, Nurenberg P, Leonard D et al (2005) Magnetic resonance spectroscopy to measure hepatic triglyceride content: prevalence of hepatic steatosis in the general population. Am J Physiol Endocrinol Metab 288:E462–E468PubMedCrossRefGoogle Scholar
  15. 15.
    Hussain HK, Chenevert TL, Londy FJ et al (2005) Hepatic fat fraction: MR imaging for quantitative measurement and display—early experience. Radiology 237:1048–1055PubMedCrossRefGoogle Scholar
  16. 16.
    Bydder M, Yokoo T, Hamilton G et al (2008) Relaxation effects in the quantification of fat using gradient echo imaging. Magn Reson Imaging 26:347–359PubMedCrossRefGoogle Scholar
  17. 17.
    Thomsen C, Becker U, Winkler K et al (1994) Quantification of liver fat using magnetic resonance spectroscopy. Magn Reson Imaging 12:487–495PubMedCrossRefGoogle Scholar
  18. 18.
    Nakae I, Mitsunami K, Omura T et al (2003) Proton magnetic resonance spectroscopy can detect creatine depletion associated with the progression of heart failure in cardiomyopathy. J Am Coll Cardiol 42:1587–1593PubMedCrossRefGoogle Scholar
  19. 19.
    Longo R, Pollesello P, Ricci C et al (1995) Proton MR spectroscopy in quantitative in vivo determination of fat content in human liver steatosis. J Magn Reson Imaging 5:281–285PubMedCrossRefGoogle Scholar
  20. 20.
    Kim H, Taksali SE, Dufour S et al (2008) Comparative MR study of hepatic fat quantification using single-voxel proton spectroscopy, two-point Dixon and three-point IDEAL. Magn Reson Med 59:521–527PubMedCrossRefGoogle Scholar
  21. 21.
    Marsman H, Matsushita T, Dierkhising R et al (2004) Assessment of donor liver steatosis: pathologist or automated software? Hum Pathol 35:430–435PubMedCrossRefGoogle Scholar
  22. 22.
    Promrat K, Lutchman G, Kleiner DE et al (2003) Pilot study of pioglitazone in nonalcoholic steatohepatitis. Gastroenterology 124:A-708CrossRefGoogle Scholar
  23. 23.
    Perkins JD (2006) Saying “yes” to obese living liver donors: short-term intensive treatment for donors with hepatic steatosis in living-donor liver transplantation. Liver Transplant 12:1012–1013CrossRefGoogle Scholar
  24. 24.
    Cotler SJ, Guzman G, Layden-Almer J et al (2007) Measurement of liver fat content using selective saturation at 3.0 T. J Magn Reson Imaging 25:743–748PubMedCrossRefGoogle Scholar
  25. 25.
    Boulanger Y, Amara M, Lepanto L et al (2003) Diffusion-weighted MR imaging of the liver of hepatitis C patients. NMR Biomed 16:132–136PubMedCrossRefGoogle Scholar
  26. 26.
    Irwan R, Edens MA, Sijens PE (2008) Assessment of the variations in fat content in normal liver using a fast MR imaging method in comparison with results obtained by spectroscopic imaging. Eur Radiol 18:806–813PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2009

Authors and Affiliations

  • Gaspard d’Assignies
    • 1
  • Martin Ruel
    • 1
  • Abdesslem Khiat
    • 1
  • Luigi Lepanto
    • 1
  • Miguel Chagnon
    • 3
  • Claude Kauffmann
    • 1
  • An Tang
    • 1
  • Louis Gaboury
    • 2
  • Yvan Boulanger
    • 1
    • 4
  1. 1.Département de radiologieCentre hospitalier de l’Université de Montréal (CHUM)MontréalCanada
  2. 2.Département d’anatomo-pathologieCentre hospitalier de l’Université de Montréal (CHUM)MontréalCanada
  3. 3.Département de mathématiques et de statistiqueUniversité de Montréal (UDEM)MontréalCanada
  4. 4.Département de radiologieHôpital Saint-Luc du CHUMMontréalCanada

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