European Radiology

, Volume 25, Issue 5, pp 1356–1365 | Cite as

Automated two-point dixon screening for the evaluation of hepatic steatosis and siderosis: comparison with R2*-relaxometry and chemical shift-based sequences

  • B. HenningerEmail author
  • H. Zoller
  • S. Rauch
  • M. Schocke
  • S. Kannengiesser
  • X. Zhong
  • G. Reiter
  • W. Jaschke
  • C. Kremser



To evaluate the automated two-point Dixon screening sequence for the detection and estimated quantification of hepatic iron and fat compared with standard sequences as a reference.


One hundred and two patients with suspected diffuse liver disease were included in this prospective study. The following MRI protocol was used: 3D-T1-weighted opposed- and in-phase gradient echo with two-point Dixon reconstruction and dual-ratio signal discrimination algorithm (“screening” sequence); fat-saturated, multi-gradient-echo sequence with 12 echoes; gradient-echo T1 FLASH opposed- and in-phase. Bland–Altman plots were generated and correlation coefficients were calculated to compare the sequences.


The screening sequence diagnosed fat in 33, iron in 35 and a combination of both in 4 patients. Correlation between R2* values of the screening sequence and the standard relaxometry was excellent (r = 0.988). A slightly lower correlation (r = 0.978) was found between the fat fraction of the screening sequence and the standard sequence. Bland–Altman revealed systematically lower R2* values obtained from the screening sequence and higher fat fraction values obtained with the standard sequence with a rather high variability in agreement.


The screening sequence is a promising method with fast diagnosis of the predominant liver disease. It is capable of estimating the amount of hepatic fat and iron comparable to standard methods.

Key points

MRI plays a major role in the clarification of diffuse liver disease.

The screening sequence was introduced for the assessment of diffuse liver disease.

It is a fast and automated algorithm for the evaluation of hepatic iron and fat.

It is capable of estimating the amount of hepatic fat and iron.


Liver Iron Fat Magnetic resonance Relaxometry 



fat fraction


hepatic iron overload


non-alcoholic fatty liver disease


magnetic resonance imaging



The scientific guarantor of this publication is Dr. Benjamin Henninger. The authors of this manuscript declare relationships with the following companies: S. Kannengiesser, X. Zhong and G. Reiter are employees of Siemens Healthcare. They had no control of all data for the duration of the study. All the other authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. One of the authors has statistical experience (C. Kremser). Nevertheless no complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, diagnostic study, performed at one institution.


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Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • B. Henninger
    • 1
    Email author
  • H. Zoller
    • 2
  • S. Rauch
    • 1
  • M. Schocke
    • 1
  • S. Kannengiesser
    • 3
  • X. Zhong
    • 4
  • G. Reiter
    • 5
  • W. Jaschke
    • 1
  • C. Kremser
    • 1
  1. 1.Department of RadiologyMedical University of InnsbruckInnsbruckAustria
  2. 2.Department of Internal MedicineMedical University of InnsbruckInnsbruckAustria
  3. 3.MR Applications DevelopmentSiemens AG, Healthcare SectorErlangenGermany
  4. 4.MR R&D CollaborationsSiemens HealthcareAtlantaUSA
  5. 5.MR R&D CollaborationsSiemens AG, Healthcare SectorGrazAustria

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