Hepatic fat quantification using the proton density fat fraction (PDFF): utility of free-drawn-PDFF with a large coverage area
To evaluate the diagnostic performance of magnetic resonance imaging-estimated proton density fat fraction (MRI-PDFF) using a free-drawn region-of-interest (ROI) measurement of hepatic fat deposition compared to MR spectroscopy (MRS) as the reference standard.
Materials and methods
A total of 156 patients underwent 3T MR imaging with a multi-step adaptive fitting approach, multi-echo volume interpolated breath-hold examination (VIBE) acquisition and single-voxel high-speed T2-corrected multiple-echo 1H-MR spectroscopy (SVS). Seven ROI measurements were performed in each segment of the fat percentage maps (“segmental-PDFF”). Three ROIs were placed at the same level as the SVS (“VOI-PDFF”). Free-hand-drawn ROIs were placed at three different levels along the entire liver (“free-drawn-PDFF”) and separately along the right and left lobes (“free-drawn-PDFF-2”).
A strong correlation was found between VOI-PDFF and SVS (r = 0.977). The right lobe had greater fat content than the left lobe (p < 0.001). After image analysis, 54 and 46 patients were classified as having steatosis using SVS and free-drawn-PDFF as a reference standard, respectively. The diagnostic performance of free-drawn-PDFF was significantly different from SVS (p < 0.05).
Free-drawn-PDFF provides accurate and generalized information regarding hepatic fat deposition. It is a useful method, particularly if fat deposition is heterogeneous, and should be considered as a new reference standard.
KeywordsFat quantification Proton density fat fraction Hepatic steatosis MR spectroscopy
Conflict of Interest
The authors declare that they have no conflict of interest.
Statement of human rights
For this type of study formal consent is not required.
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
- 12.Huang MA, Greenson JK, Chao C, Anderson L, Peterman D, Jacobson J, Emick D, Lok AS, Conjeevaram HS (2005) One-year intense nutritional counseling results in histological improvement in patients with non-alcoholic steatohepatitis: a pilot study. Am J Gastroenterol 100(5):1072–1081. doi: 10.1111/j.1572-0241.2005.41334.x CrossRefPubMedGoogle Scholar
- 13.Hickman IJ, Jonsson JR, Prins JB, Ash S, Purdie DM, Clouston AD, Powell EE (2004) Modest weight loss and physical activity in overweight patients with chronic liver disease results in sustained improvements in alanine aminotransferase, fasting insulin, and quality of life. Gut 53(3):413–419PubMedCentralCrossRefPubMedGoogle Scholar
- 20.Szczepaniak LS, Nurenberg P, Leonard D, Browning JD, Reingold JS, Grundy S, Hobbs HH, Dobbins RL (2005) Magnetic resonance spectroscopy to measure hepatic triglyceride content: prevalence of hepatic steatosis in the general population. Am J Physiol Endocrinol Metab 288(2):E462–E468. doi: 10.1152/ajpendo.00064.2004 CrossRefPubMedGoogle Scholar
- 23.Yokoo T, Bydder M, Hamilton G, Middleton MS, Gamst AC, Wolfson T, Hassanein T, Patton HM, Lavine JE, Schwimmer JB, Sirlin CB (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(1):67–76. doi: 10.1148/radiol.2511080666 PubMedCentralCrossRefPubMedGoogle Scholar
- 26.Bashir MR, Zhong X, Nickel MD, Fananapazir G, Kannengiesser SA, Kiefer B, Dale BM (2015) Quantification of hepatic steatosis with a multistep adaptive fitting MRI approach: prospective validation against MR spectroscopy. AJR Am J Roentgenol 204(2):297–306. doi: 10.2214/AJR.14.12457 CrossRefPubMedGoogle Scholar
- 27.Kim H, Taksali SE, Dufour S, Befroy D, Goodman TR, Petersen KF, Shulman GI, Caprio S, Constable RT (2008) Comparative MR study of hepatic fat quantification using single-voxel proton spectroscopy, two-point dixon and three-point IDEAL. Magn Reson Med 59(3):521–527. doi: 10.1002/mrm.21561 PubMedCentralCrossRefPubMedGoogle Scholar
- 28.Tang A, Tan J, Sun M, Hamilton G, Bydder M, Wolfson T, Gamst AC, Middleton M, Brunt EM, Loomba R, Lavine JE, Schwimmer JB, Sirlin CB (2013) Nonalcoholic fatty liver disease: MR imaging of liver proton density fat fraction to assess hepatic steatosis. Radiology 267(2):422–431. doi: 10.1148/radiol.12120896 PubMedCentralCrossRefPubMedGoogle Scholar
- 32.Noureddin M, Lam J, Peterson MR, Middleton M, Hamilton G, Le TA, Bettencourt R, Changchien C, Brenner DA, Sirlin C, Loomba R (2013) Utility of magnetic resonance imaging versus histology for quantifying changes in liver fat in nonalcoholic fatty liver disease trials. Hepatology 58(6):1930–1940. doi: 10.1002/hep.26455 CrossRefPubMedGoogle Scholar
- 35.Bonekamp S, Tang A, Mashhood A, Wolfson T, Changchien C, Middleton MS, Clark L, Gamst A, Loomba R, Sirlin CB (2014) Spatial distribution of MRI-Determined hepatic proton density fat fraction in adults with nonalcoholic fatty liver disease. J Magn Reson Imaging JMRI 39(6):1525–1532CrossRefPubMedGoogle Scholar
- 39.Yoshimitsu K, Honda H, Kuroiwa T, Irie H, Aibe H, Shinozaki K, Masuda K (2001) Unusual hemodynamics and pseudolesions of the noncirrhotic liver at CT. Radiographics 21:S81–S96Google Scholar
- 40.Joe E, Lee JM, Kim KW, Lee KB, Kim SJ, Baek JH, Shin CI, Suh KS, Yi NJ, Han JK, Choi BI (2012) Quantification of hepatic macrosteatosis in living, related liver donors using T1-independent, T2*-corrected chemical shift MRI. J Magn Reson Imag JMRI 36(5):1124–1130. doi: 10.1002/jmri.23738 CrossRefGoogle Scholar