In adults, noninvasive chemical shift encoded Cartesian magnetic resonance imaging (MRI) and single-voxel magnetic resonance (MR) spectroscopy (SVS) accurately quantify hepatic steatosis but require breath-holding. In children, especially young and sick children, breath-holding is often limited or not feasible. Sedation can facilitate breath-holding but is highly undesirable. For these reasons, there is a need to develop free-breathing MRI technology that accurately quantifies steatosis in all children.
This study aimed to compare non-sedated free-breathing multi-echo 3-D stack-of-radial (radial) MRI versus standard breath-holding MRI and SVS techniques in a group of children for fat quantification with respect to image quality, accuracy and repeatability.
Materials and methods
Healthy children (n=10, median age [±interquartile range]: 10.9 [±3.3] years) and overweight children with nonalcoholic fatty liver disease (NAFLD) (n=9, median age: 15.2 [±3.2] years) were imaged at 3 Tesla using free-breathing radial MRI, breath-holding Cartesian MRI and breath-holding SVS. Acquisitions were performed twice to assess repeatability (within-subject mean difference, MDwithin). Images and hepatic proton-density fat fraction (PDFF) maps were scored for image quality. Free-breathing and breath-holding PDFF were compared using linear regression (correlation coefficient, r and concordance correlation coefficient, ρc) and Bland-Altman analysis (mean difference). P<0.05 was considered significant.
In patients with NAFLD, free-breathing radial MRI demonstrated significantly less motion artifacts compared to breath-holding Cartesian (P<0.05). Free-breathing radial PDFF demonstrated a linear relationship (P<0.001) versus breath-holding SVS PDFF and breath-holding Cartesian PDFF with r=0.996 and ρc=0.994, and r=0.997 and ρc=0.995, respectively. The mean difference in PDFF between free-breathing radial MRI, breath-holding Cartesian MRI and breath-holding SVS was <0.7%. Repeated free-breathing radial MRI had MDwithin=0.25% for PDFF.
In this pediatric study, non-sedated free-breathing radial MRI provided accurate and repeatable hepatic PDFF measurements and improved image quality, compared to standard breath-holding MR techniques.
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The authors thank Aaron Scheffler, Dr. Joanna Yeh, Barbara Lee, Tammy Floore, Glen Nyborg and Sergio Godinez at University of California Los Angeles (UCLA) for their help with this project. This work acknowledges the use of the International Society of Magnetic Resonance in Medicine Fat-Water Toolbox (http://ismrm.org/workshops/FatWater12/data.htm).
Research reported in this publication was supported in part by a UCLA Radiology Department Exploratory Research Grant.
Conflicts of interest
T. Armstrong and H. H. Wu receive institutional research support from Siemens Healthineers.
Lin’s concordance coefficient (ρc)  for free-breathing radial compared to breath-holding (Cartesian and SVS) techniques:
μBH and μFB are the means and σBH and σFB are the standard deviations of the free-breathing radial and breath-holding techniques, respectively; r is the correlation coefficient between the free-breathing and breath-holding technique.
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Armstrong, T., Ly, K.V., Murthy, S. et al. Free-breathing quantification of hepatic fat in healthy children and children with nonalcoholic fatty liver disease using a multi-echo 3-D stack-of-radial MRI technique. Pediatr Radiol 48, 941–953 (2018). https://doi.org/10.1007/s00247-018-4127-7