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Effect of intravenous gadoxetate disodium and flip angle on hepatic proton density fat fraction estimation with six-echo, gradient-recalled-echo, magnitude-based MR imaging at 3T

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ABSTRACT

Purpose

The aim of the study was to determine in patients undergoing gadoxetate disodium (Gx)-enhanced MR exams whether proton density fat fraction (PDFF) estimation accuracy of magnitude-based multi-gradient-echo MRI (MRI-M) could be improved by using high flip angle (FA) on post-contrast images.

Materials and Methods

Thirty-one adults with known or suspected hepatic steatosis undergoing 3T clinical Gx-enhanced liver MRI were enrolled prospectively. MR spectroscopy (MRS), the reference standard, was performed before Gx to measure MRS-PDFF. Low (10°)- and high (50°)-flip angle (FA) MRI-M sequences were acquired before and during the hepatobiliary phase after Gx administration; MRI-PDFF was estimated in the MRS-PDFF voxel location. Linear regression parameters (slope, intercept, average bias, R 2) were calculated for MRS-PDFF as a function of MRI-PDFF for each MRI-M sequence (pre-Gx low-FA, pre-Gx high-FA, post-Gx low-FA, post-Gx high-FA) for all patients and for patients with MRS-PDFF <10%. Regression parameters were compared (Bonferroni-adjusted bootstrap-based tests).

Results

Three of the four MRI-M sequences (pre-Gx low-FA, post-Gx low-FA, post-Gx high-FA) provided relatively unbiased PDFF estimates overall and in the low-PDFF range, with regression slopes close to 1 and intercepts and biases close to zero. Pre-Gx high-FA MRI overestimated PDFF in proportion to MRS-PDFF, with slopes of 0.72 (overall) and 0.63 (low-PDFF range). Based on regression bias closest to 0, the post-Gx high-FA sequence was the most accurate overall and in the low-PDFF range. This sequence provided statistically significant improvements in at least two regression parameters compared to every other sequence.

Conclusion

In patients undergoing Gx-enhanced MR exams, PDFF estimation accuracy of MRI-M can be improved by using high-FA on post-contrast images.

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References

  1. 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(1):22–29

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Tang A, Tan J, Sun M, et al. (2013) Nonalcoholic fatty liver disease: MR imaging of liver proton density fat fraction to assess hepatic steatosis. Radiology 267(2):422–431

    Article  PubMed  PubMed Central  Google Scholar 

  3. Tang A, Desai A, Hamilton G, et al. (2015) Accuracy of MR imaging-estimated proton density fat fraction for classification of dichotomized histologic steatosis grades in nonalcoholic fatty liver disease. Radiology 274(2):416–425

    Article  PubMed  Google Scholar 

  4. 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(3):281–285

    Article  CAS  PubMed  Google Scholar 

  5. Thomsen C, Becker U, Winkler K, et al. (1994) Quantification of liver fat using magnetic resonance spectroscopy. Magn Reson Imaging 12(3):487–495

    Article  CAS  PubMed  Google Scholar 

  6. Hamilton G, Middleton MS, Bydder M, et al. (2009) Effect of PRESS and STEAM sequences on magnetic resonance spectroscopic liver fat quantification. J Magn Reson Imaging 30(1):145–152

    Article  PubMed  PubMed Central  Google Scholar 

  7. 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(1):67–76

    Article  PubMed  PubMed Central  Google Scholar 

  8. 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(3):749–759

    Article  PubMed  PubMed Central  Google Scholar 

  9. Meisamy S, Hines CD, Hamilton G, et al. (2011) Quantification of hepatic steatosis with T1-independent, T2-corrected MR imaging with spectral modeling of fat: blinded comparison with MR spectroscopy. Radiology 258(3):767–775

    Article  PubMed  PubMed Central  Google Scholar 

  10. Reeder SB, Cruite I, Hamilton G, Sirlin CB (2011) Quantitative assessment of liver fat with magnetic resonance imaging and spectroscopy. J Magn Reson Imaging 34(4):729–749

    Article  PubMed  Google Scholar 

  11. Yu H, McKenzie CA, Shimakawa A, et al. (2007) Multiecho reconstruction for simultaneous water-fat decomposition and T2* estimation. J Magn Reson Imaging 26(4):1153–1161

    Article  PubMed  Google Scholar 

  12. Liu CY, McKenzie CA, Yu H, Brittain JH, Reeder SB (2007) Fat quantification with IDEAL gradient echo imaging: correction of bias from T(1) and noise. Magn Reson Med 58(2):354–364

    Article  PubMed  Google Scholar 

  13. Bydder M, Yokoo T, Hamilton G, et al. (2008) Relaxation effects in the quantification of fat using gradient echo imaging. Magn Reson Imaging 26(3):347–359

    Article  PubMed  PubMed Central  Google Scholar 

  14. Yokoo T, Collins JM, Hanna RF, et al. (2008) Effects of intravenous gadolinium administration and flip angle on the assessment of liver fat signal fraction with opposed-phase and in-phase imaging. J Magn Reson Imaging 28(1):246–251

    Article  PubMed  Google Scholar 

  15. Hamilton GM, MS; Cunha, GM; Sirlin, CB.. Effect of gadolinium-based contrast agent on the relaxation properties of water and fat in human liver as measured in vivo by 1H MRS [abstract]. In: Proceedings 21st Scientific Meeting, International Society for Magnetic Resonance in Medicine. Salt Lake City; 2013. p. 1516.

  16. Hamilton G, Middleton MS, Hooker JC, et al. (2015) In vivo breath-hold H MRS simultaneous estimation of liver proton density fat fraction, and T1 and T2 of water and fat, with a multi-TR, multi-TE sequence. J Magn Reson Imaging 42(6):1538–1543

    Article  PubMed  PubMed Central  Google Scholar 

  17. Hussain HK, Chenevert TL, Londy FJ, et al. (2005) Hepatic fat fraction: MR imaging for quantitative measurement and display–early experience. Radiology 237(3):1048–1055

    Article  PubMed  Google Scholar 

  18. Bydder M, Hamilton G, Yokoo T, Sirlin CB (2008) Optimal phased-array combination for spectroscopy. Magn Reson Imaging 26(6):847–850

    Article  PubMed  PubMed Central  Google Scholar 

  19. Naressi A, Couturier C, Devos JM, et al. (2001) Java-based graphical user interface for the MRUI quantitation package. Magma 12(2–3):141–152

    Article  CAS  PubMed  Google Scholar 

  20. Vanhamme L, van den Boogaart A, Van Huffel S (1997) Improved method for accurate and efficient quantification of MRS data with use of prior knowledge. J Magn Reson 129(1):35–43

    Article  CAS  PubMed  Google Scholar 

  21. Hamilton G, Yokoo T, Bydder M, et al. (2011) In vivo characterization of the liver fat (1)H MR spectrum. NMR Biomed 24(7):784–790

    Article  PubMed  Google Scholar 

  22. Stanisz GJ, Odrobina EE, Pun J, et al. (2005) T1, T2 relaxation and magnetization transfer in tissue at 3T. Magn Reson Med 54(3):507–512

    Article  PubMed  Google Scholar 

  23. 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(5):1122–1134

    Article  PubMed  PubMed Central  Google Scholar 

  24. de Bazelaire CM, Duhamel GD, Rofsky NM, Alsop DC (2004) GD, NM, DC. MR imaging relaxation times of abdominal and pelvic tissues measured in vivo at 3.0 T: preliminary results. Radiology 230(3):652–659

    Article  PubMed  Google Scholar 

  25. Hines CD, Frydrychowicz A, Hamilton G, et al. (2011) T(1) independent, T(2) (*) corrected chemical shift based fat-water separation with multi-peak fat spectral modeling is an accurate and precise measure of hepatic steatosis. J Magn Reson Imaging 33(4):873–881

    Article  PubMed  PubMed Central  Google Scholar 

  26. Reeder SB, Robson PM, Yu H, et al. (2009) Quantification of hepatic steatosis with MRI: the effects of accurate fat spectral modeling. J Magn Reson Imaging 29(6):1332–1339

    Article  PubMed  PubMed Central  Google Scholar 

  27. Reeder SB, McKenzie CA, Pineda AR, et al. (2007) Water-fat separation with IDEAL gradient-echo imaging. J Magn Reson Imaging 25(3):644–652

    Article  PubMed  Google Scholar 

  28. Hernando D, Wells SA, Vigen KK, Reeder SB (2015) Effect of hepatocyte-specific gadolinium-based contrast agents on hepatic fat-fraction and R2(). Magn Reson Imaging 33(1):43–50

    Article  CAS  PubMed  Google Scholar 

  29. Heba ER, Desai A, Zand KA, et al. (2016) Accuracy and the effect of possible subject-based confounders of magnitude-based MRI for estimating hepatic proton density fat fraction in adults, using MR spectroscopy as reference. J Magn Reson Imaging 43(2):398–406

    Article  PubMed  Google Scholar 

  30. Zand KA, Shah A, Heba E, et al. (2015) Accuracy of multiecho magnitude-based MRI (M-MRI) for estimation of hepatic proton density fat fraction (PDFF) in children. J Magn Reson Imaging 42(5):1223–1232

    Article  PubMed  PubMed Central  Google Scholar 

  31. Rehm JL, Wolfgram PM, Hernando D, et al. (2015) Proton density fat-fraction is an accurate biomarker of hepatic steatosis in adolescent girls and young women. Eur Radiol 25(10):2921–2930

    Article  PubMed  PubMed Central  Google Scholar 

  32. Marckmann P, Skov L, Rossen K, et al. (2006) Nephrogenic systemic fibrosis: suspected causative role of gadodiamide used for contrast-enhanced magnetic resonance imaging. J Am Soc Nephrol 17(9):2359–2362

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. MR3T Bydder Laboratory, Liver Imaging Group, Department of Radiology, University of California, San Diego, 408 Dickinson Street, MC 8226, San Diego, CA, 92103-8226, USA

    Charlie C. Park, Gavin Hamilton, Kevin A. Zand, Jonathan C. Hooker, Eduardo Costa, Elhamy Heba, Lisa Clark, Michael S. Middleton & Claude B. Sirlin

  2. Department of Diagnostic and Interventional Radiology, Rochester General Hospital, Rochester, NY, USA

    Ajinkya Desai

  3. Computational and Applied Statistics Laboratory (CASL), San Diego Supercomputer Center (SDSC), University of California, San Diego, La Jolla, CA, USA

    Tanya Wolfson & Anthony Gamst

  4. Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA

    Rohit Loomba

  5. Division of Epidemiology, Department of Family Medicine and Preventive Medicine, University of California, San Diego, La Jolla, CA, USA

    Rohit Loomba

Authors
  1. Charlie C. Park
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  2. Gavin Hamilton
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  13. Claude B. Sirlin
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Corresponding author

Correspondence to Claude B. Sirlin.

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Funding

The project described was partially supported by the National Institutes of Health (Grants R01 DK08892505, R01 DK102853, TL1 TR00098) and Canon U.S.A./RSNA Research Medical Student Grant. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Conflict of interest

Dr. Claude B. Sirlin consults, advises, and is on the speakers’ bureau for Bayer. He received grants from GE Healthcare. The other authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Park, C.C., Hamilton, G., Desai, A. et al. Effect of intravenous gadoxetate disodium and flip angle on hepatic proton density fat fraction estimation with six-echo, gradient-recalled-echo, magnitude-based MR imaging at 3T. Abdom Radiol 42, 1189–1198 (2017). https://doi.org/10.1007/s00261-016-0992-4

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  • DOI: https://doi.org/10.1007/s00261-016-0992-4

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