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Intra-examination agreement between multi-echo gradient echo and confounder-corrected chemical shift-encoded MR sequences for R2* estimation as a biomarker of liver iron content in patients with a wide range of T2*/R2* and proton density fat fraction values

  • Hepatobiliary
  • Published:
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Abstract

Purpose

To investigate the intra-examination agreement between multi-echo gradient echo (MEGE) and confounder-corrected chemical shift-encoded (CSE) sequences for liver T2*/R2* estimations in a wide range of T2*/R2* and proton density fat fraction (PDFF) values. Exploratorily, to search for the T2*/R2* value where the agreement line breaks and examine differences between regions of low and high agreement.

Methods

Consecutive patients at risk for liver iron overload who underwent MEGE and CSE sequences within the same exam at 1.5 T were retrospectively selected. Regions of interest were drawn in the right and one in the left liver lobes on post-processed images for R2*(sec−1) and PDFF (%) estimation. Agreement between MEGE-R2* and CSE-R2* was evaluated using intra-class correlation coefficient (ICC) and Bland–Altman analysis. 95% confidence intervals (CI) were computed. Segment-and-regression analysis was performed to find the point where the agreement between sequences is interrupted. Regions of low and high agreement were examined using tree-based partitioning analyses.

Results

49 patients were included. Mean MEGE-R2* was 94.2 s−1 (range: 31.0–737.1) and mean CSE-R2* 87.7 (29.7–748.1). Mean CSE-PDFF was 9.12% (0.1–43.3). Agreement was strong for R2* estimations (ICC: 0.992,95%CI 0.987,0.996), but the relation was nonlinear and possibly heteroskedastic. Lower agreement occurred when MEGE-R2* > 235 s−1, with MEGE-R2* values consistently lower than CSE-R2*. Higher agreement was observed when PDFF < 14%.

Conclusion

MEGE-R2* and CSE-R2* strongly agree, though at higher iron content, MEGE-R2* is consistently lower than CSE-R2*. In this preliminary dataset, a breaking point for agreement was found at R2* > 235. Lower agreement was observed in patients with moderate to severe liver steatosis.

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Abbreviations

MEGE:

Multi-echo gradient echo

CSE:

Confounder-corrected chemical shift encoded

PDFF:

Proton density fat fraction

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Funding

The current work was carried out without any external funding.

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Authors and Affiliations

  1. Department of Radiology, University of Washington, 1705 NE Pacific St., Box 357233, Seattle, WA, 98195, USA

    Guilherme Moura Cunha, Orpheus Kolokythas, Halit Akcicek, Noah E. Briller & Kathan Amin

  2. Department of Statistics, University of Washington, Seattle, WA, USA

    Wenyu Chen

  3. Philips Healthcare North America, Cleveland, OH, USA

    Dave Hitt

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  1. Guilherme Moura Cunha
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  2. Orpheus Kolokythas
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  4. Halit Akcicek
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Correspondence to Guilherme Moura Cunha.

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Conflict of interest

One of the authors (DH) is an employee of Philips Health Care. This author provided support to imaging acquisition but was not involved in image or data analysis nor study results interpretation. One author (O.K.) receives research support from Philips Healthcare unrelated to the matter of this manuscript. All other authors of this manuscript declare no conflict of interest regarding to the content of this work.

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Moura Cunha, G., Kolokythas, O., Chen, W. et al. Intra-examination agreement between multi-echo gradient echo and confounder-corrected chemical shift-encoded MR sequences for R2* estimation as a biomarker of liver iron content in patients with a wide range of T2*/R2* and proton density fat fraction values. Abdom Radiol 48, 2302–2310 (2023). https://doi.org/10.1007/s00261-023-03902-4

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