Accuracy of Evaluation of Fatty Liver with Third-Generation Unenhanced Dual-Energy CT and MRI: Prospective Comparison with MR Spectroscopy

Abstract

Background and Objectives The purpose of this study is to evaluate and establish the accuracy of noninvasive methods, including third-generation dual-source dual-energy computed tomography (DECT) and proton density fat (PDF) fraction on magnetic resonance imaging (MRI) using three-dimensional multiecho multipoint chemical shift-encoded spoiled gradient echo (q-Dixon) sequence in the quantification of hepatic steatosis; with H1-MR spectroscopy (MRS) as the reference standard.

Materials and Methods A total of 47 patients were included in this prospective study. We studied the accuracy of fatty liver detection using third-generation DECT using mixed set images (MSIs), virtual monochromatic images (VMIs), and MRI q-Dixon. The results were compared with H1-MRS. Data were analyzed using linear regression for each technique compared with MRS.

Results Our study's correlation and linear regression analysis showed a good correlation between PDF values obtained by H1-MRS and MR q-Dixon methods (r = 0.821, r ² = 0.674, p < 0.001). On MSI, H1-MRS showed a low correlation with average liver attenuation (r ² = 0.379, p < 0.001) and a moderate correlation with liver attenuation index (r ² = 0.508, p < 0.001) noted. There was a moderate correlation between H1-MRS and average liver attenuation and liver attenuation index on VMI at 80 to 120 keV with r ² = 0.434, p < 0.001, and r ² = 0.485, p < 0.001, respectively.

Conclusion MRI q-Dixon is the method of choice for evaluating fat quantification in the absence of H1 MRS. Among DECT images, VMI is valuable in the evaluation of hepatic fat as compared with the mixed set of images.

Keywords

virtual monochromatic - third generation - dual-source - dual-energy - PDFF - q-Dixon - fat quantification - noncontrast

Publikationsverlauf

Artikel online veröffentlicht:
29. März 2023

• References

• 1 Amarapurkar D, Kamani P, Patel N. et al. Prevalence of non-alcoholic fatty liver disease: population based study. Ann Hepatol 2007; 6 (03) 161-163
• 2 Mohan V, Farooq S, Deepa M, Ravikumar R, Pitchumoni CS. Prevalence of non-alcoholic fatty liver disease in urban south Indians in relation to different grades of glucose intolerance and metabolic syndrome. Diabetes Res Clin Pract 2009; 84 (01) 84-91
• 3 Ratziu V, Bellentani S, Cortez-Pinto H, Day C, Marchesini G. A position statement on NAFLD/NASH based on the EASL 2009 special conference. J Hepatol 2010; 53 (02) 372-384
• 4 Veteläinen R, van Vliet A, Gouma DJ, van Gulik TM. Steatosis as a risk factor in liver surgery. Ann Surg 2007; 245 (01) 20-30
• 5 Kramer H, Pickhardt PJ, Kliewer MA. et al. Accuracy of liver fat quantification with advanced CT, MRI, and ultrasound techniques: prospective comparison with MR spectroscopy. AJR Am J Roentgenol 2017; 208 (01) 92-100
• 6 Bohte AE, van Werven JR, Bipat S, Stoker J. The diagnostic accuracy of US, CT, MRI and 1H-MRS for the evaluation of hepatic steatosis compared with liver biopsy: a meta-analysis. Eur Radiol 2011; 21 (01) 87-97
• 7 Lee SS, Park SH. Radiologic evaluation of nonalcoholic fatty liver disease. World J Gastroenterol 2014; 20 (23) 7392-7402
• 8 Szczepaniak LS, Nurenberg P, Leonard D. et al. Magnetic resonance spectroscopy to measure hepatic triglyceride content: prevalence of hepatic steatosis in the general population. Am J Physiol Endocrinol Metab 2005; 288 (02) E462-E468
• 9 DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988; 44 (03) 837-845
• 10 Ishizaka K, Oyama N, Mito S. et al. Comparison of 1H MR spectroscopy, 3-point DIXON, and multi-echo gradient echo for measuring hepatic fat fraction. Magn Reson Med Sci 2011; 10 (01) 41-48
• 11 van Werven JR, Marsman HA, Nederveen AJ. et al. Assessment of hepatic steatosis in patients undergoing liver resection: comparison of US, CT, T1-weighted dual-echo MR imaging, and point-resolved 1H MR spectroscopy. Radiology 2010; 256 (01) 159-168
• 12 Pickhardt PJ, Park SH, Hahn L, Lee S-G, Bae KT, Yu ES. Specificity of unenhanced CT for non-invasive diagnosis of hepatic steatosis: implications for the investigation of the natural history of incidental steatosis. Eur Radiol 2012; 22 (05) 1075-1082
• 13 Rastogi R, Gupta S, Garg B, Vohra S, Wadhawan M, Rastogi H. Comparative accuracy of CT, dual-echo MRI and MR spectroscopy for preoperative liver fat quantification in living related liver donors. Indian J Radiol Imaging 2016; 26 (01) 5-14
• 14 Park YS, Park SH, Lee SS. et al. Biopsy-proven nonsteatotic liver in adults: estimation of reference range for difference in attenuation between the liver and the spleen at nonenhanced CT. Radiology 2011; 258 (03) 760-766
• 15 Park SH, Kim PN, Kim KW. et al. Macrovesicular hepatic steatosis in living liver donors: use of CT for quantitative and qualitative assessment. Radiology 2006; 239 (01) 105-112
• 16 Lee SS, Park SH, Kim HJ. et al. Non-invasive assessment of hepatic steatosis: prospective comparison of the accuracy of imaging examinations. J Hepatol 2010; 52 (04) 579-585