Abstract
ObjectiveToday, a biopsy is the gold standard in the diagnosis of non-alcoholic fatty liver. However, a biopsy is an invasive technique, limited to the sample taken, and it may lead to misdiagnosis. Therefore, novel noninvasive options are needed. The objective of this study was to investigate the accuracy of magnetic resonance (MR) Dixon sequence and elastography using magnetic resonance spectroscopy (MRS) as a reference in the quantification of hepatic steatosis.MethodsA total of 60 patients were included in the study. All patients underwent magnetic resonance imaging (MRI), MRS, and elastography in order to quantify hepatosteatosis. MRI and MRS imaging studies were performed using MR Dixon and high-speed T2-corrected multiple-echo 1H-MRS sequence (HISTO) sequences, respectively, in order to calculate proton density fat fraction (PDFF) values.ResultsThe mean MRI-PDFF value with the MRS region of interest (ROI) was found as 9.4% ± 12.1%. The mean MRS-PDFF was found as 8.9% ± 11.3%. No statistically significant difference was found between MRS-PDFF and MRI-PDFF values measured in ROI (p < 0.005). The correlation between MRS-PDFF and MRI-PDFF was examined with Spearman’s correlation analysis. Accordingly, there was an excellent correlation between MRS and MRI values measured in ROI (r ≥ 0.8, p < 0.001). Sensitivity, specificity, positive predictive value, and negative predictive value were calculated as 96%, 100%, 89.5%, and 92.6%, respectively, for MRI-PDFF in predicting hepatic steatosis for the same ROI localization with MRS. The optimum cut-off value of MRS-PDFF in predicting hepatic steatosis was found as 5.3% using the same ROI localization with MRS.ConclusionThe results of this study indicated an excellent correlation between MRI-PDFF and MRS-PDFF. The multi-echo Dixon MRI technique seems a promising alternative method in the detection of non-alcoholic fatty liver disease.
Highlights
Non-alcoholic hepatic steatosis is a disease characterized by the accumulation of triacylglycerol (TAG)-rich macrovesicular or microvesicular lipid droplets in hepatocytes [1]
No statistically significant difference was found between magnetic resonance spectroscopy (MRS)-proton density fat fraction (PDFF) and magnetic resonance imaging (MRI)-PDFF values measured in region of interest (ROI) (p < 0.005)
There was an excellent correlation between MRS and MRI values measured in ROI (r ≥ 0.8, p < 0.001)
Summary
Non-alcoholic hepatic steatosis is a disease characterized by the accumulation of triacylglycerol (TAG)-rich macrovesicular or microvesicular lipid droplets in hepatocytes [1]. Non-alcoholic fatty liver disease (NAFLD) is defined as at least 5% of hepatocytes containing intrahepatic TAG or lipid vacuoles in the absence of alcohol-abusing or viral infections. Steatosis may progress to nonalcoholic steatohepatitis, cirrhosis, or hepatocellular carcinoma. Hepatic steatosis is a risk factor for liver transplantation and chronic kidney disease [3]. The clinical importance of fatty liver disease has resulted from its high prevalence in the general population, a wide spectrum of risk factors, and its potential of progression to cirrhosis or hepatocarcinoma. Because of the use of highly variable and subjective diagnostic criteria, the prevalence of hepatic steatosis has been reported between 3% and 39% [4,5]
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