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Accuracy of Liver Fat Quantification at MR Imaging: Comparison of Out-of-Phase Gradient-Echo and Fat-saturated Fast Spin-Echo Techniques—Initial Experience¹

¹ From the Departments of Radiology (A.Q., J.S.G., B.M.Y., F.V.C.), Pathology (S.K.), and Medicine (R.B.M.), University of California San Francisco, Box 0628, Room M-372, 505 Parnassus Ave, San Francisco, CA 94143-0628. Received March 23, 2004; revision requested June 2; revision received November 24; accepted January 12, 2005. Address correspondence to A.Q. (e-mail: Aliya.Qayyum{at}radiology.ucsf.edu).

View larger version (26K): [in a new window]   Figure 1a. (a) Graph shows linear regression analysis with correlation of histopathologically determined percentage of liver fat with percentage of relative signal intensity loss on T1-weighted out-of-phase MR images versus that on in-phase gradient-echo MR images in noncirrhotic and cirrhotic patients. Histopathologically determined percentage of liver fat was correlated with signal intensity loss on T1-weighted out-of-phase MR images versus that on in-phase gradient-echo MR images in patients without cirrhosis (r = 0.69, P = .02) but not in patients with cirrhosis (r = 0.25, P = .36). (b) Graph shows linear regression analysis with correlation of histopathologically determined percentage of liver fat with percentage of relative signal intensity loss on T2-weighted fat-saturated MR images versus that on images obtained without fat saturation in noncirrhotic and cirrhotic patients. Histopathologically determined percentage of liver fat was correlated with signal intensity loss on T2-weighted fast spin-echo MR images obtained with fat saturation versus MR images obtained without fat saturation in patients without cirrhosis (r = 0.92, P < .01) and in patients with cirrhosis (r = 0.76, P < .01).

View larger version (26K): [in a new window]   Figure 1b. (a) Graph shows linear regression analysis with correlation of histopathologically determined percentage of liver fat with percentage of relative signal intensity loss on T1-weighted out-of-phase MR images versus that on in-phase gradient-echo MR images in noncirrhotic and cirrhotic patients. Histopathologically determined percentage of liver fat was correlated with signal intensity loss on T1-weighted out-of-phase MR images versus that on in-phase gradient-echo MR images in patients without cirrhosis (r = 0.69, P = .02) but not in patients with cirrhosis (r = 0.25, P = .36). (b) Graph shows linear regression analysis with correlation of histopathologically determined percentage of liver fat with percentage of relative signal intensity loss on T2-weighted fat-saturated MR images versus that on images obtained without fat saturation in noncirrhotic and cirrhotic patients. Histopathologically determined percentage of liver fat was correlated with signal intensity loss on T2-weighted fast spin-echo MR images obtained with fat saturation versus MR images obtained without fat saturation in patients without cirrhosis (r = 0.92, P < .01) and in patients with cirrhosis (r = 0.76, P < .01).

View larger version (130K): [in a new window]   Figure 2a. MR images obtained in a 53-year-old man with chronic hepatitis B, cirrhosis, and 10% histopathologically determined liver fat who underwent liver transplantation for hepatocellular carcinoma (not shown). (a, b) Transverse dual-echo gradient-echo MR images (145/4.2 [in phase], 1.8 [out of phase]) illustrate regions of interest with paradoxical decreased signal intensity of 17% of the liver relative to spleen on (a) in-phase image (signal intensity units for liver and spleen, 158 and 132, respectively) compared with (b) out-of-phase image (signal intensity units for liver and spleen, 185 and 137, respectively). (c, d) Signal intensity loss of 8% of the liver relative to the spleen was observed between (c) T2-weighted single-shot fast spin-echo image obtained without fat saturation (effective echo time, 100 msec) (signal intensity values of liver and spleen, 70 and 61, respectively) and (d) fat-saturated T2-weighted fast spin-echo image (4000–5000/100 [effective]) (signal intensity values of liver and spleen, 26 and 23, respectively).

View larger version (132K): [in a new window]   Figure 2b. MR images obtained in a 53-year-old man with chronic hepatitis B, cirrhosis, and 10% histopathologically determined liver fat who underwent liver transplantation for hepatocellular carcinoma (not shown). (a, b) Transverse dual-echo gradient-echo MR images (145/4.2 [in phase], 1.8 [out of phase]) illustrate regions of interest with paradoxical decreased signal intensity of 17% of the liver relative to spleen on (a) in-phase image (signal intensity units for liver and spleen, 158 and 132, respectively) compared with (b) out-of-phase image (signal intensity units for liver and spleen, 185 and 137, respectively). (c, d) Signal intensity loss of 8% of the liver relative to the spleen was observed between (c) T2-weighted single-shot fast spin-echo image obtained without fat saturation (effective echo time, 100 msec) (signal intensity values of liver and spleen, 70 and 61, respectively) and (d) fat-saturated T2-weighted fast spin-echo image (4000–5000/100 [effective]) (signal intensity values of liver and spleen, 26 and 23, respectively).

View larger version (143K): [in a new window]   Figure 2c. MR images obtained in a 53-year-old man with chronic hepatitis B, cirrhosis, and 10% histopathologically determined liver fat who underwent liver transplantation for hepatocellular carcinoma (not shown). (a, b) Transverse dual-echo gradient-echo MR images (145/4.2 [in phase], 1.8 [out of phase]) illustrate regions of interest with paradoxical decreased signal intensity of 17% of the liver relative to spleen on (a) in-phase image (signal intensity units for liver and spleen, 158 and 132, respectively) compared with (b) out-of-phase image (signal intensity units for liver and spleen, 185 and 137, respectively). (c, d) Signal intensity loss of 8% of the liver relative to the spleen was observed between (c) T2-weighted single-shot fast spin-echo image obtained without fat saturation (effective echo time, 100 msec) (signal intensity values of liver and spleen, 70 and 61, respectively) and (d) fat-saturated T2-weighted fast spin-echo image (4000–5000/100 [effective]) (signal intensity values of liver and spleen, 26 and 23, respectively).

View larger version (132K): [in a new window]   Figure 2d. MR images obtained in a 53-year-old man with chronic hepatitis B, cirrhosis, and 10% histopathologically determined liver fat who underwent liver transplantation for hepatocellular carcinoma (not shown). (a, b) Transverse dual-echo gradient-echo MR images (145/4.2 [in phase], 1.8 [out of phase]) illustrate regions of interest with paradoxical decreased signal intensity of 17% of the liver relative to spleen on (a) in-phase image (signal intensity units for liver and spleen, 158 and 132, respectively) compared with (b) out-of-phase image (signal intensity units for liver and spleen, 185 and 137, respectively). (c, d) Signal intensity loss of 8% of the liver relative to the spleen was observed between (c) T2-weighted single-shot fast spin-echo image obtained without fat saturation (effective echo time, 100 msec) (signal intensity values of liver and spleen, 70 and 61, respectively) and (d) fat-saturated T2-weighted fast spin-echo image (4000–5000/100 [effective]) (signal intensity values of liver and spleen, 26 and 23, respectively).