Quantification of Hepatic Steatosis With a Multistep Adaptive Fitting MRI Approach: Prospective Validation Against MR Spectroscopy

OBJECTIVE. The purpose of this study is to prospectively compare hybrid and complex chemical shift-based MRI fat quantification methods against MR spectroscopy (MRS) for the measurement of hepatic steatosis. SUBJECTS AND METHODS. Forty-two subjects (18 men and 24 women; mean +/- SD age, 52.8 +/- 14 years) were prospectively enrolled and imaged at 3 T with a chemical shiftbased MRI sequence and a single-voxel MRS sequence, each in one breath-hold. Proton density fat fraction and rate constant (R-2*) using both single-and dual-R-2* hybrid fitting methods, as well as proton density fat fraction and R-2* maps using a complex fitting method, were generated. A single radiologist colocalized volumes of interest on the proton density fat fraction and R-2* maps according to the spectroscopy measurement voxel. Agreement among the three MRI methods and the MRS proton density fat fraction values was assessed using linear regression, intraclass correlation coefficient (ICC), and Bland-Altman analysis. RESULTS. Correlation between the MRI and MRS measures of proton density fat fraction was excellent. Linear regression coefficients ranged from 0.98 to 1.01, and intercepts ranged from -1.12% to 0.49%. Agreement measured by ICC was also excellent (0.99 for all three methods). Bland-Altman analysis showed excellent agreement, with mean differences of -1.0% to 0.6% (SD, 1.3-1.6%). CONCLUSION. The described MRI-based liver proton density fat fraction measures are clinically feasible and accurate. The validation of proton density fat fraction quantification methods is an important step toward wide availability and acceptance of the MRI-based measurement of proton density fat fraction as an accurate and generalizable biomarker.