Diagnostic value of MRI proton density fat fraction for assessing liver steatosis in chronic viral C hepatitis

Francesco Paparo, Giovanni Cenderello, Matteo Revelli, Lorenzo Bacigalupo, Mariangela Rutigliani, Daniele Zefiro, Luca Cevasco, Maria Amico, Roberto Bandelloni, Giovanni Cassola, Gian Luca Forni, Gian Andrea Rollandi, Francesco Paparo, Giovanni Cenderello, Matteo Revelli, Lorenzo Bacigalupo, Mariangela Rutigliani, Daniele Zefiro, Luca Cevasco, Maria Amico, Roberto Bandelloni, Giovanni Cassola, Gian Luca Forni, Gian Andrea Rollandi

Abstract

Objective: To assess the diagnostic performance of a T1-independent, T2*-corrected multiecho magnetic resonance imaging (MRI) technique for the quantification of hepatic steatosis in a cohort of patients affected by chronic viral C hepatitis, using liver biopsy as gold standard.

Methods: Eighty-one untreated patients with chronic viral C hepatitis were prospectively enrolled. All included patients underwent MRI, transient elastography, and liver biopsy within a time interval <10 days.

Results: Our cohort of 77 patients included 43/77 (55.8%) males and 34/77 (44.2%) females with a mean age of 51.31 ± 11.27 (18-81) years. The median MRI PDFF showed a strong correlation with the histological fat fraction (FF) (r = 0.754, 95% CI 0.637 to 0.836, P < 0.0001), and the correlation was influenced by neither the liver stiffness nor the T2* decay. The median MRI PDFF result was significantly lower in the F4 subgroup (P < 0.05). The diagnostic accuracy of MRI PDFF evaluated by AUC-ROC analysis was 0.926 (95% CI 0.843 to 0.973) for S ≥ 1 and 0.929 (95% CI 0.847 to 0.975) for S = 2.

Conclusions: Our MRI technique of PDFF estimation allowed discriminating with a good diagnostic accuracy between different grades of hepatic steatosis.

Figures

Figure 1
Figure 1
Example of ROI positioning for the calculation of MRI PDFF (a), T2* (b), and R2* decay (reciprocal of T2*, expressed in Hz) (c) in a 52-year-old male patient with chronic viral C hepatitis. The histological FF of this patient was 10%, corresponding to a steatosis grade 1 (S1). Images (d), (e), and (f) show the histogram of pixel distribution with mean values ± standard deviation and medians.
Figure 2
Figure 2
Calculation of MRI PDFF in a 45-year-old male patient with chronic viral C hepatitis (a). The median MRI PDFF value is 10% (b), while histological FF of the patient was 8%, corresponding to a steatosis grade 1 (S1).
Figure 3
Figure 3
Calculation of MRI PDFF in a 45-year-old male patient with chronic viral C hepatitis (a). The median MRI PDFF value is 15% (b), while histological FF of the patient was 37%, corresponding to steatosis grade 2 (S2).
Figure 4
Figure 4
Box-and-whisker plots for MRI PDFF measurements in relation to each grade of steatosis (a), fibrosis (b), and necroinflammatory activity (c). The top and the bottom of the boxes are the first and third quartiles, respectively. The length of the box represents the interquartile range including 50% of the values. The line through the middle of each box represents the median. The error shows the minimum and maximum values (range). An outside value (separate point) is defined as a value that is smaller than the lower quartile minus 1.5 times the interquartile range or larger than the upper quartile plus 1.5 times the interquartile range.
Figure 5
Figure 5
ROC curve analysis of MRI PDFF for patients with steatosis S ≥ 1 (S0 versus S1-S2). The area under the ROC curve is 0.926 (95% CI 0.74–0.94) (a). ROC curve analysis of MRI PDFF for patients with steatosis S = 2 (S0-S1 versus S2). The area under the ROC curve is 0.929 (95% CI 0.806 to 0.968) (b).

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