Simultaneous assessment of liver volume and whole liver fat content: a step towards one-stop shop preoperative MRI protocol

Objective The purpose of this study was to evaluate the ability of a whole liver volume (WLV) segmentation algorithm to measure fat fraction (FF). Methods Twenty consecutive patients with histologically proven fatty liver disease underwent dual-echo in-phase/out-of-phase MRI and magnetic resonance spectroscopy (MRS) at 1.5 T. Two readers independently performed semiautomatic 3D liver segmentation on the out-of-phase sequences using an active contour model. FF was calculated for voxels, segments and WLV. Segmentation inter-observer reproducibility was assessed by intra-class correlation coefficient (ICC) for WLV and FF. Fat fraction correlation and agreement as determined by histology, MRS and MRI were determined. Results ICC was 0.999 (95% CI: 0.999-1, P<0.001) for WLV FF calculation and 0.996 (95% CI: 0.990-0.998, P<0.001) for whole liver volume calculations. Strong correlations were found between FF measured by histology, MRS and WLV-MRI. A Bland-Altman analysis showed a good agreement between FF measured by MRS and WLV-MRI. No systematic variations of FF was found between segments when analyzed by ANOVA (F=1.78, P=0.096). Conclusion This study shows that a reproducible whole liver volume segmentation method to measure fat fraction can be performed. This strategy may be integrated to a "one-stop shop" protocol in liver surgery planning.