A comparison of liver fat content as determined by magnetic resonance imaging-proton density fat fraction and MRS versus liver histology in non-alcoholic fatty liver disease

Background: Many imaging methods have been defined for quantification of hepatic steatosis in non-alcoholic fatty liver disease (NAFLD). However, studies comparing the efficiency of magnetic resonance imaging-proton density fat fraction (MRI-PDFF), magnetic resonance spectroscopy (MRS), and liver histology for quantification of liver fat content are limited. Purpose: To compare the efficiency of MRI-PDFF and MRS in the quantification of liver fat content in individuals with NAFLD. Material and Methods: A total of 19 NAFLD patients underwent MRI-PDFF, MRS, and liver biopsy for quantification of liver fat content. The MR examinations were performed on a 1.5 HDx MRI system. The MRI protocol included T1-independent volumetric multi-echo gradient-echo imaging with T2* correction and spectral fat modeling and MRS with STEAM technique. Results: A close correlation was observed between liver MRI-PDFF- and histology- determined steatosis (r = 0.743, P< 0.001) and between liver MRS- and histology-determined steatosis (r = 0.712, P< 0.001), with no superiority between them (z = 0.19, P = 0.849). For quantification of hepatic steatosis, a high correlation was observed between the two MRI methods (r = 0.986, P< 0.001). MRI-PDFF and MRS accurately differentiated moderate/severe steatosis from mild/no hepatic steatosis (P = 0.007 and 0.013, respectively), with no superiority between them (AUC(MRI-PDFF) = 0.8810.0856 versus AUC(MRS) = 0.857 +/- 0.0924, P = 0.461). Conclusion:Both MRI-PDFF and MRS can be used for accurate quantification of hepatic steatosis.