Impact of sequential proton density fat fraction for quantification of hepatic steatosis in nonalcoholic fatty liver disease

Objective. To determine the utility of sequential MRI-estimated proton density fat fraction (MRI-PDFF) for quantification of the longitudinal changes in liver fat content in individuals with nonalcoholic fatty liver disease (NAFLD). Methods. A total of 18 consecutive individuals (M/F: 10/8, mean age: 47.7 +/- 9.8 years) diagnosed with NAFLD, who underwent sequential PDFF calculations for the quantification of hepatic steatosis at two different time points, were included in the study. All patients underwent T1-independent volumetric multi-echo gradient-echo imaging with T2* correction and spectral fat modeling. Results. A close correlation for quantification of hepatic steatosis between the initial MRI-PDFF and liver biopsy was observed (r(s) = 0.758, p < 0.001). The median interval between two sequential MRI-PDFF measurements was 184 days. From baseline to the end of the follow-up period, serum GGT level and homeostasis model assessment score were significantly improved (p = 0.015, p = 0.006, respectively), whereas BMI, serum AST, and ALT levels were slightly decreased. MRI-PDFFs were significantly improved (p = 0.004). A good correlation between two sequential MRI-PDFF calculations was observed (r(s) = 0.714, p = 0.001). With linear regression analyses, only delta serum ALT levels had a significant effect on delta MRI-PDFF calculations (r(2) = 38.6%, p = 0.006). At least 5.9% improvement in MRI-PDFF is needed to achieve a normalized abnormal ALT level. The improvement of MRI-PDFF score was associated with the improvement of biochemical parameters in patients who had improvement in delta MRI-PDFF (p < 0.05). Conclusions. MRI-PDFF can be used for the quantification of the longitudinal changes of hepatic steatosis. The changes in serum ALT levels significantly reflected changes in MRI-PDFF in patients with NAFLD.