4.4 Article

Comparison of reader agreement, correlation with liver biopsy, and time-burden sampling strategies for liver proton density fat fraction measured using magnetic resonance imaging in patients with obesity: a secondary cross-sectional study

Journal

BMC MEDICAL IMAGING
Volume 22, Issue 1, Pages -

Publisher

BMC
DOI: 10.1186/s12880-022-00821-6

Keywords

Liver biopsy; Magnetic resonance imaging (MRI)-based proton density fat fraction (MRI-PDFF); Region-of-interest

Funding

  1. National Natural Science Foundation of China [61871276, 82071876]
  2. National Key R&D Program of China [2015BAI13B09, 2017YFC0110904]
  3. Beijing Natural Science Foundation [7184199]
  4. Beijing Municipal Health Commission, Special Program of Scientific Research on health development in Beijing [2018-2-2023]
  5. Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support [ZYLX202101]
  6. Capital's Funds for Health Improvement and Research [2020-1-2021]

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This study assessed the effect of different ROI sampling strategies on the measurement of liver fat content. The results showed that the 9L-ROI sampling strategy at the whole-liver level performed best when liver puncture biopsy was not used as the gold standard, while the 3L-ROI sampling strategy at the puncture site segment was recommended when liver puncture biopsy was used as the gold standard.
Background The magnetic resonance imaging (MRI)-based proton density fat fraction (PDFF) has become popular for quantifying liver fat content. However, the variability of the region-of-interest (ROI) sampling strategy may result in a lack of standardisation of this technology. In an effort to establish an accurate and effective PDFF measurement scheme, this study assessed the pathological correlation, the reader agreement, and time-burden of different sampling strategies with variable ROI size, location, and number. Methods Six-echo spoiled gradient-recalled-echo magnitude-based fat quantification was performed for 50 patients with obesity, using a 3.0-T MRI scanner. Two readers used different ROI sampling strategies to measure liver PDFF, three times. Intra-reader and inter-reader agreement was evaluated using intra-class correlation coefficients and Bland-Altman analysis. Pearson correlations were used to assess the correlation between PDFFs and liver biopsy. Time-burden was recorded. Results For pathological correlations, the correlations for the strategy of using three large ROIs in Couinaud segment 3 (S3 3L-ROI) were significantly greater than those for all sampling strategies at the whole-liver level (P < 0.05). For inter-reader agreement, the sampling strategies at the segmental level for S3 3L-ROI and using three large ROIs in Couinaud segment 6 (S6 3L-ROI) and the sampling strategies at the whole-liver level for three small ROIs per Couinaud segment (27S-ROI), one large ROI per Couinaud segment (9L-ROI), and three large ROIs per Couinaud segment (27S-ROI) had limits of agreement (LOA) < 1.5%. For intra-reader agreement, the sampling strategies at the whole-liver level for 27S-ROI, 9L-ROI, and 27L-ROI had both intraclass coefficients > 0.995 and LOAs < 1.5%. The change in the time-burden was the largest (100.80 s) when 9L-ROI was changed to 27L-ROI. Conclusions For hepatic PDFF measurement without liver puncture biopsy as the gold standard, and for general hepatic PDFF assessment, 9L-ROI sampling strategy at the whole-liver level should be used preferentially. For hepatic PDFF with liver puncture biopsy as the gold standard, 3L-ROI sampling strategy at the puncture site segment is recommended.

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