Standardized Approach for ROI-Based Measurements of Proton Density Fat Fraction and R2*in the Liver

OBJECTIVE. The purpose of this study was to evaluate the reproducibility (interreviewer agreement) and repeatability (intrareviewer agreement) of ROI sampling strategies to measure chemical shift-encoded (CSE) MRI-based liver proton density fat fraction (PDFF) and R2* (1 / T2*). A secondary purpose was to standardize ROI-based liver PDFF and R2* measurements by providing a compromise between measurement reproducibility and repeatability and time burden for image analysts. MATERIALS AND METHODS. CSE data from two cohorts were retrospectively analyzed. Cohort A included 53 patients referred for abdominal MRI and healthy subjects recruited for a comparison study of CT and MRI. Cohort B included 37 patients with suspected liver iron overload. Three reviewers measured liver PDFF and R2* using previously reported ROI sampling strategies. Inter-and intrareviewer agreement of liver PDFF and R2* were evaluated using Bland-Altman analysis. RESULTS. Averaging largest-fit ROIs over the nine Couinaud segments resulted in the narrowest limits of agreement (LOA) for liver PDFF and R2* measurements in both cohorts. For PDFF, interreviewer agreement had mean LOA of +/- 0.8% for cohort A and +/- 1.7% for cohort B. Intrareviewer agreement was +/- 0.5% for cohort A and +/- 0.9% for cohort B. For R2* inter-reviewer agreement had mean LOA of +/- 3.0 s(-1) for cohort A and +/- 17.9 s(-1) for cohort B. Intrareviewer agreement was +/- 2.6 s(-1) for cohort A and +/- 14.6 s(-1) for cohort B. This approach was the most time-burdensome, requiring a mean +/- SD of 149.7 +/- 8.6 s per dataset. CONCLUSION. For improved reproducibility and repeatability of liver PDFF and R2* measurements, clinicians and researchers should sample as much area of the liver as possible using multiple large ROIs.