How to select the quantitative magnetic resonance technique for subjects with fatty liver: A systematic review

Table 1 Studies reporting on the measurement of the hepatic fat content with ¹H-magnetic resonance spectroscopy versus liver biopsy and other imaging methods

Ref.	Year	Study design	Age (year)	N	Etiology	Field strength sequence	Comparison	Interval	Results
Thomsen et al[22]	1994		48	14	Fatty liver	1.5 T. STEAM (TE = 34 ms)	Liver biopsy		r = 0.897; P < 0.001
Longo et al[26]	1995		45	29	Diffuse steatosis	1.5 T. PRESS (TE = 50–200 ms)	Liver biopsy		r = 0.70
Cowin et al[30]	2008		42	12	Steatosis	1.5 T. PRESS (TE = 30 ms)	Liver biopsy	6 wk	r = 0.928; P < 0.0001
Irwan et al[63]	2008	Prospective	47	10	Healthy volunteers	1.5 T. PRESS (TE = 30 ms)	Dual-echo imaging	One measurement session	r = 0.927. In the range 1%–10%, the MRI-determined the liver fat contents (corrected algorithm) are systematically higher, on average 4% (range: 2.1%–6.1%) than those obtained with MRS
Kim et al[64]	2008	Prospective	15.9 ± 5.3	28	Lean and obese	1.5 TPRESS (TE = 20 ms)	Two-Point Dixon		r = 0.954; P < 0.001
Borra et al[65]	2009	Prospective	62.8 ± 8.3	33	Type 2 diabetes	1.5 T. PRESS (TE = 25 ms)	IP/OP (Dixon)		r = 0.959–0.962; P < 0.001
Reeder et al[66]	2009	Prospective	49.0 ± 12	31	Suspected steatosis and unrelated reasons	1.5 T. PRESS (TE = 25 ms)	IDEAL		r = 0.83 ± 0.05; P < 0.001. Intercept (1.76 ± 0.76%; P = 0.03)
Zhong et al[31]	2009		50 ± 12	36	Fatty liver	3.0 T. PRESS (TE = 144 ms)	16-row multislice CT		r = –0.461; P = 0.005
Hu et al[67]	2010			16		3.0 T. PRESS (TE = 23 ms)	IDEAL		Slope = 0.90, intercept = 1.07%; r2 = 0.95, P < 0.001
Roldan-Valadez et al[68]	2010		35	18	Steatosis	3.0 T	Liver biopsy		r = 0.876; P ≤ 0.001
Mehta et al[32]	2010		39.9	50	Steatosis	1.5 T. PRESS (TE = 135 ms)	Ultrasound		BMI > 30, sensitivity 96%; BMI ≤ 30, sensitivity 64%
Meisamy et al[23]	2011	Prospective	40	55		1.5 T. STEAM (TE = 10, 20, 30, 40, and 50 ms)	IDEAL		r2 = 0.99
Georgoff et al[69]	2012	Prospective	50.6	52	Steatosis	3.0 T. PRESS (TE = 50 ms)	Liver biopsy	15 ± 9 d	Diagnostic accuracy was (AUC: 0.95; 95%CI: 0.89–1.0)
Kang et al[18]	2012	Prospective	54	56	Steatosis	1.5 T. STEAM (TE = 20, 30, 40, 50, and 60 ms)	Liver biopsy	1–28 d	r = 0.95
Parente et al[70]	2014	Prospective	54 ± 9	73	Nonalcoholic fatty liver disease	3.0 T. PRESS (TE = 40 ms)	Liver biopsy		r = 0.767; P < 0.001
Bashir et al[71]	2015	Prospective	55 ± 13.8	217	Various hepatic diseases	1.5 T. STEAM (TE = 12 ms)	Two-point Dixon		r = 0.61; P < 0.001
Kim et al[57]	2015		52.8 ± 14	42	Various hepatic diseases	3.0 T. STEAM (TE = 12, 24, 36, 48, and 72 ms)	In- and opposed-phase echo pairs		r = 0.97
Satkunasingham et al[72]	2015	Retrospective	57.8 (12–83)	156	Various hepatic diseases	3.0 T. STEAM (TE = 12, 24, 36, 48, and 72 ms)	MRI-PDFF		r = 0.977; P < 0.001
Rastogi et al[73]	2016	Retrospective	32.5	73	Steatosis	3.0 T. STEAM (TE = 15, 20, 25, 30, and 35 ms)	Biopsy and surgery	≤ 20 d	MRS correlated well with the histopathology results (r = 0.882). An accuracy of 96% and sensitivity of 94%
Kramer et al[6]	2017	Prospective	57 ± 5	50	Various hepatic diseases	1.5 T. STEAM (TE = 10, 20, 30, 40, and 50 ms)	PDFF		r2 = 0.992; slope, 0.974; intercept, –0.943

MRS: Magnetic resonance spectroscopy; PDFF: Proton density fat fraction; TE: Echo time; BMI: Body mass index; CT: Computed tomography; Blank: No information; PRESS: Point-resolved spectroscopy; STEAM: Stimulated-echo acquisition mode.