Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2019; 25(12): 1513-1523
Published online Mar 28, 2019. doi: 10.3748/wjg.v25.i12.1513
Accuracy of multi-echo Dixon sequence in quantification of hepatic steatosis in Chinese children and adolescents
Yu-Zhen Zhao, Yun-Gen Gan, Jian-Li Zhou, Jia-Qi Liu, Wei-Guo Cao, Shu-Mei Cheng, Da-Ming Bai, Meng-Zhu Wang, Fang-Qin Gao, Shao-Ming Zhou
Yu-Zhen Zhao, Jian-Li Zhou, Jia-Qi Liu, Da-Ming Bai, Shao-Ming Zhou, Department of Gastroenterology, Shenzhen Children’s Hospital, Shenzhen 518038, Guangdong Province, China
Yun-Gen Gan, Wei-Guo Cao, Department of Radiology, Shenzhen Children’s Hospital, Shenzhen 518038, Guangdong Province, China
Shu-Mei Cheng, Department of Physical Examination, Futian District Maternity and Child Healthcare Hospital, Shenzhen 518048, Guangdong Province, China
Meng-Zhu Wang, Department of MR Scientific Marketing, Siemens Healthineers, Guangzhou 510620, Guangdong Province, China
Fang-Qin Gao, Department of MR Clinical Marketing, Siemens Healthineers, Guangzhou 510620, Guangdong Province, China
Author contributions: Gan YG and Zhou SM designed the study; Zhao YZ, Zhou JL, Liu JQ, Bai DM, Cheng SM, and Zhou SM collected the data and performed the research; Gan YG, Cao WG, Wang MZ, and Gao FQ analyzed the data; Zhao YZ and Wang MZ wrote the paper; Gan YG and Zhou SM revised the manuscript for final submission.
Supported by Shenzhen Science Technology Research and Development Fund from Shenzhen Science Technology and Innovation Commission, Shenzhen, Guangdong, China, No. JCYJ20160429174706491 and No. CXZZ20150529144041624.
Institutional review board statement: The study was reviewed and approved by the Human Ethics Committee of Shenzhen Children’s Hospital.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest in deciding the device that we used in the study. We have no financial and personal relationships with other people or organizations that can inappropriately influence the study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
STROBE statement: All authors of the study have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Corresponding author: Shao-Ming Zhou, MD, Chief Doctor, Department of Gastroenterology, Shenzhen Children’s Hospital, 7019 Yitian Road, Shenzhen 518038, Guangdong Province, China. zhousm15d@aliyun.com
Telephone: +86-755-83008128 Fax: +86-755-83008127
Received: December 19, 2018
Peer-review started: December 21, 2018
First decision: January 18, 2019
Revised: January 29, 2019
Accepted: February 22, 2019
Article in press: February 23, 2019
Published online: March 28, 2019
Processing time: 99 Days and 3.3 Hours
Abstract
BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) is currently the outstanding cause of chronic liver disease in children and adolescents, especially in overweight and obese groups. Liver biopsy is the reference standard to diagnose NAFLD but invasive, thus it is not the best choice in clinical diagnosis and follow-up. Magnetic resonance (MR) is widely used in clinical trials to noninvasively quantify liver fat content in adults and children in foreign countries. While currently, it is rarely used in Chinese children and adolescents. We postulated that quantifying hepatic steatosis by MR could be extended to children and adolescents in China.

AIM

To investigate the accuracy of MR imaging (MRI) in quantifying liver fat with MR spectroscopy (MRS) as a reference. A secondary goal was to assess the prevalence of NAFLD in overweight and obese Chinese children and adolescents.

METHODS

There were 86 children and adolescents enrolled in this study, including 65 overweight and obese children and 21 healthy children. The participants underwent MRI and MRS. MRI and MRS were performed using multi-echo Dixon and HISTO sequences, respectively, to calculate hepatic proton density fat fraction (PDFF). Hepatic steatosis was diagnosed using MRS-PDFF > 5% as the threshold. Spearman’s analysis was used to evaluate the correlation between MRI and MRS. The agreement between these two methods was assessed by Bland-Altman analysis.

RESULTS

The MRI-PDFF in the MRS region of interest and the entire liver was 9.9% ± 10.3% with a range of 0.3%-39.9%, and 10.6% ± 9.4% with a range of 1.9%-38.9%, respectively. The MRS-PDFF was 9.1% ± 10.0%, with a range of 0.5%-37.8%. The incidence of hepatic steatosis detected by MRS-PDFF was 46.5% (40/86) of all participants, all of whom belonged to the overweight and obese group. Spearman’s analysis indicated an excellent correlation between multi-echo Dixon and MRS (r > 0.9, P < 0.01). Bland-Altman analysis also demonstrated a good agreement between these two methods.

CONCLUSION

Multi-echo Dixon shows an excellent correlation and agreement with MRS in quantifying liver fat content and could be a potential tool to detect hepatic steatosis in Chinese children and adolescents.

Keywords: Nonalcoholic fatty liver disease; Magnetic resonance imaging; Magnetic resonance spectroscopy; Children and adolescents; Hepatic steatosis

Core tip: Magnetic resonance spectroscopy (MRS) is thought to be the noninvasive gold standard in the quantification of hepatic steatosis. The present study investigated the accuracy of magnetic resonance imaging (MRI) in quantifying liver fat content in Chinese children and adolescents, with MRS as a reference. MRI and MRS were performed with multi-echo Dixon and HISTO sequences, respectively, to calculate hepatic proton density fat fraction. Multi-echo Dixon showed an excellent correlation and agreement with MRS in quantifying liver fat content, indicating that it could be a potential tool to detect hepatic steatosis in Chinese children and adolescents.