Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 7, 2020; 26(33): 4996-5007
Published online Sep 7, 2020. doi: 10.3748/wjg.v26.i33.4996
Liver fat accumulation measured by high-speed T2-corrected multi-echo magnetic resonance spectroscopy can predict risk of cholelithiasis
Hong Chen, Wei-Ke Zeng, Guang-Zi Shi, Ming Gao, Meng-Zhu Wang, Jun Shen
Hong Chen, Wei-Ke Zeng, Guang-Zi Shi, Ming Gao, Jun Shen, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, Guangdong Province, China
Meng-Zhu Wang, Department of MR Scientific Marketing, Siemens Healthineers, Guangzhou 510120, Guangdong Province, China
Author contributions: Chen H and Zeng WK contributed equally to this work; Chen H and Shen J designed the research; Chen H, Zeng WK, Shi GZ, and Wang MZ collected and analyzed the data; Chen H wrote the manuscript; Chen H, Zeng WK, Shi GZ, Gao M, and Wang MZ analyzed and interpreted the data; Shen J wrote and revised the manuscript; all co-authors participated in writing and checking the manuscript, and approved the submitted manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Sun Yat-Sen Memorial Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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:
Corresponding author: Jun Shen, MD, Doctor, Professor, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 West Yanjiang Road, Guangzhou 510120, Guangdong Province, China.
Received: May 29, 2020
Peer-review started: May 29, 2020
First decision: June 12, 2020
Revised: June 14, 2020
Accepted: August 1, 2020
Article in press: August 1, 2020
Published online: September 7, 2020

Liver fat accumulation is associated with increased cholesterol synthesis and hypersecretion of biliary cholesterol, which may be related to the development of cholelithiasis.


To investigate whether liver fat accumulation measured by high-speed T2-corrected multi-echo magnetic resonance spectroscopy (MRS) is a risk factor for cholelithiasis.


Forty patients with cholelithiasis and thirty-one healthy controls were retrospectively enrolled. The participants underwent high-speed T2-corrected multi-echo single-voxel MRS of the liver at a 3T MR scanner. The proton density fat fraction (PDFF) and R2 value were calculated. Serum parameters and waist circumference (WC) were recorded. Spearman’s correlation analysis was used to analyze the relationship between PDFF, R2, and WC values. Multivariate logistic regression analysis was carried out to determine the significant predictors of the risk of cholelithiasis. Receiver operating characteristic curve (ROC) analysis was used to evaluate the discriminative performance of significant predictors.


Patients with cholelithiasis had higher PDFF, R2, and WC values compared with healthy controls (5.8% ± 4.2% vs 3.3% ± 2.4%, P = 0.001; 50.4 ± 24.8/s vs 38.3 ± 8.8/s, P = 0.034; 85.3 ± 9.0 cm vs 81.0 ± 6.9 cm, P = 0.030; respectively). Liver iron concentration extrapolated from R2 values was significantly higher in the cholelithiasis group (2.21 ± 2.17 mg/g dry tissue vs 1.22 ± 0.49 mg/g dry tissue, P = 0.034) than in the healthy group. PDFF was positively correlated with WC (r = 0.502, P < 0.001) and R2 (r = 0.425, P < 0.001). Multivariate logistic regression analysis showed that only PDFF was an independent risk factor for cholelithiasis (odds ratio = 1.79, 95%CI: 1.22-2.62, P = 0.003). ROC analysis showed that the area under the curve of PDFF was 0.723 for discriminating cholelithiasis from healthy controls, with a sensitivity of 55.0% and specificity of 83.9% when the cut-off value of PDFF was 4.4%.


PDFF derived from high speed T2-corrected multi-echo MRS can predict the risk of cholelithiasis.

Keywords: Magnetic resonance spectroscopy, Cholelithiasis, Liver fat accumulation, Steatosis, Iron

Core tip: The increase in total cholesterol synthesis can cause tissues to be overloaded with fatty acids, resulting in more lithogenic bile due to overproduction of hepatic cholesterol. Our study showed that patients with cholelithiasis had higher liver fat content and R2 value as assessed by high speed T2-corrected multi-echo magnetic resonance spectroscopy (MRS). MRS can be used for quantitative detection of mild liver steatosis, and proton density fat fraction (PDFF) derived from MRS can predict the risk of cholelithiasis. PDFF measured by MRS can quantitatively detect liver steatosis in a simple breath-hold of 15 s, which holds a good potential for clinical application.