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
ARTICLE HIGHLIGHTS
Research background

Nonalcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease in children and adolescents. Many methods are used to diagnose NAFLD, including liver biopsy, ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance spectroscopy (MRS). Liver biopsy is the gold standard to diagnose NAFLD but invasive, which is not the best choice in clinical use. Hence, screening for a noninvasive and accurate method to diagnose NAFLD in Chinese children and adolescents is of great importance.

Research motivation

MR is widely used in clinical trials to detect hepatic steatosis. Compared with US and CT, MR can provide more accurate and reliable diagnosis information. Besides, it can be used in early diagnosis and follow-up of NAFLD. Unfortunately, limited by samples and software device, it is rarely used in Chinese children and adolescents.

Research objectives

To investigate the accuracy and agreement between MRI and MRS in estimation of hepatic proton density fat fraction in Chinese children and adolescents, which will be helpful to early diagnosis and follow-up of NAFLD in China.

Research methods

Eighty-six children and adolescents were enrolled in this study (mean age 13.6 ± 1.9 years, range 9-17 years) from Shenzhen, China. They underwent MRI and MRS scans with a 3 Tesla MR unit (MAGNETOM Skyra, Siemens Healthcare, Erlangen, Germany). MRI and MRS were performed with multi-echo Dixon (ME Dixon) and HISTO sequences, respectively, to calculate hepatic proton density fat fraction (PDFF). Hepatic steatosis was defined as MRS-PDFF > 5%. The correlation and agreement between ME Dixon and MRS were assessed via spearman’s analysis and Bland-Altman analysis, respectively. According to the liver classification results of MRS-PDFF, the sensitivity, specificity, positive predictive value, and negative predictive value were calculated to assess the diagnostic accuracy of MRI-PDFF.

Research results

PDFF of all participants were calculated via MRI and MRS. With MRS as a reference, MRI exhibited high accuracy (r > 0.9, P < 0.01) and consistency in estimation of liver fat content. More importantly, MRI can quantify hepatic steatosis not only in region of interest but also the entire liver. Due to ethical restrictions, liver biopsy was not performed on our relatively healthy participants. Further study is needed to validate the accuracy of MRI and MRS in the quantification of hepatic steatosis in Chinese children and adolescents, with histology as a reference.

Research conclusions

According to our study, MRI (ME Dixon) appears to detect hepatic steatosis in Chinese children and adolescents successfully and accurately, with MRS (HISTO sequences) as a reference. MRI (ME Dixon) may be an ideal tool for early diagnosis and follow-up of NAFLD in China.

Research perspectives

This study describes a noninvasive tool for diagnosing NAFLD in Chinese children and adolescents. This method could be widely used in detecting hepatic steatosis in China, especially for those who have risk factors of NAFLD. Of course, liver biopsy and large sample sizes are needed in further study.