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Updated: Apr 14, 2026
Author Spotlight: A Non-Invasive Tool to Assess and Differentiate Fat Patterns in Liver Using 3D Dixon MRI
Published on: October 20, 2023
Comparison between modified Dixon MRI techniques, MR spectroscopic relaxometry, and different histologic
Guido M Kukuk1, Kanishka Hittatiya, Alois M Sprinkart
1Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany, Guido.Kukuk@ukb.uni-bonn.de.
Objectives:
To compare systematically quantitative MRI, MR spectroscopy (MRS), and different histological methods for liver fat quantification in order to identify possible incongruities.
Methods:
Fifty-nine consecutive patients with liver disorders were examined on a 3 T MRI system. Quantitative MRI was performed using a dual- and a six-echo variant of the modified Dixon (mDixon) sequence, calculating proton density fat fraction (PDFF) maps, in addition to single-voxel MRS. Histological fat quantification included estimation of the percentage of hepatocytes containing fat vesicles as well as semi-automatic quantification (qHisto) using tissue quantification software.
Results:
In 33 of 59 patients, the hepatic fat fraction was >5% as determined by MRS (maximum 45%, mean 17%). Dual-echo mDixon yielded systematically lower PDFF values than six-echo mDixon (mean difference 1.0%; P < 0.001). Six-echo mDixon correlated excellently with MRS, qHisto, and the estimated percentage of hepatocytes containing fat vesicles (R = 0.984, 0.967, 0.941, respectively, all P < 0.001). Mean values obtained by the estimated percentage of hepatocytes containing fat were higher by a factor of 2.5 in comparison to qHisto. Six-echo mDixon and MRS showed the best agreement with values obtained by qHisto.
Conclusions:
Six-echo mDixon, MRS, and qHisto provide the most robust and congruent results and are therefore most appropriate for reliable quantification of liver fat.
Key Points:
• Six-echo mDixon correlates excellently with MRS, qHisto, and the estimated percentage of fat-containing hepatocytes. • Six-echo mDixon, MRS, and qHisto provide the most robust and congruent results. • Dual-echo mDixon yields systematically lower PDFF values than six-echo mDixon. • The percentage of fat-containing hepatocytes is 2.5-fold higher than fat fraction determined by qHisto. • Performance characteristics and systematic differences of the various methods should be considered.
