[Non-invasive determination of liver fat with MR-spectroscopy: 5 years on]

Five years ago, we reported on the use of 1H-magnetic resonance spectroscopy (MRS-PDFF) as a non-invasive means of determining the amount of liver fat. Liver biopsy, the current reference method, has several shortcomings (e.g. risk of complications and large interobserver variability), which are less pronounced or absent in MRS-PDFF. In RCT's, MRS-PDFF is currently used as an outcome measure to assess therapy response. Its successor is already being deployed: MRI-PDFF. This is a short whole-liver MRI scan, which takes approximately 18 seconds. The use of MRS- or MRI-PDFF has not boomed in the Netherlands. Reasons include unfamiliarity with the technique amongst both clinicians and radiologists, as well as increased reliance on ultrasound imaging with Fibroscan by hepatologists in particular. This latter method, however, is less accurate in classifying the various steatosis grades than MRS- and MRI-PDFF.