Evaluation of six-point modified dixon and magnetic resonance spectroscopy for fat quantification: a fat-water-iron...

This study aimed to evaluate (1) the agreement between the true fat fraction (FF) and proton density FF (PDFF) measured using a six-echo modified Dixon (6mDixon) and magnetic resonance spectroscopy (MRS) and (2) the influence of fat on T2* values. The study was performed using phantoms of varying fat and iron content. Point-resolved spectroscopy (PRESS) and stimulated echo acquisition mode (STEAM) with single-echo (S) and multiecho (M) (PRESS-S, PRESS-M, STEAM-S, and STEAM-M) were used for MRS. In phantoms without iron, the agreement between the true FF and measured PDFF was tested using Bland-Altman analysis. The influence of iron on PDFF was evaluated in phantoms with iron. The relationship between the true FF and T2* value was assessed in phantoms without iron, wherein the mean differences (limits of agreement) for each method were as follows: 6mDixon 2.9% (-2.4 to 8.1%); STEAM-S 3.2% (-9.5 to 16.0%); STEAM-M -0.7% (-6.9 to 5.5%); PRESS-S 8.9% (-14.5 to 32.4%); and PRESS-M -5.8% (-18.3 to 6.7%). In the 20% fat phantoms with iron, as iron increased, PDFFs with STEAM-S, PRESS-S, and PRESS-M were considerably overestimated, while, PDFF with STEAM-M was stable at 0.04-0.2 mM iron concentrations (17.2 and 21.4%, respectively), and PDFF with 6mDixon was reliable at even 0.4 mM iron concentration (24.8%). The T2* value showed a negative correlation with the true FF (r = -0.942, P = 0.005). STEAM-M and 6mDixon were reliable methods of fat quantification in the absence of iron, and the T2* value was shortened by fat.