Related Experiment Video
Updated: Jul 31, 2025
Author Spotlight: A Non-Invasive Tool to Assess and Differentiate Fat Patterns in Liver Using 3D Dixon MRI
Published on: October 20, 2023
Noninvasive liver iron quantification by MRI using refocused gradient-echo (bSSFP): preliminary results
Arthur P Wunderlich1,2, Holger Cario3, Michael Götz2
1Clinic for Diagnostic and Interventional Radiology, University Ulm Medical Centre, Ulm, Germany.
Purpose:
To evaluate the feasibility of using a balanced steady-state free precession sequence (bSSFP) to determine liver iron content (LIC).
Method:
Thirty-five consecutive patients with liver iron overload were examined with bSSFP. Signal intensity ratios of liver parenchyma to paraspinal muscles were retrospectively correlated with LIC values obtained by FerriScan, which was used as the reference method. Combinations of bSSFP protocols were also evaluated. The best combination was utilized to calculate LIC from bSSFP data. The sensitivity and specificity for the therapeutically relevant LIC threshold of 80 µmol/g (4.5 mg/g) were determined.
Results:
LIC values ranged from 24 to 756 µmol/g. The best SIR-to-LIC correlation of a single protocol was obtained with a 3.5-ms repetition time (TR) and 17° excitation flip angle (FA). A combination of protocols with TRs of 3.5, 5, and 6.5 ms, each at 17° FA, yielded a superior correlation. LIC values calculated using this combination resulted in a sensitivity/specificity of 0.91/0.85.
Conclusion:
bSSFP is basically suitable to determine LIC. Its advantages are high SNR efficiency and the ability to acquire the entire liver in a breath hold without acceleration techniques.
Key Points:
· The bSSFP sequence is suited to quantify liver iron overload.. · bSSFP has a high scanning efficiency and potential for LIC screening.. · Despite susceptibility artifacts, the LIC determined from bSSFP data showed high accuracy..
Citation Format:
· Wunderlich AP, Cario H, Götz M et al. Noninvasive liver iron quantification by MRI using refocused gradient-echo (bSSFP): preliminary results. Fortschr Röntgenstr 2023; 195: 804 - 808.
Insights
Balanced steady-state free precession (bSSFP) is suitable for determining liver iron content (LIC). This MRI technique offers high scanning efficiency and accuracy for liver iron overload screening.
Area of Science:
- Radiology
- Medical Imaging
- Magnetic Resonance Imaging
Background:
- Liver iron overload is a serious condition requiring accurate quantification.
- Non-invasive methods for determining liver iron content (LIC) are crucial for patient management.
- Traditional methods for LIC assessment can be invasive or less efficient.
Purpose of the Study:
- To evaluate the feasibility of using balanced steady-state free precession (bSSFP) sequences for non-invasive liver iron content (LIC) determination.
- To assess the accuracy and efficiency of bSSFP in quantifying liver iron overload.
- To determine the sensitivity and specificity of bSSFP for a clinically relevant LIC threshold.
Main Methods:
- Thirty-five patients with liver iron overload underwent bSSFP MRI.
- Signal intensity ratios (SIR) of liver to paraspinal muscles were correlated with FerriScan LIC values (reference method).
- Various bSSFP protocols were evaluated, and the optimal combination was used to calculate LIC.
Main Results:
- A combination of bSSFP protocols (TRs 3.5, 5, 6.5 ms; FA 17°) showed superior correlation with LIC.
- Calculated LIC values using the optimal bSSFP combination achieved a sensitivity of 0.91 and specificity of 0.85.
- The method demonstrated high accuracy despite potential susceptibility artifacts.
Conclusions:
- Balanced steady-state free precession (bSSFP) is a feasible and suitable MRI technique for quantifying liver iron content (LIC).
- bSSFP offers high signal-to-noise ratio (SNR) efficiency and enables whole-liver acquisition within a single breath-hold.
- This technique shows promise for efficient liver iron overload screening and management.
Related Concept Videos
01:25Ultrasound II: Endoscopic Ultrasound and FibroScan
Endoscopic Ultrasound (EUS):
01:24Magnetic Resonance Imaging