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Fat-Water Phantoms for Magnetic Resonance Imaging Validation: A Flexible and Scalable Protocol
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Motion-Insensitive Flip Angle Modulated Liver Proton Density Fat-Fraction and R2* Mapping During Free-Breathing MRI

Julius F Heidenreich1,2, Jiayi Tang1,3, Daiki Tamada1

  • 1Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA.

Journal of Magnetic Resonance Imaging : JMRI
|July 12, 2025
PubMed
Summary

Free-breathing MRI using 2D-FAM-CSE-MRI offers accurate liver fat and iron quantification. This motion-insensitive technique improves image quality and reduces artifacts compared to traditional breath-held methods.

Keywords:
CSE‐MRIPDFFR2*flip angle modulationliverquantification

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Area of Science:

  • Magnetic Resonance Imaging
  • Hepatology
  • Medical Imaging Physics

Background:

  • Breath-held quantitative three-dimensional chemical-shift-encoded (3D-CSE)-MRI is standard for liver fat and iron quantification.
  • Limitations exist for patients unable to hold their breath.
  • Motion-insensitive two-dimensional flip angle modulated (2D-FAM) acquisitions offer a potential solution.

Purpose of the Study:

  • To evaluate the performance of 2D-FAM-CSE-MRI during free-breathing.
  • To assess its accuracy in quantifying proton density fat-fraction (PDFF) and R2*-based liver iron concentration (LIC).

Main Methods:

  • Retrospective analysis of 230 patients (ages 4-85) using 1.5-T and 3.0-T scanners.
  • Comparison between free-breathing 2D-FAM-CSE-MRI and breath-held 3D-CSE-MRI.
  • Image quality, SNR, motion artifacts, PDFF, and LIC were assessed by three radiologists.

Main Results:

  • 2D-FAM showed superior image quality (median 4 vs. 3) and fewer motion artifacts (median 4 vs. 3).
  • Excellent agreement for PDFF (bias +0.32% to +0.66%) and high agreement for LIC (bias -0.02 mg/g) were observed.
  • Good to excellent inter-rater reliability (ICC 0.77-0.92) and high diagnostic performance (AUC up to 1.00) were achieved.

Conclusions:

  • 2D-FAM-CSE-MRI provides motion-insensitive liver fat and iron quantification during free-breathing.
  • This technique overcomes limitations of breath-held MRI.
  • It offers a viable alternative for routine clinical assessment.