Free-Breathing Volumetric Liver R2* and Proton Density Fat Fraction Quantification in Pediatric Patients Using Stack-of-Radial MRI With Self-Gating Motion Compensation.

ABSTRACT

BACKGROUND: Stack-of-radial multiecho gradient-echo MRI is promising for free-breathing liver R2* quantification and may benefit children. PURPOSE: To validate stack-of-radial MRI with self-gating motion compensation in phantoms, and to evaluate it in children. STUDY TYPE Prospective. PHANTOMS Four vials with different R2* driven by a motion stage. SUBJECTS: Sixteen pediatric patients with suspected nonalcoholic fatty liver disease or steatohepatitis (five females, 13 ± 4 years, body mass index 29.2 ± 8.6 kg/m2 ). FIELD STRENGTH/SEQUENCES Stack-of-radial, and 2D and 3D Cartesian multiecho gradient-echo sequences at 3T. ASSESSMENT Ungated and gated stack-of-radial proton density fat fraction (PDFF) and R2* maps were reconstructed without and with self-gating motion compensation. Stack-of-radial R2* measurements of phantoms without and with motion were validated against reference 2D Cartesian results of phantoms without motion. In subjects, free-breathing stack-of-radial and reference breath-hold 3D Cartesian were acquired. Subject inclusion for statistical analysis and region of interest placement were determined independently by two observers. STATISTICAL TESTS Phantom results were fitted with a weighted linear model. Demographic differences between excluded and included subjects were tested by multivariate analysis of variance. PDFF and R2* measurements were compared using Bland-Altman analysis. Interobserver agreement was assessed by the intraclass correlation coefficient (ICC). RESULTS: Ungated stack-of-radial R2* inside moving phantom vials showed a significant positive bias of 64.3 s-1 (P < 0.00001), unlike gated results (P > 0.31). Subject inclusion decisions for statistical analysis from two observers were consistent. No significant differences were found between four excluded and 12 included subjects (P = 0.14). Compared to breath-hold Cartesian, ungated and gated free-breathing stack-of-radial exhibited mean R2* differences of 18.5 s-1 and 3.6 s-1 . Mean PDFF differences were 1.1% and 1.0% for ungated and gated measurements, respectively. Interobserver agreement was excellent (ICC for PDFF = 0.99, ICC for R2* = 0.90; P < 0.0003). DATA CONCLUSION: Stack-of-radial MRI with self-gating motion compensation seems to allow free-breathing liver R2* and PDFF quantification in children. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE 2.