Validation of a standardized MRI method for liver fat and T2* quantification

Hutton, Chloe; Gyngell, Michael L.; Milanesi, M.; Bagur, Alexandre Triay; Brady, Michael

doi:10.1371/journal.pone.0204175

Cited by 26 publications

(30 citation statements)

References 30 publications

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“…Under such acquisitions, reconstruction algorithms initialized near 0% PDFF will converge to the correct solution for water‐dominant voxels, but they will converge to the wrong estimates for fat‐dominant voxels (Figure H). Magnitude methods previously described in the literature have consistently exhibited this behavior, with true PDFF > 50% voxels aliased to estimates below 50% …”

Section: Theorysupporting

confidence: 52%

“…Thus, 6 echoes may not be sufficient to identify the correct solution. A possible approach to boost SNR could be to use phase information to weight the solution of a complex‐based method more around 50%, similarly to hybrid reconstruction schemes …”

Section: Discussionmentioning

confidence: 99%

“…The UK Biobank dataset ( N = 178) was used for in vivo comparison of MAGO to LMS IDEAL, a hybrid reconstruction described in previous work . The UK Biobank acquisitions were known to have reliable phase information and high overall quality despite the low field strength setting.…”

Section: Discussionmentioning

confidence: 99%

“…Magnitude and phase images were available for each case. PDFF maps were generated using MAGO applied to just the magnitude images and discarding phase information, and they were also generated using an implementation of the hybrid iterative decomposition of water and fat with echo asymmetry and least squares estimation (IDEAL) method, LiverMultiScan IDEAL (LMS IDEAL, Perspectum Diagnostics Ltd, Oxford, UK), described in Hutton et al LMS IDEAL is a complex‐based, confounder‐corrected method that includes a region growing algorithm from Yu et al for field map estimation and a final magnitude‐based estimation step to mitigate phase errors . LMS IDEAL also includes a correction for bipolar gradients from Peterson and Månsson …”

Section: Methodsmentioning

confidence: 99%

“…For these reasons, magnitude‐based methods (i.e., that only require magnitude images) and hybrid methods have been proposed . Hybrid methods use a final magnitude‐based estimation step to refine the PDFF values from phase errors but are still subject to field map estimation . Purely magnitude‐based methods are not the first preferred option because they throw away complementary phase information that improves the SNR when phase data is available and error‐free .…”

Section: Introductionmentioning

confidence: 99%

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Magnitude‐intrinsic water–fat ambiguity can be resolved with multipeak fat modeling and a multipoint search method

Bagur

Hutton

Irving

et al. 2019

Magnetic Resonance in Med

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Purpose To develop a postprocessing algorithm for multiecho chemical‐shift encoded water–fat separation that estimates proton density fat fraction (PDFF) maps over the full dynamic range (0‐100%) using multipeak fat modeling and multipoint search optimization. To assess its accuracy, reproducibility, and agreement with state‐of‐the‐art complex‐based methods, and to evaluate its robustness to artefacts in abdominal PDFF maps. Methods We introduce MAGO (MAGnitude‐Only), a magnitude‐based reconstruction that embodies multipeak liver fat spectral modeling and multipoint optimization, and which is compatible with asymmetric echo acquisitions. MAGO is assessed first for accuracy and reproducibility on publicly available phantom data. Then, MAGO is applied to N = 178 UK Biobank cases, in which its liver PDFF measures are compared using Bland‐Altman analysis with those from a version of the hybrid iterative decomposition of water and fat with echo asymmetry and least squares estimation (IDEAL) algorithm, LiverMultiScan IDEAL (LMS IDEAL, Perspectum Diagnostics Ltd, Oxford, UK). Finally, MAGO is tested on a succession of high field challenging cases for which LMS IDEAL generated artefacts in the PDFF maps. Results Phantom data showed accurate, reproducible MAGO PDFF values across manufacturers, field strengths, and acquisition protocols. Moreover, we report excellent agreement between MAGO and LMS IDEAL for 6‐echo, 1.5 tesla human acquisitions (bias = −0.02% PDFF, 95% confidence interval = ±0.13% PDFF). When tested on 12‐echo, 3 tesla cases from different manufacturers, MAGO was shown to be more robust to artefacts compared to LMS IDEAL. Conclusion MAGO resolves the water–fat ambiguity over the entire fat fraction dynamic range without compromising accuracy, therefore enabling robust PDFF estimation where phase data is inaccessible or unreliable and complex‐based and hybrid methods fail.

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Section: Theorysupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Magnitude‐intrinsic water–fat ambiguity can be resolved with multipeak fat modeling and a multipoint search method

Bagur

Hutton

Irving

et al. 2019

Magnetic Resonance in Med

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Aspirin for Metabolic Dysfunction–Associated Steatotic Liver Disease Without Cirrhosis

Simon,

Wilechansky,

Stoyanova

et al. 2024

JAMA

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ImportanceAspirin may reduce severity of metabolic dysfunction–associated steatotic liver disease (MASLD) and lower the incidence of end-stage liver disease and hepatocellular carcinoma, in patients with MASLD. However, the effect of aspirin on MASLD is unknown.ObjectiveTo test whether low-dose aspirin reduces liver fat content, compared with placebo, in adults with MASLD.Design, Setting, and ParticipantsThis 6-month, phase 2, randomized, double-blind, placebo-controlled clinical trial was conducted at a single hospital in Boston, Massachusetts. Participants were aged 18 to 70 years with established MASLD without cirrhosis. Enrollment occurred between August 20, 2019, and July 19, 2022, with final follow-up on February 23, 2023.InterventionsParticipants were randomized (1:1) to receive either once-daily aspirin, 81 mg (n = 40) or identical placebo pills (n = 40) for 6 months.Main Outcomes and MeasuresThe primary end point was mean absolute change in hepatic fat content, measured by proton magnetic resonance spectroscopy (MRS) at 6-month follow-up. The 4 key secondary outcomes included mean percentage change in hepatic fat content by MRS, the proportion achieving at least 30% reduction in hepatic fat, and the mean absolute and relative reductions in hepatic fat content, measured by magnetic resonance imaging proton density fat fraction (MRI-PDFF). Analyses adjusted for the baseline value of the corresponding outcome. Minimal clinically important differences for study outcomes were not prespecified.ResultsAmong 80 randomized participants (mean age, 48 years; 44 [55%] women; mean hepatic fat content, 35% [indicating moderate steatosis]), 71 (89%) completed 6-month follow-up. The mean absolute change in hepatic fat content by MRS was −6.6% with aspirin vs 3.6% with placebo (difference, −10.2% [95% CI, −27.7% to −2.6%]; P = .009). Compared with placebo, aspirin treatment significantly reduced relative hepatic fat content (−8.8 vs 30.0 percentage points; mean difference, −38.8 percentage points [95% CI, −66.7 to −10.8]; P = .007), increased the proportion of patients with 30% or greater relative reduction in hepatic fat (42.5% vs 12.5%; mean difference, 30.0% [95% CI, 11.6% to 48.4%]; P = .006), reduced absolute hepatic fat content by MRI-PDFF (−2.7% vs 0.9%; mean difference, −3.7% [95% CI, −6.1% to −1.2%]; P = .004]), and reduced relative hepatic fat content by MRI-PDFF (−11.7 vs 15.7 percentage points; mean difference, −27.3 percentage points [95% CI, −45.2 to −9.4]; P = .003). Thirteen participants (32.5%) in each group experienced an adverse event, most commonly upper respiratory tract infections (10.0% in each group) or arthralgias (5.0% for aspirin vs 7.5% for placebo). One participant randomized to aspirin (2.5%) experienced drug-related heartburn.Conclusions and RelevanceIn this preliminary randomized clinical trial of patients with MASLD, 6 months of daily low-dose aspirin significantly reduced hepatic fat quantity compared with placebo. Further study in a larger sample size is necessary to confirm these findings.Trial RegistrationClinicalTrials.gov Identifier: NCT04031729

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Slice-to-Volume Registration Enables Automated Pancreas MRI Quantification in UK Biobank

Bagur

Aljabar²,

Arya³

et al. 2021

Medical Image Understanding and Analysis

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Validation of a standardized MRI method for liver fat and T2* quantification

Cited by 26 publications

References 30 publications

Magnitude‐intrinsic water–fat ambiguity can be resolved with multipeak fat modeling and a multipoint search method

Magnitude‐intrinsic water–fat ambiguity can be resolved with multipeak fat modeling and a multipoint search method

Aspirin for Metabolic Dysfunction–Associated Steatotic Liver Disease Without Cirrhosis

Slice-to-Volume Registration Enables Automated Pancreas MRI Quantification in UK Biobank

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