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Liver fat assessment using MRI in obese diabetes patient

Case Study
Dr. Pedrosa, Ivan, M.D. UT Southwestern • USA
Dr. Yokoo, Takeshi, M.D., Ph.D. UT Southwestern Med Ctr • USA

Patient history

A 50-year-old Caucasian female with obesity, type II diabetes, and abnormal liver enzymes. A non-alcoholic fatty liver is suspected.

This patient was referred for non-invasive quantification of fat deposition in the liver using MRI at UT Southwestern Medical Center in Dallas.

MR examination

Philips Achieva 3.0T TX with SENSE Torso XL coil was used.

3D T1 FFE mDIXON Quant: TR 6.2 ms, 6 echoes TE1/DTE 1.05/0.8 ms, flip 2 deg, BH 18 sec, matrix 188 x 194, 26 slices of 10 mm.

The fat fraction tool allows for color display of fat fraction measurement.

Images

Click on an image to enlarge.
 SSh T2W TSE BH <br> SSh T2W TSE SPAIR<br>
SSh T2W TSE BH
SSh T2W TSE SPAIR
 2D FFE out of phase
<br><br><br> 2D FFE in phase
<br><br><br>
2D FFE out of phase


2D FFE in phase


 DWI with b values 0, 50, 400, 800 
<br> <br>
DWI with b values 0, 50, 400, 800

 mDIXON Quant fat fraction maps
<br>
mDIXON Quant fat fraction maps


mDIXON dynamic contrast enhanced (water only)
pre                             arterial                             portal                           delayed

 

High resolution, single shot axial T2W TSE BH and fat saturated (SPAIR) images show no gross abnormality. Axial dual echo T1 2D FFE demonstrates diffuse loss of liver parenchymal signal on the out-of-phase image, compatible with diffuse fatty liver. A blooming susceptibility artifact in the gall bladder fossa, more pronounced on the long TE (in-phase) image, is compatible with metallic cholecystectomy clip(s). The respiratory triggered axial EPI DWI images are within normal limits.

 

mDIXON Quant fat fraction maps show diffuse fatty liver, slightly heterogeneous across the liver. Fat fraction values ranging from 13-22%, compatible with grade 1-2 steatosis at histology (Tang, et al, Radiology 2013, PMID: 23382291).

 

The dynamic 3D T1 FFE mDIXON contrast-enhanced series (water only) shows decreased liver parenchymal signal on the pre-contrast image in keeping with fatty liver. Minimal patchy heterogeneity of the arterial enhancement may be related to underlying liver disease. Portal and delayed venous phase images are within normal limits.

On other images in the exam (not shown) no definite morphological evidence was seen for cirrhosis or portal hypertension.

Diagnosis

Diffuse  fatty liver, slightly heterogeneous across the liver. 

Clinical impact

mDIXON Quant enables quantification of fat in the liver in a way that is non-invasive, fast, robust and provides high quality results. mDIXON Quant can be acquired in a single breathhold.

Related reading



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Aug 26, 2014

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Case Study
Achieva 3.0T
Body, diabetes, fat fraction, liver, mDIXON Quant
 

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