Abstract
BACKGROUND: Proton density fat fraction (PDFF)- the ratio of unconfounded fat signal to the sum of the unconfounded fat and water signals, is a valuable quantitative imaging biomarker of metabolic associated steatotic liver disease (MASLD) widely applied in clinical practice and clinical trials. PDFF of the liver is commonly measured using 3 T MRI systems. However, low-field systems are increasingly favored due to lower cost, improved safety profile, minimized artifacts around metallic implants, and enhanced patient comfort. OBJECTIVE: In this pilot study, we used knowledge of standardized and widely used 3 T liver PDFF protocols, and adapted parameters to be appropriate for the 0.55 T MRI. We evaluate a liver fat quantification protocol at 0.55 T compared to a standard clinical 3 T protocol to measure liver fat in patients with MASLD. MATERIAL AND METHODS: Eight adult patients (average age 53.6 ± 13.6 years, 5 females) with ≥ 5% PDFF on 3 T MRI underwent a 0.55 T MRI PDFF protocol within 90 days. To keep the acquisition time to be within a reasonable breath hold duration and with reasonable signal-to-noise ratio (SNR), four echoes were acquired at a lower resolution and fewer number of slices at 0.55 T compared to 3 T which uses a 6-echo multi-echo Dixon volumetric interpolated breath hold examination (VIBE) protocol. PDFF quantification accuracy of the 0.55 T approach was evaluated using a commercial PDFF phantom and in vivo. RESULTS: In the phantom, there was excellent match (R(2) > 0.999) between PDFF estimated by 0.55 T MRI and ground truth. Mean in vivo 3 T MRI-PDFF was 16.5%, compared to 16.3% 0.55 T MRI-PDFF (correlation coefficient r = 0.99). The Bland-Altman analysis showed good agreement of in vivo PDFF measurements across 0.55 T and 3 T estimating a bias or mean difference of - 0.25% and the limits of agreements (LoA) of - 3.98% and 3.48%. DISCUSSION: Our data demonstrate that 0.55 T MRI is feasible and comparable to 3 T MRI in quantifying liver PDFF among patients with MASLD.