ArticleQuantitative imaging in medicine and surgery2026
Clinical assessment of hepatic steatosis and iron content using three-dimensional (3D) multi-echo chemical shift encoded magnetic resonance imaging (MRI): correlation with histopathology.
Article in Quantitative imaging in medicine and surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Hepatic steatosis and iron overload are common in chronic liver diseases and may cause progressive damage if undetected. Liver biopsy, the gold standard, is invasive with limited clinical applicability. This study evaluated the diagnostic performance of three-dimensional (3D) multi-echo chemical shift-encoded magnetic resonance imaging (MRI) for simultaneous non-invasive quantification of hepatic fat and iron content against histopathology. Methods: A total of 177 patients with chronic liver disease underwent 3D Multi-Echo Chemical Shift Encoded MRI examination followed by liver biopsy. Proton density fat fraction (PDFF) and R2* values were measured to quantify hepatic fat and iron content, respectively. Histopathological grading served as the reference standard. Diagnostic accuracy, correlation coefficients, and inter-reader reliability were assessed. Receiver operating characteristic (ROC) analysis determined optimal cut-off values for different grades of steatosis and iron content. Results: High repeatability and consistency were observed in measuring PDFF and R2* values [intraclass correlation coefficient (ICC) =0.998 and 0.991, respectively]. Significant correlations were observed between MRI measurements and histopathology for both hepatic fat (r=0.856, P<0.001) and iron content (r=0.617, P<0.001). For steatosis detection, PDFF demonstrated excellent diagnostic accuracy with area under the curves (AUCs) of 0.932, 0.974, and 0.992 for grades ≥1, ≥2, and ≥3, respectively. The R2* value performed comparably in assessing the presence of iron deposition, with an AUC of 0.880. Spearman's correlation analysis demonstrated a significant positive correlation between PDFF and R2* values (r=0.589, P<0.001). Conclusions: 3D Multi-Echo Chemical Shift Encoded MRI demonstrates excellent diagnostic performance with high reproducibility for simultaneous assessment of hepatic steatosis and iron content, showing strong correlations with histopathological findings. This non-invasive technique provides a reliable alternative to liver biopsy and supports its clinical implementation as a standard tool for comprehensive hepatic evaluation.
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