Hepatic R2* is more strongly associated with proton density fat fraction than histologic liver iron scores in patients with nonalcoholic fatty liver disease

Author(s): Bashir, Mustafa R; Wolfson, Tanya; Gamst, Anthony C; Fowler, Kathryn J; Ohliger, Michael; Shah, Shetal N; Alazraki, Adina; Trout, Andrew T; Behling, Cynthia; Allende, Daniela S; Loomba, Rohit; Sanyal, Arun; Schwimmer, Jeffrey; Lavine, Joel E; Shen, Wei; Tonascia, James; Van Natta, Mark L; Mamidipalli, Adrija; Hooker, Jonathan; Kowdley, Kris V; Middleton, Michael S; Sirlin, Claude B; NASH Clinical Research Network (NASH CRN) | Abstract: BACKGROUND:The liver R2* value is widely used as a measure of liver iron but may be confounded by the presence of hepatic steatosis and other covariates. PURPOSE:To identify the most influential covariates for liver R2* values in patients with nonalcoholic fatty liver disease (NAFLD). STUDY TYPE:Retrospective analysis of prospectively acquired data. POPULATION:Baseline data from 204 subjects enrolled in NAFLD/NASH (nonalcoholic steatohepatitis) treatment trials. FIELD STRENGTH:1.5T and 3T; chemical-shift encoded multiecho gradient echo. ASSESSMENT:Correlation between liver proton density fat fraction and R2*; assessment for demographic, metabolic, laboratory, MRI-derived, and histological covariates of liver R2*. STATISTICAL TESTS:Pearson's and Spearman's correlations; univariate analysis; gradient boosting machines (GBM) multivariable machine-learning method. RESULTS:Hepatic proton density fat fraction (PDFF) was the most strongly correlated covariate for R2* at both 1.5T (r = 0.652, P l 0.0001) and at 3T (r = 0.586, P l 0.0001). In the GBM analysis, hepatic PDFF was the most influential covariate for hepatic R2*, with relative influences (RIs) of 61.3% at 1.5T and 47.5% at 3T; less influential covariates had RIs of up to 11.5% at 1.5T and 16.7% at 3T. Nonhepatocellular iron was weakly associated with R2* at 3T only (RI 6.7%), and hepatocellular iron was not associated with R2* at either field strength. DATA CONCLUSION:Hepatic PDFF is the most influential covariate for R2* at both 1.5T and 3T; nonhepatocellular iron deposition is weakly associated with liver R2* at 3T only. LEVEL OF EVIDENCE:4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018.