Comparison of CT and magnetic resonance mDIXON-Quant sequence in the diagnosis of mild hepatic steatosis

Objective: To determine the diagnostic performance of CT in the assessment of mild hepatic steatosis by comparison with MR mDIXON-Quant as a reference standard, and to explore their clinical applications. Methods: In this prospective study 169 volunteers were included. Each subject underwent CT and MR mDIXON-Quant examinations. Hepatic steatosis evaluations were performed via liver attenuation alone (CT L), liver to spleen attenuation ratio (CT L/S), difference between liver and spleen attenuation (CT L-S), and MR mDIXON-Quant imaging. The effectiveness of CT L, CT L/S, and CT L-S in diagnosing hepatic steatosis severity of >=5%, >=10%, and >=15% was compared, using mDIXON-Quant results as standard. Results: 65 subjects exhibited mild hepatic steatosis. Hepatic steatosis measurement with mDIXON-Quant was strongly correlated with the three CT methods. Using cutoff value, the sensitivity and specificity of diagnosing hepatic steatosis >=5, >=10, and >=15% were 64.6, 91.3, 100%, and 90.4, 89.7, 93.0% for CT L; 50.8, 87.0, 100%, and 96.2, 98.6, 97.5% for CT L/S; and 67.7, 87.0, 100%, and 81.7, 98.6, 97.5% for CT L-S, respectively. ROC analysis indicated that 58.9, 56.5, and 52.8 HU for CT L; 1.06, 0.98, and 0.90 HU for CT L/S; and 6.21,-1.04, and -4.93 HU for CT L-S were cutoff values for diagnosing hepatic steatosis >=5%,>=10%, and >=15%, respectively. Conclusions: The three CT methods exhibit better agreements with mDIXON-Quant imaging for diagnosing hepatic steatosis >=10%. Hence, CT and mDIXON-Quant could serve as suitable tools for the accurate quantification of mild hepatic steatosis. Significant finds of the study: The close agreement between the three different CT methods (based on our cutoff values) and mDIXON-Quant imaging suggests that CT could accurately diagnose hepatic steatosis >=10%. Thus, CT and mDIXON-Quant imaging can accurately measure mild hepatic steatosis. What this study adds: Only few studies have compared hepatic steatosis quantification between CT and mDIXON-Quant. We are the first to determine the diagnostic performance of unenhanced CT for quantitatively assessing mild hepatic steatosis, in reference to magnetic resonance mDIXON-Quant imaging.