Assessment of Hepatic Steatosis in Living Donor Liver Transplantation: Comparison Between IDEAL MRI and CT

Objective: To evaluate and compare the diagnostic accuracy of Iterative Decomposition of Water and Fat with Echo Asymmetry and Least Squares Estimation (IDEAL) Magnetic Resonance Imaging (MRI) sequence with Computed Tomography (CT) for the quantitative assessment of hepatic steatosis in living donor liver transplantation using histopathology as the standard of reference. Methods: A total of 21 donors (11 females and 10 males) underwent CT and MRI prior to biopsy. MR IDEAL IQ sequences and CT were performed. Fourty-three biopsies in 21 patients were evaluated by a pathologist by traditional determination of the cell-count fraction. Histopathologically, the presence of steatosis was assessed on a four-point scale (1=< 5%, 2=5%-10%, 3=10%-20%, 4=>20%). The relationship between fat fraction and histological grade was analyzed using the Spearman correlation test. To evaluate the diagnostic performance of the parameters, Receiver Operating Characteristics analysis was performed. Results: Histopathologically, <5% fat content was found in 12 donors (57%), 5%-10% fat content was found in 4 donors (19%), 10%-20% fat content was found in 3 donors (14%), and >20% fat content was found in 2 donors (10%). Both MR IDEAL IQ and CT results correlated with the pathological grade (r=0.736, p=0.005; r=0.510, p=0.018, respectively). MR IDEAL fat fraction results were a better predictor predictor for the evaluation of liver steatosis. MR IDEAL fat fraction sensitivity was 83%. Conclusion: MR IDEAL sequence for the measurement of liver fat content provides a non-invasive and accurate estimation of the presence and grading of hepatic steatosis.