Accurate simultaneous quantification of liver steatosis and iron overload in diffuse liver diseases with MRI Manuela Franc ¸a , 1 A ´ ngel Alberich-Bayarri, 2 Luis Martı ´-Bonmatı ´, 2 Pedro Oliveira, 3,4 Francisca Emanuel Costa, 5 Grac ¸a Porto, 6,7,8 Jose ´ Ramo ´n Vizcaı ´no, 5 Javier Sanchez Gonzalez, 9 Eduardo Ribeiro, 1 Joa ˜ o Oliveira, 1 Helena Pessegueiro Miranda 4,10 1 Imaging Department, Centro Hospitalar do Porto, Largo Prof Abel Salazar, 4099-001 Porto, Portugal 2 Radiology Department, Hospital Universitario y Polite´cnico La Fe and Biomedical Imaging Research Group (GIBI230), Valencia, Spain 3 Population Studies Department, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal 4 Epidemiology Research Unit (EPIUnit), Institute of Public Health of the University of Porto, Porto, Portugal 5 Pathology Department, Centro Hospitalar do Porto, Porto, Portugal 6 Hematology Department, Centro Hospitalar do Porto, Porto, Portugal 7 I3S, Instituto de Investigac¸a˜o e Inovac¸a˜o em Sau´de, Porto, Portugal 8 IBMC, Institute for Molecular and Cell Biology, Porto, Portugal 9 MR Clinical Science, Philips Healthcare, Madrid, Spain 10 Liver and Pancreas Transplantation Unit and Medicine Department, Centro Hospitalar do Porto, Porto, Portugal Abstract Purpose: To evaluate the diagnostic performances of 3 Tesla multi-echo chemical shift-encoded gradient echo magnetic resonance (MECSE-MR) imaging to simulta- neously quantify liver steatosis and iron overload in a wide spectrum of diffuse liver diseases having biopsy as reference standard. Methods: MECSE-MR-acquired images were used to calculate fat fraction and iron content in a single breath- hold in 109 adult patients. Proton density fat fraction (PDFF) was prospectively estimated using complex- based data reconstruction with multipeak fat modeling. Water R2* was used to estimate iron content. Biopsy was obtained in all cases, grading liver steatosis, siderosis, inflammation, and fibrosis. Differences in PDFF and R2* values across histopathological grades were ana- lyzed, and ROC curves analyses evaluated the MR diagnostic performance. Results: Calculated fat fraction measurements showed significant differences (p < 0.001) among steatosis grades, being unaffected by the presence of inflammation or fibrosis (p ‡ 0.05). A strong correlation was found between fat fraction and steatosis grade (R S = 0.718, p < 0.001). Iron deposits did not affect fat fraction quantitation (p ‡ 0.05), except in cases with severe iron overload (grade 4). A strong positive correlation was also observed between R2* mea- surements and iron grades (R S = 0.704, p < 0.001). Cal- culated R2* values were not different across grades of steatosis, inflammation, and fibrosis (p ‡ 0.05). Conclusion: A MECSE-MR sequence simultaneously quantifies liver steatosis and siderosis, regardless coexist- ing liver inflammation or fibrosis, with high accuracy in a wide spectrum of diffuse liver disorders. This sequence can be acquired within a single breath-hold and can be implemented in the routine MR evaluation of the liver. Key words: Fat quantification—Iron overload—R2* measurement—Chronicliver diseases—Quantitative imaging biomarkers Diffuse liver diseases result from a wide spectrum of disorders, with fat and iron being the most common Correspondence to: Manuela Franc¸a; email: mariamanuela.franca@ gmail.com ª Springer Science+Business Media New York 2017 Published online: 21 January 2017 Abdominal Radiology Abdom Radiol (2017) 42:1434–1443 DOI: 10.1007/s00261-017-1048-0