Measuring Liver Stiffness and Steatosis

One of two abdominal radiologists independently measured liver stiffness using a magnetic resonance software tool (Philips IntelliSpace Portal 6.0, Philips Healthcare, Best, Netherlands). Regions of interest were manually drawn as geographic areas on each of the four slices in portions of the liver that had adequate wave amplitude, avoiding areas close to the major blood vessels, liver margins, and artifacts. The mean stiffness value was assessed by averaging the values across the regions of interest, and the result was displayed automatically on each MRE slice in units of kilopascals (kPa). The values measured on the four slices were averaged. When the value was ≥3.6 kPa, it was defined as advanced fibrosis [18 (link)]. In contrast, an axial 3D multi-echo modified Dixon gradient echo sequence (mDIXON–Quant) was obtained to evaluate hepatic steatosis [19 (link)].