J Korean Med Sci.  2022 Dec;37(49):e339. 10.3346/jkms.2022.37.e339.

Radiomics Analysis of Magnetic Resonance Proton Density Fat Fraction for the Diagnosis of Hepatic Steatosis in Patients With Suspected NonAlcoholic Fatty Liver Disease

• Sim KC
• Kim MJ
• Cho Y
• Kim HJ
• Park BJ
• Sung DJ
• Han NY
• Han YE
• Kim TH
• Lee YJ

• KMID: 2537043
• DOI: http://doi.org/10.3346/jkms.2022.37.e339

Abstract

Background
This study aimed to assess the diagnostic feasibility of radiomics analysis based on magnetic resonance (MR)-proton density fat fraction (PDFF) for grading hepatic steatosis in patients with suspected non-alcoholic fatty liver disease (NAFLD).
Methods
This retrospective study included 106 patients with suspected NAFLD who underwent a hepatic parenchymal biopsy. MR-PDFF and MR spectroscopy were performed on all patients using a 3.0-T scanner. Following whole-volume segmentation of the MRPDFF images, 833 radiomic features were analyzed using a commercial program. Radiologic features were analyzed, including median and mean values of the multiple regions of interest and variable clinical features. A random forest regressor was used to extract the important radiomic, radiologic, and clinical features. The model was trained using 20 repeated 10-fold cross-validations to classify the NAFLD steatosis grade. The area under the receiver operating characteristic curve (AUROC) was evaluated using a classifier to diagnose steatosis grades.
Results
The levels of pathological hepatic steatosis were classified as low-grade steatosis (grade, 0–1; n = 82) and high-grade steatosis (grade, 2–3; n = 24). Fifteen important features were extracted from the radiomic analysis, with the three most important being wavelet-LLL neighboring gray tone difference matrix coarseness, original first-order mean, and 90th percentile. The MR spectroscopy mean value was extracted as a more important feature than the MR-PDFF mean or median in radiologic measures. Alanine aminotransferase has been identified as the most important clinical feature. The AUROC of the classifier using radiomics was comparable to that of radiologic measures (0.94 ± 0.09 and 0.96 ± 0.08, respectively).
Conclusion
MR-PDFF-derived radiomics may provide a comparable alternative for grading hepatic steatosis in patients with suspected NAFLD.

Keyword

Radiomics; Liver Steatosis; Magnetic Resonance Imaging; Proton Density Fat Fraction; Non-alcoholic Fatty Liver Disease

Figure

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  Fig. 1 Flow diagram for the study population.MR-PDFF = magnetic resonance-proton density fat fraction, MRS = magnetic resonance spectroscopy, HBV = hepatitis B virus, HCV = hepatitis C virus.

• 

  Fig. 2 A 30-year-old woman with non-alcoholic fatty liver disease. The work screen shows the completion of the whole-volume segmentation of the fat fracture image of the magnetic resonance-proton density fat fraction using a commercial program. Vascular structures such as portal veins (asterisk) are excluded and only the liver parenchyma indicated in green is accurately segmented.

• 

  Fig. 3 A 33-year-old man with non-alcoholic fatty liver disease (hepatic steatosis grade 1 and 20% steatosis on histopathology). The liver steatosis values on the MR-PDFF are measured to be approximately 19.0% (A) and 21.3% (B). The value of liver steatosis on MRS is 19.6% (C, D). The MR-PDFF and MRS values measured at similar locations in segment 4a of the liver are almost identical (A, C).MR-PDFF = magnetic resonance-proton density fat fraction, MRS = magnetic resonance spectroscopy.

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  Fig. 4 Radiomics pipeline.MR-PDFF = magnetic resonance-proton density fat fraction, DM = diabetes mellitus, ALT = alanine aminotransferase, AST = aspartate aminotransferase, TG = triglyceride, LDL = low-density lipoprotein, BMI = body mass index, HDL = high-density lipoprotein, GGT = gamma-glutamyl transferase, ALP = alkaline phosphatase, MRS = magnetic resonance spectroscopy, AUROC = area under the receiver operating characteristic curve.

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  Fig. 5 Receiver operating characteristic curve for prediction of the grade of liver steatosis.AUROC = area under the receiver operating characteristic curve.

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