Quantification of hepatic fat fraction in patients with nonalcoholic fatty liver disease: Comparison of multimaterial decomposition algorithm and fat (water)-based material decomposition algorithm using single-source dual-energy computed tomography

Objective: The purpose of this study was to evaluate the accuracy of quantifying hepatic fat fraction (HFF) in nonalcoholic fatty liver disease patients with multimaterial decomposition (MMD) and fat (water)-based material decomposition by single-source dual-energy computed tomography. Methods: Hepatic fat fractions were quantified by noncontrast (HFFnon-CE) and contrast-enhanced single-source dual-energy computed tomography in arterial phase (HFFAP), portal venous phase (HFFPVP) and equilibrium phase (HFFEP) using MMD in 19 nonalcoholic fatty liver disease patients. The fat concentration was measured on fat (water)-based images. As the standard of reference, magnetic resonance iterative decomposition of water and fat with echo asymmetry and least-squares estimation-iron quantification images were reconstructed to obtain HFF (HFFIDEAL-IQ). Results: There was a strong correlation between HFFnon-CE, HFFAP, HFFPVP, HFFEP, fat concentration and HFFIDEAL-IQ (r = 0.943, 0.923, 0.942, 0.952, and 0.726) with HFFs having better correlation with HFFIDEAL-IQ. Hepatic fat fractions did not significantly differ across scanning phases. The HFFs of 3-phase contrast-enhanced computed tomography had a good consistency with HFFnon-CE. Conclusions: Hepatic fat fraction using MMD has excellent correlation with that of magnetic resonance imaging, is independent of the computed tomography scanning phases, and may be used as a routine technique for quantitative assessment of HFF.