Intra-examination agreement between multi-echo gradient echo and confounder-corrected chemical shift-encoded MR sequences for R2 estimation as a biomarker of liver iron content in patients with a wide range of T2/R2 and proton density fat fraction values

Purpose To investigate the intra-examination agreement between multi-echo gradient echo (MEGE) and confounder-corrected chemical shift-encoded (CSE) sequences for liver T2*/R2* estimations in a wide range of T2*/R2* and proton density fat fraction (PDFF) values. Exploratorily, to search for the T2*/R2* value where the agreement line breaks and examine differences between regions of low and high agreement. Methods Consecutive patients at risk for liver iron overload who underwent MEGE and CSE sequences within the same exam at 1.5 T were retrospectively selected. Regions of interest were drawn in the right and one in the left liver lobes on post-processed images for R2*(sec −1 ) and PDFF (%) estimation. Agreement between MEGE-R2* and CSE-R2* was evaluated using intra-class correlation coefficient (ICC) and Bland–Altman analysis. 95% confidence intervals (CI) were computed. Segment-and-regression analysis was performed to find the point where the agreement between sequences is interrupted. Regions of low and high agreement were examined using tree-based partitioning analyses. Results 49 patients were included. Mean MEGE-R2* was 94.2 s −1 (range: 31.0–737.1) and mean CSE-R2* 87.7 (29.7–748.1). Mean CSE-PDFF was 9.12% (0.1–43.3). Agreement was strong for R2* estimations (ICC: 0.992,95%CI 0.987,0.996), but the relation was nonlinear and possibly heteroskedastic. Lower agreement occurred when MEGE-R2* > 235 s −1 , with MEGE-R2* values consistently lower than CSE-R2*. Higher agreement was observed when PDFF 235. Lower agreement was observed in patients with moderate to severe liver steatosis.