Vendor-Neutral Development and Cross-Center Validation of Flip Angle Modulated 2D Sequential CSE-MRI Technique for Liver Fat Quantification

Abstract

Motivation: 2D sequential chemical-shift-encoded acquisitions with centric encoding and flip-angle modulation (FAM) enables motion-robust and high-SNR liver fat quantification. Originally developed in a single vendor, the performance and relative simplicity of FAM motivate vendor-neutral implementation and validation. Goal(s): Implement FAM in the vendor-neutral framework Pulseq, and determine its feasibility, bias, and reproducibility in a multi-center, multi-vendor study. Approach: Pulseq-FAM was applied in two centers with two vendors on a phantom with controlled PDFF/T1water values, and in volunteers during free breathing. Results: At both centers, Pulseq-FAM shows low bias and good reproducibility in the phantom, and excellent motion robustness and image quality in volunteers. Impact: A vendor-neutral implementation of motion-robust liver fat quantification, as demonstrated in this study, may enable detection, staging, and treatment monitoring of steatotic liver disease with improved availability and standardization.