Fat quantification in skeletal muscle using multigradient-echo imaging: Comparison of fat and water references.

PURPOSE To investigate the precision, accuracy, and repeatability of water/fat imaging-based fat quantification in muscle tissue using a large flip angle (FA) and a fat reference for the calculation of the proton density fat fraction (FF). Comparison is made to a small FA water reference approach. MATERIALS AND METHODS An Intralipid phantom and both forearms of six patients suffering from lymphedema and 10 healthy volunteers were investigated at 1.5T. Two multigradient-echo sequences with eight echo times and FAs of 10° and 85° were acquired. For healthy volunteers, the acquisition of the right arm was performed twice with repositioning. From each set, water reference FF and fat reference FF images were reconstructed and the average FF and the standard deviation were calculated within the subfascial compartment. The small FA water reference was considered the reference standard. RESULTS A high agreement was found between the small FA water reference and large FA fat reference methods (FF bias = 0.31%). In this study, the large FA fat reference approach also resulted in higher precision (38% smaller FF standard deviation in homogenous muscle tissue), but no significant difference in repeatability between the various methods was detected (coefficient of repeatability of small FA water reference approach 0.41%). CONCLUSION The precision of fat quantification in muscle tissue can be increased with maintained accuracy using a larger flip angle, if a fat reference instead of a water reference is used.