Optimization of ROI sampling strategies for proton density fat-fraction MRI of hepatic steatosis before liver transplantation in ex vivo

This study aims to determine sampling strategy (SS) with the fewest regions of interest (ROIs) that could diagnose hepatic steatosis (HS) as reliably as the 9-ROI strategy before liver transplantation in ex vivo. All strategies with ≥5 ROIs had an intraclass correlation coefficients(ICC) ≥ 0.995 and limit of agreement (|LOA|)≤ 1.5%. The average proton density fat-fraction (PDFF) was moderately correlated with the histological diagnosis. The 5-ROI SS obtains similar PDFF results as the 9-ROI strategy before liver transplantation in ex vivo. After further verification, this method may become an available standard to assess HS before liver transplantation in ex vivo.