Friend or Foe: How to Suppress and Measure Fat During Abdominal Resonance Imaging?

Abstract

The suppression of fat signals in abdominal magnetic resonance imaging has become a basic and routine practice in the diagnosis of pathologic conditions of abdominal organs in clinical settings. Many fat-suppression techniques have been developed in the past several decades, with fat-quantification methods introduced in response in more recent years. Fat-suppression techniques can be divided into two categories. Chemical shift–based techniques include chemical shift selective (CHESS), water excitation, and the Dixon method. CHESS is the most commonly used fat-suppression method, nulling the fat signal using a fat-selective radiofrequency pulse with a spoiler gradient. Water excitation employs a binomial pulse that excites only the water protons. Finally, the Dixon method involves using the in-phase/out-of-phase cycling of fat and water. An inversionbased technique, known as short tau inversion recovery (STIR), uses a pre-excitation inversion pulse that inverts the spin of all tissues. By selecting the appropriate MRI inversion time such that the longitudinal magnetization of fat is zero, fat protons will not contribute to the MRI signal. Also, spectral attenuated inversion recovery (SPAIR) is a hybrid technique that combines the characteristics of both CHESS and STIR. The most precise fat-quantification technique known to date is a complex-based multipoint Dixon method, with which the protondensity fat fraction (PDFF) can be obtained. Multiple confounding factors must be well-corrected for accurate fat quantification. Radiologists should be familiar with the various fat suppression and measurement methods during MRI and be able to apply them to enhance patient care.