Hyperintensity at fat spared area in steatotic liver on the hepatobiliary phase MRI

Diagn Interv Radiol. 2019 Nov;25(6):416-420. doi: 10.5152/dir.2019.18535.


Purpose: We aimed to investigate the reasons for hyperintensity at fat spared area in steatotic liver at hepatobiliary phase (HBP) on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced liver magnetic resonance imaging.

Methods: Twenty-two patients with focal fat spared area demonstrating hyperintensity on HBP images were included. A region of interest was placed on in- and opposed-phase images at fat spared area and liver to measure the fat. The measurement was also performed on precontrast T1-weighted and HBP images. The signal intensities of spleen, kidney, muscle, intervertebral disc, and spinal cord were also recorded.

Results: The mean fat fraction of liver and fat spared area was 24.86% (8%-46%) and 8.41% (1%-34%), respectively (P < 0.001). There was a significant positive correlation between liver parenchyma fat fraction and delta fat fraction (r=0.74, P < 0.001). The mean signal intensity values of fat spared areas were higher compared with liver on precontrast T1-weighted and HBP images (P < 0.001). The mean relative enhancement ratio of liver and fat spared areas were 0.98 (0.05-1.90) and 1.15 (0.22-2.03), respectively (P < 0.001). However, in 6 patients, the relative enhancement ratio of liver and fat spared areas were almost equal. The uptake of Gd-EOB at fat spared area was not correlated with the degree of steatosis (r = -0.01, P = 0.95).

Conclusion: Fat spared area in steatotic liver appears hyperintense on HBP images due to increased relative enhancement ratio and/or baseline hyperintensity on precontrast images.

Publication types

  • Comparative Study

MeSH terms

  • Adipose Tissue / diagnostic imaging*
  • Adipose Tissue / pathology
  • Adiposity
  • Administration, Intravenous
  • Adult
  • Aged
  • Contrast Media / administration & dosage
  • Fatty Liver / diagnostic imaging*
  • Fatty Liver / pathology
  • Female
  • Gadolinium DTPA / administration & dosage
  • Humans
  • Image Enhancement / methods
  • Imaging, Three-Dimensional / methods
  • Liver / diagnostic imaging*
  • Liver / pathology
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Retrospective Studies


  • Contrast Media
  • gadolinium ethoxybenzyl DTPA
  • Gadolinium DTPA