Liver proton density fat fraction (PDFF), the ratio between fat-only and overall proton densities, is an extensively validated biomarker associated with several diseases. In recent years, numerous deep learning-based methods for estimating PDFF have been proposed to optimize acquisition and post-processing times without sacrificing accuracy, compared to conventional methods. However, the lack of interpretability and the often poor generalizability of these DL-based models undermine the adoption of such techniques in clinical practice. In this work, we propose an Artificial Intelligence-based Decomposition of water and fat with Echo Asymmetry and Least-squares (AI-DEAL) method, designed to estimate both proton density fat fraction (PDFF) and the associated uncertainty maps. Once trained, AI-DEAL performs a one-shot MRI water-fat separation by first calculating the nonlinear confounder variables, R2∗ and off-resonance field. It then employs a weighted least squares approach to compute water-only and fat-only signals, along with their corresponding covariance matrix, which are subsequently used to derive the PDFF and its associated uncertainty. We validated our method using in vivo liver CSE-MRI, a fat-water phantom, and a numerical phantom. AI-DEAL demonstrated PDFF biases of 0.25% and -0.12% at two liver ROIs, outperforming state-of-the-art deep learning-based techniques. Although trained using in vivo data, our method exhibited PDFF biases of -3.43% in the fat-water phantom and -0.22% in the numerical phantom with no added noise. The latter bias remained approximately constant when noise was introduced. Furthermore, the estimated uncertainties showed good agreement with the observed errors and the variations within each ROI, highlighting their potential value for assessing the reliability of the resulting PDFF maps.
Meneses et al. (Mon,) studied this question.