Highly Reproducible, Vendor‐Agnostic, Motion‐Insensitive Liver PDFF Mapping at 0.55T , 1.5T , and 3T

ABSTRACT Purpose To develop and validate a vendor‐agnostic, motion‐insensitive proton‐density fat‐fraction (PDFF) quantification method. Methods Flip‐angle‐modulated (FAM) 2D chemical‐shift‐encoded (CSE) MRI for PDFF quantification was implemented in both the vendor‐agnostic platform Pulseq (“Pulseq‐FAM”) and one vendor‐specific platform (“GE‐specific FAM”). These implementations were distributed to four sites with twelve MR systems of three vendors (Siemens/GE/Philips) and field strengths (0.55T/1.5T/3T). A sequentially‐shipped 16‐vial phantom (PDFF = 0%–30%/T1 water = 200–1400 ms) underwent confounder‐corrected PDFF mapping with commercial 3D‐CSE methods and GE‐specific FAM as available on each system, and Pulseq‐FAM on every system. To assess bias, phantom PDFF measurements were compared to reference. Between‐system variance was evaluated with linear mixed‐effects modeling. Different volunteers were also imaged at each site to assess free‐breathing PDFF mapping feasibility. A prospective single‐site volunteer study was also conducted. Adult patients and children were imaged with breath‐held 3D‐CSE and free‐breathing GE‐specific and Pulseq‐FAM. Radiologists evaluated images for overall quality and motion artifacts. To assess bias, Pulseq‐FAM PDFF measurements were compared to 3D‐CSE and GE‐specific FAM. Test–retest repeatability was assessed by re‐imaging after repositioning. Between‐field‐strength reproducibility was assessed at 1.5T and 3.0T. Results In the multi‐center study, Pulseq‐FAM showed reduced T1‐bias and between‐system variability versus 3D‐CSE in phantom PDFF measurements, and free‐breathing feasibility in volunteers. In the single‐site volunteer study ( N = 57), Pulseq‐FAM improved image quality and motion artifacts versus 3D‐CSE ( p < 0.01). Pulseq‐FAM showed excellent agreement with 3D‐CSE (95% limits‐of‐agreement (LoA) = 3.4% PDFF) and GE‐specific FAM (LoA = 2.0%). Pulseq‐FAM showed excellent repeatability (repeatability coefficient (RC) = 1.6% PDFF) and between‐field‐strength reproducibility (reproducibility coefficient (RDC) = 2.4%) versus 3D‐CSE (RC = 2.7%/RDC = 3.4%; differences p < 0.05). Conclusion Pulseq‐FAM enables accurate, reproducible, vendor‐agnostic, and motion‐insensitive PDFF quantification in adults and children.