Validation of magnetic resonance imaging for quantification of intrapancreatic fat deposition using phantom and histologic comparators: a systematic review and meta-analysis

OBJECTIVES: Recent insights into understanding intrapancreatic fat deposition (IPFD) and its relationship with common pancreatic diseases have opened new opportunities for their prevention and treatment. This progress underscores the need for an accurate and universally applicable non-invasive imaging modality tailored for IPFD quantification. Chemical shift-encoded magnetic resonance imaging (CSE-MRI) is a non-ionising, time-efficient technique thought to be naturally fit for IPFD quantification because of its excellent fat-water separation. However, this assumption has not yet been systematically evaluated. The aim of this study was to conduct a systematic review assessing the validity of CSE-MRI in measuring IPFD. MATERIALS AND METHODS: A systematic search was performed in MEDLINE, Embase, and Scopus databases. Data from studies comparing CSE-MRI-derived measurements with known phantom fat values or histologically measured fat in the human pancreas were pooled using the Hedges-Olkin method. RESULTS: A total of 13 studies were included. CSE-MRI-derived fat fraction (FF) demonstrated an excellent correlation with known FF in phantoms (r = 0.996; 95% CI: 0.992-0.998; p < 0.0001) and a strong correlation with histologically measured FF (r = 0.775; 95% CI: 0.675-0.847; p < 0.0001). CONCLUSION: These findings support the suitability of CSE-MRI for quantifying IPFD. Future research should focus on developing optimised and universally applicable imaging protocols. KEY POINTS: Question Could chemical shift-encoded magnetic resonance imaging (CSE-MRI) become the modality of choice for non-invasive quantification of intrapancreatic fat deposition? Findings Fat fraction measured by CSE-MRI closely matched known phantom values and correlated strongly with histologically determined fat in the pancreas. Clinical relevance Broad use of CSE-MRI for quantifying intrapancreatic fat deposition has the potential to reduce the global burden of pancreatitis, pancreatic cancer, and type 2 diabetes mellitus.