Confidence maps for reliable estimation of proton density fat fraction and R2* in the liver

Abstract Purpose The objective was to develop a fully automated algorithm that generates confidence maps to identify regions valid for analysis of quantitative proton density fat fraction (PDFF) and maps of the liver, generated with chemical shift–encoded MRI (CSE‐MRI). Confidence maps are urgently needed for automated quality assurance, particularly with the emergence of automated segmentation and analysis algorithms. Methods Confidence maps for both PDFF and maps are generated based on goodness of fit, measured by normalized RMS error between measured complex signals and the CSE‐MRI signal model. Based on Cramér‐Rao lower bound and Monte‐Carlo simulations, normalized RMS error threshold criteria were developed to identify unreliable regions in quantitative maps. Simulation, phantom, and in vivo clinical studies were included. To analyze the clinical data, a board‐certified radiologist delineated regions of interest (ROIs) in each of the nine liver segments for PDFF and analysis in consecutive clinical CSE‐MRI data sets. The percent area of ROIs in areas deemed unreliable by confidence maps was calculated to assess the impact of confidence maps on real‐world clinical PDFF and measurements. Results Simulations and phantom studies demonstrated that the proposed algorithm successfully excluded regions with unreliable PDFF and measurements. ROI analysis by the radiologist revealed that 2.6% and 15% of the ROIs were placed in unreliable areas of PDFF and maps, as identified by confidence maps. Conclusion A proposed confidence map algorithm that identifies reliable areas of PDFF and measurements from CSE‐MRI acquisitions was successfully developed. It demonstrated technical and clinical feasibility.