Flow chart shows diagnostic imaging work-up for hepatic steatosis and
nonalcoholic fatty liver disease (NAFLD). In patients with abnormal liver
function tests or incidental findings of hepatic steatosis at imaging and
high clinical suspicion for NAFLD, a rapid MRI protocol targeted for liver
fat quantification is the method of choice to estimate steatosis severity.
MRI elastography might be added to assess stiffnesses of liver tissue and
fibrosis presence. If the probability of having NAFLD is lower, but
steatosis cannot be excluded, an extended liver protocol should be
considered. CSE-MRI = chemical shift–encoded MRI, GBCA =
gadolinium-based contrast agent, IP/OP = in-phase and opposed-phase imaging,
T2w = T2-weighted imaging.