4.1. MRI-PDFF Protocol

The primary outcome was estimating LFC (%) changes using the mDixon Quant. technique [46,52]. Liver fats were quantified using a 1.5-T MRI system (Philips MR system Ingenia). This technique yields in-phase (IP) and out-of-phase (OP) scans (separating water and fat signals). These images were used to calculate LFC (%) according to this equation: [(SI_IP − SI_OP)/2SI_IP] ×100.

SIIP and SIOP refer to the hepatic-to-splenic SI ratios in the IP and OP images. SI was estimated as the mean regions of interest (ROIs) placed in each liver segment (Segment I, II, III, IVa, IVb, V, VI, VII, and VIII) and spleen, avoiding major vessels and bile ducts, visual artifacts, and organ margins. The previous steps were performed by a radiologist, who was blinded to the clinical data of study patients [29,53].

Patients were classified according to the following MRI-PDFF values: no steatosis (<6.5%), Grade I (>6.5 and <17.4%), Grade II (>17.4 and <22.1%), and Grade III (>22.1%) [52].