Chemical shift encoding-based water–fat MRI derived proton density fat fraction (PDFF) of the thigh muscles has been emerging as surrogate marker in subjects with osteoarthritis, sarcopenia, and neuromuscular disorders. However, little is known about the relationship of thigh muscle PDFF and corresponding muscle strength measurements. The present study demonstrated that PDFF measurements improve the prediction of thigh muscle strength beyond muscle cross-sectional area in healthy subjects. Thus, chemical shift encoding-based water–fat MRI can provide clinically important information and may potentially track early changes in muscles that are not severely atrophied or fattily infiltrated.
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