Use of magnetic resonance elastography to assess hepatic fibrosis in children with chronic liver disease

Abstract

Management of pediatric chronic liver disease is limited by lack of validated noninvasive biomarkers of histologic severity. We demonstrate that magnetic resonance elastography is feasible and accurate in detecting significant hepatic fibrosis in a case series of 35 children with chronic liver disease, including severely obese children.

Keywords: ARFI; AUROC; Acoustic radiation force imaging; Area under the receiver operating characteristic curve; BMI; Body mass index; MRE; Magnetic resonance elastography; NAFLD; NASH; Nonalcoholic fatty liver disease; Nonalcoholic steatohepatitis; ROI; Region of interest; TE; Transient elastography; US; Ultrasound.

Copyright © 2014 Mosby, Inc. All rights reserved.

Figures

Figure 1

Representative axial MRE images from three subjects. (A) 9 year old female, BMI 33.4 kg/m2, with NASH and stage 1c fibrosis. The elastogram demonstrates a hepatic ROI with mean liver stiffness value of 2.2 kPa (blue-purple colors indicate low liver stiffness). The software algorithm automatically excludes the cross-hatched regions secondary to insufficient wave penetration. (B) 12 year old male, BMI 38.6 kg/m2, with NASH and stage 3 fibrosis. The hepatic ROI has a mean liver stiffness value of 3.6 kPa (yellow and orange colors indicate elevated liver stiffness). (C) 15 year old female, BMI 22 kg/m2, with autoimmune sclerosing cholangitis and cirrhosis. The hepatic ROI has a mean liver stiffness value of 4.9 kPa (prominent yellow, orange and red colors indicate markedly elevated liver stiffness).

Figure 1

Representative axial MRE images from three subjects. (A) 9 year old female, BMI 33.4 kg/m2, with NASH and stage 1c fibrosis. The elastogram demonstrates a hepatic ROI with mean liver stiffness value of 2.2 kPa (blue-purple colors indicate low liver stiffness). The software algorithm automatically excludes the cross-hatched regions secondary to insufficient wave penetration. (B) 12 year old male, BMI 38.6 kg/m2, with NASH and stage 3 fibrosis. The hepatic ROI has a mean liver stiffness value of 3.6 kPa (yellow and orange colors indicate elevated liver stiffness). (C) 15 year old female, BMI 22 kg/m2, with autoimmune sclerosing cholangitis and cirrhosis. The hepatic ROI has a mean liver stiffness value of 4.9 kPa (prominent yellow, orange and red colors indicate markedly elevated liver stiffness).

Figure 1

Representative axial MRE images from three subjects. (A) 9 year old female, BMI 33.4 kg/m2, with NASH and stage 1c fibrosis. The elastogram demonstrates a hepatic ROI with mean liver stiffness value of 2.2 kPa (blue-purple colors indicate low liver stiffness). The software algorithm automatically excludes the cross-hatched regions secondary to insufficient wave penetration. (B) 12 year old male, BMI 38.6 kg/m2, with NASH and stage 3 fibrosis. The hepatic ROI has a mean liver stiffness value of 3.6 kPa (yellow and orange colors indicate elevated liver stiffness). (C) 15 year old female, BMI 22 kg/m2, with autoimmune sclerosing cholangitis and cirrhosis. The hepatic ROI has a mean liver stiffness value of 4.9 kPa (prominent yellow, orange and red colors indicate markedly elevated liver stiffness).

Figure 2

AUROC for MRE discrimination between stage ≥ 2 vs. stage 0-1 fibrosis.