MR Elastography Detects Pediatric Liver Disease Without Need for Needle Biopsy

Magnetic resonance elastography (MRE), noninvasive imaging technique, can now help physicians effectively identify fibrosis in children with chronic liver disease, a growing problem caused partly by the increase of obesity rates.

The new study revealed that MRE detects such chronic diseases as nonalcoholic fatty liver disease (NAFLD), which is increasingly common in children and teens, affecting an estimated 13% of adolescents. NAFLD can lead to progressive liver disease and liver failure. Obesity is a major risk factor. “Because many pediatrics patients in the United States with NAFLD are severely obese, MRE is likely to be superior to ultrasound-based elastography in this population, as ultrasound-based methods are less reliable in severely obese patients,” stated Stavra Xanthakos, MD, a gastroenterologist at Cincinnati Children’s Hospital Medical Center (OH, USA), and lead author of the study.

The study was published online September 23, 2013, in the Journal of Pediatrics. If the findings are confirmed in larger studies, MRE could lessen dependence on expensive and invasive liver biopsies to detect fibrosis. The researchers, in 2011 and 2012, evaluated 35 children and teenagers between the ages of 4 and 20 for chronic liver disease employing both liver biopsy and MRE. The study demonstrated that MRE was highly accurate in detecting more advanced fibrosis in children with chronic liver disease, including severely obese patients.

A needle biopsy is standard practice for assessing liver fibrosis. This not only has risks for the patient and high expense, but it is frequently quite scary for children and teens. MRE is a way to gauges tissue stiffness that uses low frequency sound waves in combination with magnetic resonance, which involves the combination of magnetic fields and radio frequency waves to generate diagnostic images. MRE can be accomplished in just a few minutes using the MR scanner.

“Having the ability to easily and noninvasively assess the degree of fibrosis in a child's liver could help us identify the issue early and being the right course of treatment in a timely and effective manner,” noted Daniel Podberesky, MD, chief of thoracoabdominal imaging at Cincinnati Children's and a coauthor of the study. “An added strength of magnetic resonance technology is the ability to more precisely measure liver fat, which allows us to noninvasively determine changes in liver fat quantity after clinical interventions.”

“Our results show the exciting potential of MRE to improve clinical care and reduce dependence on liver biopsies, but it is not yet ready for primetime clinical use,” added Dr. Xanthakos. “In addition to validation in larger pediatric cohorts, we still need to determine whether MRE can predict changes in liver disease over time. We hope to study MRE in patients to test how well changes in imaging correlate with changes in liver stiffness after treatment or lifestyle changes.”

Dr. Xanthakos codirects the Cincinnati Children’s Steatohepatitis Center. Steatohepatitis is an advanced stage of fatty liver disease. In all, physicians at Cincinnati Children’s have effectively evaluated more than 200 children using liver MRE with no adverse events.

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