These older adults substantially under-report health services use, including hospital episodes over a 12-month period. Reliance on self-reported use data over the prior year to model patterns of health care use among older adults is not supported by these data.

A high percentage of patients had imaging abnormalities of the liver, chiefly abnormal parenchymal enhancement, which became more apparent as the duration of the Fontan circulation increased. The hypervascular nodules sometimes present had imaging characteristics most closely resembling those of focal nodular hyperplasia. The underlying fibrosis and eventual development of cirrhosis raise the risk of developing hepatocellular carcinoma.

Purpose To assess the diagnostic performance of magnetic resonance (MR) elastography-derived liver stiffness to detect liver fibrosis in a pediatric and young adult population with a spectrum of liver diseases. Materials and Methods This retrospective study included patients younger than 21 years of age who underwent MR elastography and liver biopsy within 3 months of one another between January 2012 and September 2016 for indications other than liver transplantation or Fontan palliation of congenital heart disease. MR elastography examinations were reprocessed by a single observer, blinded to pathologic findings. Pathology specimens were reviewed by a single pathologist who scored steatosis (lipid in ≥ 5% of hepatocytes) and staged fibrosis. Receiver operating characteristic (ROC) curves were used to assess diagnostic performance. Results A total of 86 patients, 49 (57%) male with a median age of 14.2 years (range, 0.3-20.6 years), were included. Fifty-one patients (59.3%) had Ludwig stage 2 or higher fibrosis; 44 patients (51.2%) had hepatic steatosis. The area under the ROC curve for Ludwig stage 0-1 versus stage 2 or higher fibrosis was 0.70 (95% confidence interval [CI]: 0.59, 0.81) for the whole population and was significantly lower for patients with steatosis versus those without (0.53 [95% CI: 0.35, 0.71] vs 0.82 [95% CI: 0.67, 0.96], P = .014). Optimal stiffness cut-offs for the entire population were 2.27 kPa with 68.6% sensitivity (95% CI: 57.2%, 80.1%) and 74.3% specificity (95% CI: 63.5%, 85.1%) or 1.67 kPa with 35.3% sensitivity (95% CI: 23.5%, 47.1%) and 91.4% specificity (95% CI: 84.5%, 98.3%). Conclusion In children and young adults, MR elastography performs significantly better for distinguishing stage 0-1 versus stage 2 or higher fibrosis in patients without steatosis than in those with steatosis. This suggests a confounding effect of steatosis or inflammation in the population with nonalcoholic fatty liver disease. RSNA, 2018.

Objective: The purpose of this study was to evaluate the feasibility of performing MR Elastography (MRE) as a screening tool for elevated liver stiffness in patients’ status-post Fontan procedure. With Fontan patients now reaching adulthood, one of the factors that is increasingly affecting long-term prognosis is the presence of hepatic congestion and fibrosis. When the liver fibrosis progresses to cirrhosis, these patients may be candidates for liver transplantation. However, if detected early, steps can be taken to potentially slow or halt the progression of hepatic fibrosis. Currently, liver biopsy is the gold-standard for assessing liver fibrosis. Magnetic Resonance Elastography (MRE) is a relatively new, non-invasive imaging technique that quantitatively measures liver stiffness and provides an estimate of fibrosis extent. A retrospective study was performed evaluating liver stiffness with MRE in patients with a history of Fontan procedure. The MRE of the liver was performed in the same session as a clinical cardiac MRI. Liver stiffness values were calculated by drawing regions-of-interest on the stiffness maps. The mean liver stiffness and its correlation with the length of time since Fontan surgery were studied. Sixteen patients with 17 MRE exams were included in this study. All patients had elevated liver stiffness values by MRE, suggesting the presence of mild to severe fibrosis, and there was a trend towards higher liver stiffness with greater duration of time with the Fontan circulation. MRE is a feasible method for evaluating the liver in patients status-post Fontan procedure who are undergoing surveillance cardiac MRI. Our preliminary study shows that duration of hepatic congestion following Fontan procedure may be related to liver stiffness. Further investigation with histologic correlation is needed to determine the etiology and long-term sequela of elevated liver stiffness in this population.

Various imaging modalities may be used in pediatric pancreatology, but TUS and MRI/MRCP are favored. Interventional therapeutic maneuvers primarily involve use of ERCP and EUS. Future research is necessary to optimize equipment, expertise, and appropriate indications.