Diagnostic Performance of MR Elastography for Liver Fibrosis in Children and Young Adults with a Spectrum of Liver Diseases

Abstract

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.

Dual‐frequency MR elastography to differentiate between inflammation and fibrosis of the liver: Comparison with histopathology

“…One possible explanation is that the presence of hepatic inflammation, which causes swelling of hepatocytes, interstitial edema, and infiltration of inflammatory cells, results in increased apparent liver stiffness . Inflammatory reaction differs according to various chronic liver diseases, including the hepatitis C virus, the hepatitis B virus, autoimmune hepatitis, and steatohepatitis, which result in different apparent stiffness values . Liver stiffness generally consists of elasticity and viscosity, and intrahepatic hemodynamic changes, such as inflammation, congestion, and portal hypertension .…”

“…25 Inflammatory reaction differs according to various chronic liver diseases, including the hepatitis C virus, the hepatitis B virus, autoimmune hepatitis, and steatohepatitis, which result in different apparent stiffness values. [10][11][12][26][27][28] Liver stiffness generally consists of elasticity and viscosity, and intrahepatic hemodynamic changes, such as inflammation, congestion, and portal hypertension. [17][18][19] The utility of multifrequency MRE is emerging as an interest for the separation of fibrosis from inflammation of the liver by calculating multiple parameters including loss modulus and damping ratio.…”

Hepatitis C virus infection in children in the era of direct-acting antiviral

“…Currently, there are no test results using MRE to analyse liver fibrosis in a cohort of patients with CHC. Two available studies on children and adolescents with CLD who are undergoing MRE and liver biopsy showed excellent accuracy of MRE for detecting significant fibrosis[ 99 , 100 ]. Moreover, by using MR elastography, Trout et al[ 99 ] confirmed the importance of a confounding effect of steatosis or inflammation of liver stiffness values on the example of a subgroup of patients with NFLD.…”

Feasibility of Spin-Echo Echo-Planar Imaging MR Elastography in Livers of Children and Young Adults

“…For this reason, non-invasive imaging techniques such as ultrasound elastography and magnetic resonance elastography (MRE) are available to assess hepatic fibrosis quantitatively (7). The use of a MRE offers results from larger areas with superior repeatability and reproducibility (8,9). This technique was approved by the U.S. Food and Drug Administration, and is considered an accurate method of evaluating hepatic fibrosis (7).…”