Use of Magnetic Resonance Elastography to Assess Hepatic Fibrosis in Children with Chronic Liver Disease

Xanthakos, Stavra A.; Podberesky, Daniel J.; Serai, Suraj D.; Miles, Lili; King, Eileen; Balistreri, William F.; Kohli, Rohit

doi:10.1016/j.jpeds.2013.07.050

Cited by 124 publications

(100 citation statements)

References 12 publications

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“…A study evaluating the use of transient elastography in children with chronic liver disease found that this method had good capacity to discriminate between significant fibrosis, severe fibrosis and cirrhosis [40] . Pediatric MR elastography has also begun to be used in recent years [44,45] . However, the reproducibility of these tests has yet to be evaluated in patients with cirrhosis of different causes [39] .…”

Section: Investigationmentioning

confidence: 99%

Cirrhosis in children and adolescents: An overview

Pinto

Schneider

Silveira

2015

WJH

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Several conditions, especially chronic liver diseases, can lead to cirrhosis in children and adolescents. Most cases in clinical practice are caused by similar etiologies. In infants, cirrhosis is most often caused by biliary atresia and genetic-metabolic diseases, while in older children, it tends to result from autoimmune hepatitis, Wilson's disease, alpha-1-antitrypsin deficiency and primary sclerosing cholangitis. The symptoms of cirrhosis in children and adolescents are similar to those of adults. However, in pediatric patients, the first sign of cirrhosis is often poor weight gain. The complications of pediatric cirrhosis are similar to those observed in adult patients, and include gastrointestinal bleeding caused by gastroesophageal varices, ascites and spontaneous bacterial peritonitis. In pediatric patients, special attention should be paid to the nutritional alterations caused by cirrhosis, since children and adolescents have higher nutritional requirements for growth and development. Children and adolescents with chronic cholestasis are at risk for several nutritional deficiencies. Malnutrition can have severe consequences for both pre-and post-liver transplant patients. The treatment of cirrhosis-induced portal hypertension in children and adolescents is mostly based on methods developed for adults. The present article will review the diagnostic and differential diagnostic aspects of end-stage liver disease in children, as well as the major treatment options for this condition.

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Section: Investigationmentioning

confidence: 99%

Cirrhosis in children and adolescents: An overview

Pinto

Schneider

Silveira

2015

WJH

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“…However, biopsy is limited by invasiveness, sampling error, cost and limited acceptance by patients and families [11]. Liver biopsies are also subject to inter-and intra-observer variability [12][13][14][15]. These limitations of liver biopsy highlight the need for a noninvasive test that can accurately and objectively measure the degree of hepatic hemosiderosis, especially in children, for whom the risk-to-benefit ratio of biopsy must be even more carefully weighed than in adults [2,16].…”

Section: Introductionmentioning

confidence: 99%

“…These limitations of liver biopsy highlight the need for a noninvasive test that can accurately and objectively measure the degree of hepatic hemosiderosis, especially in children, for whom the risk-to-benefit ratio of biopsy must be even more carefully weighed than in adults [2,16]. Thus noninvasive diagnostic methods are highly attractive [2,[15][16][17][18][19]. Recently, noninvasive methods to determine LIC by MRI have gained popularity [2,16,[18][19][20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

Retrospective comparison of gradient recalled echo R2* and spin-echo R2 magnetic resonance analysis methods for estimating liver iron content in children and adolescents

et al. 2015

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“…177 Conventional hepatic ultrasonography, however, cannot meet the evolving clinical and investigational needs to monitor changes in liver fibrosis during treatment. Transient elastography, 178 real-time elastography, 179 magnetic resonance elastography, [180][181][182][183][184][185] and acoustic radiation force impulse (ARFI) imaging 186 have emerged in response to these demands (Table 3). Each radiological assessment enhances the resources that are evolving for the assessment of hepatic fibrosis, 187 but none has been rigorously evaluated in autoimmune hepatitis or assimilated into a diagnostic or management algorithm for this disease.…”

Section: Staging Of Hepatic Fibrosis By Radiological Assessmentsmentioning

confidence: 99%

“…183 Preliminary studies have supported the role of magnetic resonance elastography as a diagnostic instrument by which to establish or exclude the presence of cirrhosis (Table 3). 180,182,184,185 These experiences have also discounted the confounding effect of hepatic steatosis on the evaluation of hepatic fibrosis, 180,182 and they have suggested a possible role for the procedure in the non-invasive evaluation of portal hypertension and its consequences. 183 Comparative studies, however, have not been performed between the various procedures with the same clinical objectives in order to establish a preference.…”

Section: Magnetic Resonance Elastographymentioning

confidence: 99%

Review article: the prevention and reversal of hepatic fibrosis in autoimmune hepatitis

Czaja

2014

Aliment Pharmacol Ther

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SummaryBackgroundImmunosuppressive treatment of autoimmune hepatitis can prevent or reverse hepatic fibrosis, but these anti‐fibrotic effects are inconsistent secondary gains.AimTo describe the anti‐fibrotic effects of current therapies for autoimmune hepatitis, discuss the pathogenic mechanisms of hepatic fibrosis that might be targeted by anti‐fibrotic interventions, indicate the non‐invasive diagnostic tests of hepatic fibrosis that must be validated in autoimmune hepatitis and to suggest promising treatment opportunities.MethodsStudies cited in PubMed from 1972 to 2013 for autoimmune hepatitis, hepatic fibrosis, cirrhosis, anti‐fibrotic therapy and non‐invasive tests of hepatic fibrosis were selected.ResultsHepatic fibrosis improves in 53–57% of corticosteroid‐treated patients with autoimmune hepatitis; progressive fibrosis slows or is prevented in 79%; and cirrhosis may be reversed. Progressive hepatic fibrosis is associated with liver inflammation, and the inability to fully suppress inflammatory activity within 12 months is associated with progression to cirrhosis (54%) and death or need for liver transplantation (15%). Liver tissue examination remains the gold standard for assessing hepatic fibrosis, but laboratory and radiological tests may be useful non‐invasive methods to measure the fibrotic response. Severe liver inflammation can confound radiological assessments, and the preferred non‐invasive test in autoimmune hepatitis is uncertain. Individualised treatment adjustments and adjunctive anti‐fibrotic therapies are poised for study in this disease.ConclusionsThe prevention and reversal of hepatic fibrosis are achievable objectives in autoimmune hepatitis. Strategies that evaluate individualised therapies adjusted to the rapidity and completeness of the inflammatory response, and the use of adjunctive anti‐fibrotic interventions, must be evaluated.

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Use of Magnetic Resonance Elastography to Assess Hepatic Fibrosis in Children with Chronic Liver Disease

Cited by 124 publications

References 12 publications

Cirrhosis in children and adolescents: An overview

Cirrhosis in children and adolescents: An overview

Retrospective comparison of gradient recalled echo R2* and spin-echo R2 magnetic resonance analysis methods for estimating liver iron content in children and adolescents

Review article: the prevention and reversal of hepatic fibrosis in autoimmune hepatitis

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