Pediatric Liver MR Elastography

Many chronic pediatric liver disorders are complicated by the development of fibrosis and ultimately cirrhosis. Although hepatic fibrogenesis progresses along a common pathway irrespective of the specific etiology, fibrosis in pediatric liver diseases has different histopathological patterns than in adults. In pediatric liver disease, as in adults, management choices may depend upon the stage of fibrosis at diagnosis. With early intervention, the progression of hepatic fibrosis can be slowed or halted, and in some situations, reversed. While liver biopsy is the gold standard for diagnosing and assessing the presence and degree of fibrosis, it has several disadvantages including the potential for sampling error, the risk of complications, the relatively high cost, and general poor acceptance by pediatric patients and their parents. MR elastography (MRE) is a relatively new imaging technique with the potential for allowing a safe, rapid, cost-effective, and non-invasive evaluation of a wide variety of hepatic diseases by quantitatively evaluating the stiffness of the liver parenchyma. The purpose of this article is to present our initial clinical experience and illustrate our modified technique for the application of liver MRE in pediatric patients at our medical center. Pediatric MRE techniques were developed and applied to over 45 patients scanned with our new protocol. Liver MRE is a safe, non-invasive method for assessing hepatic fibrosis in pediatric patients.