Normal range for MR elastography measured liver stiffness in children without liver disease

Mary Catherine Sawh, Kimberly P. Newton, Nidhi P. Goyal, Jorge Eduardo Angeles, Kathryn Harlow, Craig Bross, Alexandra N. Schlein, Jonathan C. Hooker, Ethan Z. Sy, Kevin J. Glaser, Meng Yin, Richard Lorne Ehman, Claude B. Sirlin, Jeffrey B. Schwimmer

Research output: Contribution to journalArticle

Abstract

Background: Magnetic resonance elastography (MRE) can determine the presence and stage of liver fibrosis. Data on normative MRE values, while reported in adults, are limited in children. Purpose: To determine the distribution of MRE-measured liver stiffness in children without liver disease. Study Type: Prospective, observational. Population: Eighty-one healthy children (mean 12.6 ± 2.6 years, range 8–17 years). Field Strength/Sequence: 3.0T Signa HDxt, General Electric MR Scanner; 2D GRE MRE sequence. Assessment: History, examination, laboratory evaluation, and (MR) exams (proton density fat fraction, PDFF, and MRE) were performed. MR elastograms were analyzed manually at two reading centers and compared with each other for agreement and with published values in healthy adults and thresholds for fibrosis in adult and pediatric patients. Statistical Tests: Descriptive statistics, Bland–Altman analysis, t-test to compare hepatic stiffness values with reference standards. Results: Stiffness values obtained at both reading centers were similar, without significant bias (P = 0.362) and with excellent correlation (intraclass correlation coefficient [ICC] = 0.782). Mean hepatic stiffness value for the study population was 2.45 ± 0.35 kPa (95th percentile 3.19 kPa), which was significantly higher than reported values for healthy adult subjects (2.10 ± 0.23 kPa, P < 0.001). In all, 74–85% of subjects had stiffness measurements suggestive of no fibrosis. Data Conclusion: Mean liver stiffness measured with MRE in this cohort was significantly higher than that reported in healthy adults. Despite rigorous screening, some healthy children had stiffness measurements suggestive of liver fibrosis using current published thresholds. Although MRE has the potential to provide noninvasive assessment in patients with suspected hepatic disease, further refinement of this technology will help advance its use as a diagnostic tool for evidence of fibrosis in pediatric populations. Level of Evidence: 1. Technical Efficacy: 5. J. Magn. Reson. Imaging 2019.

Original languageEnglish (US)
JournalJournal of Magnetic Resonance Imaging
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Elasticity Imaging Techniques
Liver Diseases
Reference Values
Liver
Fibrosis
Liver Cirrhosis
Reading
Pediatrics
Population
Protons
Healthy Volunteers
History
Fats
Prospective Studies
Technology

Keywords

  • hepatic shear stiffness
  • magnetic resonance imaging
  • pediatric radiology
  • quantitative imaging biomarkers

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Sawh, M. C., Newton, K. P., Goyal, N. P., Angeles, J. E., Harlow, K., Bross, C., ... Schwimmer, J. B. (Accepted/In press). Normal range for MR elastography measured liver stiffness in children without liver disease. Journal of Magnetic Resonance Imaging. https://doi.org/10.1002/jmri.26905

Normal range for MR elastography measured liver stiffness in children without liver disease. / Sawh, Mary Catherine; Newton, Kimberly P.; Goyal, Nidhi P.; Angeles, Jorge Eduardo; Harlow, Kathryn; Bross, Craig; Schlein, Alexandra N.; Hooker, Jonathan C.; Sy, Ethan Z.; Glaser, Kevin J.; Yin, Meng; Ehman, Richard Lorne; Sirlin, Claude B.; Schwimmer, Jeffrey B.

In: Journal of Magnetic Resonance Imaging, 01.01.2019.

Research output: Contribution to journalArticle

Sawh, MC, Newton, KP, Goyal, NP, Angeles, JE, Harlow, K, Bross, C, Schlein, AN, Hooker, JC, Sy, EZ, Glaser, KJ, Yin, M, Ehman, RL, Sirlin, CB & Schwimmer, JB 2019, 'Normal range for MR elastography measured liver stiffness in children without liver disease', Journal of Magnetic Resonance Imaging. https://doi.org/10.1002/jmri.26905
Sawh, Mary Catherine ; Newton, Kimberly P. ; Goyal, Nidhi P. ; Angeles, Jorge Eduardo ; Harlow, Kathryn ; Bross, Craig ; Schlein, Alexandra N. ; Hooker, Jonathan C. ; Sy, Ethan Z. ; Glaser, Kevin J. ; Yin, Meng ; Ehman, Richard Lorne ; Sirlin, Claude B. ; Schwimmer, Jeffrey B. / Normal range for MR elastography measured liver stiffness in children without liver disease. In: Journal of Magnetic Resonance Imaging. 2019.
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abstract = "Background: Magnetic resonance elastography (MRE) can determine the presence and stage of liver fibrosis. Data on normative MRE values, while reported in adults, are limited in children. Purpose: To determine the distribution of MRE-measured liver stiffness in children without liver disease. Study Type: Prospective, observational. Population: Eighty-one healthy children (mean 12.6 ± 2.6 years, range 8–17 years). Field Strength/Sequence: 3.0T Signa HDxt, General Electric MR Scanner; 2D GRE MRE sequence. Assessment: History, examination, laboratory evaluation, and (MR) exams (proton density fat fraction, PDFF, and MRE) were performed. MR elastograms were analyzed manually at two reading centers and compared with each other for agreement and with published values in healthy adults and thresholds for fibrosis in adult and pediatric patients. Statistical Tests: Descriptive statistics, Bland–Altman analysis, t-test to compare hepatic stiffness values with reference standards. Results: Stiffness values obtained at both reading centers were similar, without significant bias (P = 0.362) and with excellent correlation (intraclass correlation coefficient [ICC] = 0.782). Mean hepatic stiffness value for the study population was 2.45 ± 0.35 kPa (95th percentile 3.19 kPa), which was significantly higher than reported values for healthy adult subjects (2.10 ± 0.23 kPa, P < 0.001). In all, 74–85{\%} of subjects had stiffness measurements suggestive of no fibrosis. Data Conclusion: Mean liver stiffness measured with MRE in this cohort was significantly higher than that reported in healthy adults. Despite rigorous screening, some healthy children had stiffness measurements suggestive of liver fibrosis using current published thresholds. Although MRE has the potential to provide noninvasive assessment in patients with suspected hepatic disease, further refinement of this technology will help advance its use as a diagnostic tool for evidence of fibrosis in pediatric populations. Level of Evidence: 1. Technical Efficacy: 5. J. Magn. Reson. Imaging 2019.",
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AU - Bross, Craig

AU - Schlein, Alexandra N.

AU - Hooker, Jonathan C.

AU - Sy, Ethan Z.

AU - Glaser, Kevin J.

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AU - Ehman, Richard Lorne

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AU - Schwimmer, Jeffrey B.

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