Magnetic resonance elastography (MRE) can help physicians accurately detect fibrosis (scarring) in children with chronic liver disease – a growing problem related to rising obesity rates – without the risks and expense of a needle biopsy, according to scientists at Cincinnati Children’s.

The prevalence of non-alcoholic fatty liver disease (NAFLD), which can lead to liver failure, has grown to affect an estimated 13 percent of adolescents. A study published online Sept. 23, 2013, in the Journal of Pediatrics shows that MRE effectively and accurately detects this condition.   

Superior to ultrasound

“Because many pediatric patients with NAFLD are severely obese, MRE is likely to be superior to ultrasound-based elastography in this population, as ultrasound-based methods are less reliable in severely obese patients,” says gastroenterologist Stavra Xanthakos, MD, co-Director of the Steatohepatitis Center at Cincinnati Children’s and lead author of the study.

In 2011 and 2012, the researchers evaluated 35 patients aged 4 to 20 for chronic liver disease using both MRE and liver biopsy. The study demonstrated that MRE was highly accurate in detecting more advanced fibrosis, including severely obese patients.

MRE measures tissue stiffness using a combination of low-frequency sound waves and magnetic resonance imaging. MRE can be accomplished in just a few minutes using the MR scanner. If the findings are validated in larger studies, MRE could reduce dependence on needle biopsies, the standard practice for evaluating liver fibrosis. 

Non-invasive way to track progress

“Having the ability to easily and non-invasively assess the degree of fibrosis in a child’s liver could help us identify the issue early and the right course of treatment in a timely and effective manner,” says Daniel Podberesky, MD, chief of thoracoabdominal imaging at Cincinnati Children’s and a co-author of the study. “An added strength of magnetic resonance technology is the ability to more precisely measure liver fat, which allows us to non-invasively determine changes in liver fat quantity after clinical interventions.”

Overall, physicians at Cincinnati Children’s have successfully evaluated more than 200 children using liver MRE with no adverse events. However, MRE remains not quite ready for primetime clinical use.

“In addition to validation in larger pediatric cohorts, we still need to determine whether MRE can predict changes in liver disease over time,” Xanthakos says. “We hope to study how well changes in imaging correlate with changes in liver stiffness after treatment or lifestyle changes.”