Magnetic resonance elastography in evaluation of liver fibrosis in children with chronic liver disease

Abstract

Background: Magnetic resonance elastography (MRE) has been used to stage liver fibrosis in adults. We aimed to assess the agreement between the Ishak scoring system and magnetic resonance elastography-measured liver stiffness (MRE-LS) in children. This study included all the children who underwent abdominal MRE and liver biopsies between February 2018 and January 2021. The correlation between MRE-LS and Ishak fibrosis stage, MRE parameters, and clinical and biochemical markers affecting this relationship was investigated.

Results: A total of 52 patients (31 male; a median age of 11.8 years) were included in the study. The MRE-LS values were significantly different between Ishak fibrosis stages (p = 0.036). With a cut-off value of 2.97 kilopascals, MRE-LS had sensitivity, specificity, PPV, NPV and accuracy values of 90.9%, 82.9%, 58.8%, 97.1%, and 84.6%, respectively, for differentiating mild/moderate fibrosis (F0, 1, 2, 3) from severe fibrosis (F ≥ 4). Although MRE-LS was moderately correlated with Ishak fibrosis score and histological activity index and weakly correlated with aspartate aminotransferase, hepatic steatosis, and R2*, only Ishak fibrosis score was a significant predictor of MRE-LS. MRE-measured spleen stiffness was weakly correlated with the Ishak fibrosis score.

Conclusions: MRE has high sensitivity and specificity for evaluating liver fibrosis in children. MRE may be used to evaluate liver fibrosis in pediatric patients.

Keywords: Ishak scoring system; Liver stiffness; Magnetic resonance elastography; Spleen stiffness.

Fig. 1

Receiver operating characteristic curve for differentiation of Ishak stage 0–1 from stage 2 or higher. *Area Under Curve 0.760 (95% CI 0.618–0.901) (p = 0.003)

Fig. 2

Receiver operating characteristic curve for differentiation of Group 1 (Ishak stage 0–1-2–3) from Group 2 (Ishak stage 4–5–6). *Area Under Curve 0.905 (95% CI 0.814–0.996) (p < 0.001)