Tomoelastography for the Evaluation of Pediatric Nonalcoholic Fatty Liver Disease

Objectives Today, nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in children and adults alike. Yet, the noninvasive evaluation of disease severity remains a diagnostic challenge. In this study, we apply multifrequency magnetic resonance elastography (mMRE) for the quantification of liver steatosis and fibrosis in adolescents with NAFLD. Methods Fifty adolescents (age range, 10–17 years; mean BMI, 33.9 kg/m2; range, 21.4–42.1 kg/m2) with biopsy-proven NAFLD were included in this prospective study. Multifrequency magnetic resonance elastography was performed using external multifrequency vibrations of 30 to 60 Hz and tomoelastography postprocessing, resulting in penetration rate (a) and shear wave speed (c). Hepatic fat fraction was determined using Dixon method. The diagnostic accuracy of mMRE in grading liver steatosis and staging liver fibrosis was assessed by receiver operating characteristic curve analysis. Results Multifrequency magnetic resonance elastography parameters c and a were independently sensitive to fibrosis and steatosis, respectively, providing area under the receiver operating characteristic values of 0.79 (95% confidence interval [CI], 0.66–0.92), 0.91 (95% CI, 0.83–0.99), and 0.90 (95% CI, 0.80–0.99) for the detection of any (≥F1), moderate (≥F2), and advanced (≥F3) fibrosis, and 0.87 (95% CI, 0.76–0.97) and 0.87 (95% CI, 0.77–0.96) for the detection of moderate (≥S2) and severe (S3) steatosis. Conclusions One mMRE measurement provides 2 independent parameters with very good diagnostic accuracy in detecting moderate and advanced fibrosis as well as moderate and severe steatosis in pediatric NAFLD. Received for publication August 14, 2018; and accepted for publication, after revision, September 21, 2018. Conflicts of interest and sources of funding: Financial support is acknowledged from the German Federal Ministry of Education and Research (grant number: LiSyM 031L0057). The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (https://ift.tt/2kq7jVD). Correspondence to: Jing Guo, PhD, Department of Radiology, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany. E-mail: jing.guo@charite.de. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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