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Diagnostic performance of quantitative magnetic resonance imaging biomarkers for predicting portal hypertension in children and young adults with autoimmune liver disease

  • Jonathan R. DillmanEmail author
  • Suraj D. Serai
  • Andrew T. Trout
  • Ruchi Singh
  • Jean A. Tkach
  • Amy E. Taylor
  • Burns C. Blaxall
  • Lin Fei
  • Alexander G. Miethke
Original Article

Abstract

Background

Primary sclerosing cholangitis, autoimmune hepatitis and autoimmune sclerosing cholangitis are forms of chronic, progressive autoimmune liver disease (AILD) that can affect the pediatric population.

Objective

To determine whether quantitative MRI- and laboratory-based biomarkers are associated with conventional imaging findings of portal hypertension (radiologic portal hypertension) in children and young adults with AILD.

Materials and methods

Forty-four patients with AILD enrolled in an institutional registry underwent a research abdominal MRI examination at 1.5 tesla (T). Five quantitative MRI techniques were performed: liver MR elastography, spleen MR elastography, liver iron-corrected T1 mapping, liver T2 mapping, and liver diffusion-weighted imaging (DWI, quantified as apparent diffusion coefficients). Two anatomical sequences were used to document splenomegaly, varices and ascites. We calculated aspartate aminotransferase (AST)-to-platelet ratio index (APRI) and fibrosis-4 (FIB-4) scores — laboratory-based biomarkers of liver fibrosis. We used receiver operating characteristic (ROC) curve analyses to establish the diagnostic performance of quantitative MRI and laboratory biomarkers for indicating the presence of radiologic portal hypertension.

Results

Twenty-three (52%) patients were male; mean age was 15.2±4.0 years. Thirteen (30%) patients had radiologic portal hypertension. Liver and spleen stiffness demonstrated the greatest diagnostic performance for indicating the presence of portal hypertension (area-under-the-ROC-curve [AUROC]=0.98 and 0.96, respectively). The APRI and FIB-4 scores also demonstrated good diagnostic performance (AUROC=0.87 and 0.88, respectively).

Conclusion

MRI-derived measures of liver and spleen stiffness as well as laboratory-based APRI and FIB-4 scores are highly associated with imaging findings of portal hypertension in children and young adults with AILD and thus might be useful for predicting portal hypertension impending onset and directing personalized patient management.

Keywords

Autoimmune liver disease Children Liver Magnetic resonance elastography Magnetic resonance imaging Multiparametric Portal hypertension 

Notes

Acknowledgments

This study was partially funded by: (1) a Cincinnati Children’s Hospital Medical Center (CCHMC) Academic and Research Committee grant and (2) the CCHMC Center for Autoimmune Liver Disease. Iron-corrected T1 image processing was performed by Perspectum Diagnostics (Oxford, UK) at no cost through a research agreement.

Compliance with ethical standards

Conflicts of interest

None

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Jonathan R. Dillman
    • 1
    • 2
    • 3
  • Suraj D. Serai
    • 1
    • 4
  • Andrew T. Trout
    • 1
    • 2
    • 3
  • Ruchi Singh
    • 2
    • 5
  • Jean A. Tkach
    • 1
  • Amy E. Taylor
    • 2
    • 5
  • Burns C. Blaxall
    • 6
  • Lin Fei
    • 7
  • Alexander G. Miethke
    • 2
    • 5
  1. 1.Department of RadiologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  2. 2.Center for Autoimmune Liver Disease (CALD)Cincinnati Children’s Hospital Medical CenterCincinnatiUSA
  3. 3.Department of RadiologyUniversity of Cincinnati College of MedicineCincinnatiUSA
  4. 4.Department of RadiologyChildren’s Hospital of PhiladelphiaPhiladelphiaUSA
  5. 5.Division of Gastroenterology, Hepatology, and Nutrition, Department of PediatricsCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  6. 6.Heart Institute, Department of PediatricsCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  7. 7.Division of Biostatistics and EpidemiologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA

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