MR elastography: high rate of technical success in pediatric and young adult patients

Abstract

Background

Magnetic resonance (MR) elastography allows the noninvasive assessment of liver stiffness, which is a surrogate for fibrosis.

Objective

The purpose of this study was to describe our experience using liver MR elastography in a large pediatric population with attention to the frequency and causes of exam failure.

Materials and methods

Imaging records were searched for patients ≤18 years of age who underwent 2-D gradient recalled echo (GRE) MR elastography of the liver between September 2011 and August 2015 on one of two 1.5-T MRI platforms. Imaging reports and clinical records were reviewed for failed MR elastography acquisitions, factor(s) resulting in failure and whether a subsequent successful examination had been performed.

Results

Four hundred sixty-eight MR elastography examinations were performed in 372 patients between 1.5 months and 18 years of age during the study period. Ninety-six percent (450/468) of the examinations were successful. There was no significant difference in mean age (12.6±3.6 vs. 11.2±4.1 years, P=0.12) or body mass index (BMI) (28.2±12.4 vs. 29.5±10 kg/m2, P=0.6) between patients with and without successful examinations. MR elastography failures were due to poor paddle positioning resulting in inadequate generation of hepatic shear waves (n=5), iron overload (n=4), patient inability to tolerate MRI (n=3), patient breathing/motion (n=3), artifact from implanted hardware (n=1) and technical malfunction (n=2). Seven of nine (78%) repeat examinations were successful (78%).

Conclusion

Hepatic 2-D GRE MR elastography at 1.5 T is technically robust in children. Exam failure is infrequent and largely reflects patient specific factors, some of which can be mitigated with careful technique.

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References

  1. 1.

    Mavis AM, Alonso EM (2015) Liver disease in the adolescent. Clin Liver Dis 19:171–185

    Article  PubMed  Google Scholar 

  2. 2.

    Yeh WC, Li PC, Jeng YM et al (2002) Elastic modulus measurements of human liver and correlation with pathology. Ultrasound Med Biol 28:467–474

    Article  PubMed  Google Scholar 

  3. 3.

    Ziol M, Handra-Luca A, Kettaneh A et al (2005) Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C. Hepatology 41:48–54

    Article  PubMed  Google Scholar 

  4. 4.

    Godfrey EM, Mannelli L, Griffin N et al (2013) Magnetic resonance elastography in the diagnosis of hepatic fibrosis. Semin Ultrasound CT MR 34:81–88

    Article  PubMed  Google Scholar 

  5. 5.

    Huwart L, Sempoux C, Vicaut E et al (2008a) Magnetic resonance elastography for the noninvasive staging of liver fibrosis. Gastroenterology 135:32–40

    Article  PubMed  Google Scholar 

  6. 6.

    Loomba R, Wolfson T, Ang B et al (2014) Magnetic resonance elastography predicts advanced fibrosis in patients with nonalcoholic fatty liver disease: a prospective study. Hepatology 60:1920–1928

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Rustogi R, Horowitz J, Harmath C et al (2012) Accuracy of MR elastography and anatomic MR imaging features in the diagnosis of severe hepatic fibrosis and cirrhosis. J Magn Reson Imaging 35:1356–1364

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Singh S, Venkatesh SK, Loomba R et al (2016) Magnetic resonance elastography for staging liver fibrosis in non-alcoholic fatty liver disease: a diagnostic accuracy systematic review and individual participant data pooled analysis. Eur Radiol 26:1431–1440

    Article  PubMed  Google Scholar 

  9. 9.

    Yin M, Glaser KJ, Talwalkar JA et al (2016) Hepatic MR elastography: clinical performance in a series of 1377 consecutive examinations. Radiology 278:114–124

    Article  PubMed  Google Scholar 

  10. 10.

    Yin M, Talwalkar JA, Glaser KJ et al (2007) Assessment of hepatic fibrosis with magnetic resonance elastography. Clin Gastroenterol Hepatol 5:1207–1213.e1202

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Xanthakos SA, Podberesky DJ, Serai SD et al (2014) Use of magnetic resonance elastography to assess hepatic fibrosis in children with chronic liver disease. J Pediatr 164:186–188

    Article  PubMed  Google Scholar 

  12. 12.

    Manduca A, Oliphant TE, Dresner MA et al (2001) Magnetic resonance elastography: non-invasive mapping of tissue elasticity. Med Image Anal 5:237–254

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Mariappan YK, Glaser KJ, Ehman RL (2010) Magnetic resonance elastography: a review. Clin Anat 23:497–511

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Yoon JH, Lee JM, Woo HS et al (2013) Staging of hepatic fibrosis: comparison of magnetic resonance elastography and shear wave elastography in the same individuals. Korean J Radiol 14:202–212

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Wagner M, Corcuera-Solano I, Lo G et al (2017) Technical failure of MR elastography examinations of the liver: experience from a large single-center study. Radiology 160863. doi:10.1148/radiol.2016160863

  16. 16.

    Chen J, Yin M, Talwalkar JA, Oudry J, Glaser KJ, Smyrk TC, Miette V, Sandrin L, Ehman RL (2016) Diagnostic Performance of MR Elastography and Vibration-controlled Transient Elastography in the Detection of Hepatic Fibrosis in Patients with Severe to Morbid Obesity. Radiology 18:160685. doi:10.1148/radiol.2016160685. [Epub ahead of print] PubMed PMID: 27861111

  17. 17.

    Garteiser P, Sahebjavaher RS, Ter Beek LC et al (2013) Rapid acquisition of multifrequency, multislice and multidirectional MR elastography data with a fractionally encoded gradient echo sequence. NMR Biomed 26:1326–1335

    Article  PubMed  Google Scholar 

  18. 18.

    Huwart L, Salameh N, ter Beek L et al (2008b) MR elastography of liver fibrosis: preliminary results comparing spin-echo and echo-planar imaging. Eur Radiol 18:2535–2541

    Article  PubMed  Google Scholar 

  19. 19.

    Serai SD, Dillman JR, Trout AT (2016) Spin-echo echo-planar imaging MR elastography versus gradient-echo MR elastography for assessment of liver stiffness in children and young adults suspected of having liver disease. Radiology 282:761–777

    Article  PubMed  Google Scholar 

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Correspondence to Andrew T. Trout.

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Joshi, M., Dillman, J.R., Towbin, A.J. et al. MR elastography: high rate of technical success in pediatric and young adult patients. Pediatr Radiol 47, 838–843 (2017). https://doi.org/10.1007/s00247-017-3831-z

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Keywords

  • Children
  • Fibrosis
  • Liver
  • Magnetic resonance elastography
  • Stiffness