Evaluation of liver fibrosis with T2 relaxation time in infants with cholestasis: comparison with normal controls
Mi-Jung Lee1, Myung-Joon Kim, Choon-Sik Yoon
1Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University, College of Medicine, 250 Seongsanno (134 Sinchon-dong), Seodaemun-gu, Seoul, 120-752, South Korea.
Insights
T2 relaxation time measurements in infants did not effectively quantify liver fibrosis in biliary atresia. This noninvasive method showed no significant difference between healthy infants and those with biliary atresia or varying fibrosis stages.
Area of Science:
- Pediatric Radiology
- Hepatology
- Medical Imaging
Background:
- Early diagnosis of liver fibrosis in biliary atresia (BA) is crucial for prognosis.
- Liver biopsy, the current gold standard, is invasive and requires sedation in infants.
- Noninvasive methods for assessing liver fibrosis are highly desirable.
Purpose of the Study:
- To evaluate the potential of T2 relaxation time measurements for quantifying liver fibrosis in infants.
- To determine if T2 relaxation time can serve as a noninvasive biomarker for liver fibrosis in BA.
Main Methods:
- Prospective study involving infants with neonatal cholestasis and healthy controls.
- T2 relaxation time of the liver measured using 1.5-T MRI with spin-echo sequences.
- Correlation analysis between T2 relaxation times and histopathological fibrosis stages from liver biopsies.
Main Results:
- No statistically significant difference in T2 relaxation times was found between normal controls and infants with BA (57.8 ms vs 56.8 ms, P=0.811).
- T2 relaxation times did not differ significantly between low-stage (≤F1) and high-stage (≥F2) fibrosis.
- Mean T2 relaxation time in normal infants (57.8 ms) was comparable to adult values.
Conclusions:
- T2 relaxation time measurement at 1.5-T MRI is not a suitable method for quantifying liver fibrosis in infants with biliary atresia.
- The technique did not differentiate between varying stages of liver fibrosis in the study population.
Background:
The degree of hepatic fibrosis in biliary atresia (BA) correlates with the prognosis of the disease and thus, early diagnosis of liver fibrosis is clinically important. Liver biopsy is the gold standard for the evaluation of liver fibrosis, but it is an invasive procedure requiring sedation in children. Therefore, it is desirable to identify a noninvasive method for diagnosis and follow-up of hepatic fibrosis.
Objective:
The purpose of this study is to evaluate the possibility of quantifying liver fibrosis in infants by T2 relaxation time measurements.
Materials And Methods:
The institutional review board approved this prospective study and parental informed consent was obtained. During MR cholangiopancreatography using a 1.5-T MR scanner in infants with neonatal cholestasis, T2 relaxation time of the liver was calculated with the mean signal intensities measured on images obtained using spin-echo sequences (TR/TE, 2,000/20, 40, 60, 80, 100, 120, 140, 160 ms). A normal control study was performed during spinal MRI in infants with anorectal malformation and normal liver enzyme profiles. A liver biopsy was obtained in the children with cholestasis. The correlation between histopathological fibrosis stage and T2 relaxation time was evaluated by Kendall's Tau-b test.
Results:
Twenty-five infants (male: female, 12:13; age range 0-11 months, mean 3.2 months), 14 with neonatal cholestasis (9 BA and 5 non-BA) and 11 normal controls were included in this study. Relaxation times (mean ± standard deviation [SD]) for the liver were 57.8 ms ± 8.8 in the normal control group (n=11) and 56.8 ms ± 9.6 in the BA group (n=9) without statistically significant differences (P=0.811). T2 relaxation times were not significantly different between the low stage (≤ F1) and high stage (≥ F2) fibrosis (mean 57.8 vs 56.8; P=0.934).
Conclusion:
T2 relaxation of a normal infant liver at 1.5-T had a mean value of 57.8 ms, which is comparable with adult data (46-57 ms). However, T2 relaxation time was not different in patients with BA and did not correlate with stage of fibrosis.
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