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Author Spotlight: Advancing Hepatic Fibrosis Diagnosis Using Magnetic Resonance Elastography and AI
Published on: July 21, 2023
Periportal thickening on magnetic resonance imaging for hepatic fibrosis in infantile cholestasis
Myung Hwan Lee1, Hyun Joo Shin1, Haesung Yoon1
1Department of Radiology, Severance Hospital, Severance Pediatric Liver Disease Research Group, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 03722, South Korea.
Insights
Periportal thickening (PT) on liver MRI is a valuable non-invasive tool for assessing hepatic fibrosis in infants with cholestasis. This method, along with spleen size ratio (SR), aids in diagnosing significant liver disease, including biliary atresia.
Area of Science:
- Pediatric Radiology
- Hepatology
- Medical Imaging
Background:
- Neonatal cholestasis can lead to severe liver damage, including cirrhosis and end-stage liver disease.
- Early, non-invasive assessment of hepatic fibrosis is crucial for timely intervention in infants with cholestasis.
- Liver transplantation may be required in severe cases due to prolonged hepatocyte and biliary tree injury.
Purpose of the Study:
- To evaluate the effectiveness of periportal thickening (PT) measured via liver magnetic resonance imaging (MRI) in assessing hepatic fibrosis among infants with cholestasis.
- To compare the diagnostic performance of PT, spleen size ratio (SR), and aspartate transaminase to platelet ratio index (APRI) for hepatic fibrosis in this population.
- To specifically investigate the utility of PT in infants diagnosed with biliary atresia (BA).
Main Methods:
- Retrospective analysis of infants under 6 months old who underwent liver MRI and biopsy for cholestasis evaluation.
- Measurement of periportal thickening (PT) and spleen size (normalized to spleen size ratio, SR) on liver MRI.
- Histopathologic fibrosis grading using the METAVIR system and correlation with MRI findings and APRI scores.
- Receiver-operating characteristic (ROC) curve analysis to determine the diagnostic performance of PT, SR, and APRI for significant fibrosis and cirrhosis.
Main Results:
- A total of 155 infants were included, with 110 diagnosed with biliary atresia (BA).
- Periportal thickening (PT) and spleen size ratio (SR) showed positive correlations with fibrosis grade, even after age adjustment (P < 0.001).
- For significant fibrosis (F2-F4), PT demonstrated superior diagnostic performance (AUC=0.899) compared to SR (AUC=0.741) and APRI (AUC=0.712) (P < 0.001).
- Spleen size ratio (SR) showed the highest diagnostic performance for cirrhosis (F4) (AUC=0.790).
Conclusions:
- Liver MRI findings, specifically periportal thickening (PT) and spleen size ratio (SR), are effective non-invasive indicators for assessing clinically significant hepatic fibrosis (METAVIR grade F2 and higher) in infants with cholestasis.
- These imaging parameters are particularly useful in the context of biliary atresia (BA).
- MRI-based assessments offer a valuable alternative or adjunct to liver biopsy for evaluating fibrosis in this vulnerable patient group.
Background:
Untreated neonatal cholestasis can progress to liver cirrhosis and end stage liver disease in infancy due to prolonged hepatocyte and biliary tree injury and may require liver transplantation. Therefore, non-invasive evaluation of hepatic fibrosis is important in infants with cholestasis.
Aim:
To investigate the usefulness of periportal thickening (PT) measured on liver magnetic resonance imaging (MRI) for the assessment of hepatic fibrosis in infants with cholestasis including biliary atresia (BA).
Methods:
This retrospective study included infants less than 6 mo who underwent liver MRI and biopsy for the evaluation of infantile cholestasis. PT and spleen size were measured on MRI. Serologic assessment was based on aspartate transaminase to platelet ratio index (APRI). The grade of histopathologic fibrosis was assessed by the METAVIR grading system. Correlation and diagnostic performance of PT, normalized spleen size ratio (SR, using the upper normal size limit), and APRI for diagnosing hepatic fibrosis were obtained by receiver-operating characteristic (ROC) curve analysis.
Results:
A total of 155 patients were included, 110 of which were diagnosed with BA. Mean age at the time of MRI was 57.6 ± 34.4 d. There were positive correlations between fibrosis grade and PT and SR, even after adjusting age (all, P < 0.001). For the diagnosis of significant fibrosis (METAVIR grade F2-F4), the area under the ROC curve was 0.899 (95%CI: 0.840-0.941) for PT (cutoff, 4.2 mm), which was higher than 0.741 (95%CI: 0.664-0.808) for SR and 0.712 (95%CI: 0.634-0.782) for APRI (both, P < 0.001). For the diagnosis of cirrhosis (F4), the area under the ROC curve was the highest with SR as 0.790 (95%CI: 0.718-0.852).
Conclusion:
Liver MRI findings of PT and SR are useful to assess clinically significant hepatic fibrosis (F2 and higher) in infants with cholestasis including BA.
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