Related Experiment Video
Updated: Dec 8, 2025
Measurement of Liver Stiffness Using Atomic Force Microscopy Coupled with Polarization Microscopy
Published on: July 20, 2022
Normal Liver Stiffness Measured with MR Elastography in Children
Andrew T Trout1, Sudha A Anupindi1, Michael S Gee1
1From the Department of Radiology (A.T.T., J.R.D.), Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), and Division of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229; Departments of Radiology (A.T.T., J.R.D.) and Pediatrics (A.T.T., S.A.X., B.Z.), University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (S.A.A., S.D.S., J.S.C.T.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (S.A.A., S.D.S.); Department of Radiology (M.S.G.) and Center for Ultrasound Research & Translation, Department of Radiology (M.B., A.O.), Massachusetts General Hospital, Boston, Mass; Department of Radiology, Harvard Medical School, Boston, Mass (M.S.G.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (G.K.).
Insights
Normal liver stiffness in children measured by MR elastography is 2.1 kPa, similar to adults. This study establishes normative data, showing liver stiffness is independent of patient or MRI factors, with a 95th percentile of 2.8 kPa.
Area of Science:
- Radiology and Imaging
- Pediatric Gastroenterology
- Medical Physics
Background:
- Liver stiffness thresholds for pediatric MR elastography (MRE) lack standardization and may differ from adult values.
- Establishing normative liver stiffness data in children is crucial for accurate diagnostic threshold determination.
Purpose of the Study:
- To determine normal liver stiffness values and their associated ranges in children using MR elastography.
- To assess liver stiffness across different MRI vendors and field strengths (1.5 T and 3.0 T) in a pediatric cohort.
Main Methods:
- Prospective, multicenter cohort study (NCT03235414) involving healthy volunteers aged 7-17.9 years.
- Standardized MRI scans including MRE, proton density fat fraction (PDFF), and R2* measurements were performed.
- Data were centrally analyzed, with statistical methods including Pearson correlation and t-tests/ANOVA to assess associations.
Main Results:
- Seventy-one children with complete data had a mean liver stiffness of 2.1 kPa (95% CI: 2.0-2.2 kPa).
- The 95th percentile for normal liver stiffness was 2.8 kPa.
- No significant associations were found between liver stiffness and patient demographics (age, sex, BMI) or MRI scanner factors (vendor, field strength).
Conclusions:
- Mean liver stiffness in children, measured by MRE, is comparable to adult values (2.1 kPa).
- Normal liver stiffness in children is independent of age, sex, BMI, MRI vendor, or field strength.
- The established 95th percentile of 2.8 kPa provides a valuable reference for pediatric liver stiffness assessment.
Abstract:
Background Stiffness thresholds for liver MR elastography in children vary between studies and may differ from thresholds in adults. Normative liver stiffness data are needed to optimize diagnostic thresholds for children. Purpose To determine normal liver stiffness, and associated normal ranges for children, as measured with MR elastography across vendors and field strengths. Materials and Methods This was a prospective multicenter cohort study (ClinicalTrials.gov identifier: NCT03235414). Volunteers aged 7-17.9 years without a known history of liver disease were recruited at four sites for a research MRI and blood draw between February 2018 and October 2019. MRI was performed on three vendor platforms and at two field strengths (1.5 T and 3.0 T). All MRI scans were centrally analyzed; stiffness, proton density fat fraction (PDFF), and R2* values were expressed as means of means. Mean and 95% confidence intervals (CIs) for liver stiffness were calculated. Pearson correlation coefficient (r), two-sample t test, or analysis of variance was used to assess univariable associations. Results Seventy-one volunteers had complete data and no documented exclusion criterion (median age, 12 years; interquartile range [IQR], 10-15 years; 39 female participants). Median body mass index percentile was 54% (IQR, 32.5%-69.5%). Mean liver stiffness was 2.1 kPa (95% CI: 2.0, 2.2 kPa) with mean ± 1.96 kPa standard deviation of 1.5-2.8 kPa. Median liver PDFF was 2.0% (IQR, 1.7%-2.6%). There was no association between liver stiffness and any patient variable or MRI scanner factor. Conclusion Mean liver stiffness measured with MR elastography in children without liver disease was 2.1 kPa (similar to that in adults). The 95th percentile of normal liver stiffness was 2.8 kPa. Liver stiffness was independent of sex, age, or body mass index and did not vary with MRI scanner vendor or field strength. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Yin in this issue.
More Related Videos
05:56Implementation of Non-invasive Point of Care Transient Elastography for Evaluation of Liver Disease in Pediatric Populations with Cystic Fibrosis
Published on: August 29, 2025
06:09Author Spotlight: Advancing Hepatic Fibrosis Diagnosis Using Magnetic Resonance Elastography and AI
Published on: July 21, 2023
Related Concept Videos
01:25Ultrasound II: Endoscopic Ultrasound and FibroScan
Endoscopic Ultrasound (EUS):
01:17Gross Anatomy of the Liver
Located under the diaphragm, the liver is almost entirely ensconced within the rib cage, providing it with substantial protection. Except for the superior most bare area, the liver's surface is...