Sensitivity and specificity of magnetic resonance elastography in liver diseases in the pediatric age group

Liver fibrosis staging in pediatric patients traditionally relies on invasive methods, such as liver biopsy, which pose risks and limitations. Magnetic Resonance Elastography (MRE) has emerged as a promising noninvasive alternative. This study aimed to validate the use of MRE in pediatric liver diseases and assess its diagnostic accuracy.

A total of 110 participants (61 with autoimmune hepatitis (AIH), 33 post-liver transplantation (LTx), and 16 healthy controls) underwent MRE examinations. Liver biopsies were performed based on ESPGHAN indications in patients with AIH and according to institutional post-transplant protocols in LTx patients. Biochemical data were collected including ALT (alanine aminotransferase), AST (aspartate transaminase), INR (international normalized ratio), bilirubin, and platelet counts. The APRI (aspartate aminotransferase to platelet ratio index) and FIB 4 (Fibrosis Index Based on 4 Factors) were calculated.

In AIH patients MRE showed a sensitivity of 76.2% and specificity of 84.6% for moderete to severe fibrosis, incomplete cirrhosis and cirrhosis (Ishak 4-6, AUC 0.828, cutoff 3.28 kPa) and a sensitivity of 80% and specificity of 88.9% for incomplete cirrhosis and cirrhosis (Ishak 5-6, AUC 0.896, cutoff 3.68 kPa). In LTx patients, MRE demonstrated a sensitivity of 80% and specificity of 91.3% for moderete to severe fibrosis and cirrhosis (Ishak 4-6, AUC 0.865, cutoff 3.1 kPa). Inter-observer agreement for MRE was excellent (ICC(3,1) of 0.988) CONCLUSIONS: MRE is a valuable noninvasive tool offering an accurate assessment of fibrosis. Further research is warranted to expand MRE's utility across diverse pediatric liver conditions. This validation of the MRE highlights its potential to enhance clinical decision-making and patient care in pediatric hepatology.