Magnetic resonance elastography of the pediatric kidney: technical considerations and emerging clinical applications

Renal fibrosis is a common pathway of chronic kidney injury in children and an important determinant of long-term outcomes in both native and transplanted kidneys. Current assessment relies heavily on biopsy, which is invasive, prone to sampling error, and challenging to repeat in pediatric patients. Magnetic resonance elastography (MRE) is a noninvasive imaging technique that quantifies tissue stiffness and has become an established biomarker for hepatic fibrosis; however, its application to the pediatric kidney remains less well defined. This review summarizes the principles of renal MRE with a focus on pediatric-specific technical considerations and practical implementation. We discuss patient preparation, driver selection and positioning, sequence choices, image acquisition strategies, and common pitfalls unique to pediatric imaging. Methods for image analysis and interpretation are reviewed, with attention to confounding factors such as perfusion, inflammation, and hydration status. Emerging clinical applications are highlighted, particularly in pediatric kidney transplantation, where early detection and longitudinal monitoring of interstitial fibrosis and tubular atrophy may complement existing surveillance strategies. Renal MRE is a feasible and promising adjunct to pediatric renal MRI that can be implemented on modern clinical scanners. With continued technical refinement and validation, MRE has the potential to play an important role in noninvasive assessment of pediatric kidney disease.