According to Daniel Podberesky, MD, Associate Director, Clinical Services and Chief, Thoracoabdominal Imaging Division at Cincinnati Children’s, when he learned about MRE, he believed his hospital would find the technology beneficial when applied to pediatric liver disease. So he contacted Dr. Ehman at Mayo Clinic to put a collaborative research agreement in place. Between August, 2011 and March, 2012, the hospital performed over 40 pediatric MRE exams. The department of radiology has three child life specialists. Before the MRE scan, they take the children to a special room with a mock-up of the MRE drum. It’s placed on their abdomens so they can feel the vibration and get comfortable with the “tickling” sensation before the exam. So far, the staff has not had any complaints or “freak outs.” The hospital gives any child over five or six the opportunity to be scanned without sedation. “The potential of needle-free elastography has opened a door for our children,” says Dr. Podberesky. “Our gastroenter- ologists were very excited and on board with the new technology from the start.” For children, the benefit of not using a “scary” needle is obvious, and for parents, the potential for lowering or eliminating He underscores the benefits of MRE, which Dr. Podberesky and his staff use on their Signa* HDxt 1.5T system from GE Healthcare, using three real-life scenarios. In the first scenario, MRE showed inconspicuous tissue stiffness. “It has provided us with a paradigm shift on how we approach our patients. And down the road, we’ll probably be able to use it with other diseases. It gives us hope for a better future for sick children. „ Dr. Daniel Podberesky risks associated with biopsy is very attractive. MRE is a non-invasive, well tolerated, and ionizing radiation-free xam, and it’s hoped that it can help determine whether a patient should undergo an invasive liver biopsy. “Having the ability to easily and non-invasively assess the child’s liver could help us identify the issue early and begin the right course of treatment in a timely and effective manner,” comments Dr. Podberesky. “This technique could give us the opportunity to help slow, stop, or even reverse the progression in some cases.” The care team decided to cancel a planned biopsy in a child with non- alcoholic fatty liver disease because, in this situation, the treatment might be diet and exercise—and monitoring with additional MRE scans. In a second scenario, an ultrasound suggested only mild fatty liver infiltration, but MRE indicated a greater degree of tissue stiffness. A subsequent biopsy confirmed a diagnosis of inflammation and fibrosis. In the past, based solely on the ultrasound, it’s unlikely that a biopsy would have been performed and the disease could have been missed.
A 15-year-old obese patient with elevated liver enzymes and fatty liver infiltration on ultrasound and MR. The MRE was performed to evaluate tissue stiffness. The MRE returned with evidence of mild steatohepatitis and mild fibrosis. Subsequent biopsy confirmed those findings.