A 4-year-old patient with familial intrahepatic cholestasis syndrome. Ultrasound was normal. MRE demonstrated elevated liver stiffness. Biopsy findings revealed mild to moderate fibrosis.
Third, congenital heart disease patients
who undergo a Fontan procedure
often develop liver disease as a late
complication—diagnosing it as early
as possible is critical. With MRE, Dr.
Podberesky and his team could see
that the liver stiffness was more
pronounced than expected. A biopsy
confirmed this and mild to moderate
fibrosis was diagnosed.
The liver MRE protocol at Cincinnati
Children’s Hospital Medical Center
includes a 3D FSPGR axial opposed
phase imaging sequence, a coronal T1
sequence, an axial T2 frFSE sequence
with fat-saturation and respiratory
triggering, and the MRE sequence. The
patients are scheduled in a 30 minute
time slot and the imaging takes
approximately 15 minutes.
MRE vs. ultrasound
Ultrasound is often used to assess
liver disease. However, according to
Dr. Podberesky, it has limitations,
especially in obese patients. With
ultrasound, each user is subjectively
grading the degree of fatty infiltration,
but no two clinicians/radiologists will
always grade it the same. On the other
hand, MRE is consistent, providing
reproducible color-coded stiffness
maps of the liver that help reduce
the subjectivity and differences in
reading interpretations. MRE takes
advantage of MR’s strength in imaging
obese patients or patients with ascites.
The future is bright
Dr. Podberesky is confident that MRE
has a bright future. Once the hospital
staff became familiar with MRE, the
application became very intuitive and
user friendly. “We push our limits and
expand our horizons because our
patients expect us to be on the cutting
edge. Right now, with MRE, we have
a chance to change the course of
pediatric liver disease. It has provided
us with a paradigm shift on how we
approach our patients,” offers Dr.
Podberesky. “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.”
2. available at: http://optn.transplant.hrsa.gov/latestData/
3. Arya G, Balistreri WF. Pediatric liver disease in the
United States: Epidemiology and impact. Journal of
Gastroenterology and Hepatology. 2002:17;521–525.
5. Ehman EC, Rossman PJ, Kruse SA, et al. Vibration safety
limits for magnetic resonance elastography. Phys Med Biol
2008; 53( 4):925-935.
6. Yin M. Talwalkar JA, Glaser KJ, et al. Assessment of hepatic
fibrosis with magnetic resonance elastography. Clin
Gastroenterol Hospital 2007; 5( 10):1207-1213.
Daniel J. Podberesky, MD, is Associate Director, Clinical Services, Chief of the Thoracoabdominal Imaging Division, and Assistant Professor, Division of Pediatric
Radiology, Cincinnati Children’s Hospital Medical Center. Dr. Podberesky obtained his undergraduate and medical degrees at the University of Maryland, and
completed a residency in diagnostic radiology at the San Antonio Uniformed Services Health Education Consortium as an active duty member of the U.S. Air
Force. After completing a fellowship in pediatric radiology at Cincinnati Children’s Hospital Medical Center, Dr. Podberesky served as Chief of Pediatric Radiology
at Wilford Hall Medical Center, the U.S. Air Force’s flagship tertiary care medical facility. Dr. Podberesky returned to Cincinnati Children’s Hospital as Chief of Body
CT in July 2008. He helped create the Division of Thoracoadbominal Imaging, and became its Chief in 2009.
Cincinnati Children's Hospital Medical Center ranks third in the nation among all Honor Roll hospitals in U.S. News and World Report’s 2011 Best Children’s
Hospitals ranking. It is ranked #1 for gastroenterology and in the top 10 for all pediatric specialties—a distinction shared by only two other pediatric hospitals
in the United States. Cincinnati Children’s is one of the top two recipients of pediatric research grants from the National Institutes of Health. It is internationally
recognized for improving child health and transforming delivery of care through fully integrated, globally recognized research, education, and innovation.
Additional information can be found at www.cincinnatichildrens.org.