19 OCT 2013
Contributing Author Claire Duplan
Survival in diseases such as cancer has been significantly increased by the use of biopsies and similar diagnostic techniques, but these can often be painful and invasive. Eliminating these difficult procedures, without losing diagnostic accuracy, can greatly improve patient experiences. Techniques that can achieve this are useful in all fields of medicine, but they are particularly important in pediatric medicine, so the development of magnetic resonance elastography (MRE) as a tool for the detection of fibrosis caused by liver disease in children will be particularly important, since this type of disease is likely to become more common in the future.
Non-Invasive Imaging Technology
Researchers from the Cincinnati Children’s Hospital have demonstrated that MRE is an effective technique for detecting symptoms of chronic liver disease in pediatric patients. The study, published in the Journal of Pediatrics, evaluated the technique by comparing the results of MRE and conventional liver biopsies in 35 pediatric patients aged between 4 and 20. The results demonstrated that MRE was providing accurate diagnoses of chronic liver conditions such as non-alcoholic fatty liver disease (NAFLD). If this work is validated by further trials in larger patient populations, then MRE could join similar non-invasive technologies in providing diagnosis without the need for surgical or needle biopsies. According to Licensed Prescriptions, handheld scanners have already enabled dermatologists to assess melanoma risk, reducing the number of patients who have to undergo biopsy. Further reducing the need for invasive techniques by introducing technologies such as MRE will continue to make the detection of disease cheaper and easier, as well as making the patient’s experience less unpleasant.
Replacing Liver Biopsies with MRE
The standard technique for evaluating liver damage is a needle biopsy. This invasive technique is costly and comes with the risk of certain side effects, which can be eliminated by the use of a cheaper, non-invasive technique. MRE has been used on more than 200 children at Cincinnati Children’s, with no adverse side effects. Undergoing a biopsy can also be traumatic, particularly for young children and teenagers, so finding a means of assessing the liver without using a needle could make treatment easier for both doctors and patients.
The study authors believe that the use of MRE could help to improve the quality of care and to reduce dependence on biopsies. Co-author Daniel Podberesky, MD, who is the chief of thoracoabdominal imaging at the hospital, suggests that “Having the ability to easily and non-invasively assess the degree of fibrosis in a child’s liver could help us to identify the issue early and begin the right course of treatment in a timely and effective manner.”
Benefits of MRE
MRE combines the use of low frequency sound waves and magnetic resonance to measure the stiffness of liver tissue, which gives an indication of how damaged it is, in a matter of minutes. MRE can also provide additional information about the health of the liver than is possible with a conventional biopsy, by measuring the quantity of fat stored in the liver. This information could help to determine how successful clinical interventions have been. Lead scientist Stavra Xanthakos, MD, suggests that MRE might provide a means of assessing changes in the liver following treatment, or predicting and monitoring the course of disease. Replacing biopsies with MRE could enable closer monitoring by allowing more frequent assessments of the liver, since there would be no need to undergo an invasive procedure every time measurements are taken.
MRE is superior to biopsy because it is non-invasive, but it has also proven to be more accurate than other non-invasive techniques that have been used as alternatives for assessing damage to the liver. The ultrasound-based technologies that have previously been used were often unreliable, particularly in the highest risk patients. One of the main risk factors for liver disease is obesity, and ultrasound is unable to accurately assess the health of the liver in overweight patients. MRE offers a non-invasive alternative that can be relied upon even for these obese individuals, and in children.
Rise of Liver Disease in Children Requires Better Diagnostic Techniques
The ability to detect conditions like NAFLD early is becoming increasingly important as they begin to affect children and teenagers more frequently due to changes in lifestyle that are putting people at risk at a younger age. Obesity is a significant risk factor for liver disease, and with growing numbers of seriously overweight children, doctors are being confronted with more young patients whose livers have already been damaged. It is estimated that about 13 percent of adolescents in the US have been affected by NAFLD, which is a progressive disease that can eventually lead to liver failure. Finding non-invasive techniques that can help us to detect and monitor these types of conditions could ensure that these young people receive treatment that is as early and effective as possible.