A recent study conducted at Children's Hospital Los Angeles has revealed significant limitations in the effectiveness of current non-invasive imaging techniques for detecting high-grade fibrosis in pediatric patients with metabolic dysfunction-associated steatotic liver disease (MASLD).
The research, led by Dr. Naseem Ravanbakhsh from the Department of Pediatric Gastroenterology, Hepatology, and Nutrition, evaluated the accuracy of magnetic resonance elastography (MRE) and transient elastography (TE) compared to liver biopsy results.
Study Findings and Clinical Implications
The investigation revealed that both MRE and TE fell short in accurately predicting high-grade fibrosis when compared to liver biopsy results. While MRE showed slightly superior performance with an AUROC of 0.817 compared to TE's 0.750, the difference did not reach statistical significance (P=0.4785).
"As MASLD and MASH become an ever-growing diagnosis in pediatrics, it is imperative to find noninvasive modalities that can reliably monitor disease progression," emphasized Dr. Ravanbakhsh and colleagues.
Study Design and Patient Demographics
The retrospective analysis examined data from 77 children aged 9-18 years with biopsy-proven MASLD between September 2017 and January 2023. The study population showed notable characteristics:
- Median age: 14 years
- Gender distribution: 57% male
- Hispanic ethnicity: 64%
- Comorbidities: 100% obesity, 19% dyslipidemia, 21% type 2 diabetes
Detailed Liver Assessment Results
Liver biopsy findings revealed:
- Steatosis distribution: 40% Grade 1, 47% Grade 2, 13% Grade 3
- NAS scoring: 13% NAS 3, 39% NAS 4, 38% NAS 5
- Fibrosis present in 90% of biopsies, predominantly Metavir Stages 1 and 2
Technical measurements showed:
- TE median controlled attenuation parameter: 346 dB/m
- TE median kPa: 8.4
- MRI-PDFF median: 22%
- MRE median kPa: 2.1
Clinical Context and Significance
MASLD represents a significant health concern, affecting up to 38% of children with obesity in the United States. The condition's potential progression to cirrhosis and liver failure underscores the critical need for accurate diagnostic tools and monitoring methods.
The study's findings highlight a crucial gap in current non-invasive monitoring capabilities for pediatric MASLD patients. While these imaging modalities may serve as general guidance tools, their limitations suggest the need for continued reliance on liver biopsy for definitive assessment of high-grade fibrosis.
Future Directions
The researchers acknowledge the need for larger, more diverse studies to establish more reliable non-invasive monitoring methods. As new treatments emerge for pediatric MASLD, the development of accurate non-invasive assessment tools becomes increasingly critical for effective disease management and monitoring.
