Kistik Fibrozisli Çocuk Hastalarda Karaciğer Tutulumunun Mr Elastografi ile Non-İnvazif Değerlendirilmesi

Abstract

Purpose: The aim of this study is to prospectively evaluate liver involvement with magnetic resonance (MR) elastography and compare it with clinical-laboratory findings in pediatric cystic fibrosis (CF) patients. Material and Method: After the approval of ethics committee (GO 20/567), 51 pediatric CF patients and 24 pediatric volunteers with no known disease were included in the study between 01 June 2020 and 01 March 2022. MR images were performed on a 1.5 Tesla MRI device (Magnetom Aera, Siemens, Erlangen, Germany). Numerical values in kilopascals were obtained by processing MR elastography with Syngo. Via software. MR spectroscopy technique based on chemical shift difference was used to determine the amount of fat fraction [STEAM (30×30×30 mm voxel volume, TR=3000 ms TE=12/24/36/48/72 ms)]. The liver parenchymal stiffness assessment intervals are determined as respectively; <2.5 kPa: normal; 2.5-3 kPa: normal-chronic inflammation; 3-3.5 kPa: stage 1-2 fibrosis; 3,5-4 kPa: stage 2-3 fibrosis; 4-5 kPa: stage 4 fibrosis. >5% fat fraction in MR spectroscopy evaluated as hepatosteatosis. The symptoms at the time of diagnosis, sweat test results, genetic mutation results, last hepatobiliary ultrasonography findings, laboratory parameters; thrombocyte value, AST, ALT, GGT, ALP, total protein, albumin, total/indirect bilirubin values were analyzed. Independent sample T-test was used for normally distributed variables and Mann Whitney-U test was used for non-normally distributed variables. Statistically, P value <0.05 was considered significant. Findings: The age of CF patients (32 M, 19 F) is between 4-17 years, with a mean age of 12 years. The age of control group (15 M, 9 F) was between 6.5 and 16 years, with a mean age of 11. Liver MR elastography values of the patient group (median: 2.4 kPa, 1.73-5.86 kPa, min-max) were found to be higher than the control group (median: 2.1 kPa, 1.7-2.9 kPa min-max) values (P=0.003). The GGT values of the patients were higher than the control group, and the MR elastography values showed statistically positive correlation with GGT (P=0.003). A significant difference in fat fraction was found between the CF patient group (median: 4.4%) and the control group (median: 3.15%) (P=0.032). A significant difference was found between the MR elastography values of patients with and without chronic liver disease in the CF patient group (P=0.007). A significant difference was found between the MR elastography values of those with thrombocyte values <180.000 μl (indicating liver function) and those with > 180.000 μl in the patient group (P<0.001). Results: Non-invasive evaluation of liver involvement CF patients with MR elastography is promising in the early diagnosis and follow-up of these patients.