https://pubmed.ncbi.nlm.nih.gov/32925554/ Autoimmune hepatitis

J Pediatr Gastroenterol Nutr. 2020 Sep 9.

Multiparametric MRI as a Non-Invasive Monitoring Tool for Children with Autoimmune Hepatitis

Kamil Janowski 1, Elizabeth Shumbayawonda 2, Andrea Dennis 2, Matt Kelly 2, Velicia Bachtiar 2, David DeBrota 2, Caitlin Langford 2, Helena Thomaides-Brears 2, Maciej Pronicki 3, Wieslawa Grajkowska 3, Malgorzata Wozniak 1, Piotr Pawliszak 4, Sylwia Chełstowska 4, Elzbieta Jurkiewicz 4, Rajarshi Banerjee 2, Piotr Socha 1

PMID: 32925554

Abstract

Objectives: Autoimmune hepatitis (AIH) is a progressive liver disease managed with corticosteroids and immunosuppression and monitored using a combination of liver biochemistry and histology. However, liver biopsy is invasive with risk of pain and bleeding. The aim of this study was to investigate the utility of non-invasive imaging with multiparametric MRI (mpMRI) to provide clinically useful information on the presence and extent of hepatic inflammation, potentially guiding immunosuppression.
Methods: 81 participants (aged 6-18); 21 healthy and 60 AIH patients underwent multi-parametric MRI to measure fibro-inflammation with cT1 at the Children's Memorial Health Institute in Warsaw alongside other clinical blood tests and liver biopsy at recruitment and after an average of 16 months follow-up (range 9-22 months). Correlation analyses were used to investigate the associations between cT1 with blood serum markers, and histological scores.

Results: At recruitment patients with AIH had a higher cT1 value than healthy controls (p < 0.01). cT1 correlated significantly with key histopathological features of disease. Treatment naïve AIH patients showed evidence of inflammation and heterogeneity across the liver compared to healthy controls.At follow-up, cT1 showed utility in monitoring disease regression as most patients showed significantly reduced fibro-inflammation with treatment (p < 0.0001) over the observational period. Six patients had histological fibrosis and clear fibro-inflammation on MR despite biochemical remission (normalised AST, ALT and IgG).

Conclusions: Multiparametric MR can measure disease burden in paediatric AIH and can show changes over time in response to therapy. Active disease can be seen even in biochemical remission in children.