89 - Parenchymal Liver Disease

Abstract

There are myriad causes of pediatric parenchymal liver disease, of which hepatic steatosis is the most common. The major concern with diffuse parenchymal liver disease is progression to end-stage fibrosis and cirrhosis. As such, early detection and treatment of pediatric liver disease can improve patient outcomes and prolong survival. Liver biopsy remains the gold standard for diagnosis of parenchymal liver disease, but it is not without several shortcomings (sampling error and invasiveness being most prominent). Various imaging modalities can provide important information on the extent of liver involvement and development of complications without the invasiveness of a liver biopsy. Of these noninvasive modalities, MRI provides the most comprehensive evaluation of liver parenchyma. Liver MRI, including advanced MR modalities like spectroscopy and elastography, can provide noninvasive monitoring of disease distribution within the liver, as well as disease progression and response to therapy. In end-stage liver disease, MRI can also monitor for the development of hepatocellular carcinoma, and can help determine eligibility for transplantation when indicated. In this review, we summarize the more common pediatric parenchymal liver diseases encountered at any busy children's hospital, with an emphasis on the imaging appearance of the various diseases. A summary of MR applications in diffuse parenchymal liver disease is also provided.