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Magnetic Resonance Imaging

A Personalized Approach to Understanding Fatty Liver Disease

Barnekow, Kris*; Shyken, Paige; Ito, Joy; Deng, Jie; Mohammad, Saeed; Fishbein, Mark

Journal of Pediatric Gastroenterology and Nutrition: June 2019 - Volume 68 - Issue 6 - p 777–781
doi: 10.1097/MPG.0000000000002316
Original Articles: Hepatology

Objectives: To assess information retention by parents/caretakers regarding nonalcoholic fatty liver disease (NAFLD) utilizing the actual image of their child's affected liver.

Methods: In this pilot study, parents/caretakers of children with newly diagnosed NAFLD were presented with an magnetic resonance (MR) image of their child's fatty liver. An adjacent image of a normal-appearing liver was used to highlight the degree of fat accumulation present in their child's liver. The appearance of the fatty liver was used as an adjunct to patient education as provided by a nurse clinician. The efficacy of this approach was determined by a set of image- and disease-specific queries. Health literacy was assessed concurrently by the Newest Vital Sign (NVS) instrument. The image- and disease-specific queries were then repeated by telephone follow-up 2 to 4 weeks after initial clinic visit.

Results: Parents/caretakers initially gave 100% correct responses regarding the variation of appearance of normal liver (pink) and their child's fatty liver (yellow). They also all correctly stated the fat content initially. At follow-up, their recall was 95% for the appearance of normal liver and 81% for fatty liver; recall was only 52% for fat content at follow-up. Nonvisualized elements of nonalcoholic steatohepatitis (NASH) and cirrhosis were not identified or recalled as well. Results may have been influenced by parent/caretaker health literacy competence.

Conclusions: Personalized images of fatty liver were effective visualization tools for parents/caretakers to comprehend NAFLD and comprehension was not compromised by health literacy. Clear visual instruments may improve parent/caretaker comprehension of these conditions and may help to address deficiencies in health literacy.

*University of Wisconsin-Milwaukee College of Health Sciences, Milwaukee, WI

Ann & Robert H Lurie Children's Hospital of Chicago

Feinberg School of Medicine at Northwestern University, Chicago, IL.

Address correspondence and reprint requests to Mark Fishbein, MD, Feinberg School of Medicine at Northwestern University, 225 E Chicago Avenue, Chicago, IL 60611 (e-mail:

Received 15 March, 2018

Accepted 3 February, 2019

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The authors report no conflicts of interest.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,