Liver fibrosis by diffusion-weighted magnetic resonance imaging and its functional correlates in fontan patients

医学 肝硬化 瞬态弹性成像 磁共振成像 纤维化 内科学 心脏病学 胃肠病学 肝纤维化 肝病 肝纤维化 放射科
作者
Chun‐Wei Lu,Chih‐Horng Wu,Miao‐Tzu Huang,Chee‐Seng Lee,Huey-Ling Chen,Ming‐Tai Lin,Shuenn‐Nan Chiu,Wei‐Chieh Tseng,Chun‐An Chen,Jou‐Kou Wang,Mei‐Hwan Wu
出处
期刊:European Journal of Cardio-Thoracic Surgery [Oxford University Press]
卷期号:66 (1)
标识
DOI:10.1093/ejcts/ezae249
摘要

Abstract OBJECTIVES The evaluation of Fontan-associated liver disease is often challenging. Diffusion-weighted magnetic resonance imaging can detect hepatic fibrosis from capillary perfusion and diffusion abnormalities from extracellular matrix accumulation. This study investigated its role in the evaluation of liver disease in Fontan patients and explored possible diagnostic methods for early detection of advanced liver fibrosis. METHODS Stable adult Fontan patients who could safely be examined with magnetic resonance imaging were enrolled, and blood biomarkers, transient elastography were also examined. RESULTS Forty-six patients received diffusion-weighted imaging; and 58.7% were diagnosed with advanced liver fibrosis (severe liver fibrosis, 37.0%, and cirrhosis 21.7%). Two parameters of hepatic dysfunction, platelet counts (Spearman’s ρ: –0.456, P = 0.001) and cholesterol levels (Spearman’s ρ: –0.383, P = 0.009), decreased with increasing severity of fibrosis. Using transient elastography, a cut-off value of 14.2 kPa predicted the presence of advanced liver fibrosis, but with a low positive predictive value. When we included platelet count, cholesterol, post-Fontan years and transient elastography values as a composite, the capability of predicting advanced liver fibrosis was the most satisfactory (C statistic 0.817 ± 0.071, P < 0.001). A cut-off value of 5.0 revealed a sensitivity of 78% and a specificity of 82%. CONCLUSIONS In Fontan patients, diffusion-weighted imaging was helpful in detecting liver fibrosis that was correlated with hepatic dysfunction. A simple score was proposed for long-term surveillance and early detection of advanced liver disease in adult Fontan patients. For adult Fontan patients with a calculated score > 5.0, we may consider timely diffusion-weight imaging and early management for liver complications.
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