Noninvasive Liver Assessment in Adult Patients With Fontan Circulation Using Acoustic Radiation Force Impulse Elastography and Hepatic Magnetic Resonance Imaging.

Autores de IIS La Fe

• Josep Lluís Melero Ferrer

  Autor

• Diego Plaza Lopez

  Autor

• Joaquín Rueda Soriano

  Autor

• Ana María Osa Sáez

  Autor

• Jaume Agüero Ramón-Llin

  Autor

• María Pilar Calvillo Batlles

  Autor

• Maria Fonemia Esparcia

  Autor

• Antonio Ballesta Cuñat

  Autor

• 

  Luis Martí Bonmatí

  Autor

• 

  Luis Vicente Martínez Dolz

  Autor

Participantes ajenos a IIS La Fe

• Buendia-Fuentes, F

Grupos

• Grupo de Investigación Clínica y Traslacional en Cardiología

• Investigacion Biomédica en Imagen (GIBI 2-30)

Abstract

BACKGROUND: Patients who have undergone the Fontan procedure are at risk of developing hepatic dysfunction. However, broad recommendations regarding liver monitoring are limited. The purpose of this study was to characterize the frequency of liver disease in adult Fontan patients using multimodality imaging (hepatic magnetic resonance imaging [MRI], acoustic radiation force impulse [ARFI] elastography, or hepatic ultrasound). METHODS: In a prospective cross-sectional analysis of adult patients palliated with a Fontan procedure, hepatic MRI, ARFI, and hepatic ultrasound were used to assess for liver disease. The protocol compared (1) varying prevalence of liver disease based on each imaging technique, (2) agreement between different techniques, and (3) association between noninvasive imaging diagnosis of liver disease and clinical variables, including specific liver disease biomarkers. RESULTS: Thirty-seven patients were enrolled. The ARFI results showed high wave propagation velocity in 35 patients (94.6%). All patients had some abnormality in the hepatic MRI. Specifically, 8 patients (21.6%) showed signs of chronic liver disease, 10 patients (27%) had significant liver fibrosis, and 27 patients (73%) had congestion. No correlation was found between liver stiffness measured as propagation velocity and hepatic MRI findings. Only 7 patients had an abnormal hepatic ultrasound study. CONCLUSIONS: There is an inherent liver injury in adult Fontan patients. Signs of liver disease were observed in most patients by both hepatic MRI and ARFI elastography but not by ultrasound imaging. Increased liver stiffness did not identify specific disease patterns from MRI, supporting the need for multimodality imaging to characterize liver disease in Fontan patients.

Keywords

• *Fontan circulation; *elastography; *hepatic magnetic resonance; *liver disease