Multimodality Screening of Hepatic Nodules in Patients With Congenital Heart Disease After Fontan Procedure: Role of Ultrasound, ARFI Elastography, CT, and MRI

Horvat, Natally; Rocha, Manoel de Souza; Chagas, Aline Lopes; Oliveira, Brunna Clemente; Pacheco, Mariana Poltronieri; Binotto, Maria Angélica; Ikari, Nana Miura; Paranaguá‐Vezozzo, Denise Cerqueira; Leão-Filho, Hilton Muniz; Vicentini, J.R.T.; Filho, Mauricio Ricardo Moreira da Silva; Jatene, Marcelo Biscegli; Carrilho, Flair José; Cerri, Giovanni Guido

doi:10.2214/ajr.18.19762

Cited by 37 publications

(32 citation statements)

References 40 publications

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“…Of that, 76% of patients had a value over the cirrhosis threshold of 1.55 m/s. In contrast, the mean shear wave propagation velocity was significantly lower in patients who had undergone heart transplant 31 . However, TE/shear-wave elastography (SWE) cannot distinguish hepatic congestion from fibrosis 34 .…”

Section: Introductionmentioning

confidence: 74%

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Fontan-associated liver disease and hepatocellular carcinoma in adults

Kogiso

Tokushige

2020

Sci Rep

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The Fontan operation creates a unique circulation, and is a palliative therapy for patients with single-ventricle congenital heart disease. Increased venous pressure and decreased cardiac output and hepatic venous drainage result in sinusoidal dilatation around the central veins. This causes congestion and hypoxia in the liver, leading to Fontan-associated liver disease (FALD). Non-invasive and invasive markers enable diagnosis and evaluation of the fibrosis status in chronic liver disease; however, these markers have not been validated in FALD. Additionally, regenerative nodules such as focal nodular hyperplasia (FNH) are frequently found. The severity of fibrosis correlates with the duration of the Fontan procedure and the central venous pressure. Cirrhosis is a risk factor for hepatocellular carcinoma (HCC), the annual risk of which is 1.5–5.0%. HCC is frequently difficult to diagnose and treat because of cardiac complications, coagulopathy, and congenital abnormalities. The mortality rate of FALD with liver cirrhosis and/or FALD-HCC was increased to ~ 29.4% (5/17 cases) in a nationwide survey. Although there is no consensus on the surveillance of patients with FALD, serial monitoring of the alpha fetoprotein level and imaging at 6-month intervals is required in patients with cirrhosis.

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Section: Introductionmentioning

confidence: 74%

“…Assessment of liver stiffness by transient elastography (TE), acoustic radiation force impulse (ARFI) elastography, and magnetic resonance elastography (MRE) enables evaluation of hepatic fibrosis 29 – 31 . However, it was not correlated with the histopathologic findings at a single time point 32 .…”

Section: Introductionmentioning

confidence: 99%

Fontan-associated liver disease and hepatocellular carcinoma in adults

Kogiso

Tokushige

2020

Sci Rep

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“…Ultrasonography has been proposed as a first choice of investigation, although it is relatively insensitive in detecting fibrotic changes and can miss nodules, which are often isoechoic with the liver parenchyma [ 57 ]. US imaging can, however, identify early phases of congestive hepatopathy and provide hemodynamic information on hepatic flow, important for serial evaluation of fibrosis/cirrhosis development.…”

Section: Fontan-associated Liver Diseasementioning

confidence: 99%

“…US imaging can, however, identify early phases of congestive hepatopathy and provide hemodynamic information on hepatic flow, important for serial evaluation of fibrosis/cirrhosis development. US elastography, especially shear-wave techniques, is gaining more experience in the serial follow-up in these patients [ 57 , 58 ]. Increased liver stiffness is present in the immediate Fontan postoperative period and persists in the majority of patients (Fig.…”

Section: Fontan-associated Liver Diseasementioning

confidence: 99%

Imaging of complications following Fontan circulation in children — diagnosis and surveillance

Lange

2020

Pediatr Radiol

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The Fontan operation is performed for various cardiac lesions with single-ventricle physiology. The survival rate of Fontan patients is increasing for adolescents and young adults, with an expected 30-year survival of >80%. Medical health care providers including specialists in organ systems and pediatric radiologists need to improve their knowledge about the Fontan circulation and the various organ complications to monitor care. In this review the author explains the basic anatomical and functional features of Fontan palliation and gives an overview of the multiple long-term organ complications that might present in the pediatric population. These include decreased physical capacity, ventricular dysfunction, atrioventricular valve regurgitation and arrhythmia, as well as protein-losing enteropathy, plastic bronchitis, growth/bone composition disturbances, renal dysfunction, and the recently recognized and important liver fibrosis (Fontan-associated liver disease). Neuropsychological and behavioral deficits occur frequently. This review focuses on the key role of radiology in making the diagnosis of these complications, monitoring therapy and predicting outcomes in the pediatric age group. The author discusses how and when radiology is important in Fontan patients, as well as how new techniques enabling quantitative measures in imaging with US, MRI and CT are adapted for pediatric use, and how they contribute to urgently needed surveillance strategies. Electronic supplementary material The online version of this article (10.1007/s00247-020-04682-5) contains supplementary material, which is available to authorized users.

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“…Camposilvan et al (25) e Buendia-Fuentes et al (72) avaliaram 34 e 37 pacientes, respectivamente, apenas com USG e não detectaram NH. Yoo et al (63) Outros estudos que utilizaram TC ou RM também apresentaram resultados comparáveis aos nossos com frequência de NH acima de 30% (81) , entre os quais os estudos de Buendia-Fuentes et al (72) , Bullut et al (58) , Wallihan et al (32) e Ginde et al (57) . Nesses estudos a frequência de NH foi de Com relação a USG, houve uma maior frequência de NH em dois estudos anteriores: a frequência de NH foi de 29% no estudo de Ackerman et al (79) e de 35% no estudo de Bae et al (66) .…”

Section: Frequência De Nódulos Hepáticosunclassified

Avaliação da frequência de nódulos hepáticos em pacientes submetidos ao procedimento de Fontan: o papel da ultrassonografia, tomografia computadorizada e ressonância magnética

Horvat¹

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Multimodality Screening of Hepatic Nodules in Patients With Congenital Heart Disease After Fontan Procedure: Role of Ultrasound, ARFI Elastography, CT, and MRI

Cited by 37 publications

References 40 publications

Fontan-associated liver disease and hepatocellular carcinoma in adults

Fontan-associated liver disease and hepatocellular carcinoma in adults

Imaging of complications following Fontan circulation in children — diagnosis and surveillance

Avaliação da frequência de nódulos hepáticos em pacientes submetidos ao procedimento de Fontan: o papel da ultrassonografia, tomografia computadorizada e ressonância magnética

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