Magnetic resonance elastography of the liver in patients status-post fontan procedure: Feasibility and preliminary results

Suraj D. Serai, Daniel B. Wallihan, Sudhakar K Venkatesh, Richard Lorne Ehman, Kathleen M. Campbell, Joshua Sticka, Bradley S. Marino, Daniel J. Podberesky

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Objective: The purpose of this study was to evaluate the feasibility of performing magnetic resonance elastography (MRE) as a screening tool for elevated liver stiffness in patients' status-post Fontan procedure. Background: With greater numbers of Fontan patients surviving far into adulthood, a factor increasingly affecting long-term prognosis is the presence of hepatic congestion and fibrosis. If detected early, steps can be taken to potentially slow or halt the progression of fibrosis. MRE is a relatively new, noninvasive imaging technique, which can quantitatively measure liver stiffness and provide an estimate of the extent of fibrosis. Methods: A retrospective study was conducted using MRE to evaluate liver stiffness in patients with a history of Fontan procedure. An MRE was performed in the same session as a clinical cardiac MRI. The liver was interrogated at four slice locations, and a mean liver stiffness value was calculated for each patient using postprocessing software. The medical records were reviewed for demographic and clinical characteristics. Results: During the time frame of this investigation, 17 MRE exams were performed on 16 patients. All patients had elevated liver stiffness values as defined by MRE standards. The median of the individual mean liver stiffness values was 5.1kPa (range: 3.4-8.2kPa). This range of liver stiffness elevation would suggest the presence of mild to severe fibrosis in a patient with standard cardiovascular anatomy. We found a significant trend toward higher liver stiffness values with greater duration of Fontan circulation (rs = 0.55, P = .02). Conclusion: Our preliminary findings suggest that MRE is a feasible method for evaluating the liver in Fontan patients who are undergoing surveillance cardiac MRI. Further investigation with histologic correlation is needed to determine the contributions of hepatic congestion and fibrosis to the liver stiffness in this population.

Original languageEnglish (US)
Pages (from-to)7-14
Number of pages8
JournalCongenital Heart Disease
Volume9
Issue number1
DOIs
StatePublished - Jan 2014

Fingerprint

Fontan Procedure
Elasticity Imaging Techniques
Liver
Fibrosis
Liver Cirrhosis
Medical Records
Anatomy

Keywords

  • Elastography
  • Fontan
  • Liver biopsy
  • MRE
  • Pediatric

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Radiology Nuclear Medicine and imaging

Cite this

Magnetic resonance elastography of the liver in patients status-post fontan procedure : Feasibility and preliminary results. / Serai, Suraj D.; Wallihan, Daniel B.; Venkatesh, Sudhakar K; Ehman, Richard Lorne; Campbell, Kathleen M.; Sticka, Joshua; Marino, Bradley S.; Podberesky, Daniel J.

In: Congenital Heart Disease, Vol. 9, No. 1, 01.2014, p. 7-14.

Research output: Contribution to journalArticle

Serai, Suraj D. ; Wallihan, Daniel B. ; Venkatesh, Sudhakar K ; Ehman, Richard Lorne ; Campbell, Kathleen M. ; Sticka, Joshua ; Marino, Bradley S. ; Podberesky, Daniel J. / Magnetic resonance elastography of the liver in patients status-post fontan procedure : Feasibility and preliminary results. In: Congenital Heart Disease. 2014 ; Vol. 9, No. 1. pp. 7-14.
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AU - Ehman, Richard Lorne

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AB - Objective: The purpose of this study was to evaluate the feasibility of performing magnetic resonance elastography (MRE) as a screening tool for elevated liver stiffness in patients' status-post Fontan procedure. Background: With greater numbers of Fontan patients surviving far into adulthood, a factor increasingly affecting long-term prognosis is the presence of hepatic congestion and fibrosis. If detected early, steps can be taken to potentially slow or halt the progression of fibrosis. MRE is a relatively new, noninvasive imaging technique, which can quantitatively measure liver stiffness and provide an estimate of the extent of fibrosis. Methods: A retrospective study was conducted using MRE to evaluate liver stiffness in patients with a history of Fontan procedure. An MRE was performed in the same session as a clinical cardiac MRI. The liver was interrogated at four slice locations, and a mean liver stiffness value was calculated for each patient using postprocessing software. The medical records were reviewed for demographic and clinical characteristics. Results: During the time frame of this investigation, 17 MRE exams were performed on 16 patients. All patients had elevated liver stiffness values as defined by MRE standards. The median of the individual mean liver stiffness values was 5.1kPa (range: 3.4-8.2kPa). This range of liver stiffness elevation would suggest the presence of mild to severe fibrosis in a patient with standard cardiovascular anatomy. We found a significant trend toward higher liver stiffness values with greater duration of Fontan circulation (rs = 0.55, P = .02). Conclusion: Our preliminary findings suggest that MRE is a feasible method for evaluating the liver in Fontan patients who are undergoing surveillance cardiac MRI. Further investigation with histologic correlation is needed to determine the contributions of hepatic congestion and fibrosis to the liver stiffness in this population.

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