Magnetic resonance imaging of the liver in hepatosplenic schistosomiasis mansoni

For the last two decades, ultrasound (US) has been considered a surrogate for the gold standard in the evaluation of liver fibrosis in schistosomiasis. The use of magnetic resonance imaging (MRI) is not yet standardised for diagnosing and grading liver schistosomal fibrosis. The aim of this paper was to analyse MRI using an adaptation of World Health Organization (WHO) patterns for US assessment of schistosomiasis-related morbidity. US and MRI were independently performed in 60 patients (42.1 ± 13.4 years old), including 37 men and 23 women with schistosomiasis. Liver involvement appraised by US and MRI was classified according to the WHO protocol from patterns A-F. Agreement between image methods was evaluated by kappa index (k). The correlation between US and MRI was poor using WHO patterns [k = 0.14; confidence interval (CI) 0.02; 0.26]. Even after grouping image patterns as "A-D", "Dc-E" and "Ec-F", the correlation between US and MRI remained weak (k = 0.39; CI 0.21; 0.58). The magnetic resonance adaptation used in our study did not confirm US classification of WHO patterns for liver fibrosis

Section: Discussionsupporting

confidence: 90%

mentioning

confidence: 99%

Schistosoma mansoni: magnetic resonance analysis of liver fibrosis according to WHO patterns for ultrasound assessment of schistosomiasis-related morbidity

Silva

Andrade

Queiroz

et al. 2010

“…A recent investigation comparing ultrasound to magnetic resonance and liver histology further revealed drawbacks of ultrasound diagnosis and grading of Symmers fibrosis (Lambertucci et al 2002, Voieta 2008. Magnetic resonance, however, demands resources unavailable in most endemic countries and large scale liver biopsy in field-based studies contradicts elementary ethical principles.…”

Section: Discussionmentioning

confidence: 99%

Serum hyaluronan and collagen IV as non-invasive markers of liver fibrosis in patients from an endemic area for schistosomiasis mansoni: a field-based study in Brazil

Marinho¹,

Bretas

Voieta³

et al. 2010

Self Cite

“…In schistosomiasis, MR alterations have already been described in case reports and in series of cases (Patel et al 1993, Willemsen et al 1995, Lambertucci et al 2002, 2004, Silva et al 2006, Bezerra et al 2007, Silva 2007. However, to our knowledge, no study has compared US and MR to liver histology in patients with hepatosplenic schistosomiasis.…”

mentioning

confidence: 95%

Imaging techniques and histology in the evaluation of liver fibrosis in hepatosplenic schistosomiasis mansoni in Brazil: a comparative study

Voieta

Queiroz

Andrade

et al. 2010

Self Cite

Few publications have compared ultrasound (US) to histology in diagnosing schistosomiasis-induced liver fibrosis (LF); none has used magnetic resonance (MR). The aim of this study was to evaluate schistosomal LF using these three methods. Fourteen patients with hepatosplenic schistosomiasis admitted to hospital for surgical treatment of variceal bleeding were investigated. They were submitted to upper digestive endoscopy, US, MR and wedge liver biopsy. The World Health Organization protocol for US in schistosomiasis was used. Hepatic fibrosis was classified as absent, slight, moderate or intense. Histology and MR confirmed Symmers' fibrosis in all cases. US failed to detect it in one patient. Moderate agreement was found comparing US to MR; poor agreement was found when US or MR were compared to histology. Re-classifying LF as only slight or intense created moderate agreement between imaging techniques and histology. Histomorphometry did not separate slight from intense LF. Two patients with advanced hepatosplenic schistosomiasis presented slight LF. Our data suggest that the presence of the characteristic periportal fibrosis, diagnosed by US, MR or histology, associated with a sign of portal hypertension, defines the severity of the disease. We conclude that imaging techniques are reliable to define the presence of LF but fail in grading its intensity