Hepatic magnetic resonance T1-mapping and extracellular volume fraction compared to shear-wave elastography in pediatric Fontan-associated liver disease

Abstract

Background Children with Fontan circulation are at risk of developing hepatic fibrosis/cirrhosis. Reliable noninvasive monitoring techniques are lacking or under development. Objective To investigate surrogate indicators of hepatic fibrosis in adolescents with Fontan circulation by evaluating hepatic magnetic resonance (MR) T1 mapping and extracellular volume fraction measurements compared to US shear-wave elastography. Materials and methods We analyzed hepatic native T1 times and extracellular volume fractions with modified Look-Locker inversion recovery. Liver stiffness was analyzed with shear-wave elastography. We compared results between 45 pediatric patients ages 16.7±0.6 years with Fontan circulation and 15 healthy controls ages 19.2±1.2 years. Measurements were correlated to clinical and hemodynamic data from cardiac catheterization. Results MR mapping was successful in 35/45 patients, revealing higher hepatic T1 times (774±44 ms) than in controls (632±52 ms; P<0.001) and higher extracellular volume fractions (47.4±5.0%) than in controls (34.6±3.8%; P<0.001). Liver stiffness was 1.91±0.13 m/s in patients vs. 1.20±0.10 m/s in controls (P<0.001). Native T1 times correlated with central venous pressures (r=0.5, P=0.007). Native T1 was not correlated with elastography in patients (r=0.2, P=0.1) or controls (r = −0.3, P=0.3). Extracellular volume fraction was correlated with elastography in patients (r=0.5, P=0.005) but not in controls (r=0.2, P=0.6). Conclusion Increased hepatic MR relaxometry and shear-wave elastography values in adolescents with Fontan circulation suggested the presence of hepatic fibrosis or congestion. Central venous pressure was related to T1 times. Changes were detected differently with MR relaxometry and elastography; thus, these techniques should not be used interchangeably in monitoring hepatic fibrosis.

4D flow cardiovascular magnetic resonance derived energetics in the Fontan circulation correlate with exercise capacity and CMR-derived liver fibrosis/congestion

“…Although cT1 values showed good correlation with histologic liver fibrosis in adult patients with liver disease [ 15 ], validation in Fontan patients is currently lacking. Especially venous congestion will influence T1 values in Fontan patients since increased CVP has been correlated with increased levels of liver T1 [ 30 ]. Therefore, distinction between liver fibrosis or congestion due to increased CVP on elevated cT1 cannot be determined.…”

Efficacy Analysis of Double‐Low Dynamic Contrast‐Enhanced CT and Hepatic Extracellular Volume Fraction in the Diagnosis of Liver Fibrosis

“…High radiation doses will cause long-term adverse effects on high-sensitive organs such as the thyroid, thereby increasing the risk of iatrogenic renal failure. With the advantages of low dose and low radiation, the double-low DCE-CT technology not only effectively reduces the damage of the high-dose X-ray radiation caused by scanning but also markedly reduces the risk of contrast-induced nephropathy caused by the injection of high-dose contrast agents [ 15 ], which has been confirmed in diseases such as pulmonary embolism and solitary pulmonary nodules [ 16 , 17 ]. In this study, the double-low DCE-CT diagnostic technique could not only obtain the perfusion information of the lesions but also comprehensively evaluate the overall morphology and blood supply of the liver lesions.…”

Liver T1/T2 values with cardiac MRI during respiration

“…Figure 5 shows a summary of previously reported liver T1 values and extracellular volume (ECV) by modified Look-Locker inversion recovery in children and adults. 6,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] The data were calculated from the range or mean ± 2SD, as described in the paper. Similar to myocardial T1 values, liver T1 values were higher at 3 T than at 1.5 T. Patients with hepatic and cardiac diseases tend to have higher liver T1 values than controls, especially in patients who had undergone the Fontan operation.…”