Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Assessment of liver morphology as a target organ in patients after Fontan operation using computed and magnetic resonance imaging

Authors: Kaderkaeva A.R., Aleksandrova S.A., Kovalev D.V., Glazkova E.Yu., Mataeva T.V., Terekhov M.I., Dorofeev A.V., Aslanidis I.P., Yurlov I.A.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

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DOI: https://doi.org/10.24022/1814-6910-2023-20-4-380-389

UDC: [616.12-007-053.1-089-06]+[616.36-073.756.8]

Link: Clinical Physiology of Blood Circulaiton. 2023; 4 (20): 380-389

Quote as: Kaderkaeva A.R., Aleksandrova S.A., Kovalev D.V., Glazkova E.Yu., Mataeva T.V., Terekhov M.I., Dorofeev A.V., Aslanidis I.P., Yurlov I.A. Assessment of liver morphology as a target organ in patients after Fontan operation using computed and magnetic resonance imaging. Clinical Physiology of Circulation. 2023; 20 (4): 380–9 (in Russ.). DOI: 10.24022/1814-6910-2023-20-4-380-389

Received / Accepted:  12.07.2023 / 10.10.2023

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Abstract

Objective. To identify morphologic changes of the liver in patients with a Fontan circulation on the base of computed (CT) and magnetic resonance imaging (MRI).

Material and methods. The study included 72 patients after Fontan operation, average age was 15±7 years. Liver assessment was performed as part of a comprehensive chest and abdominal scan with contrast enhancement in these patients: 42 CT scans and 37 1.5T MRI scans.

Results. The assessing the liver protocol includes morphometry, tissue characteristics of the liver and the presence of pathological nodules. The volume of the liver with linear dimensions compared by CT data revealed a high correlation (r=0.76; p<0.01) between the oblique vertical size and the indexed liver volume was revealed, however, according to MRI, there was no correlation (r=0.35; p >0.05). The structure of the liver was assessed by CT, measuring the density in the native phase, using MRI data from T1 and T2 mapping, as well as the value of the extracellular volume (ECV) of the left and right lobes of the liver. The thickness of the fibrous septa was measured by CT at 46±16 s from the start of the contrast agent injection, by MRI on T1_FS in the venous phase, when comparing the data, no statistically significant difference was found (Mann–Whitney U=0.96, p=0.05). A significant correlation was found between the thickness of the fibrous septa and T1-mapping values of the left lobe of the liver (r=0.53; p<0.01). According to the ROC analysis, the native time of T1 relaxation of the left lobe of the liver, more than 761 ms, increased the presence of pronounced fibrous septa (sensitivity 75%, specificity 83.3%). A significant correlation was established between the age of patients, the duration of the interval after the Fontan operation and the severity of fibrous septa (r=0.46, p<0.05 and r=0.48, p<0.01). Hepatic nodules were detected by CT scan at 27±2 s from the start of contrast agent administration, by MRI on T2_TSE_Tra and T1_FS in the venous phase, and they were detected in 17% of cases by CT and in 6% by MRI, the median post-op period was 11 years, which is consistent with literature data.

Conclusion. The presented approach to evaluation for the liver assessing by means of CT and MRI in patients with a Fontan circulation allows to characterize: morphometric parameters and structure of the liver, the severity of fibrous septa, the presence of hypervascular hepatic nodules, and the diameter of the portal vein. The data obtained can be used for dynamic monitoring of patients after Fontan operation and timely diagnosis of emerging complications.

About Authors

  • Alfiya R. Kaderkaeva, Resident Physician; ORCID
  • Aleksandrova, Cand. Med. Sci., Senior Researcher, Head of MRI Department; ORCID
  • Dmitriy V. Kovalev, Dr. Med. Sci, Leading Researcher, Cardiovascular Surgeon; ORCID
  • Elena Yu. Glazkova, Cand. Med. Sci., Researcher, Associate Professor at Chair of Radiation Diagnostics; ORCID
  • Tatyana V. Mataeva, Cand. Med. Sci., Radiologist; ORCID
  • Maksim I. Terekhov, Radiologist; ORCID
  • Aleksey V. Dorofeev, Cand. Med. Sci., Head of Department of X-ray diagnostics, CT and MRI, Associate Professor at Chair of Radiation Diagnostics; ORCID
  • Irakliy P. Aslanidis, Dr. Med. Sc., Professor, Deputy Director, Head of Department of Nuclear Medicine, Chief of Chair of Radiation Diagnostics; ORCID
  • Ivan A. Yurlov, Cand. Med. Sci., Cardiovascular Surgeon; ORCID

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