1 Radiology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Dr. Enéas de Carvalho Aguiar, Rua Dr. Ovídio Pires de Campos, 255 Cerqueira César, São Paulo, SP 05403-900, Brazil.
2 Hepatology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
AJR Am J Roentgenol. 2018 Dec;211(6):1212-1220. doi: 10.2214/AJR.18.19762. Epub 2018 Sep 24.
Currently, there is no consensus in the literature regarding the screening of hepatic nodules in patients who have undergone the Fontan procedure. The objectives of this study are to evaluate in this population the frequency of hepatic nodules at ultrasound (US), CT, and MRI; to measure liver stiffness using acoustic radiation force impulse (ARFI) elastography; and to investigate predictive factors for hepatic nodules.
In this cross-sectional study, 49 patients who underwent the Fontan procedure were prospectively recruited from August 2014 through June 2016. These patients underwent clinical evaluation for hepatic disorders, ARFI elastography, US, CT, and MRI.
Most of the patients had no symptoms, and hepatic nodules were detected in three of 49 (6.1%) patients at US, 14 of 44 (31.8%) patients at CT, and 19 of 48 (39.6%) patients at MRI. Liver stiffness at ARFI elastography was significantly higher in patients with hepatic nodules than in patients without such nodules (2.64 ± 0.81 m/s vs 1.94 ± 0.49 m/s; p = 0.002) and was a significant predictor of hepatic nodule (AUC, 0.767; p = 0.002). No clinical or laboratory data had any significant correlation with the existence of hepatic nodules, including time since Fontan procedure.
In our study, more than one-third of patients had hepatic nodules at CT or MRI, but US did not detect most hepatic nodules. Liver stiffness at ARFI elastography was significantly higher in patients with hepatic nodules, and it may help guiding which patient should be further imaged with CT or MRI.
目前，对于 Fontan 手术后患者的肝脏结节筛查，文献中尚无共识。本研究的目的是评估该人群中超声（US）、CT 和 MRI 检查肝脏结节的频率；使用声辐射力脉冲（ARFI）弹性成像测量肝脏硬度；并探讨肝脏结节的预测因素。
在这项前瞻性的横断面研究中，从 2014 年 8 月至 2016 年 6 月，共招募了 49 例接受了 Fontan 手术的患者。这些患者接受了肝脏疾病的临床评估、ARFI 弹性成像、US、CT 和 MRI 检查。
大多数患者无症状，US 检查发现 49 例患者中有 3 例（6.1%）、CT 检查发现 44 例中有 14 例（31.8%）、MRI 检查发现 48 例中有 19 例（39.6%）存在肝脏结节。ARFI 弹性成像检测到肝脏结节的患者肝脏硬度明显高于未检测到肝脏结节的患者（2.64 ± 0.81 m/s 比 1.94 ± 0.49 m/s；p = 0.002），且是肝脏结节的显著预测因子（AUC，0.767；p = 0.002）。包括 Fontan 手术后时间在内的临床或实验室数据与肝脏结节的存在均无显著相关性。
在我们的研究中，超过三分之一的患者在 CT 或 MRI 上存在肝脏结节，但 US 未检测到大多数肝脏结节。ARFI 弹性成像检测到肝脏结节的患者肝脏硬度明显升高，这可能有助于指导哪些患者需要进一步进行 CT 或 MRI 成像。
