Shiraga Kazuhiro, Ono Kojiro, Inuzuka Ryo, Asakai Hiroko, Ookubo Takumi, Shirayama Akira, Higashi Kouji, Nakajima Hiromichi
Department of Cardiology, Chiba Children's Hospital, Chiba, Japan.
Department of Pediatrics, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan.
Cardiol Young. 2019 Jul;29(7):898-903. doi: 10.1017/S1047951119001070. Epub 2019 Jun 28.
Liver fibrosis and cirrhosis are one of the critical complications in Fontan patients. However, there are no well-established non-invasive and quantitative techniques for evaluating liver abnormalities in Fontan patients. Intravoxel incoherent motion diffusion-weighted imaging with MRI is a non-invasive and quantitative method to evaluate capillary network perfusion and molecular diffusion. The objective of this study is to assess the feasibility of intravoxel incoherent motion imaging in evaluating liver abnormalities in Fontan children.
Five consecutive Fontan patients and four age-matched healthy volunteers were included. Fontan patients were 12.8 ± 1.5 years old at the time of MRI scan. Intravoxel incoherent motion imaging parameters (D, D*, and f values) within the right hepatic lobe were compared. Laboratory test, ultrasonography, and cardiac MRI were also conducted in the Fontan patients. Results of cardiac catheterization conducted within one year of the intravoxel incoherent motion imaging were also examined.
In Fontan patients, laboratory test and liver ultrasonography showed almost normal liver condition. Cardiac catheter and MRI showed good Fontan circulation. Cardiac index was 2.61 ± 0.23 L/min/m2. Intravoxel incoherent motion imaging parameters D, D*, and f values were lower in Fontan patients compared with controls (D: 1.1 ± 0.0 versus 1.3 ± 0.2 × 10-3 mm2/second (p = 0.04), D*: 30.8 ± 24.8 versus 113.2 ± 25.6 × 10-3 mm2/second (p < 0.01), and f: 13.2 ± 3.1 versus 22.4 ± 2.4% (p < 0.01), respectively).
Intravoxel incoherent motion imaging is feasible for evaluating liver abnormalities in children with Fontan circulation.
肝纤维化和肝硬化是Fontan手术患者的关键并发症之一。然而，目前尚无成熟的非侵入性定量技术用于评估Fontan手术患者的肝脏异常情况。磁共振成像的体素内不相干运动扩散加权成像（IVIM-DWI）是一种评估毛细血管网络灌注和分子扩散的非侵入性定量方法。本研究的目的是评估体素内不相干运动成像在评估Fontan手术患儿肝脏异常情况中的可行性。
纳入连续5例Fontan手术患者和4例年龄匹配的健康志愿者。Fontan手术患者在进行磁共振成像扫描时的年龄为12.8±1.5岁。比较右肝叶内的体素内不相干运动成像参数（D、D*和f值）。对Fontan手术患者还进行了实验室检查、超声检查和心脏磁共振成像。同时检查了在体素内不相干运动成像后一年内进行的心导管检查结果。
在Fontan手术患者中，实验室检查和肝脏超声显示肝脏情况基本正常。心导管检查和磁共振成像显示Fontan循环良好。心脏指数为2.61±0.23L/min/m²。与对照组相比，Fontan手术患者的体素内不相干运动成像参数D、D和f值较低（D：1.1±0.0对1.3±0.2×10⁻³mm²/秒（p = 0.04），D：30.8±24.8对113.2±25.6×10⁻³mm²/秒（p < 0.01），f：13.2±3.1对22.4±2.4%（p < 0.01））。
体素内不相干运动成像在评估Fontan循环患儿的肝脏异常情况方面是可行的。
