Pediatric Radiology Department.
Istanbul University, Istanbul Medical Faculty, Pediatric Cardiology Department, Istanbul. Turkey.
Ultrasound Q. 2020 Dec;36(4):350-356. doi: 10.1097/RUQ.0000000000000541.
We aimed to investigate Fontan associated liver disease in children by shear wave elastography (SWE). This is a single-center, prospective case-control study included 41 patients with Fontan physiology and 30 healthy controls. Hepatic and splenic shear wave elasticity values were exhibited both as kPa and m/s. The mean hepatic SWE values of Fontan patients (n = 41; 15.8 ± 3.2 kPa or 2.5 ± 1.8 m/s) were significantly higher than the control group (n = 30; 5.59 ± 0.6 kPa or 1.37 ± 0.07 m/s) (P < 0.001). The mean splenic SWE values of Fontan patients were (25.6 ± 4.61 kPa or 2.85 ± 0.22 m/s) significantly higher than the control group (15.9 ± 1.44 kPa or 2.29 ± 0.1 m/s) (P < 0.001). There were statistically significant positive correlations among the follow-up duration after the Fontan procedure with NT-proBNP (P = 0.008, r = 1) and prothrombin time (P = 0.009, r = 0.4) as well as the hepatic SWE values with alanine aminotransferase (P = 0.039, r = 0.32), gamma-glutamyl transferase (P = 0.045, r = 0.31), and PT (P = 0.011, r = 0.39). There has been statistically significant moderate positive correlations of splenic stiffness values with PT (P = 0.047, r = 0.34), and INR (P = 0.038, r = 0.35). The sensitivity and specificity of liver stiffness cutoff value as 11.1 kPa for detection of Fontan associated liver disease were 95% and 100%, respectively. The hepatic and splenic stiffness increase independently in Fontan patients due to parenchymal disease. Hepatic SWE is a reliable and noninvasive predictor of early hepatic alterations that could not be detected only by biochemical results or routine ultrasound examinations.
我们旨在通过剪切波弹性成像（SWE）研究 Fontan 相关肝病。这是一项单中心前瞻性病例对照研究，纳入了 41 例 Fontan 生理学患者和 30 例健康对照者。肝脏和脾脏的剪切波弹性值以千帕和米/秒表示。Fontan 患者（n=41）的平均肝脏 SWE 值（15.8±3.2kPa 或 2.5±1.8m/s）明显高于对照组（n=30）（5.59±0.6kPa 或 1.37±0.07m/s）（P<0.001）。Fontan 患者的平均脾脏 SWE 值（25.6±4.61kPa 或 2.85±0.22m/s）明显高于对照组（15.9±1.44kPa 或 2.29±0.1m/s）（P<0.001）。Fontan 手术后的随访时间与 NT-proBNP（P=0.008，r=1）和凝血酶原时间（P=0.009，r=0.4）呈正相关，与肝 SWE 值与丙氨酸氨基转移酶（P=0.039，r=0.32）、γ-谷氨酰转移酶（P=0.045，r=0.31）和 PT（P=0.011，r=0.39）呈正相关。脾脏硬度值与 PT（P=0.047，r=0.34）和 INR（P=0.038，r=0.35）呈中度正相关。肝脏硬度截断值为 11.1kPa 时，检测 Fontan 相关肝病的敏感性和特异性分别为 95%和 100%。由于实质疾病，Fontan 患者的肝脾硬度均独立增加。肝 SWE 是早期肝改变的可靠、非侵入性预测因子，仅通过生化结果或常规超声检查无法检测到。
