Inmutto Nakarin, Jantarangkoon Attaporn, Nimitrungtawee Natthapong, Sriwicha Nattaporn, Kongkarnka Sarawut, Sethasathien Saviga, Srisuwan Tanop
Radiology department, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
BMC Gastroenterol. 2025 Aug 5;25(1):553. doi: 10.1186/s12876-025-04151-z.
The Fontan operation improves survival in patients with single ventricle physiology but is associated with Fontan-associated liver disease (FALD), characterized by progressive fibrosis due to prolonged elevated central venous pressure. While 2D shear wave elastography (2D-SWE) can assess fibrosis, it often overestimates stiffness in congestive conditions. Doppler ultrasound, which evaluates hepatic hemodynamics, may complement 2D-SWE for fibrosis assessment. This study evaluated the diagnostic performance of Doppler ultrasound and 2D-SWE in assessing hepatic fibrosis in Fontan patients and compared the findings with biopsy-proven fibrosis severity.
A retrospective study was conducted on 27 Fontan patients who underwent Doppler ultrasound, 2D-SWE, and liver biopsy between January 2020 and December 2022. ROC curves and AUC values were used to assess diagnostic performance.
AST to Platelet Ratio Index (APRI) and Fibrosis-4 index (FIB-4) scores demonstrated good discriminatory performance, with AUC values of 0.79 and 0.72, respectively. Resistive Index (RI) of hepatic artery showed moderate discriminatory performance (AUC = 0.62), while 2D-SWE demonstrated poor discriminatory ability (AUC = 0.35). When RI was combined with APRI, the AUC improved from 0.79 to 0.82.
APRI and FIB-4 provided the most accurate assessment of significant fibrosis, while RI of hepatic artery may serve as a useful adjunct to serum biomarkers. Incorporating Doppler ultrasound into a multi-parametric model may improve fibrosis evaluation in Fontan patients.
Fontan手术可提高单心室生理患者的生存率，但与Fontan相关肝病（FALD）有关，其特征是由于中心静脉压长期升高导致进行性纤维化。虽然二维剪切波弹性成像（2D-SWE）可以评估纤维化，但在充血状态下它往往会高估硬度。评估肝脏血流动力学的多普勒超声可能会补充2D-SWE用于纤维化评估。本研究评估了多普勒超声和2D-SWE在评估Fontan患者肝纤维化中的诊断性能，并将结果与经活检证实的纤维化严重程度进行比较。
对2020年1月至2022年12月期间接受多普勒超声、2D-SWE和肝活检的27例Fontan患者进行了回顾性研究。使用ROC曲线和AUC值评估诊断性能。
AST与血小板比值指数（APRI）和纤维化-4指数（FIB-4）评分显示出良好的鉴别性能，AUC值分别为0.79和0.72。肝动脉阻力指数（RI）显示出中等鉴别性能（AUC = 0.62），而2D-SWE显示出较差的鉴别能力（AUC = 0.35）。当RI与APRI联合使用时，AUC从0.79提高到0.82。
APRI和FIB-4对显著纤维化提供了最准确的评估，而肝动脉RI可作为血清生物标志物的有用辅助指标。将多普勒超声纳入多参数模型可能会改善Fontan患者的纤维化评估。
