title: Magnetic Resonance Elastography: A Novel Technique for the Detection of Hepatic Fibrosis and Hepatocellular Carcinoma After the Fontan Operation.
abstract: OBJECTIVE
  To evaluate the utility of magnetic resonance elastography (MRE) in screening patients for hepatic fibrosis, cirrhosis, and hepatocellular carcinoma after the Fontan operation.
  
  
  METHODS
  Hepatic MRE was performed in conjunction with cardiac magnetic resonance imaging in patients who had undergone a Fontan operation between 2010 and 2014. Liver stiffness was calculated using previously reported techniques. Comparisons to available clinical, laboratory, imaging, and histopathologic data were made.
  
  
  RESULTS
  Overall, 50 patients at a median age of 25 years (range, 21-33 years) who had undergone a Fontan operation were evaluated. The median interval between Fontan operation and MRE was 22 years (range, 16-26 years). The mean liver stiffness values were increased: 5.5 ± 1.4 kPa relative to normal participants. Liver stiffness directly correlated with liver biopsy-derived total fibrosis score, time since operation, mean Fontan pressure, γ-glutamyltransferase level, Model for End-Stage Liver Disease score, creatinine level, and pulmonary vascular resistance index. Liver stiffness was inversely correlated with cardiac index. All 3 participants with hepatic nodules exhibiting decreased contrast uptake on delayed postcontrast imaging and increased nodule stiffness had biopsy-proven hepatocellular carcinoma.
  
  
  CONCLUSIONS
  The association between hepatic stiffness and fibrosis scores, Model for End-Stage Liver Disease scores, and γ-glutamyltransferase level suggests that MRE may be useful in detecting (and possibly quantifying) hepatic cirrhosis in patients after the Fontan operation. The correlation between stiffness and post-Fontan time interval, mean Fontan pressure, pulmonary vascular resistance index, and reduced cardiac index suggests a role for long-term hepatic congestion in creating these hepatic abnormalities. Magnetic resonance elastography was useful in detecting abnormal nodules ultimately diagnosed as hepatocellular carcinoma. The relationship between stiffness with advanced fibrosis and hepatocellular carcinoma provides a strong argument for additional study and broader application of MRE in these patients.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN. Electronic address: poterucha.joseph@mayo.edu.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Poterucha
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Johnson
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
authors.forename: M Yasir
authors.initials: MY
authors.lastname: Qureshi
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: O'Leary
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Kamath
authors.affiliation: Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Lennon
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Crystal R
authors.initials: CR
authors.lastname: Bonnichsen
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN.
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Young
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN.
authors.forename: Sudhakar K
authors.initials: SK
authors.lastname: Venkatesh
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Ehman
authors.affiliation: Department of Pathology, Mayo Clinic, Rochester, MN.
authors.forename: Sounak
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Department of Pathology, Mayo Clinic, Rochester, MN.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Smyrk
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Dearani
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Carole A
authors.initials: CA
authors.lastname: Warnes
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN; Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Frank
authors.initials: F
authors.lastname: Cetta
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000209:etiology; D003937:Diagnosis, Differential; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000009:adverse effects*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000209:etiology; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000209:etiology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055815:Young Adult