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Prevalence, features and predictive factors of liver nodules in Fontan surgery patients: The VALDIG Fonliver prospective cohort
Journal of Hepatology ( IF 26.8 ) Pub Date : 2020-04-01 , DOI: 10.1016/j.jhep.2019.10.027 Luis Téllez 1 , Enrique Rodríguez de Santiago 1 , Beatriz Minguez 2 , Audrey Payance 3 , Ana Clemente 4 , Anna Baiges 5 , Dalia Morales-Arraez 6 , Vincenzo La Mura 7 , Elba Llop 8 , Elena Garrido 1 , Elvira Garrido-Lestache 9 , Stephanie Tasayco 2 , Onorina Bruno 10 , Raquel Prieto 11 , Silvia Montserrat 12 , Mónica Pons 2 , Andreína Olavarría 13 , Laura Dos 14 , Antoine Legendre 15 , María Jesús Del Cerro 9 , Rafael Bañares 4 , Juan Carlos García-Pagán 5 , Pierre-Emmanuel Rautou 3 , Agustín Albillos 1 ,
Journal of Hepatology ( IF 26.8 ) Pub Date : 2020-04-01 , DOI: 10.1016/j.jhep.2019.10.027 Luis Téllez 1 , Enrique Rodríguez de Santiago 1 , Beatriz Minguez 2 , Audrey Payance 3 , Ana Clemente 4 , Anna Baiges 5 , Dalia Morales-Arraez 6 , Vincenzo La Mura 7 , Elba Llop 8 , Elena Garrido 1 , Elvira Garrido-Lestache 9 , Stephanie Tasayco 2 , Onorina Bruno 10 , Raquel Prieto 11 , Silvia Montserrat 12 , Mónica Pons 2 , Andreína Olavarría 13 , Laura Dos 14 , Antoine Legendre 15 , María Jesús Del Cerro 9 , Rafael Bañares 4 , Juan Carlos García-Pagán 5 , Pierre-Emmanuel Rautou 3 , Agustín Albillos 1 ,
Affiliation
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BACKGROUND AND AIMS
Fontan surgery is used to treat a variety of congenital heart malformations, and may lead to advanced chronic liver disease in the long-term. This study examines the prevalence, characteristics and predictors of liver nodules in patients with Fontan surgery. METHODS
This was a prospective, cross-sectional and observational study conducted at eight European centres. Consecutive patients with Fontan surgery underwent blood tests, abdominal ultrasonography (US), transient elastography (Fibroscan®), echocardiography, hemodynamics, and abdominal MRI/CT scan. The primary outcome measure was liver nodules detected in the MRI/CT scan. Predictors of liver nodules were identified by multivariate logistic regression. RESULTS
One hundred and fifty-two patients were enrolled (mean age 27.3 years). The mean time elapsed from surgery to inclusion was 18.3 years. Liver nodule prevalences were 29.6% (95% CI: 23-37%) on US and 47.7% (95% CI: 39-56%) on MRI/CT. Nodules were usually hyperechoic (76.5%), round-shaped (>80%), hyperenhancing in the arterial phase (92%) and located in the liver periphery (75%). The sensitivity and specificity of US were 50% (95% CI: 38-62%) and 85.3% (95% CI: 75-92%), respectively. Inter-imaging test agreement was low (adjusted kappa: 0.34). In the multivariate analysis, time since surgery > 10 years was the single independent predictor of liver nodules (OR: 4.18, P=0.040). Hepatocellular carcinoma was histologically diagnosed in 2 of the 8 patients with hypervascular and washout liver nodules. CONCLUSION
While liver nodules are frequent in Fontan patients, they may go unnoticed in US. Liver nodules are usually hyperechoic, hypervascular and predominantly peripheral. This population is at risk of hepatocellular carcinoma, the diagnosis of which requires biopsy confirmation.
中文翻译：
Fontan 手术患者肝结节的患病率、特征和预测因素：VALDIG Fonliver 前瞻性队列
背景与目的 Fontan手术用于治疗多种先天性心脏畸形，长期可能导致晚期慢性肝病。本研究调查了 Fontan 手术患者肝结节的患病率、特征和预测因素。方法 这是一项在八个欧洲中心进行的前瞻性、横断面和观察性研究。连续接受 Fontan 手术的患者接受了血液检查、腹部超声检查 (US)、瞬时弹性成像 (Fibroscan®)、超声心动图、血流动力学和腹部 MRI/CT 扫描。主要结果指标是在 MRI/CT 扫描中检测到的肝脏结节。通过多变量逻辑回归确定肝结节的预测因子。结果 招募了 152 名患者（平均年龄 27.3 岁）。从手术到入组的平均时间为 18.3 年。肝结节患病率在 US 上为 29.6%（95% CI：23-37%），在 MRI/CT 上为 47.7%（95% CI：39-56%）。结节通常为高回声 (76.5%)、圆形 (>80%)、动脉期高强化 (92%) 和位于肝脏外围 (75%)。US 的敏感性和特异性分别为 50% (95% CI: 38-62%) 和 85.3% (95% CI: 75-92%)。图像间测试一致性较低（调整后的 kappa：0.34）。在多变量分析中，手术时间 > 10 年是肝结节的单一独立预测因素（OR：4.18，P=0.040）。在 8 名患有血管丰富和冲洗性肝结节的患者中，有 2 名被组织学诊断为肝细胞癌。结论 虽然 Fontan 患者肝脏结节很常见，但在美国可能会被忽视。肝结节通常呈高回声、血管丰富且主要是外周。该人群有患肝细胞癌的风险，其诊断需要活检确认。
更新日期：2020-04-01
中文翻译：
Fontan 手术患者肝结节的患病率、特征和预测因素：VALDIG Fonliver 前瞻性队列
背景与目的 Fontan手术用于治疗多种先天性心脏畸形，长期可能导致晚期慢性肝病。本研究调查了 Fontan 手术患者肝结节的患病率、特征和预测因素。方法 这是一项在八个欧洲中心进行的前瞻性、横断面和观察性研究。连续接受 Fontan 手术的患者接受了血液检查、腹部超声检查 (US)、瞬时弹性成像 (Fibroscan®)、超声心动图、血流动力学和腹部 MRI/CT 扫描。主要结果指标是在 MRI/CT 扫描中检测到的肝脏结节。通过多变量逻辑回归确定肝结节的预测因子。结果 招募了 152 名患者（平均年龄 27.3 岁）。从手术到入组的平均时间为 18.3 年。肝结节患病率在 US 上为 29.6%（95% CI：23-37%），在 MRI/CT 上为 47.7%（95% CI：39-56%）。结节通常为高回声 (76.5%)、圆形 (>80%)、动脉期高强化 (92%) 和位于肝脏外围 (75%)。US 的敏感性和特异性分别为 50% (95% CI: 38-62%) 和 85.3% (95% CI: 75-92%)。图像间测试一致性较低（调整后的 kappa：0.34）。在多变量分析中，手术时间 > 10 年是肝结节的单一独立预测因素（OR：4.18，P=0.040）。在 8 名患有血管丰富和冲洗性肝结节的患者中，有 2 名被组织学诊断为肝细胞癌。结论 虽然 Fontan 患者肝脏结节很常见，但在美国可能会被忽视。肝结节通常呈高回声、血管丰富且主要是外周。该人群有患肝细胞癌的风险，其诊断需要活检确认。
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