Prevalence, features and predictive factors of liver nodules in Fontan surgery patients: The VALDIG Fonliver prospective cohort
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 following Fontan surgery. This was a prospective, cross-sectio...
Gespeichert in:
| Veröffentlicht in: | Journal of hepatology 2020-04, Vol.72 (4), p.702-710 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 710 |
|---|---|
| container_issue | 4 |
| container_start_page | 702 |
| container_title | Journal of hepatology |
| container_volume | 72 |
| creator | Téllez, Luis Rodríguez de Santiago, Enrique Minguez, Beatriz Payance, Audrey Clemente, Ana Baiges, Anna Morales-Arraez, Dalia La Mura, Vincenzo Llop, Elba Garrido, Elena Garrido-Lestache, Elvira Tasayco, Stephanie Bruno, Onorina Prieto, Raquel Montserrat, Silvia Pons, Mónica Olavarría, Andreína Dos, Laura Legendre, Antoine Jesús del Cerro, María Bañares, Rafael García-Pagán, Juan Carlos Rautou, Pierre-Emmanuel Albillos, Agustín Aguilera, Lara Romera, Rut Rincón, Diego Fuente, María Álvarez Merino, Xavier Chessa, Massimo Triolo, Michela Ronot, Maxime Vilgrain, Valérie Legendre, Antoine Chassing, Caroline Hernández-Gea, Virginia Garcia-Criado, Maria Angeles Darnell, Anna Belmonte, Ernest Turon, Fanny Ferrusquia, Jose Magaz, Marta |
| description | 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 following Fontan surgery.
This was a prospective, cross-sectional, observational study conducted at 8 European centres. Consecutive patients who had undergone Fontan surgery underwent blood tests, abdominal ultrasonography (US), transient elastography (Fibroscan®), echocardiography, haemodynamic assessments, 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.
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 (odds ratio 4.18; p = 0.040). Hepatocellular carcinoma was histologically diagnosed in 2 of the 8 patients with hypervascular liver nodules displaying washout.
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 confirmatory biopsy.
Fontan surgery is the standard of care for many patients with univentricular congenital cardiopathies. Recent advances have improved the survival of Fontan patients, and nowadays most of them reach adulthood. In this setting, Fontan-associated liver disease (FALD) is increasingly recognised, and has become a significant prognostic factor. Liver nodules are considered a component of FALD yet their prevalence, imaging features and predictors have hardly been evaluated. In this study, we observed that liver nodules are frequent, typically hyperechoic, hypervascular and predominantly peripheral in patients with FALD. This population is at risk of hepatocellular carcinoma, t |
| doi_str_mv | 10.1016/j.jhep.2019.10.027 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2315092096</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0168827819306683</els_id><sourcerecordid>2315092096</sourcerecordid><originalsourceid>FETCH-LOGICAL-c494t-19ca508bf87b146ca3f7fb86913c747ac7dc4368da9665f95d28456d44ca0a293</originalsourceid><addsrcrecordid>eNp9kcFu1DAQhi0EotvCC3BAlrhwIIvtOHaMuFSlLZVWgkPhanntCesoawc7WaknXh1HKRw4cLI8-ubXzHwIvaJkSwkV7_ttf4BxywhVpbAlTD5BGyoIqYjg9CnaFKitWibbM3Sec08IqYniz9FZTSUTlIoN-vU1wckMECy8wx2YaU6QsQkOjwmct5M_Ae6MnWLKOHZ4KP-EQ3TzUDgf8E0Mkwk4z-kHpAc8mslDmPIHfH8A_P1y9-nudmHWvjHFPMIaauMhpukFetaZIcPLx_cCfbu5vr_6XO2-3N5dXe4qyxWfKqqsaUi771q5p1xYU3ey27dC0dpKLo2VzvJatM4oIZpONY61vBGOc2uIYaq-QG_X3DLCzxnypI8-WxgGEyDOWbOaNkQxokRB3_yD9nFOoUynGedSCVYTXii2UrbslBN0ekz-aNKDpkQvenSvFz160bPUip7S9Poxet4fwf1t-eOjAB9XAMotTh6SztYvcpxP5W7aRf-__N9SS6GJ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2447962304</pqid></control><display><type>article</type><title>Prevalence, features and predictive factors of liver nodules in Fontan surgery patients: The VALDIG Fonliver prospective cohort</title><source>Access via ScienceDirect (Elsevier)</source><creator>Téllez, Luis ; Rodríguez de Santiago, Enrique ; Minguez, Beatriz ; Payance, Audrey ; Clemente, Ana ; Baiges, Anna ; Morales-Arraez, Dalia ; La Mura, Vincenzo ; Llop, Elba ; Garrido, Elena ; Garrido-Lestache, Elvira ; Tasayco, Stephanie ; Bruno, Onorina ; Prieto, Raquel ; Montserrat, Silvia ; Pons, Mónica ; Olavarría, Andreína ; Dos, Laura ; Legendre, Antoine ; Jesús del Cerro, María ; Bañares, Rafael ; García-Pagán, Juan Carlos ; Rautou, Pierre-Emmanuel ; Albillos, Agustín ; Aguilera, Lara ; Romera, Rut ; Rincón, Diego ; Fuente, María Álvarez ; Merino, Xavier ; Chessa, Massimo ; Triolo, Michela ; Ronot, Maxime ; Vilgrain, Valérie ; Legendre, Antoine ; Chassing, Caroline ; Hernández-Gea, Virginia ; Garcia-Criado, Maria Angeles ; Darnell, Anna ; Belmonte, Ernest ; Turon, Fanny ; Ferrusquia, Jose ; Magaz, Marta</creator><creatorcontrib>Téllez, Luis ; Rodríguez de Santiago, Enrique ; Minguez, Beatriz ; Payance, Audrey ; Clemente, Ana ; Baiges, Anna ; Morales-Arraez, Dalia ; La Mura, Vincenzo ; Llop, Elba ; Garrido, Elena ; Garrido-Lestache, Elvira ; Tasayco, Stephanie ; Bruno, Onorina ; Prieto, Raquel ; Montserrat, Silvia ; Pons, Mónica ; Olavarría, Andreína ; Dos, Laura ; Legendre, Antoine ; Jesús del Cerro, María ; Bañares, Rafael ; García-Pagán, Juan Carlos ; Rautou, Pierre-Emmanuel ; Albillos, Agustín ; Aguilera, Lara ; Romera, Rut ; Rincón, Diego ; Fuente, María Álvarez ; Merino, Xavier ; Chessa, Massimo ; Triolo, Michela ; Ronot, Maxime ; Vilgrain, Valérie ; Legendre, Antoine ; Chassing, Caroline ; Hernández-Gea, Virginia ; Garcia-Criado, Maria Angeles ; Darnell, Anna ; Belmonte, Ernest ; Turon, Fanny ; Ferrusquia, Jose ; Magaz, Marta ; VALDIG an EASL consortium</creatorcontrib><description>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 following Fontan surgery.
This was a prospective, cross-sectional, observational study conducted at 8 European centres. Consecutive patients who had undergone Fontan surgery underwent blood tests, abdominal ultrasonography (US), transient elastography (Fibroscan®), echocardiography, haemodynamic assessments, 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.
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 (odds ratio 4.18; p = 0.040). Hepatocellular carcinoma was histologically diagnosed in 2 of the 8 patients with hypervascular liver nodules displaying washout.
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 confirmatory biopsy.
Fontan surgery is the standard of care for many patients with univentricular congenital cardiopathies. Recent advances have improved the survival of Fontan patients, and nowadays most of them reach adulthood. In this setting, Fontan-associated liver disease (FALD) is increasingly recognised, and has become a significant prognostic factor. Liver nodules are considered a component of FALD yet their prevalence, imaging features and predictors have hardly been evaluated. In this study, we observed that liver nodules are frequent, typically hyperechoic, hypervascular and predominantly peripheral in patients with FALD. This population is at risk of hepatocellular carcinoma, the diagnosis of which must be confirmed by biopsy.
[Display omitted]
•Liver nodules are frequent in Fontan patients.•Some liver nodules may go unnoticed on abdominal ultrasound.•The risk of hepatocellular carcinoma is low but present.•Arterial hyperenhancement and washout are not specific for hepatocellular carcinoma in this population.•Fontan patients with hepatocellular carcinoma present with suspicious radiological features and elevated alpha-fetoprotein.</description><identifier>ISSN: 0168-8278</identifier><identifier>EISSN: 1600-0641</identifier><identifier>DOI: 10.1016/j.jhep.2019.10.027</identifier><identifier>PMID: 31726116</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Biopsy ; Cancer ; Cirrhosis ; Computed tomography ; Congenital defects ; Congenital diseases ; Diagnosis ; Echocardiography ; Fontan ; Heart ; Heart surgery ; Hepatocellular carcinoma ; Imaging ; Liver ; Liver cancer ; Liver diseases ; Magnetic resonance imaging ; Medical imaging ; Multivariate analysis ; Nodules ; Prognosis ; Surgery ; Ultrasound</subject><ispartof>Journal of hepatology, 2020-04, Vol.72 (4), p.702-710</ispartof><rights>2019 European Association for the Study of the Liver</rights><rights>Copyright © 2019 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.</rights><rights>Copyright Elsevier Science Ltd. Apr 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c494t-19ca508bf87b146ca3f7fb86913c747ac7dc4368da9665f95d28456d44ca0a293</citedby><cites>FETCH-LOGICAL-c494t-19ca508bf87b146ca3f7fb86913c747ac7dc4368da9665f95d28456d44ca0a293</cites><orcidid>0000-0001-9567-1859 ; 0000-0002-2535-5073 ; 0000-0002-6612-7501</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jhep.2019.10.027$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31726116$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Téllez, Luis</creatorcontrib><creatorcontrib>Rodríguez de Santiago, Enrique</creatorcontrib><creatorcontrib>Minguez, Beatriz</creatorcontrib><creatorcontrib>Payance, Audrey</creatorcontrib><creatorcontrib>Clemente, Ana</creatorcontrib><creatorcontrib>Baiges, Anna</creatorcontrib><creatorcontrib>Morales-Arraez, Dalia</creatorcontrib><creatorcontrib>La Mura, Vincenzo</creatorcontrib><creatorcontrib>Llop, Elba</creatorcontrib><creatorcontrib>Garrido, Elena</creatorcontrib><creatorcontrib>Garrido-Lestache, Elvira</creatorcontrib><creatorcontrib>Tasayco, Stephanie</creatorcontrib><creatorcontrib>Bruno, Onorina</creatorcontrib><creatorcontrib>Prieto, Raquel</creatorcontrib><creatorcontrib>Montserrat, Silvia</creatorcontrib><creatorcontrib>Pons, Mónica</creatorcontrib><creatorcontrib>Olavarría, Andreína</creatorcontrib><creatorcontrib>Dos, Laura</creatorcontrib><creatorcontrib>Legendre, Antoine</creatorcontrib><creatorcontrib>Jesús del Cerro, María</creatorcontrib><creatorcontrib>Bañares, Rafael</creatorcontrib><creatorcontrib>García-Pagán, Juan Carlos</creatorcontrib><creatorcontrib>Rautou, Pierre-Emmanuel</creatorcontrib><creatorcontrib>Albillos, Agustín</creatorcontrib><creatorcontrib>Aguilera, Lara</creatorcontrib><creatorcontrib>Romera, Rut</creatorcontrib><creatorcontrib>Rincón, Diego</creatorcontrib><creatorcontrib>Fuente, María Álvarez</creatorcontrib><creatorcontrib>Merino, Xavier</creatorcontrib><creatorcontrib>Chessa, Massimo</creatorcontrib><creatorcontrib>Triolo, Michela</creatorcontrib><creatorcontrib>Ronot, Maxime</creatorcontrib><creatorcontrib>Vilgrain, Valérie</creatorcontrib><creatorcontrib>Legendre, Antoine</creatorcontrib><creatorcontrib>Chassing, Caroline</creatorcontrib><creatorcontrib>Hernández-Gea, Virginia</creatorcontrib><creatorcontrib>Garcia-Criado, Maria Angeles</creatorcontrib><creatorcontrib>Darnell, Anna</creatorcontrib><creatorcontrib>Belmonte, Ernest</creatorcontrib><creatorcontrib>Turon, Fanny</creatorcontrib><creatorcontrib>Ferrusquia, Jose</creatorcontrib><creatorcontrib>Magaz, Marta</creatorcontrib><creatorcontrib>VALDIG an EASL consortium</creatorcontrib><title>Prevalence, features and predictive factors of liver nodules in Fontan surgery patients: The VALDIG Fonliver prospective cohort</title><title>Journal of hepatology</title><addtitle>J Hepatol</addtitle><description>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 following Fontan surgery.
This was a prospective, cross-sectional, observational study conducted at 8 European centres. Consecutive patients who had undergone Fontan surgery underwent blood tests, abdominal ultrasonography (US), transient elastography (Fibroscan®), echocardiography, haemodynamic assessments, 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.
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 (odds ratio 4.18; p = 0.040). Hepatocellular carcinoma was histologically diagnosed in 2 of the 8 patients with hypervascular liver nodules displaying washout.
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 confirmatory biopsy.
Fontan surgery is the standard of care for many patients with univentricular congenital cardiopathies. Recent advances have improved the survival of Fontan patients, and nowadays most of them reach adulthood. In this setting, Fontan-associated liver disease (FALD) is increasingly recognised, and has become a significant prognostic factor. Liver nodules are considered a component of FALD yet their prevalence, imaging features and predictors have hardly been evaluated. In this study, we observed that liver nodules are frequent, typically hyperechoic, hypervascular and predominantly peripheral in patients with FALD. This population is at risk of hepatocellular carcinoma, the diagnosis of which must be confirmed by biopsy.
[Display omitted]
•Liver nodules are frequent in Fontan patients.•Some liver nodules may go unnoticed on abdominal ultrasound.•The risk of hepatocellular carcinoma is low but present.•Arterial hyperenhancement and washout are not specific for hepatocellular carcinoma in this population.•Fontan patients with hepatocellular carcinoma present with suspicious radiological features and elevated alpha-fetoprotein.</description><subject>Biopsy</subject><subject>Cancer</subject><subject>Cirrhosis</subject><subject>Computed tomography</subject><subject>Congenital defects</subject><subject>Congenital diseases</subject><subject>Diagnosis</subject><subject>Echocardiography</subject><subject>Fontan</subject><subject>Heart</subject><subject>Heart surgery</subject><subject>Hepatocellular carcinoma</subject><subject>Imaging</subject><subject>Liver</subject><subject>Liver cancer</subject><subject>Liver diseases</subject><subject>Magnetic resonance imaging</subject><subject>Medical imaging</subject><subject>Multivariate analysis</subject><subject>Nodules</subject><subject>Prognosis</subject><subject>Surgery</subject><subject>Ultrasound</subject><issn>0168-8278</issn><issn>1600-0641</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kcFu1DAQhi0EotvCC3BAlrhwIIvtOHaMuFSlLZVWgkPhanntCesoawc7WaknXh1HKRw4cLI8-ubXzHwIvaJkSwkV7_ttf4BxywhVpbAlTD5BGyoIqYjg9CnaFKitWibbM3Sec08IqYniz9FZTSUTlIoN-vU1wckMECy8wx2YaU6QsQkOjwmct5M_Ae6MnWLKOHZ4KP-EQ3TzUDgf8E0Mkwk4z-kHpAc8mslDmPIHfH8A_P1y9-nudmHWvjHFPMIaauMhpukFetaZIcPLx_cCfbu5vr_6XO2-3N5dXe4qyxWfKqqsaUi771q5p1xYU3ey27dC0dpKLo2VzvJatM4oIZpONY61vBGOc2uIYaq-QG_X3DLCzxnypI8-WxgGEyDOWbOaNkQxokRB3_yD9nFOoUynGedSCVYTXii2UrbslBN0ekz-aNKDpkQvenSvFz160bPUip7S9Poxet4fwf1t-eOjAB9XAMotTh6SztYvcpxP5W7aRf-__N9SS6GJ</recordid><startdate>202004</startdate><enddate>202004</enddate><creator>Téllez, Luis</creator><creator>Rodríguez de Santiago, Enrique</creator><creator>Minguez, Beatriz</creator><creator>Payance, Audrey</creator><creator>Clemente, Ana</creator><creator>Baiges, Anna</creator><creator>Morales-Arraez, Dalia</creator><creator>La Mura, Vincenzo</creator><creator>Llop, Elba</creator><creator>Garrido, Elena</creator><creator>Garrido-Lestache, Elvira</creator><creator>Tasayco, Stephanie</creator><creator>Bruno, Onorina</creator><creator>Prieto, Raquel</creator><creator>Montserrat, Silvia</creator><creator>Pons, Mónica</creator><creator>Olavarría, Andreína</creator><creator>Dos, Laura</creator><creator>Legendre, Antoine</creator><creator>Jesús del Cerro, María</creator><creator>Bañares, Rafael</creator><creator>García-Pagán, Juan Carlos</creator><creator>Rautou, Pierre-Emmanuel</creator><creator>Albillos, Agustín</creator><creator>Aguilera, Lara</creator><creator>Romera, Rut</creator><creator>Rincón, Diego</creator><creator>Fuente, María Álvarez</creator><creator>Merino, Xavier</creator><creator>Chessa, Massimo</creator><creator>Triolo, Michela</creator><creator>Ronot, Maxime</creator><creator>Vilgrain, Valérie</creator><creator>Legendre, Antoine</creator><creator>Chassing, Caroline</creator><creator>Hernández-Gea, Virginia</creator><creator>Garcia-Criado, Maria Angeles</creator><creator>Darnell, Anna</creator><creator>Belmonte, Ernest</creator><creator>Turon, Fanny</creator><creator>Ferrusquia, Jose</creator><creator>Magaz, Marta</creator><general>Elsevier B.V</general><general>Elsevier Science Ltd</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9567-1859</orcidid><orcidid>https://orcid.org/0000-0002-2535-5073</orcidid><orcidid>https://orcid.org/0000-0002-6612-7501</orcidid></search><sort><creationdate>202004</creationdate><title>Prevalence, features and predictive factors of liver nodules in Fontan surgery patients: The VALDIG Fonliver prospective cohort</title><author>Téllez, Luis ; Rodríguez de Santiago, Enrique ; Minguez, Beatriz ; Payance, Audrey ; Clemente, Ana ; Baiges, Anna ; Morales-Arraez, Dalia ; La Mura, Vincenzo ; Llop, Elba ; Garrido, Elena ; Garrido-Lestache, Elvira ; Tasayco, Stephanie ; Bruno, Onorina ; Prieto, Raquel ; Montserrat, Silvia ; Pons, Mónica ; Olavarría, Andreína ; Dos, Laura ; Legendre, Antoine ; Jesús del Cerro, María ; Bañares, Rafael ; García-Pagán, Juan Carlos ; Rautou, Pierre-Emmanuel ; Albillos, Agustín ; Aguilera, Lara ; Romera, Rut ; Rincón, Diego ; Fuente, María Álvarez ; Merino, Xavier ; Chessa, Massimo ; Triolo, Michela ; Ronot, Maxime ; Vilgrain, Valérie ; Legendre, Antoine ; Chassing, Caroline ; Hernández-Gea, Virginia ; Garcia-Criado, Maria Angeles ; Darnell, Anna ; Belmonte, Ernest ; Turon, Fanny ; Ferrusquia, Jose ; Magaz, Marta</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c494t-19ca508bf87b146ca3f7fb86913c747ac7dc4368da9665f95d28456d44ca0a293</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Biopsy</topic><topic>Cancer</topic><topic>Cirrhosis</topic><topic>Computed tomography</topic><topic>Congenital defects</topic><topic>Congenital diseases</topic><topic>Diagnosis</topic><topic>Echocardiography</topic><topic>Fontan</topic><topic>Heart</topic><topic>Heart surgery</topic><topic>Hepatocellular carcinoma</topic><topic>Imaging</topic><topic>Liver</topic><topic>Liver cancer</topic><topic>Liver diseases</topic><topic>Magnetic resonance imaging</topic><topic>Medical imaging</topic><topic>Multivariate analysis</topic><topic>Nodules</topic><topic>Prognosis</topic><topic>Surgery</topic><topic>Ultrasound</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Téllez, Luis</creatorcontrib><creatorcontrib>Rodríguez de Santiago, Enrique</creatorcontrib><creatorcontrib>Minguez, Beatriz</creatorcontrib><creatorcontrib>Payance, Audrey</creatorcontrib><creatorcontrib>Clemente, Ana</creatorcontrib><creatorcontrib>Baiges, Anna</creatorcontrib><creatorcontrib>Morales-Arraez, Dalia</creatorcontrib><creatorcontrib>La Mura, Vincenzo</creatorcontrib><creatorcontrib>Llop, Elba</creatorcontrib><creatorcontrib>Garrido, Elena</creatorcontrib><creatorcontrib>Garrido-Lestache, Elvira</creatorcontrib><creatorcontrib>Tasayco, Stephanie</creatorcontrib><creatorcontrib>Bruno, Onorina</creatorcontrib><creatorcontrib>Prieto, Raquel</creatorcontrib><creatorcontrib>Montserrat, Silvia</creatorcontrib><creatorcontrib>Pons, Mónica</creatorcontrib><creatorcontrib>Olavarría, Andreína</creatorcontrib><creatorcontrib>Dos, Laura</creatorcontrib><creatorcontrib>Legendre, Antoine</creatorcontrib><creatorcontrib>Jesús del Cerro, María</creatorcontrib><creatorcontrib>Bañares, Rafael</creatorcontrib><creatorcontrib>García-Pagán, Juan Carlos</creatorcontrib><creatorcontrib>Rautou, Pierre-Emmanuel</creatorcontrib><creatorcontrib>Albillos, Agustín</creatorcontrib><creatorcontrib>Aguilera, Lara</creatorcontrib><creatorcontrib>Romera, Rut</creatorcontrib><creatorcontrib>Rincón, Diego</creatorcontrib><creatorcontrib>Fuente, María Álvarez</creatorcontrib><creatorcontrib>Merino, Xavier</creatorcontrib><creatorcontrib>Chessa, Massimo</creatorcontrib><creatorcontrib>Triolo, Michela</creatorcontrib><creatorcontrib>Ronot, Maxime</creatorcontrib><creatorcontrib>Vilgrain, Valérie</creatorcontrib><creatorcontrib>Legendre, Antoine</creatorcontrib><creatorcontrib>Chassing, Caroline</creatorcontrib><creatorcontrib>Hernández-Gea, Virginia</creatorcontrib><creatorcontrib>Garcia-Criado, Maria Angeles</creatorcontrib><creatorcontrib>Darnell, Anna</creatorcontrib><creatorcontrib>Belmonte, Ernest</creatorcontrib><creatorcontrib>Turon, Fanny</creatorcontrib><creatorcontrib>Ferrusquia, Jose</creatorcontrib><creatorcontrib>Magaz, Marta</creatorcontrib><creatorcontrib>VALDIG an EASL consortium</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of hepatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Téllez, Luis</au><au>Rodríguez de Santiago, Enrique</au><au>Minguez, Beatriz</au><au>Payance, Audrey</au><au>Clemente, Ana</au><au>Baiges, Anna</au><au>Morales-Arraez, Dalia</au><au>La Mura, Vincenzo</au><au>Llop, Elba</au><au>Garrido, Elena</au><au>Garrido-Lestache, Elvira</au><au>Tasayco, Stephanie</au><au>Bruno, Onorina</au><au>Prieto, Raquel</au><au>Montserrat, Silvia</au><au>Pons, Mónica</au><au>Olavarría, Andreína</au><au>Dos, Laura</au><au>Legendre, Antoine</au><au>Jesús del Cerro, María</au><au>Bañares, Rafael</au><au>García-Pagán, Juan Carlos</au><au>Rautou, Pierre-Emmanuel</au><au>Albillos, Agustín</au><au>Aguilera, Lara</au><au>Romera, Rut</au><au>Rincón, Diego</au><au>Fuente, María Álvarez</au><au>Merino, Xavier</au><au>Chessa, Massimo</au><au>Triolo, Michela</au><au>Ronot, Maxime</au><au>Vilgrain, Valérie</au><au>Legendre, Antoine</au><au>Chassing, Caroline</au><au>Hernández-Gea, Virginia</au><au>Garcia-Criado, Maria Angeles</au><au>Darnell, Anna</au><au>Belmonte, Ernest</au><au>Turon, Fanny</au><au>Ferrusquia, Jose</au><au>Magaz, Marta</au><aucorp>VALDIG an EASL consortium</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prevalence, features and predictive factors of liver nodules in Fontan surgery patients: The VALDIG Fonliver prospective cohort</atitle><jtitle>Journal of hepatology</jtitle><addtitle>J Hepatol</addtitle><date>2020-04</date><risdate>2020</risdate><volume>72</volume><issue>4</issue><spage>702</spage><epage>710</epage><pages>702-710</pages><issn>0168-8278</issn><eissn>1600-0641</eissn><abstract>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 following Fontan surgery.
This was a prospective, cross-sectional, observational study conducted at 8 European centres. Consecutive patients who had undergone Fontan surgery underwent blood tests, abdominal ultrasonography (US), transient elastography (Fibroscan®), echocardiography, haemodynamic assessments, 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.
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 (odds ratio 4.18; p = 0.040). Hepatocellular carcinoma was histologically diagnosed in 2 of the 8 patients with hypervascular liver nodules displaying washout.
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 confirmatory biopsy.
Fontan surgery is the standard of care for many patients with univentricular congenital cardiopathies. Recent advances have improved the survival of Fontan patients, and nowadays most of them reach adulthood. In this setting, Fontan-associated liver disease (FALD) is increasingly recognised, and has become a significant prognostic factor. Liver nodules are considered a component of FALD yet their prevalence, imaging features and predictors have hardly been evaluated. In this study, we observed that liver nodules are frequent, typically hyperechoic, hypervascular and predominantly peripheral in patients with FALD. This population is at risk of hepatocellular carcinoma, the diagnosis of which must be confirmed by biopsy.
[Display omitted]
•Liver nodules are frequent in Fontan patients.•Some liver nodules may go unnoticed on abdominal ultrasound.•The risk of hepatocellular carcinoma is low but present.•Arterial hyperenhancement and washout are not specific for hepatocellular carcinoma in this population.•Fontan patients with hepatocellular carcinoma present with suspicious radiological features and elevated alpha-fetoprotein.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>31726116</pmid><doi>10.1016/j.jhep.2019.10.027</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-9567-1859</orcidid><orcidid>https://orcid.org/0000-0002-2535-5073</orcidid><orcidid>https://orcid.org/0000-0002-6612-7501</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0168-8278 |
| ispartof | Journal of hepatology, 2020-04, Vol.72 (4), p.702-710 |
| issn | 0168-8278 1600-0641 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2315092096 |
| source | Access via ScienceDirect (Elsevier) |
| subjects | Biopsy Cancer Cirrhosis Computed tomography Congenital defects Congenital diseases Diagnosis Echocardiography Fontan Heart Heart surgery Hepatocellular carcinoma Imaging Liver Liver cancer Liver diseases Magnetic resonance imaging Medical imaging Multivariate analysis Nodules Prognosis Surgery Ultrasound |
| title | Prevalence, features and predictive factors of liver nodules in Fontan surgery patients: The VALDIG Fonliver prospective cohort |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-19T06%3A14%3A27IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Prevalence,%20features%20and%20predictive%20factors%20of%20liver%20nodules%20in%20Fontan%20surgery%20patients:%20The%20VALDIG%20Fonliver%20prospective%20cohort&rft.jtitle=Journal%20of%20hepatology&rft.au=T%C3%A9llez,%20Luis&rft.aucorp=VALDIG%20an%20EASL%20consortium&rft.date=2020-04&rft.volume=72&rft.issue=4&rft.spage=702&rft.epage=710&rft.pages=702-710&rft.issn=0168-8278&rft.eissn=1600-0641&rft_id=info:doi/10.1016/j.jhep.2019.10.027&rft_dat=%3Cproquest_cross%3E2315092096%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2447962304&rft_id=info:pmid/31726116&rft_els_id=S0168827819306683&rfr_iscdi=true |