Abdominal Imaging Surveillance in Adult Patients After Fontan Procedure: Risk of Chronic Liver Disease and Hepatocellular Carcinoma
Abdominal Imaging Surveillance in Adult Patients After Fontan Procedure: Risk of Chronic Liver Disease and Hepatocellular Carcinoma
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DOI：
10.1067/j.cpradiol.2017.04.002
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发表时间：
2018-01-01
影响因子：
1.4
通讯作者：
Mittal, Pardeep
中科院分区：
文献类型：
--
作者：
Nandwana, Sadhna B.;Olaiya, Babatunde;Mittal, Pardeep
目的：评估 Fontan 手术后接受影像学监测的成年患者中慢性肝病 (CLD) 和肝细胞癌 (HCC) 的患病率。方法：机构审查委员会批准、符合健康保险流通与责任法案的回顾性研究评估了 1993 年 1 月至 2016 年 1 月 Fontan 手术后成人患者的电子病历，包括放射学报告和临床记录。审查腹部超声、计算机断层扫描和磁共振成像报告的变化CLD 和 HCC。还记录了伴随病毒性肝炎的存在。 结果：共有 145 名患者（男性：78 名，女性：67 名）在 Fontan 手术后进行了监测影像学检查。总共，78% (113/145) 进行了持续的影像学监测（中位随访时间 3.05 年，IQR：0.75-5.3 年）； 19% (21/113) 的初始研究正常，并在整个随访过程中保持正常； 19% (21/113) 进行了初步正常研究，随后影像学报告了 CLD 的变化； 62% (71/113) 在初步研究中存在 CLD 变化。 5 名患者（中位 Fontan 后 22 年，IQR：10-29 岁）发现了 HCC，其中 4 名初始研究正常。只有 1 名 HCC 患者伴有病毒性丙型肝炎感染。结论：放射科医生应意识到 CLD 在 Fontan 后心脏生理学中极为常见，考虑到 HCC 的风险，有必要进行影像学监测。 (C) 2017 Elsevier Inc. 保留所有权利。
Purpose: To assess the prevalence of chronic liver disease (CLD) and hepatocellular carcinoma (HCC) in adult patients who had surveillance imaging after Fontan procedure.Methods: Institutional review board-approved, Health Insurance Portability and Accountability Act-compliant retrospective study evaluated electronic medical records including radiology reports and clinical notes for adult patients after Fontan procedure between January 1993 and January 2016. Abdominal ultrasound, computed tomography, and magnetic resonance imaging reports were reviewed for changes of CLD and HCC. Existence of concomitant viral hepatitis was also recorded.Results: A total of 145 patients (male: 78 and female: 67) had surveillance imaging after Fontan procedure. In all, 78% (113/145) had ongoing imaging surveillance (median follow-up 3.05 years, IQR: 0.75-5.3 years); 19% (21/113) had an initial normal study and remained normal throughout follow-up; 19% (21/113) had an initial normal study with subsequent imaging reporting changes of CLD; and 62% (71/113) had existing changes of CLD on initial study. HCC was identified in 5 patients (median 22 years post-Fontan, IQR: 10-29 years), 4 of which had a normal initial study. Only 1 patient with HCC had concomitant viral hepatitis C infection.Conclusion: Radiologists should be aware that CLD is exceedingly common in post-Fontan cardiac physiology, and surveillance imaging is warranted given the risk of HCC. (C) 2017 Elsevier Inc. All rights reserved.