Magnetic resonance elastography could serve as a non-invasive quantitative screening study in the post-Fontan patient po
- PDF / 309,499 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 17 Downloads / 160 Views
LETTER TO THE EDITOR
Magnetic resonance elastography could serve as a non‑invasive quantitative screening study in the post‑Fontan patient population Mitchell P. Wilson1 · Ranjit Singh1 · Prayash Katlariwala1 · Gavin Low1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Dear Dr. Johnson, We read with interest your recent publication by Dr. Yang et al. entitled “CT and MR imaging findings of the livers in adults with Fontan palliation: an observational study” [1]. The high frequency of congestive hepatopathy, fibrosis, and cirrhosis identified in their cohort in combination with the frequent development of abnormal imaging features such as contour lobulation was of particular interest to us. We appreciate the authors’ recognition that a confident diagnosis of fibrosis is challenging and may be best evaluated with quantitative imaging. Recent literature is suggesting that magnetic resonance elastography (MRE) may be a particularly useful quantitative tool in evaluating for liver fibrosis in children and young adults, particularly in non-steatosis populations [2]. This has specifically included potential applicability in patients who have previously undergone Fontan palliation [3]. However, differentiating between hepatic congestion and liver fibrosis on MRE has been a limitation for applicability in this patient population [2, 4]. We recently attempted a meta-analysis evaluating the diagnostic accuracy of MRE for assessing liver fibrosis and cirrhosis in post-Fontan patients. We performed a systematic review of Medline, Embase, Scopus, Cochrane Library, and the Grey Literature searching for original articles with > 10 patients evaluating the diagnostic performance of MRE in assessment of any (>/= stage 1), significant (>/= stage * Mitchell P. Wilson [email protected] Ranjit Singh [email protected] Prayash Katlariwala [email protected] Gavin Low [email protected] 1
Department of Radiology and Diagnostic Imaging, University of Alberta, 2B2.41 WMC, 8440‑112 Street NW, Edmonton, AB T6G 2B7, Canada
2), advanced hepatic fibrosis (>/= stage 3), and cirrhosis (stage 4) in post-Fontan patients with a histopathology reference standard. We identified 13 potentially relevant papers. However, after excluding 9 studies (2 wrong index test; 2 non-histopathological reference standard; 5 abstracts with subsequent publications), only 4 studies met our inclusion criteria [5–8]. Unfortunately, no 2 × 2 contingency tables could be constructed to evaluate diagnostic accuracy of MRE in assessing liver fibrosis compared to a pathology reference standard. The failure of this meta-analysis highlights the need for more non-invasive imaging studies attempting to differentiate congestive hepatopathy from fibrosis in this patient population. If MRE is found to be accurate in characterizing hepatic fibrosis in this population, it could serve as a better quantitative imaging alternative to Sirius red percentage collagen staining as suggested in Yang et al.’s article.
References 1. Yang HK, Jang HJ, Khali
Data Loading...
