Abdominal Imaging Surveillance in Post-Fontan Adult Patients: Risk of Chronic Liver Disease and Hepatocellular Carcinoma

Publication date: Available online 11 April 2017
Source:Current Problems in Diagnostic Radiology
Author(s): Sadhna B. Nandwana, Babatunde Olaiya, Kelly Cox, Anurag Sahu, Pardeep Mittal
PurposeAssess prevalence of chronic liver disease (CLD) and hepatocellular carcinoma (HCC) in adult post-Fontan patients on surveillance imaging.MethodsIRB approved, HIPAA compliant retrospective study evaluated electronic medical records including radiology reports and clinical notes for adult post-Fontan patients 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.Results145 patients (M: 78, F: 67) had surveillance imaging after Fontan procedure. 78% [113/145] had ongoing imaging surveillance (MDN 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. 62% [71/113] had existing changes of CLD on initial study. HCC was identified in 5 patients (MDN 22 years post-Fontan, IQR = 10, 29 years), 4 of which had a normal initial study. Only one HCC patient had concomitant viral hepatitis C infection.ConclusionRadiologists should be aware that CLD is exceedingly common in post-Fontan cardiac physiology and surveillance imaging is warranted given risk of HCC.



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