Radiologic follow-up in Fontan-associated liver disease in Europe: European Society of Paediatric Radiology survey...

Area of Science:

• Cardiology
• Hepatology
• Pediatric Radiology

Background:

• Fontan surgery is crucial for complex congenital heart defects but can lead to liver complications like fibrosis, cirrhosis, and hepatocellular carcinoma.
• There is a lack of consensus on standardized protocols for monitoring liver disease progression in Fontan patients.
• Effective surveillance is essential for early detection and management of liver disease in this vulnerable population.

Purpose of the Study:

• To investigate current practices and identify variations in liver follow-up protocols for Fontan procedure patients.
• To understand the approaches used by pediatric radiologists in screening for and characterizing liver disease in Fontan survivors.
• To assess the level of agreement on imaging modalities and timing for liver surveillance.

Main Methods:

• An online questionnaire was distributed to members of the European Society of Paediatric Radiology (ESPR).
• The survey included seven questions focusing on the timing and methods of liver follow-up in Fontan patients.
• Data analysis focused on identifying common practices and areas of significant discrepancy.

Main Results:

• While ultrasound (US) is generally agreed upon for screening, and MRI for nodule characterization, significant variations exist in the timing of follow-up.
• Discrepancies in surveillance schedules and the absence of a unified protocol were identified.
• The current lack of a shared protocol hinders the ability to compare liver disease data across different centers.

Conclusions:

• Current liver follow-up practices for Fontan patients are heterogeneous, with notable disagreements on surveillance timing.
• While imaging tools like US and MRI show some consensus, a standardized protocol is urgently needed.
• Establishing a shared protocol is critical for consistent data collection and improved patient management.