Imaging of Fontan-Associated Liver Disease

Area of Science:

• Cardiology
• Hepatology
• Radiology

Background:

• The Fontan procedure treats single-ventricle physiology, with increasing adult survivors.
• Fontan-associated liver disease (FALD) involves liver congestion, fibrosis, and mass development.
• Assessing FALD is challenging, requiring integrated clinical, lab, and imaging data.

Purpose of the Study:

• To review the role of imaging in assessing Fontan-associated liver disease (FALD).
• To discuss the detection and characterization of liver masses in Fontan patients.
• To highlight the risk of hepatocellular carcinoma (HCC) in this population.

Main Methods:

• Review of current imaging modalities including ultrasound, CT, and MRI for FALD.
• Discussion of novel imaging techniques like magnetic resonance elastography.
• Analysis of imaging's role in differentiating benign masses from hepatocellular carcinoma (HCC).

Main Results:

• Standard imaging can reveal FALD-related abnormalities.
• Benign FNH-like masses can mimic HCC, posing a diagnostic challenge.
• Fontan patients face an elevated risk of HCC, necessitating surveillance.

Conclusions:

• Imaging is crucial for FALD detection, characterization, and mass evaluation.
• Optimal surveillance strategies for HCC in Fontan patients require further consensus.
• Continued research into advanced imaging biomarkers for FALD progression is warranted.