Liver Imaging in Fontan Patients: How Does Ultrasound Compare to Cross-Sectional Imaging?

Fontan patients frequently develop liver cirrhosis (LC); however, the diagnostic accuracy of ultrasound (US) for detecting LC and the clinical implications of such diagnoses have not been clearly established.

This study aims to evaluate the diagnostic performance of US for detecting LC in an adult population with Fontan circulation and to determine the correlation between LC and mortality/transplantation.

This was a retrospective study. Data on cross-sectional imaging, liver USs, and clinical visits that occurred within 12 months of the cross-sectional imaging were collected. Liver US diagnostic accuracy was evaluated against cross-sectional imaging. Kappa agreement between methods was assessed. Univariate Cox proportional hazards regression analysis was employed to compare mortality and transplant outcomes.

Overall, 131 patients were included. Liver US and cross-sectional imaging (computed tomography 74, magnetic resonance imaging 57) was performed in all patients. Liver US reported heterogeneous parenchyma, lobar redistribution, and surface nodularity in 85.4%, 72.5%, and 65.6% of cases. Cross-sectional imaging reported these features in 60.3%, 87.0%, and 84.9% of cases, respectively. US sensitivity was greater than 0.75 for all variables, while specificity was 0.21, 0.58, and 0.85, respectively. LC was diagnosed in 78% of cases by US and in 90% by cross-sectional imaging, with a kappa agreement of 0.21 between techniques. There was no significant correlation between the presence of hepatic parenchymal changes or cirrhosis and mortality/transplantation.

Liver US is effective for screening and monitoring liver cirrhotic features in the adult Fontan population. In a univariate analysis, there was no association between LC and mortality or transplantation.