Discordant 2D shear wave elastography values in post-Fontan patients with ascites: a potential interpretive pitfall

Area of Science:

• Hepatology
• Pediatric Cardiology
• Medical Imaging

Background:

• Fontan-associated liver disease (FALD) is a progressive condition leading to portal hypertension, ascites, and liver remodeling.
• Two-dimensional shear wave elastography (2D-SWE) is a non-invasive method to assess liver stiffness, but its accuracy in patients with ascites is not well-established.

Purpose of the Study:

• To investigate the reliability of 2D-SWE for measuring liver stiffness in post-Fontan patients with ascites.
• To highlight potential confounding factors affecting elastography measurements in this specific patient population.

Main Methods:

• Case report of two post-Fontan patients with ascites and nodular liver morphology.
• Assessment of liver stiffness using 2D-SWE and comparison of results with clinical presentation and imaging findings.

Main Results:

• Discordant liver stiffness values were observed in the two patients despite similar liver morphology.
• A pediatric patient showed high stiffness (median 24.25 kPa), while a decompensated adult patient with large ascites had unexpectedly low stiffness (median 9.55 kPa).

Conclusions:

• Substantial ascites can significantly impact and potentially mislead 2D-SWE measurements in post-Fontan patients.
• Interpretation of 2D-SWE in FALD requires careful consideration of acquisition quality, liver morphology, clinical status, and the presence of ascites.