Wolff, D. (Djoeke) (2014) Diffusion-weighted imaging van de lever bij Fontan patiënten. thesis, Medicine.
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Abstract
Background: The Fontan operation is used in patients with a univentricular heart (onechamber- heart) and creates a unique, unphysiological circulation (the Fontan circulation), in which desaturated blood flows passively through the pulmonary vascular bed without the aid of a pumping right heart chamber. Due to the abnormal physiology, Fontan patients are prone to develop liver fibrosis, cirrhosis and even hepatocellular carcinoma. Diffusion-weighted imaging (DWI) is an upcoming magnetic resonance (MRI) technique for the non-invasive analyses of hepatic fibrosis and cirrhosis. The aim of this study is to investigate the role of the DWI in Fontan patients in the evaluation of the liver and the functional performance of the Fontan circulation. Methods: 59 Fontan patients were evaluated using DWI of the liver. De general diffusion values were segregated in the microperfusion and the true diffusion components using a bi-exponential model. The correlation between the DWI values and patient characteristics, biochemical parameters and functional parameters of the Fontan circulation (cardiac MRI and cardiopulmonary exercise tests) were investigated. Results: The general diffusion, true diffusion and microperfusion in livers of Fontan patients were lower compared to previously reported healthy subjects (p<0.001). Both the general as the true diffusion were correlated with longer follow-up duration after the Fontan operation (p<0.001). The diffusion correlates with ammaglutamyltransferase (p=0.021), antithrombin (p=0.004) and calculated liverscores. Also, diffusion correlates with functional parameters of the Fontan circulation (cardiac index, p=0.019 and ventricular mass, p=0.033). The microperfusion in the liver correlated with aspartate transaminase (p=0.043) and shows no association with functional parameters. Conclusions: Liver fibrosis/cirrhosis, measured as low diffusion values, is present in Fontan patients and increases with longer follow-up duration after Fontan operation. Functional parameters of the Fontan circulation are reflected in de degree of fibrosis measured by DWI.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Berger, prof. dr. R.M.F. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:40 |
| Last Modified: | 25 Jun 2020 10:40 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/147 |
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