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12474_6014032_1-s2.0-s0168827819306683-main.pdf (6.87 MB)

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2019-11-11

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cc-by-nc-nd (c) European Association for the Study of the Liver, 2019
Si us plau utilitzeu sempre aquest identificador per citar o enllaçar aquest document: https://hdl.handle.net/2445/160317

Prevalence, features and predictive factors of liver nodules in Fontan surgery patients: The VALDIG Fonliver prospective cohort

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https://doi.org/10.1016/j.jhep.2019.10.027

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Background & Aims: Fontan surgery is used to treat a variety of congenital heart malformations, and may lead to advanced chronic liver disease in the long-term. This study examines the prevalence, characteristics and predictors of liver nodules in patients following Fontan surgery. Methods: This was a prospective, cross-sectional, observational study conducted at 8 European centres. Consecutive patients who had undergone Fontan surgery underwent blood tests, abdominal ultrasonography (US), transient elastography (Fibroscan®), echocardiography, haemodynamic assessments, and abdominal MRI/CT scan. The primary outcome measure was liver nodules detected in the MRI/CT scan. Predictors of liver nodules were identified by multivariate logistic regression. Results: One hundred and fifty-two patients were enrolled (mean age 27.3 years). The mean time elapsed from surgery to inclusion was 18.3 years. Liver nodule prevalences were 29.6% (95% CI 23–37%) on US and 47.7% (95% CI 39–56%) on MRI/CT. Nodules were usually hyperechoic (76.5%), round-shaped (>80%), hyperenhancing in the arterial phase (92%) and located in the liver periphery (75%). The sensitivity and specificity of US were 50% (95% CI 38–62%) and 85.3% (95% CI 75–92%), respectively. Inter-imaging test agreement was low (adjusted kappa: 0.34). In the multivariate analysis, time since surgery >10 years was the single independent predictor of liver nodules (odds ratio 4.18; p = 0.040). Hepatocellular carcinoma was histologically diagnosed in 2 of the 8 patients with hypervascular liver nodules displaying washout. Conclusion: While liver nodules are frequent in Fontan patients, they may go unnoticed in US. Liver nodules are usually hyperechoic, hypervascular and predominantly peripheral. This population is at risk of hepatocellular carcinoma, the diagnosis of which requires confirmatory biopsy.

Matèries

Càncer, Cirrosi hepàtica, Pronòstic mèdic

Matèries (anglès)

Cancer, Hepatic cirrhosis, Prognosis

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Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)

Citació

TÉLLEZ, Luis, RODRÍGUEZ DE SANTIAGO, Enrique, MINGUEZ, Beatriz, PAYANCÉ, Audrey, CLEMENTE, Ana, BAIGES I JARDÍ, Anna, MORALES ARRAEZ, Dalia, MURA, Vincenzo la, LLOP, Elba, GARRIDO, Elena, GARRIDO LESTACHE, Elvira, TASAYCO, Stephanie, BRUNO, Onorina, PRIETO, Raquel, MONTSERRAT-VILA, Sílvia, PONS, Mónica, OLAVARRÍA, Andreína, DOS, Laura, LEGENDRE, Antoine, CERRO, María jesús del, RODRÍGUEZ DE SANTIAGO, Enrique, BAÑARES, Rafael, GARCÍA PAGÁN, Juan carlos, RAUTOU, Pierre-emmanuel, ALBILLOS, Agustín, VALDIG an EASL consortium. Prevalence, features and predictive factors of liver nodules in Fontan surgery patients: The VALDIG Fonliver prospective cohort. _Journal of Hepatology_. 2020. Vol. 72, núm. 4, pàgs. 702-710. [consulta: 7 de febrer de 2026]. [Disponible a: https://hdl.handle.net/2445/160317]

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