Incidental Findings of Liver Lesions in Cardiac Magnetic Resonance Imaging Examinations in Patients with Congenital Heart Disease—Preliminary Data

Background: Incidental findings of mainly hyperintense liver lesions in T2-weighted images covering parts of the liver are found during cardiac magnetic resonance imaging (cMRI) exams in patients with congenital heart disease (CHD). Here, we describe preliminary data of a systematic analysis of the prevalence of liver lesions in patients with different CHD.

Methods: We retrospectively analyzed cMRI examinations of 899 patients with CHD that were performed at our institution between 2014 and 2024. All cMRI exams were assessed by four independent reviewers (medical student, pediatrician, radiologist, and pediatric cardiologist) who reached a consensus upon their findings. Liver lesions were defined as round structures that were neither typical for normal liver parenchyma nor normal parts of liver vessels. Liver lesions were graded according to three features: size (<1 vs. >1 cm), number (single vs. multiple), and qualitative T2 intensity (hypointense vs. hyperintense).

Results: We found liver lesions in 9.5% (85/899) of all CHD patients (size: 62% <1 cm vs. 38% >1 cm; number: 64% single lesion vs. 36% multiple lesions; T2 intensity: 4% hypointense vs. 96% hyperintense). In 11% of patients, liver lesions were already known before the cMRI examination (e.g., 34% focal nodular hyperplasia, 22% hemangioma, 11% cyst, 11% metastases); however, in 89% of patients, liver lesions had not been mentioned in the diagnoses before the cMRI examination. Liver lesions were present in 36% of patients with univentricular CHD, in 15% of patients with transposition of great arteries (TGA), in 17% of patients with atrial septal defect (ASD), and in 9% of patients with CHD and left heart disease. Comparing patient populations with and without liver lesions, patients with liver lesions were older (29 vs. 22 years, p < 0.0001) and showed no difference in right ventricular (RV) or left ventricular (LV) ejection fraction (EF; LVEF: 57% vs. 58%, p = 0.78; RVEF: 55% vs. 54%, p = 0.35).

Conclusion: We found a noteworthy prevalence of incidentally identified liver lesions in patients with CHD who underwent cMRI examinations, especially in adult patients with univentricular CHD, TGA, and ASD. Although the clinical relevance of this finding is yet unknown it deserves further attention in the growing population of adult patients with CHD.

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Artikel online veröffentlicht:
11. Februar 2025