Potential of Liver T ₁ Mapping for the Detection of Fontan-associated Liver Disease in Adults

Purpose: The native T₁ value at 3T MRI is a sensitive marker for diffuse fibrosis or damage in various organs including the heart, liver, and pancreas. Despite the fact that Fontan-associated liver disease (FALD) is a crucial issue in adults with Fontan circulation, there are only a few studies with liver T₁ mapping in children and adolescents. We investigated the potential of the liver native T₁ mapping in detecting FALD in adult patients.

Methods: We prospectively enrolled 16 consecutive adults with Fontan circulation (age 31.3 ± 8.5 years), who were in New York Heart Association Functional class II-IV. Twenty with tetralogy of Fallot (TOF), and 20 age-matched controls also underwent cardiac magnetic resonance (CMR) imaging at 3T. Myocardial T₁ mapping with a Modified Look-Locker Inversion recovery sequence was applied to liver T₁ mapping. Patients in the Fontan group underwent the right heart catheter and liver function tests, including those for fibrotic markers.

Results: Liver native T₁ values in the Fontan group were significantly higher than that in TOF and controls (P < 0.001). In the Fontan group, the liver native T₁ value was significantly correlated with age, γ-glutamyltransferase, model for end-stage liver disease XI score, and albumin-bilirubin score (P = 0.01, 0.01, 0.044, 0.001). However, it demonstrated no correlation with central venous pressure, pulmonary vessel resistance, or fibrotic markers.

Conclusion: Liver native T₁ value derived from CMR may be a non-invasive adjunctive and/or screening marker to detect FALD.

Keywords: Fontan; T1 mapping; cardiac magnetic resonance; liver dysfunction.