# Incidental Hepatic Findings in Cardiac Magnetic Resonance Imaging Examinations in Patients with Congenital Heart Disease: A Pilot Study

## TL;DR

This study finds that nearly 10% of cardiac MRI exams in congenital heart disease patients show unexpected liver issues, suggesting the need for liver monitoring.

## Contribution

The study provides the first systematic analysis of incidental liver findings in cardiac MRI exams of CHD patients.

## Key findings

- Liver lesions were found in 9.5% of cardiac MRI exams in CHD patients.
- Patients with liver lesions were significantly older than those without.
- Univentricular hearts and atrial septal defects showed the highest incidence of liver lesions.

## Abstract

Objectives: During cardiac magnetic resonance imaging (cMRI) exams in patients with congenital heart disease (CHD), incidental liver abnormalities are increasingly found. However, no systematic data exist on the incidence of liver lesions in patients with different CHDs. In order to gain a first overview, we retrospectively analyzed cMRI examinations from the last 10 years at our institution. Methods: CMRI examinations including T2-weighted images covering parts of the liver were performed on 899 patients with CHD at our institution between 2014 and 2024. The cMRI examinations were analyzed by a medical student, a pediatrician, a radiologist, and a pediatric cardiologist. Liver lesions were defined as atypical liver parenchyma, showing T2 hyper- or hypointensity compared to the surrounding liver tissue. Results: Liver lesions were found in 9.5% (85/899) of all cMRI studies; of these, 89% ((76/85) of cases) were unknown at time of cMRI, 96% (82/85) were T2 hyperintense, and 38% (32/85) were larger than 1 cm. The patients with liver lesions were older (29 years vs. 22 years, p < 0.0001). There were no sex differences in the incidence of liver lesions or differences in right or left ventricular function (LVEF: 57% vs. 58%, p = 0.78; RVEF: 55% vs. 54%, p = 0.35). The patients with univentricular hearts, transposition of great arteries after atrial switch operation, and atrial septal defects showed the highest incidence (18%, 17%, and 21%, respectively). However, 9% of patients with left heart-sided valve disease also showed liver lesions. Conclusions: Incidental findings of liver lesions in cMRI examinations of patients with CHD are reasonably high with almost 10%. In the growing population of adults with CHD, liver monitoring might be helpful to assure overall patient health.