{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T08:29:50Z","timestamp":1786696190272,"version":"build-2736575974"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Faculdade Idor De Ci\u00eancias M\u00e9dicas"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Abdom Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Native T1 and extracellular volume (ECV) mapping have emerged as promising tools for noninvasive assessment of hepatic congestion and fibrosis; however, optimal strategies for region-of-interest (ROI) selection remain uncertain. The aim was to evaluate the level of agreement between two methods for quantifying hepatic native T1 and ECV: single wide ROI versus multiple small ROIs, in patients with repaired tetralogy of Fallot (TOF) and Fontan circulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This agreement study prospectively enrolled outpatients with repaired TOF or Fontan circulation between 2022 and 2025. All participants underwent hepatic evaluation using a cardiac Magnetic Resonance Imaging (MRI) protocol on a 3.0-T scanner. Native and post-contrast T1 mapping were acquired using Modified Look-Locker Inversion Recovery (MOLLI) sequences. Hepatic T1 and ECV were measured using (1) one wide ROI avoiding vascular structures and (2) three small circular ROIs placed in distinct parenchymal regions. Agreement was assessed using intraclass correlation coefficients (ICC) and survival-agreement plots.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 61 patients was included (31 with TOF; 30 with Fontan circulation). Agreement between single-ROI and multiple-ROI strategies was excellent in TOF patients for both native T1 and ECV (ICC\u2009=\u20090.98), and good in patients with Fontan circulation for both parameters (ICC\u2009=\u20090.79). Survival-agreement analysis demonstrated that in TOF patients, all measurements differed by less than 80 ms for native T1 and less than 5% for ECV. In Fontan patients, 86% of measurements showed differences\u2009&lt;\u200980 ms for native T1 and &lt;\u20095% for ECV, reflecting greater hepatic heterogeneity while preserving overall concordance between ROI strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Hepatic native T1 and ECV measurements showed excellent agreement between single-wide and multiple-small ROI strategies in repaired TOF, supporting interchangeable use for longitudinal follow-up. In Fontan patients, concordance between methods was also good, as demonstrated by both ICC and survival-agreement analyses, indicating that either strategy remains feasible; nonetheless, the greater hepatic heterogeneity in this population warrants some caution when comparing measurements obtained with different ROI approaches.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00261-026-05441-0","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T07:27:34Z","timestamp":1773041254000},"page":"4421-4430","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Agreement between single and multiple ROI strategies for hepatic T1 and ECV mapping in tetralogy of Fallot and Fontan circulation"],"prefix":"10.1007","volume":"51","author":[{"given":"Adriana Macintyre","family":"Innocenzi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernanda Padr\u00e3o","family":"Fernandes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Carlos Pizzolante","family":"Secco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor Costa","family":"Costermani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Lucas","family":"Rebelo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aline Silva de","family":"Medeiros","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniella Braz","family":"Parente","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renata Mello","family":"Perez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronir Raggio","family":"Luiz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel Cordeiro","family":"Camargo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renata","family":"Moll-Bernardes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana","family":"P\u00f3voa-Corr\u00eaa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"issue":"2","key":"5441_CR1","doi-asserted-by":"publisher","first-page":"e33-e50","DOI":"10.1161\/CIR.0000000000001245","volume":"150","author":"S Amdani","year":"2024","unstructured":"Amdani S, Conway J, George K, Martinez HR, Asante-Korang A, Goldberg CS, et al. (2024) Evaluation and management of chronic heart failure in children and adolescents with congenital heart disease: a scientific statement from the American Heart Association. Circulation 150(2):e33-e50. doi:https:\/\/doi.org\/10.1161\/CIR.0000000000001245","journal-title":"Circulation"},{"issue":"6","key":"5441_CR2","doi-asserted-by":"publisher","first-page":"e234-e84","DOI":"10.1161\/CIR.0000000000000696","volume":"140","author":"J Rychik","year":"2019","unstructured":"Rychik J, Atz AM, Celermajer DS, Deal BJ, Gatzoulis MA, Gewillig MH, et al. (2019) Evaluation and management of the child and adult with Fontan circulation: a scientific statement from the American Heart Association. Circulation 140(6):e234-e84. https:\/\/doi.org\/10.1161\/CIR.0000000000000696","journal-title":"Circulation"},{"key":"5441_CR3","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/j.ijcard.2019.04.032","volume":"287","author":"K Yamamura","year":"2019","unstructured":"Yamamura K, Sakamoto I, Morihana E, Hirata Y, Nagata H, Yamasaki Y, et al. (2019) Elevated non-invasive liver fibrosis markers and risk of liver carcinoma in adult patients after repair of tetralogy of Fallot. Int J Cardiol 287:121\u20136. DOI: https:\/\/doi.org\/10.1016\/j.ijcard.2019.04.032","journal-title":"Int J Cardiol"},{"issue":"25","key":"5441_CR4","doi-asserted-by":"publisher","first-page":"e689-e707","DOI":"10.1161\/CIR.0000000000001291","volume":"150","author":"T Geva","year":"2024","unstructured":"Geva T, Wald RM, Bucholz E, Cnota JF, McElhinney DB, Mercer-Rosa LM, et al. (2024) Long-term management of right ventricular outflow tract dysfunction in repaired tetralogy of Fallot: a scientific statement from the American Heart Association. Circulation 150(25):e689-e707. doi: https:\/\/doi.org\/10.1161\/CIR.0000000000001291","journal-title":"Circulation"},{"issue":"2","key":"5441_CR5","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1007\/s10554-024-03310-9","volume":"41","author":"K Tao","year":"2025","unstructured":"Tao K, Ishikawa Y, Suzuki S, Muraji S, Kuraoka A, Sato M, et al. (2025) Native liver T1 mapping on magnetic resonance imaging for an evaluation of congestive liver injury in children with congenital heart disease. Int J Cardiovasc Imaging 41(2):315\u201324. doi: https:\/\/doi.org\/10.1007\/s10554-024-03310-9","journal-title":"Int J Cardiovasc Imaging"},{"issue":"7","key":"5441_CR6","doi-asserted-by":"publisher","first-page":"2403","DOI":"10.1007\/s00261-019-01990-9","volume":"44","author":"P Ramachandran","year":"2019","unstructured":"Ramachandran P, Serai SD, Veldtman GR, Lang SM, Mazur W, Trout AT, et al. (2019) Assessment of liver T1 mapping in fontan patients and its correlation with magnetic resonance elastography-derived liver stiffness. Abdom Radiol 44(7):2403\u20138. DOI: https:\/\/doi.org\/10.1007\/s00261-019-01990-9","journal-title":"Abdom Radiol"},{"issue":"3","key":"5441_CR7","doi-asserted-by":"publisher","first-page":"295","DOI":"10.2463\/mrms.mp.2020-0063","volume":"20","author":"Y Shiina","year":"2021","unstructured":"Shiina Y, Inai K, Ohashi R, Nagao M (2021) Potential of liver T1 mapping for the detection of Fontan-associated liver disease in adults. Magn Reson Med Sci 20(3):295\u2013302. DOI: https:\/\/doi.org\/10.2463\/mrms.mp.2020-0063","journal-title":"Magn Reson Med Sci"},{"issue":"2","key":"5441_CR8","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1007\/s10554-024-03314-5","volume":"41","author":"Y Ide","year":"2025","unstructured":"Ide Y, Gabbert DD, Hansen JH, Uebing A, Voges I (2025) Liver T1 mapping in Fontan patients and patients with biventricular congenital heart disease\u2013insights into the effects of venous congestions on diffuse liver disease. Int J Cardiovasc Imaging 41(2):347\u201358. DOI: https:\/\/doi.org\/10.1007\/s10554-024-03314-5","journal-title":"Int J Cardiovasc Imaging"},{"issue":"7","key":"5441_CR9","doi-asserted-by":"publisher","first-page":"e70174","DOI":"10.1111\/petr.70174","volume":"29","author":"O Holmvard","year":"2025","unstructured":"Holmvard O, P\u00f3voa-Corr\u00eaa M, Macintyre Innocenzi A, Pacheco LF, Parente DB, Luiz RR, et al. (2025) Mortality Outcomes of Combined Heart and Liver Transplantation and Isolated Heart Transplantation Following Fontan Procedures: A Systematic Review and Meta\u2010Analysis. Pediatr Transplant 29(7):e70174. DOI: https:\/\/doi.org\/10.1111\/petr.70174","journal-title":"Pediatr Transplant"},{"key":"5441_CR10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcchd.2025.100631","author":"JCP Secco","year":"2025","unstructured":"Secco JCP, Schaustz E, Innocenzi AM, Fernandes FP, Medei E, Silvestre-Sousa A, et al. (2025) Burden of Diffuse Myocardial Fibrosis assessed by Cardiac Magnetic Resonance in Repaired Tetralogy of Fallot: A Systematic Review and Meta-Analysis. Int J Cardiol Congenit Heart Dis:100631. DOI: https:\/\/doi.org\/10.1016\/j.ijcchd.2025.100631","journal-title":"Int J Cardiol Congenit Heart Dis:100631."},{"key":"5441_CR11","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1007\/s13244-018-0609-2","volume":"9","author":"T-H Kim","year":"2018","unstructured":"Kim T-H, Yang HK, Jang H-J, Yoo S-J, Khalili K, Kim TK (2018) Abdominal imaging findings in adult patients with Fontan circulation. Insights imaging 9:357\u201367. DOI: https:\/\/doi.org\/10.1007\/s13244-018-0609-2","journal-title":"Insights imaging"},{"issue":"4","key":"5441_CR12","doi-asserted-by":"publisher","first-page":"1024","DOI":"10.1148\/rg.2016150207","volume":"36","author":"ML Wells","year":"2016","unstructured":"Wells ML, Fenstad ER, Poterucha JT, Hough DM, Young PM, Araoz PA, et al. (2016) Imaging findings of congestive hepatopathy. Radiographics 36(4):1024\u201337. DOI: https:\/\/doi.org\/10.1148\/rg.2016150207","journal-title":"Radiographics"},{"issue":"4","key":"5441_CR13","doi-asserted-by":"publisher","first-page":"966","DOI":"10.1007\/s00246-024-03522-9","volume":"46","author":"A Innocenzi","year":"2025","unstructured":"Innocenzi A, Rangel I, P\u00f3voa-Corr\u00eaa M, Parente DB, Perez R, Rodrigues RS, et al. (2025) Cardiac and liver fibrosis assessed by multiparametric MRI in patients with Fontan circulation. Pediatr Cardiol 46(4):966\u201375. DOI: https:\/\/doi.org\/10.1007\/s00246-024-03522-9","journal-title":"Pediatr Cardiol"},{"issue":"10","key":"5441_CR14","doi-asserted-by":"publisher","first-page":"2679","DOI":"10.1007\/s00261-018-1528-x","volume":"43","author":"I Kazour","year":"2018","unstructured":"Kazour I, Serai SD, Xanthakos SA, Fleck RJ (2018) Using T1 mapping in cardiovascular magnetic resonance to assess congestive hepatopathy. Abdom Radiol 43(10):2679\u201385. doi: https:\/\/doi.org\/10.1007\/s00261-018-1528-x","journal-title":"Abdom Radiol"},{"issue":"10","key":"5441_CR15","doi-asserted-by":"publisher","first-page":"1333","DOI":"10.1007\/s00247-020-04682-5","volume":"50","author":"C de Lange","year":"2020","unstructured":"de Lange C (2020) Imaging of complications following Fontan circulation in children\u2014diagnosis and surveillance. Pediatr Radiol 50(10):1333\u201348. doi: https:\/\/doi.org\/10.1007\/s00247-020-04682-5","journal-title":"Pediatr Radiol"},{"issue":"1","key":"5441_CR16","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1186\/s12968-019-0545-4","volume":"21","author":"C De Lange","year":"2019","unstructured":"De Lange C, Reichert MJ, Pagano JJ, Seed M, Yoo S-J, Broberg CS, et al. (2019) Increased extracellular volume in the liver of pediatric Fontan patients. J Cardiovasc Magn Reson 21(1):39. DOI: https:\/\/doi.org\/10.1186\/s12968-019-0545-4","journal-title":"J Cardiovasc Magn Reson"},{"issue":"6","key":"5441_CR17","doi-asserted-by":"publisher","first-page":"2458","DOI":"10.1007\/s00261-020-02822-x","volume":"46","author":"N Mesropyan","year":"2021","unstructured":"Mesropyan N, Kupczyk P, Dold L, Weism\u00fcller TJ, Sprinkart AM, M\u00e4dler B, et al. (2021) Non-invasive assessment of liver fibrosis in autoimmune hepatitis: Diagnostic value of liver magnetic resonance parametric mapping including extracellular volume fraction. Abdom Radiol 46(6):2458\u201366. DOI: https:\/\/doi.org\/10.1007\/s00261-020-02822-x","journal-title":"Abdom Radiol"},{"issue":"1","key":"5441_CR18","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1002\/mrm.20110","volume":"52","author":"DR Messroghli","year":"2004","unstructured":"Messroghli DR, Radjenovic A, Kozerke S, Higgins DM, Sivananthan MU, Ridgway JP (2004) Modified Look-Locker inversion recovery (MOLLI) for high\u2010resolution T1 mapping of the heart. Magn Reson Med 52(1):141\u20136. DOI: https:\/\/doi.org\/10.1002\/mrm.20110","journal-title":"Magn Reson Med"},{"issue":"2","key":"5441_CR19","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1016\/j.jcm.2016.02.012","volume":"15","author":"TK Koo","year":"2016","unstructured":"Koo TK, Li MY (2016) A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15(2):155\u201363. DOI: https:\/\/doi.org\/10.1016\/j.jcm.2016.02.012","journal-title":"J Chiropr Med"},{"issue":"10","key":"5441_CR20","doi-asserted-by":"publisher","first-page":"963","DOI":"10.1016\/s0895-4356(03)00164-1","volume":"56","author":"RR Luiz","year":"2003","unstructured":"Luiz RR, Costa AJL, Kale PL, Werneck GL (2003) Assessment of agreement of a quantitative variable: a new graphical approach. J Clin Epidemiol 56(10):963\u20137. DOI: https:\/\/doi.org\/10.1016\/s0895-4356(03)00164-1","journal-title":"J Clin Epidemiol"},{"issue":"9","key":"5441_CR21","doi-asserted-by":"publisher","first-page":"942","DOI":"10.1097\/pas.0000000000002418","volume":"49","author":"RC Reed","year":"2025","unstructured":"Reed RC, Yeh MM, Files MD, Price J, Ahmed H, Hsu EK, et al. (2025) Validation of Congestive Hepatic Fibrosis Score in Pediatric and Adult Fontan-Associated Liver Disease. Am J Surg Pathol 49(9):942\u20137. https:\/\/doi.org\/10.1097\/pas.0000000000002418","journal-title":"Am J Surg Pathol"},{"key":"5441_CR22","doi-asserted-by":"publisher","unstructured":"Yanovskiy A, Ojala T, Kormi A, Kivisaari R, Peltonen J, Martelius L (2025) Peripheral vs. central parametric mapping of the liver in single ventricle patients: Measurement location matters. Eur J Radiol:112158. DOI: https:\/\/doi.org\/10.1016\/j.ejrad.2025.112158","DOI":"10.1016\/j.ejrad.2025.112158"},{"key":"5441_CR23","doi-asserted-by":"publisher","unstructured":"P\u00f3voa-Corr\u00eaa M, Innocenzi AM, Fernandes FP, Costermani I, Secco JCP, Terzi FV, et al. (2026) Assessing liver disease in cyanotic CHD using multiparametric MRI: a call to prevent future burden. Cardiol Young:1\u20137. doi:https:\/\/doi.org\/10.1017\/S1047951125110792","DOI":"10.1017\/S1047951125110792"}],"container-title":["Abdominal Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00261-026-05441-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00261-026-05441-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00261-026-05441-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T08:03:04Z","timestamp":1786694584000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00261-026-05441-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,9]]},"references-count":23,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["5441"],"URL":"https:\/\/doi.org\/10.1007\/s00261-026-05441-0","relation":{},"ISSN":["2366-0058"],"issn-type":[{"value":"2366-0058","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,9]]},"assertion":[{"value":"11 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 February 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 February 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 March 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was performed in line with the principles of the Declaration of Helsinki. The protocol was approved by the institutional review boards and ethics committees at the participating site (CAAE: 70699417.7.0000.5249), and written informed consent was obtained from all participants and\/or their legal guardians.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}}]}}