{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T14:40:02Z","timestamp":1782139202874,"version":"3.54.5"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,6,24]],"date-time":"2024-06-24T00:00:00Z","timestamp":1719187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100005762","name":"National Taiwan University Hospital","doi-asserted-by":"publisher","award":["NTUH105-S3157"],"award-info":[{"award-number":["NTUH105-S3157"]}],"id":[{"id":"10.13039\/501100005762","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007225","name":"Ministry of Science and Technology","doi-asserted-by":"publisher","award":["107\u20132314-B-002-172-MY2"],"award-info":[{"award-number":["107\u20132314-B-002-172-MY2"]}],"id":[{"id":"10.13039\/100007225","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>The evaluation of Fontan-associated liver disease is often challenging. Diffusion-weighted magnetic resonance imaging can detect hepatic fibrosis from capillary perfusion and diffusion abnormalities from extracellular matrix accumulation. This study investigated its role in the evaluation of liver disease in Fontan patients and explored possible diagnostic methods for early detection of advanced liver fibrosis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Stable adult Fontan patients who could safely be examined with magnetic resonance imaging were enrolled, and blood biomarkers, transient elastography were also examined.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Forty-six patients received diffusion-weighted imaging; and 58.7% were diagnosed with advanced liver fibrosis (severe liver fibrosis, 37.0%, and cirrhosis 21.7%). Two parameters of hepatic dysfunction, platelet counts (Spearman\u2019s \u03c1: \u20130.456, P\u2009=\u20090.001) and cholesterol levels (Spearman\u2019s \u03c1: \u20130.383, P\u2009=\u20090.009), decreased with increasing severity of fibrosis. Using transient elastography, a cut-off value of 14.2\u2009kPa predicted the presence of advanced liver fibrosis, but with a low positive predictive value. When we included platelet count, cholesterol, post-Fontan years and transient elastography values as a composite, the capability of predicting advanced liver fibrosis was the most satisfactory (C statistic 0.817\u2009\u00b1\u20090.071, P\u2009&amp;lt;\u20090.001). A cut-off value of 5.0 revealed a sensitivity of 78% and a specificity of 82%.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>In Fontan patients, diffusion-weighted imaging was helpful in detecting liver fibrosis that was correlated with hepatic dysfunction. A simple score was proposed for long-term surveillance and early detection of advanced liver disease in adult Fontan patients. For adult Fontan patients with a calculated score &amp;gt; 5.0, we may consider timely diffusion-weight imaging and early management for liver complications.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezae249","type":"journal-article","created":{"date-parts":[[2024,6,24]],"date-time":"2024-06-24T18:51:20Z","timestamp":1719255080000},"source":"Crossref","is-referenced-by-count":3,"title":["Liver fibrosis detected by diffusion-weighted magnetic resonance imaging and its functional correlates in Fontan patients"],"prefix":"10.1093","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6872-4764","authenticated-orcid":false,"given":"Chun-Wei","family":"Lu","sequence":"first","affiliation":[{"name":"Adult Congenital Heart Center, National Taiwan University Hospital , Taipei, Taiwan"},{"name":"Department of Pediatrics, National Taiwan University Hospital , Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chih-Horng","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, National Taiwan University Hospital , Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2427-3391","authenticated-orcid":false,"given":"Miao-Tzu","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Medical Research, National Taiwan University Hospital , Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chee-Seng","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Biomedical Park Branch , Hsin-Chu, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huey-Ling","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, National Taiwan University Hospital , Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Tai","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, National Taiwan University Hospital , Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuenn-Nan","family":"Chiu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, National Taiwan University Hospital , Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Chieh","family":"Tseng","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, National Taiwan University Hospital , Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8880-7113","authenticated-orcid":false,"given":"Chun-An","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, National Taiwan University Hospital , Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3043-3873","authenticated-orcid":false,"given":"Jou-Kou","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, National Taiwan University Hospital , Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei-Hwan","family":"Wu","sequence":"additional","affiliation":[{"name":"Adult Congenital Heart Center, National Taiwan University Hospital , Taipei, Taiwan"},{"name":"Department of Pediatrics, National Taiwan University Hospital , Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,6,24]]},"reference":[{"key":"2024071113305919200_ezae249-B1","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1161\/CIRCULATIONAHA.107.738559","article-title":"Long-term survival, modes of death, and predictors of mortality in patients with Fontan surgery","volume":"117","author":"Khairy","year":"2008","journal-title":"Circulation"},{"key":"2024071113305919200_ezae249-B2","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1136\/hrt.2004.051789","article-title":"The Fontan circulation","volume":"91","author":"Gewillig","year":"2005","journal-title":"Heart"},{"key":"2024071113305919200_ezae249-B3","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1161\/CIRCULATIONAHA.120.045597","article-title":"Fontan-associated liver disease: screening, management, and transplant considerations","volume":"142","author":"Emamaullee","year":"2020","journal-title":"Circulation"},{"key":"2024071113305919200_ezae249-B4","doi-asserted-by":"crossref","first-page":"e14120","DOI":"10.1111\/ctr.14120","article-title":"Does liver biopsy accurately measure fibrosis in Fontan-associated liver disease? 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