TOPLINE:

Incidental liver lesions were detected in 9.5% of patients with congenital heart disease (CHD) undergoing cardiac MRI (cMRI), with 89% of these findings being previously unknown. Patients with univentricular hearts, transposition of the great arteries (TGAs) after atrial switch, and atrial septal defects (ASDs) showed the highest incidence at 18%, 17%, and 21%, respectively.

METHODOLOGY:

• Researchers retrospectively analysed cMRI examinations performed on 899 patients with CHD at a radiology department in Germany between January 2014 and April 2024.
• Liver lesions were evaluated using T2-weighted half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences that typically included superior hepatic segments adjacent to the diaphragm.
• Liver lesions were defined as atypical liver parenchyma, showing T2 hyperintensity or hypointensity compared to the surrounding liver tissue, and were analysed by a medical student, a paediatrician, a radiologist, and a paediatric cardiologist.
• Data collected included sex, age, ventricular function, and liver lesion details. The CHD type was categorised into three groups: venous congestion/hypoxia, left ventricular pressure/volume overload, and negligible cardiac burden.
• Left ventricular ejection fraction (LVEF) measurements were available for 98% of patients, and right ventricular ejection fraction (RVEF) measurements were available for 95% of patients.

TAKEAWAY:

• Incidental liver lesions were identified in 9.5% of cMRI scans, with 96% of scans showing T2 hyperintensity and 38% measuring lesions larger than 1 cm; the highest incidences were observed in patients with ASDs (21%), univentricular hearts (18%), and TGAs after atrial switch (17%).
• Patients with identified liver lesions were significantly older than those without liver lesions (mean age, 29 vs 22 years; P < .0001), with no significant sex-based differences observed in the incidence (P = .5).
• No significant differences were observed between patients with and without liver lesions in terms of mean LVEF (57% vs 58%; P = .78) or mean RVEF (55% vs 54%; P = .35).
• Patients with liver lesions more frequently presented with RVEF below 45% than those without liver lesions (P = .02).

IN PRACTICE:

"The study demonstrated that liver lesions are not uncommon in patients with congenital heart defects undergoing cardiac MRI examinations. It is particularly noteworthy that liver lesions were observed not only in patients with heart defects accompanied by significant hemodynamic alterations, such as the Fontan circulation, but also in those with less pronounced hemodynamic changes," the authors wrote.

"The results of this study are a first insight into the incidence of liver lesions in patients with different congenital heart diseases, and they suggest that especially young adults with congenital heart disease would benefit from periodic liver screening and subsequent regular follow-up examinations throughout their lives," they added.

SOURCE:

This study was led by Gretha Hecke, Paracelsus Medical University, Salzburg, Austria. It was published online on March 23, 2026, in the Journal of Clinical Medicine.

LIMITATIONS:

The study was limited by its single-centre retrospective design and the lack of liver-specific MRI sequences. The HASTE sequences used for liver lesion detection did not always cover the entire liver, potentially leading to an underestimation of the rate of liver lesions. The study included only patients with CHD who had an indication for cMRI, potentially limiting the generalisability of the findings. The absence of a control group from the general population prevented the determination of whether the observed liver lesions were specifically associated with CHD or represented incidental findings.

DISCLOSURES:

This study did not receive any external funding. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.