RSS-Feed abonnieren
DOI: 10.1055/s-0037-1613684
Liver Injury in Hemolysis, Elevated Liver Enzymes, and Low Platelets Syndrome Measured by Diffusion-Weighted Magnetic Resonance Imaging
Publikationsverlauf
02. Juni 2017
10. November 2017
Publikationsdatum:
27. Dezember 2017 (online)
![](https://www.thieme-connect.de/media/ajp/201808/lookinside/thumbnails/10-1055-s-0037-1613684_170283-1.jpg)
Abstract
Objective The objective of this study was to evaluate acute liver injury (ALI) detected by diffusion-weighted magnetic resonance imaging (MRI) and the associated laboratory findings in women with hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome.
Study Design This was a retrospective, observational study of women with HELLP syndrome defined by serum aspartate aminotransferase (AST) levels ≥100 U/L and thrombocytopenia with platelets ≤100,000/µL. All women underwent MRI postpartum including diffusion-weighted imaging to estimate the volume of ALI with reconstructed apparent diffusion coefficient (ADC) maps. The ADC map and the volume of ALI were compared with laboratory abnormalities by Spearman's correlation analysis.
Results From March 2013 through August 2015, 16 women with HELLP syndrome underwent MRI, and of these, 14 (88%) women had areas of increased signal intensity suggestive of ALI. Their median (range) maximum AST level was 262 (140–1,958) IU/L, and at the time of MRI, AST was 103 (36–1,426) IU/L. Both of these AST levels significantly correlated with ADC map as well as the volume of ALI (both p-values <0.001).
Conclusion Women with HELLP syndrome frequently exhibited areas of abnormal diffusion in the liver on diffusion-weighted MRI, suggestive of ALI. The extent of liver injury was significantly correlated with serum AST.
Keywords
abdominal MRI - acute liver injury - apparent diffusion coefficient - diffusion-weighted imaging - HELLP syndrome - hepatic - lesionNote
Portions of this article were presented at the Society for Maternal-Fetal Medicine 37th Annual Pregnancy Meeting Poster Session V, January 28, 2017 (abstract #965).
-
References
- 1 Antia FP, Bharadwaj TP, Watsa MC, Master J. Liver in normal pregnancy, pre-eclampsia, and eclampsia. Lancet 1958; 2 (7050): 776-778
- 2 Combes B, Adams RH. Disorders of the liver in pregnancy. In: Assali NS. , ed. Pathophysiology of Gestation, Vol I. New York: Academic Press; 1971
- 3 Ingerslev M, Teilum G. Biopsy studies on the liver in pregnancy, 2. Liver biopsy on normal pregnancy women. Acta Obstet Gynecol Scand 1946; 25: 352
- 4 Sheehan HL, Lynch JB. Pathology of Toxaemia of Pregnancy. Baltimore: Williams & Wilkin; s; 1973
- 5 Chesley L. Hypertensive Disorders in Pregnancy. New York: Appleton-Century-Crofts; 1978
- 6 Pritchard JA, Weisman Jr R, Ratnoff OD, Vosburgh GJ. Intravascular hemolysis, thrombocytopenia and other hematologic abnormalities associated with severe toxemia of pregnancy. N Engl J Med 1954; 250 (03) 89-98
- 7 Pritchard JA, Cunningham FG, Mason RA. Coagulation changes in eclampsia: their frequency and pathogenesis. Am J Obstet Gynecol 1976; 124 (08) 855-864
- 8 Arias F, Mancilla-Jimenez R. Hepatic fibrinogen deposits in pre-eclampsia. Immunofluorescent evidence. N Engl J Med 1976; 295 (11) 578-582
- 9 Weinstein L. Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy. Am J Obstet Gynecol 1982; 142 (02) 159-167
- 10 Weinstein L. Preeclampsia/eclampsia with hemolysis, elevated liver enzymes, and thrombocytopenia. Obstet Gynecol 1985; 66 (05) 657-660
- 11 Barton JR, Riely CA, Adamec TA, Shanklin DR, Khoury AD, Sibai BM. Hepatic histopathologic condition does not correlate with laboratory abnormalities in HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count). Am J Obstet Gynecol 1992; 167 (06) 1538-1543
- 12 Minakami H, Oka N, Sato T, Tamada T, Yasuda Y, Hirota N. Preeclampsia: a microvesicular fat disease of the liver?. Am J Obstet Gynecol 1988; 159 (05) 1043-1047
- 13 Davidge S, de Groot C, Tayolor RN. Endothelial cell dysfunction and oxidative stress. In: Taylor RN, Roberts JM, Cunningham FG. , eds. Chesley's Hypertensive Disorders in Pregnancy, 4th ed. Amsterdam: Academic Press; 2014
- 14 Zeeman GG, Fleckenstein JL, Twickler DM, Cunningham FG. Cerebral infarction in eclampsia. Am J Obstet Gynecol 2004; 190 (03) 714-720
- 15 Brewer J, Owens MY, Wallace K. , et al. Posterior reversible encephalopathy syndrome in 46 of 47 patients with eclampsia. Am J Obstet Gynecol 2013; 208 (06) 468.e1-468.e6
- 16 American College of Obstetricians and Gynecologists; Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; 122 (05) 1122-1131
- 17 Sibai BM, Ramadan MK, Usta I, Salama M, Mercer BM, Friedman SA. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). Am J Obstet Gynecol 1993; 169 (04) 1000-1006
- 18 Martin Jr JN, Rinehart BK, May WL, Magann EF, Terrone DA, Blake PG. The spectrum of severe preeclampsia: comparative analysis by HELLP (hemolysis, elevated liver enzyme levels, and low platelet count) syndrome classification. Am J Obstet Gynecol 1999; 180 (6 Pt 1): 1373-1384
- 19 Nelson DB, Yost NP, Cunningham FG. Acute fatty liver of pregnancy: clinical outcomes and expected duration of recovery. Am J Obstet Gynecol 2013; 209 (05) 456.e1-456.e7
- 20 Cunningham F, Leveno KJ, Bloom SL. , et al. Hypertensive disorders. In: Cunningham F, Leveno KJ, Bloom SL. , et al, eds. Williams Obstetrics, 24th ed. New York, NY: McGraw-Hill; 2013
- 21 Zeeman GG, Wendel Jr GD, Cunningham FG. A blueprint for obstetric critical care. Am J Obstet Gynecol 2003; 188 (02) 532-536
- 22 Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc B 1995; 57 (01) 289-300
- 23 Albers GW. Diffusion-weighted MRI for evaluation of acute stroke. Neurology 1998; 51 (03) (Suppl. 03) S47-S49
- 24 Kidwell CS. MRI biomarkers in acute ischemic stroke: a conceptual framework and historical analysis. Stroke 2013; 44 (02) 570-578
- 25 Eccles CL, Haider EA, Haider MA, Fung S, Lockwood G, Dawson LA. Change in diffusion weighted MRI during liver cancer radiotherapy: preliminary observations. Acta Oncol 2009; 48 (07) 1034-1043
- 26 Wu X, Wang H, Chen F. , et al. Rat model of reperfused partial liver infarction: characterization with multiparametric magnetic resonance imaging, microangiography, and histomorphology. Acta Radiol 2009; 50 (03) 276-287
- 27 Cheung JS, Fan SJ, Chow AM, Hui ES, Wu EX. In vivo DTI assessment of hepatic ischemia reperfusion injury in an experimental rat model. J Magn Reson Imaging 2009; 30 (04) 890-895
- 28 Guo CW, Shen SD, Zhang Y, Liang CH, Yi XL, Luo W. Determination of apparent diffusion coefficient to quantitatively study partial hepatic ischemia reperfusion injury in a rabbit model. Transplant Proc 2011; 43 (05) 1474-1479
- 29 Shang QL, Xiao EH, Zhou QC, Luo JG, Wu HJ. Pathological and MR-DWI study of the acute hepatic injury model after stem cell transplantation. World J Gastroenterol 2011; 17 (23) 2821-2828
- 30 Zhang Q, Yu NN, Wen LJ. , et al. A preliminary study of apparent diffusion coefficient in chemotherapy-induced liver damage. Eur J Radiol 2012; 81 (11) 2943-2946
- 31 Burdette JH, Elster AD, Ricci PE. Acute cerebral infarction: quantification of spin-density and T2 shine-through phenomena on diffusion-weighted MR images. Radiology 1999; 212 (02) 333-339
- 32 Yoshihara M, Mayama M, Ukai M, Tano S, Kishigami Y, Oguchi H. Fulminant liver failure resulting from massive hepatic infarction associated with hemolysis, elevated liver enzymes, and low platelets syndrome. J Obstet Gynaecol Res 2016; 42 (10) 1375-1378
- 33 Kwee TC, Takahara T, Niwa T. , et al. Influence of cardiac motion on diffusion-weighted magnetic resonance imaging of the liver. MAGMA 2009; 22 (05) 319-325
- 34 Barton JR, Sibai BM. Hepatic imaging in HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count). Am J Obstet Gynecol 1996; 174 (06) 1820-1825