Incidental Liver Lesions in Patients With Congenital Heart Disease: What cMRI Reveals

When doctors perform a cardiac magnetic resonance imaging (cMRI) scan, the primary goal is to evaluate the heart. However, because these scans often capture parts of the liver, they frequently uncover unexpected findings. Recent data shows that incidental liver lesions are surprisingly common in patients with congenital heart disease (CHD), and in most cases, these lesions were completely unknown to the patient and their clinicians before the scan.

The Prevalence of Incidental Liver Findings

A retrospective analysis of cMRI examinations conducted between 2014 and 2024 revealed that 9.5% of patients with CHD had incidental liver lesions. This means nearly one in ten patients showed atypical liver parenchyma during their cardiac imaging.

Perhaps most striking is how often these lesions travel undetected. Of the patients who had liver lesions, 89% were unaware of them prior to the cMRI. This highlights the role of cardiac imaging as a critical tool for identifying otherwise silent hepatic abnormalities.

Characteristics of the Detected Lesions

Researchers defined these liver lesions as atypical parenchyma that showed either hyper- or hypointensity on T2-weighted images compared to the surrounding liver tissue. The study found specific patterns among these findings:

• T2 Hyperintensity: The vast majority of lesions—96%—were T2 hyperintense.
• Size: About 38% of the detected lesions were larger than 1 cm.

Which CHD Patients Are Most At Risk?

While liver lesions can appear across various heart conditions, certain types of congenital heart disease show a higher incidence. According to research data, the highest rates of liver lesions were found in patients with:

• Atrial septal defects: 21% incidence
• Univentricular hearts: 18% incidence
• Transposition of great arteries (after atrial switch operation): 17% incidence

9% of patients with left heart-sided valve disease also presented with liver lesions.

Demographics and Cardiac Function

The data suggests that age plays a role in the discovery of these lesions. Patients with liver lesions tended to be older, with an average age of 29 compared to 22 years for those without lesions (p < 0.0001).

Interestingly, the presence of liver lesions didn’t seem to correlate with sex or the efficiency of the heart’s pumping action. There were no significant differences in ventricular function between the two groups:

• Left Ventricular Ejection Fraction (LVEF): 57% in patients with lesions vs. 58% in those without.
• Right Ventricular Ejection Fraction (RVEF): 55% in patients with lesions vs. 54% in those without.

Why This Matters for Patient Health

As the population of adults living with congenital heart disease continues to grow, the discovery of these incidental findings suggests a need for a more holistic approach to care. Because liver lesions are frequent in this group, integrating liver monitoring into the long-term care of adult CHD patients may be helpful to ensure overall health and early detection of hepatic issues.

Frequently Asked Questions

What is a cMRI?

cMRI stands for cardiac magnetic resonance imaging. It’s a non-invasive imaging test that provides detailed pictures of the heart’s structure and function.

Are these liver lesions dangerous?

The provided research identifies these as “incidental findings,” meaning they were found by chance while looking for something else. The study emphasizes that monitoring is helpful to assure overall patient health, but it does not categorize the specific danger level of each lesion.

Why are these lesions found during a heart scan?

Because the liver is located near the heart, the imaging slices used during a cMRI often cover parts of the liver, allowing radiologists to spot atypical tissue (parenchyma) that differs from the surrounding liver.