DİĞDEM KURU ÖZ, Elif PEKER, İlknur CAN, Ayşe ERDEN, İlhan ERDEN

Karaciğer fonksiyon testleri bozukluğu göstergesi olarak Manyetik Rezonans Kolanjiyopankreatografide minimal perihepatik sıvı varlığı

Giriş ve Amaç: Karaciğer ve karaciğer dışı patolojilere bağlı görüntülemede perihepatik alanda sıvı görülebilmektedir. Belirli bir patolojiye spesifik olmayan bu durum değişik mekanizmalar ile oluşabilmektedir. Bu çalışmanın amacı manyetik rezonans kolanjiyopankreatografide minimal perihepatik sıvı varlığı ile karaciğer fonksiyon testleri ve manyetik rezonans kolanjiyopankreatografide ortaya koyulabilecek etiyolojik faktörlerden olan biliyer obstrüksiyon ile arasındaki ilişkiyi araştırmaktır. Gereç ve Yöntem: Hastanemiz Radyoloji bölümünde 2017 yılında manyetik rezonans kolanjiyopankreatografi yapılan hastalar retrospektif olarak tarandı. Minimal perihepatik sıvısı olan 62 hasta çalışma grubuna, perihepatik sıvısı olmayan ve rastgele seçilen 62 hasta kontrol grubuna dahil edildi. Hasta ve kontrol grubuna ait karaciğer fonksiyon testleri (aspartat aminotransferaz, alanin aminotransferaz, alkalen fosfataz, gama-glutamil transpeptidaz, laktat dehidrogenaz, total/direkt/indirekt bilirübin) karşılaştırıldı. Perihepatik sıvı kalınlığı, dağılım paterni, karaciğer loblarına göre lokalizasyonu, intrahepatik safra kanallarında genişleme varlığı ve derecesi, koledok taşı, periportal ödem, perisplenik sıvı varlığı kaydedildi ve perihepatik sıvı ile arasındaki ilişki değerlendirildi. Bulgular: Perihepatik sıvısı olan hasta grubunda laktat dehidrogenaz dışında tüm laboratuvar değerleri kontrol grubuna göre anlamlı olarak yüksekti (p = 0.131 ve p ≤ 0.011, sırasıyla) ve perihepatik sıvısı olan grupta kontrol grubuna göre daha fazla hastada laboratuvar değerlerinde yükseklik saptandı (p ≤ 0.037). İntrahepatik safra kanallarında genişleme ve perisplenik sıvı varlığı açısından iki grup arasındaki fark istatistiksel olarak anlamlı idi (p = 0.01 ve p < 0.001, sırasıyla). Alkalen fosfataz değerleri ile intrahepatik safra kanalları genişleme derecesi korelasyon göstermekteydi (r = 0.349, p = 0.05). Sonuç: Manyetik rezonans kolanjiyopankreatografide karaciğer çevresinde minimal düzeyde sıvı varlığı karaciğer fonksiyon testlerinde bozukluğa işaret edebilir ve kolestaza neden olabilecek patolojiler açısından uyarıcı olmalıdır.

Anahtar Kelimeler:

MRKP, perihepatik sıvı, karaciğer fonksiyon testi

Presence of minimal perihepatic fluid in magnetic resonance cholangiopancreatography as a marker of liver function test impairment

Background and Aims: Perihepatic fluid caused by liver and non-liver pathologies can be observed through imaging. This condition is not specific to a particular pathology and can occur with different mechanisms. This study aimed to investigate the relationship between the presence of minimal perihepatic fluid in magnetic resonance cholangiopancreatography and liver function tests and biliary obstruction, which is one of the etiological factors that can be detected through magnetic resonance cholangiopancreatography. Materials and Methods: Patients who underwent magnetic resonance cholangiopancreatography in the department of radiology in our hospital in 2017 were retrospectively screened. Sixty-two patients with minimal peripheral fluid were included in the study group, and randomly selected 62 patients without perihepatic fluid were included in the control group. Liver function tests (aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase, lactate dehydrogenase, total/direct/indirect bilirubin) of the patient and control groups were compared. Perihepatic fluid thickness, distribution pattern, localization according to liver lobes, presence and degree of intrahepatic bile duct dilatation, and presence of choledocholitiasis, periportal edema, perisplenic fluid were recorded, and the relationship with perihepatic fluid was evaluated. Results: All laboratory values except lactate dehydrogenase were significantly higher in the patient group than in the control group (p = 0.131 and p ≤ 0.011, respectively). The number of patients with higher laboratory values was higher in the patient group than in the control group (p ≤ 0.037). The difference between the two groups as regards intrahepatic bile duct dilatation and presence of perisplenic fluid was significant (p = 0.01 and p < 0.001, respectively). Alkaline phosphatase values correlated with the degree of intrahepatic bile duct dilatation (r = 0.349, p = 0.05). Conclusions: The presence of minimal fluid around the liver detected by magnetic resonance cholangiopancreatography may indicate impairment in liver function tests and should alert clinicians of pathologies that can cause cholestasis.

Keywords:

MRCP, perihepatic fluid, liver function test,

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