Alterações na morfologia hepática observadas à ressonância magnética empacientes com esquistossomose hepatoesplênica

Abstract

Purpose: to evaluate liver morphology in hepatosplenic schistosomiasis mansoni. Materials and Methods: Ethical permission and written informed patient consent were obtained. 50 patients with chronic hepatosplenic schistosomiasis were assessed using abdominal magnetic resonance imaging (MRI). Several morphologic changes in the hepatic lobes were qualitatively and quantitatively assessed and compared to MRI results observed in 2 control groups (20 cirrhotic patients and 23 subjects without liver disease). Volume indexes of each liver segment (based on three-axis measurements) and the relation between right hepatic and caudate lobes were evaluated. Results: Qualitative analysis revealed liver atrophy-hypertrophy complex in all patients with chronic hepatosplenic schistosomiasis as well as in patients with cirrhosis but not in those without liver disease. Atrophy of the posterior segment of right liver lobe was only observed in the schistosomiasis group. The anteroposterior diameter of the posterior right liver lobe below 4.5 cm had a sensitivity of 96% and a specificity of 100 % in diagnosing hepatosplenic schistosomiasis. The mean segment IV diameter was 4.55 cm in schistosomiasis patients and 2.96 cm in the cirrhosis group (p=.001). Conclusion: Analysis of liver morphology revealed that schistosomiasis evolves with right liver lobe atrophy, particularly, the right posterior segment, whereas thelateral left lobe and caudate lobe are hypertrophied and the middle left lobe is preserved. Therefore, morphologic changes in schistosomiasis mansoni, such as caudate and lateral left lobe hypertrophy, mimics other chronic liver diseases, but a normal segment IV and an atrophic posterior right liver lobe segment were only encountered in hepatosplenic schistosomiasis.