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Am J Perinatol 2018; 35(08): 741-747
DOI: 10.1055/s-0037-1613684
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Liver Injury in Hemolysis, Elevated Liver Enzymes, and Low Platelets Syndrome Measured by Diffusion-Weighted Magnetic Resonance Imaging

David B. Nelson
1   Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, Texas
,
Ambereen Khan
2   Department of Radiology, UT Southwestern Medical Center, Dallas, Texas
,
April Bailey
2   Department of Radiology, UT Southwestern Medical Center, Dallas, Texas
,
Takeshi Yokoo
2   Department of Radiology, UT Southwestern Medical Center, Dallas, Texas
,
Ivan Pedrosa
2   Department of Radiology, UT Southwestern Medical Center, Dallas, Texas
,
Donald D. McIntire
1   Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, Texas
,
F. Gary Cunningham
1   Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, Texas
› Author Affiliations
Further Information

Publication History

02 June 2017

10 November 2017

Publication Date:
27 December 2017 (online)

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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 - lesion

Note

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).


 

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