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Differentiating Cirrhosis and Chronic Hepatosplenic Schistosomiasis Using MRI

¹ Department of Diagnostic Imaging, Federal University of São Paulo, Rua Napoleão de Barros 800, São Paulo, SP 04024-002, Brazil.
² The SARAH Network of Hospitals for Reabilitation, Brasília, Brazil.
³ Department of Medicine, Federal University of São Paulo, São Paulo, Brazil.
⁴ Department of Surgery, Federal University of São Paulo, São Paulo, Brazil.
⁵ Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA.

OBJECTIVE. The objective of our study was to identify which imaging features may be used to differentiate between cirrhosis and chronic hepatosplenic schistosomiasis and to assess image interpretation agreement for MRI findings.

MATERIALS AND METHODS. Retrospective review of 27 patients with alcoholic or virus-induced cirrhosis and 24 patients with chronic hepatosplenic schistosomiasis who underwent MRI (1.5 T) of the abdomen was performed. Images were interpreted independently by two radiologists evaluating the following MRI features: hepatic fissure widening, irregularity of hepatic contours, periportal fibrosis, hepatic parenchyma heterogeneity, and splenic siderotic nodules. Left, right, and caudate hepatic lobe measurements were obtained, and the splenic index was measured. The Fisher's exact test, chi-square test, and Student's t test were used to compare both groups, and regression analysis was performed. Observer agreement was measured using kappa and intraclass correlation tests.

RESULTS. Periportal fibrosis, heterogeneity of hepatic parenchyma, and splenic siderotic nodules were more frequent in the group with schistosomiasis (p < 0.05), with periportal fibrosis showing the largest difference in presence and distribution (peripheral greater than central). The transverse diameter of the right hepatic lobe, caudate lobe–right lobe ratio, and splenic index were larger in patients with chronic schistosomiasis (p < 0.001). At multiple regression analysis, splenic siderotic nodules, splenic index, and caudate lobe–right lobe ratio were predictive of schistosomiasis. Observer agreement was substantial or almost perfect for almost all variables analyzed ( or r = 0.81–1.00).

CONCLUSION. The presence of peripheral periportal fibrosis, heterogeneity of hepatic parenchyma, and splenic siderotic nodules, and the splenic index and caudate lobe–right lobe ratio are useful features for differentiating alcoholic or virus-induced cirrhosis from chronic schistosomiasis using MRI.

Keywords: cirrhosis • hepatosplenic schistosomiasis • liver disease • MRI • schistosomiasis

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