Objective
Acute fatty liver of pregnancy (AFLP) is a life-threatening complication of pregnancy characterized by acute development of intrahepatocyte microvesicular steatosis. Recovery is associated with normalization of liver blood test results in early postpartum weeks and full restitution of normal liver tissue. Diagnosis of AFLP is accepted when at least 6 of the 14 Swansea criteria are present in the absence of another explanation. The aim of this study was to show that magnetic resonance (MR) imaging (MRI) with quantification of intrahepatic fat allows detection of transient liver steatosis in patients with AFLP noninvasively.
Study Design
We prospectively selected 5 patients in whom AFLP was suspected on the basis of at least 6 Swansea criteria ( Table ). Serum tested negative for hepatitis B virus, hepatitis C virus, and HIV and no patient had recently ingested acetylsalicylic acid or paracetamol. MRI is recognized as a very sensitive tool for the detection and accurate quantification of steatosis in the liver. In our study, acquisitions were performed on a Philips Ingenia 3·0T system (Philips, Best, The Netherlands) with 40 mT.m-1 gradient amplitude. To derive the proton density fat fraction (PDFF), the multiple-echo set of images was processed offline using a dedicated algorithm (MR-based liver fat quantification). Normal measure of PDFF was <5%.
| Patient, no. (age, y) | 1 (25) | 2 (32) | 3 (32) | 4 (36) | 5 (34) |
| Predelivery clinical symptoms | |||||
| Vomiting (Sw Cr) | + | + | + | – | + |
| Abdominal pain (Sw Cr) | + | + | + | – | + |
| Polydipsia/polyuria (Sw Cr) | + | + | + | + | – |
| Encephalopathy (Sw Cr) | – a | – | + | – | – |
| Delivery date, gestational wk | 37 | 38 | 36 | 37 | 34 |
| Cesarean delivery | Yes | Yes | Yes | Yes | Yes |
| Ascites or bright liver on ultrasound scan (Sw Cr) | (Postpartum day 1) + | – | – | (Postpartum day 1) + | – |
| Predelivery biological features | |||||
| Total bilirubin, μmol/L (Sw Cr, >14) | 81 + | 38 + | 115 + | 50 + | 15 + |
| Glucose, mmol/L (Sw Cr, <4) | 3.3 + | 5.8 | 3.88 + | NA | 4.9 |
| Serum uric acid, μmol/L (Sw Cr, >340) | 599 + | 439 + | 399 + | 458 + | 446 + |
| Serum creatinine, μmol/L (Sw Cr, >150) | 82 | 125 | 275 + | 251 + | 58 |
| Leucocytosis, 10 9 /L (Sw Cr, >11) | 16.8 + | 25.2 + | 18.6 + | 15 + | 15 + |
| Serum alanine aminotransferase,UI/L (Sw Cr, >42) | 190 + | 640 + | 143 + | 195 + | 967 + |
| Blood ammonia | NA | NA | NA | NA | NA |
| Prothrombin time, s (Sw Cr, >14) | 26.5 + | 15.4 + | 19.3 + | 17.1 + | 12.2 |
| Liver histology with specific fat staining (Sw Cr, microvesicular steatosis of hepatocytes) | NA | NA | NA | NA | No microvesicular steatosis Sinusoidal fibrin deposits |
| Sw Cr: total no. | 10 | 8 | 11 | 8 | 6 |
| Fat liver quantification at first MRI (postpartum day) | 5.9% (5) | 10% (delivery day) | 7% (2) | 13% (1) | 0% (–1) |
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
