Non-invasive assessment of portal hypertension using quantitative magnetic resonance imaging

Palaniyappan, Naaventhan and Cox, Eleanor and Bradley, Christopher and Scott, Robert and Austin, Andrew and O’Neill, Richard and Ramjas, Greg and Travis, Simon and White, Hilary and Singh, Rajeev and Thurley, Peter and Guha, Indra Neil and Francis, Susan and Aithal, Guruprasad Padur (2016) Non-invasive assessment of portal hypertension using quantitative magnetic resonance imaging. Journal of Hepatology, 65 (6). pp. 1131-1139. ISSN 0168-8278

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Abstract

Background & Aims

Hepatic venous pressure gradient (HVPG) measurement is currently the only validated technique to accurately evaluate changes in portal pressure. In this study, we evaluate the use of non-contrast quantitative magnetic resonance imaging (MRI) as a surrogate measure of portal pressure.

Methods

Thirty patients undergoing HVPG measurement were prospectively recruited. MR parameters of longitudinal relaxation time (T1), perfusion of the liver and spleen (by arterial spin labelling), and blood flow in the portal, splanchnic and collateral circulation (by phase contrast MRI) were assessed. We estimated the liver stiffness measurement (LSM) and enhanced liver fibrosis (ELF) score. The correlation of all non-invasive parameters with HVPG was evaluated.

Results

The mean (range) HVPG of the patients was 9.8 (1–22) mmHg, and 14 patients (48%) had clinically significant portal hypertension (CSPH, HVPG ⩾10 mmHg). Liver T1 relaxation time, splenic artery and superior mesenteric artery velocity correlated significantly with HVPG. Using multiple linear regression, liver T1 and splenic artery velocity remained as the two parameters in the multivariate model significantly associated with HVPG (R = 0.90, p <0.001). This correlation was maintained in patients with CSPH (R = 0.85, p <0.001). A validation cohort (n = 10) showed this linear model provided a good prediction of HVPG. LSM and ELF score correlated significantly with HVPG in the whole population but the correlation was absent in CSPH.

Conclusions

MR parameters related to both hepatic architecture and splanchnic haemodynamics correlate significantly with HVPG. This proposed model, confirmed in a validation cohort, could replace the invasive HVPG measurement.

Item Type: Article
Keywords: Portal hypertension; Hepatic venous pressure gradient; Magnetic resonance imaging; Longitudinal T1 relaxation time
Schools/Departments: University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine
Identification Number: https://doi.org/10.1016/j.jhep.2016.07.021
Depositing User: Eprints, Support
Date Deposited: 24 Nov 2016 08:41
Last Modified: 26 Nov 2016 07:24
URI: http://eprints.nottingham.ac.uk/id/eprint/38931

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