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Noninvasive prediction of portal pressure with MR elastography and DCE-MRI of the liver and spleen: Preliminary results


Wagner, Mathilde; Hectors, Stefanie; Bane, Octavia; Gordic, Sonja; Kennedy, Paul; Besa, Cecilia; Schiano, Thomas D; Thung, Swan; Fischman, Aaron; Taouli, Bachir (2018). Noninvasive prediction of portal pressure with MR elastography and DCE-MRI of the liver and spleen: Preliminary results. Journal of Magnetic Resonance Imaging (JMRI), 48(4):1091-1103.

Abstract

BACKGROUND Portal hypertension (PH), defined by hepatic venous pressure gradient (HVPG) ≥5 mmHg and clinically significant PH, defined by HVPG ≥10 mmHg, are complications of chronic liver disease. PURPOSE To assess the diagnostic performance of MR elastography (MRE) and dynamic contrast-enhanced MRI (DCE-MRI) of the liver and spleen for the prediction of PH and clinically significant PH, in comparison with a qualitative PH imaging scoring system. STUDY TYPE IRB-approved prospective study. POPULATION In all, 34 patients with chronic liver disease who underwent HVPG measurement. FIELD STRENGTH/SEQUENCE 1.5/3T examination including 2D-GRE MRE (n = 33) and DCE-MRI of the liver/spleen (n = 28). ASSESSMENT Liver and spleen stiffness were calculated from elastogram maps. DCE-MRI was analyzed using model-free parameters and pharmacokinetic modeling. Two observers calculated qualitative PH imaging scores based on routine images. STATISTICAL TESTS Imaging parameters were correlated with HVPG. Receiver operating characteristic (ROC) analysis was performed for prediction of PH and clinically significant PH. RESULTS There were significant correlations between DCE-MRI parameters (liver time-to-peak, r = 0.517 / P = 0.006, liver distribution volume, r = 0.494 / P = 0.009, liver upslope, r = -0.567 / P = 0.002), liver stiffness (r = 0.478 / P = 0.016), PH imaging score (r = 0.441 / P = 0.009), and HVPG. ROC analysis provided significant area under the ROC (AUROCs) for PH (liver upslope 0.765, liver stiffness 0.809, spleen volume/diameter 0.746-0.731, PH imaging score 0.756) and for clinically significant PH (liver and spleen perfusion parameters 0.733-0.776, liver stiffness 0.742, PH imaging score 0.742). The ratio of liver stiffness to liver upslope had the highest AUROC for diagnosing PH (0.903) and clinically significant PH (0.785). DATA CONCLUSION These preliminary results suggest that the combination of liver stiffness and perfusion metrics provide excellent accuracy for diagnosing PH, and fair accuracy for clinically significant PH. Combined MRE and DCE-MRI outperformed qualitative imaging scores for prediction of PH. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018.

Abstract

BACKGROUND Portal hypertension (PH), defined by hepatic venous pressure gradient (HVPG) ≥5 mmHg and clinically significant PH, defined by HVPG ≥10 mmHg, are complications of chronic liver disease. PURPOSE To assess the diagnostic performance of MR elastography (MRE) and dynamic contrast-enhanced MRI (DCE-MRI) of the liver and spleen for the prediction of PH and clinically significant PH, in comparison with a qualitative PH imaging scoring system. STUDY TYPE IRB-approved prospective study. POPULATION In all, 34 patients with chronic liver disease who underwent HVPG measurement. FIELD STRENGTH/SEQUENCE 1.5/3T examination including 2D-GRE MRE (n = 33) and DCE-MRI of the liver/spleen (n = 28). ASSESSMENT Liver and spleen stiffness were calculated from elastogram maps. DCE-MRI was analyzed using model-free parameters and pharmacokinetic modeling. Two observers calculated qualitative PH imaging scores based on routine images. STATISTICAL TESTS Imaging parameters were correlated with HVPG. Receiver operating characteristic (ROC) analysis was performed for prediction of PH and clinically significant PH. RESULTS There were significant correlations between DCE-MRI parameters (liver time-to-peak, r = 0.517 / P = 0.006, liver distribution volume, r = 0.494 / P = 0.009, liver upslope, r = -0.567 / P = 0.002), liver stiffness (r = 0.478 / P = 0.016), PH imaging score (r = 0.441 / P = 0.009), and HVPG. ROC analysis provided significant area under the ROC (AUROCs) for PH (liver upslope 0.765, liver stiffness 0.809, spleen volume/diameter 0.746-0.731, PH imaging score 0.756) and for clinically significant PH (liver and spleen perfusion parameters 0.733-0.776, liver stiffness 0.742, PH imaging score 0.742). The ratio of liver stiffness to liver upslope had the highest AUROC for diagnosing PH (0.903) and clinically significant PH (0.785). DATA CONCLUSION These preliminary results suggest that the combination of liver stiffness and perfusion metrics provide excellent accuracy for diagnosing PH, and fair accuracy for clinically significant PH. Combined MRE and DCE-MRI outperformed qualitative imaging scores for prediction of PH. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018.

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Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Diagnostic and Interventional Radiology
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:Radiology Nuclear Medicine and imaging
Language:English
Date:1 October 2018
Deposited On:19 Apr 2018 13:23
Last Modified:08 Oct 2018 01:01
Publisher:Wiley-Blackwell Publishing, Inc.
ISSN:1053-1807
OA Status:Closed
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1002/jmri.26026
PubMed ID:29638020
Project Information:
  • : FunderSNSF
  • : Grant IDP2ZHP3_161691
  • : Project TitleMultiparametric Magnetic Resonance Imaging Techniques for Assessment of Transplant Kidney Function

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