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

Palaniyappan, Naaventhan; Cox, Eleanor; Bradley, Christopher; Scott, Robert; Austin, Andrew; O�Neill, Richard; Ramjas, Greg; Travis, Simon; White, Hilary; Singh, Rajeev; Thurley, Peter; Guha, Indra Neil; Francis, Susan; Aithal, Guruprasad Padur

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.

Citation

Palaniyappan, N., Cox, E., Bradley, C., Scott, R., Austin, A., O’Neill, R., Ramjas, G., Travis, S., White, H., Singh, R., Thurley, P., Guha, I. N., Francis, S., & Aithal, G. P. (2016). Non-invasive assessment of portal hypertension using quantitative magnetic resonance imaging. Journal of Hepatology, 65(6), 1131-1139. https://doi.org/10.1016/j.jhep.2016.07.021

• Journal Article Type: Article
• Acceptance Date: Jul 21, 2016
• Online Publication Date: Jul 27, 2016
• Publication Date: Dec 1, 2016
• Deposit Date: Nov 24, 2016
• Publicly Available Date: Nov 24, 2016
• Journal: Journal of Hepatology
• Print ISSN: 0168-8278
• Electronic ISSN: 1600-0641
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 65
• Issue: 6
• Pages: 1131-1139
• DOI: https://doi.org/10.1016/j.jhep.2016.07.021
• Keywords: Portal hypertension; Hepatic venous pressure gradient; Magnetic resonance imaging; Longitudinal T1 relaxation time
• Public URL: https://nottingham-repository.worktribe.com/output/825722
• Publisher URL: http://dx.doi.org/10.1016/j.jhep.2016.07.021
• Additional Information: This article is maintained by: Elsevier; Article Title: Non-invasive assessment of portal hypertension using quantitative magnetic resonance imaging; Journal Title: Journal of Hepatology; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.jhep.2016.07.021; Content Type: article; Copyright: © 2016 European Association for the Study of the Liver. Published by Elsevier B.V.