Abstract
Background/ObjectivesPortal hypertension (PH) is a clinical sequelae of liver cirrhosis, and bleeding from esophageal varices (EV) is a serious complication of PH with significant morbidity and mortality. The aims of this study were to assess the ability of 2D multislice breath-hold susceptibility weighted imaging (SWI) to detect Gamna-Gandy bodies (GGBs) in the spleens of patients with PH and to evaluate the potential role of GGB number as a non-invasive marker of PH and EV.Materials and MethodsT1-, T2- and T2*- weighted imaging and SWI were performed on 135 patients with PH and on 37 control individuals. Platelet counts were collected from all PH patients. Two radiologists analyzed all magnetic resonance imaging (MRI) data, and measured the portal vein diameter, splenic index (SI), and platelet count/spleen diameter ratio. The numbers of patients with GGBs in the spleen were determined, and the numbers of GGB were counted in the four MRI sequences in GGB-positive patients. The portal vein diameter, SI, platelet count, and platelet count/spleen diameter ratio of control individuals were compared with those of GGB-negative and GGB-positive patients on SWI images. The correlations among GGB numbers, the portal vein diameter, the SI, the platelet count, and the platelet count/spleen diameter ratio were analyzed.ResultsThe GGB detection rate and the detected GGB number by using SWI were significantly greater than those by using T1-, T2-, and T2*- weighted images. The number of GGBs in the SWI images correlated positively with the portal vein diameter and SI and correlated negatively with the platelet count and platelet count/spleen diameter ratio.ConclusionSWI provided more accurate information of GGBs in patients with PH. The number of GGB may be a non-invasive predictor of improving the selection for endoscopic screening of PH patients at risk of EV.
Highlights
Portal hypertension (PH) is a serious clinical complication of liver fibrosis of different etiologies
The number of Gamna-Gandy bodies (GGBs) may be a noninvasive predictor of improving the selection for endoscopic screening of PH patients at risk of esophageal varices (EV)
The aims of this study were to assess the ability of 2D multislice breath-hold susceptibility weighted imaging (SWI) to detect GGBs in the spleens of patients with PH caused by liver cirrhosis of different etiologies and to evaluate the potential role of GGB number as a non-invasive marker of PH and EV after a correlation analysis among the GGB number, the portal vein diameter, the splenic index (SI), the platelet count, and the platelet count/spleen diameter ratio
Summary
Portal hypertension (PH) is a serious clinical complication of liver fibrosis of different etiologies. The development of PH in cirrhotic liver is related to architectural changes caused by progressive hepatic fibrosis [1]. Congestive splenomegaly is a common finding in patients with PH [2]. Micro-hemorrhages in the splenic parenchyma, caused by a prolonged blood transit time and increased blood pressure secondary to congestive splenomegaly, followed by accumulation of hemosiderin and impregnation of collagen and elastic fibers with iron and calcium were named Gamna-Gandy bodies (GGBs); these are known as siderotic nodules in the spleen [3,4]. Due to the sensitivity to iron-containing structures, GGBs can be detected with a 9–12% detection rate by magnetic resonance imaging (MRI). GGBs can be demonstrated as multiple tiny foci of decreased signal intensity with all pulse sequences, especially gradient-echo sequences with low flip angle [5,6,7,8]
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