Abstract
ObjectivesIn patients with advanced liver disease, portal hypertension is an important risk factor, leading to complications such as esophageal variceal bleeding, ascites, and hepatic encephalopathy. This study aimed to determine the diagnostic value of T1 and T2 mapping and extracellular volume fraction (ECV) for the non-invasive assessment of portal hypertension.MethodsIn this prospective study, 50 participants (33 patients with indication for trans-jugular intrahepatic portosystemic shunt (TIPS) and 17 healthy volunteers) underwent MRI. The derivation and validation cohorts included 40 and 10 participants, respectively. T1 and T2 relaxation times and ECV of the liver and the spleen were assessed using quantitative mapping techniques. Direct hepatic venous pressure gradient (HVPG) and portal pressure measurements were performed during TIPS procedure. ROC analysis was performed to compare diagnostic performance.ResultsSplenic ECV correlated with portal pressure (r = 0.72; p < 0.001) and direct HVPG (r = 0.50; p = 0.003). No significant correlations were found between native splenic T1 and T2 relaxation times with portal pressure measurements (p > 0.05, respectively). In the derivation cohort, splenic ECV revealed a perfect diagnostic performance with an AUC of 1.000 for the identification of clinically significant portal hypertension (direct HVPG ≥ 10 mmHg) and outperformed other parameters: hepatic T2 (AUC, 0.731), splenic T2 (AUC, 0.736), and splenic native T1 (AUC, 0.806) (p < 0.05, respectively). The diagnostic performance of mapping parameters was comparable in the validation cohort.ConclusionSplenic ECV was associated with portal pressure measurements in patients with advanced liver disease. Future studies should explore the diagnostic value of parametric mapping accross a broader range of pressure values.Key Points• Non-invasive assessment and monitoring of portal hypertension is an area of unmet interest.• Splenic extracellular volume fraction is strongly associated with portal pressure in patients with end-stage liver disease.• Quantitative splenic and hepatic MRI-derived parameters have a potential to become a new non-invasive diagnostic parameter to assess and monitor portal pressure.
Highlights
Any chronic liver disease may lead to liver fibrosis, which distorts normal liver architecture by the expansion of the extracellular space, and impairs hepatic function [1]
Splenic extracellular volume fraction is strongly associated with portal pressure in patients with end-stage liver disease
From November 2018 to September 2019, patients with advanced liver disease and portal hypertension scheduled for trans-jugular intrahepatic portosystemic shunt (TIPS) implantation were consecutively included in this study
Summary
Any chronic liver disease may lead to liver fibrosis, which distorts normal liver architecture by the expansion of the extracellular space, and impairs hepatic function [1]. Portal hypertension may lead to life-threatening complications such as esophageal variceal bleeding, ascites, and hepatic encephalopathy. Therapy refractory ascites is associated with significantly increased mortality 6–12 months after diagnosis [3]. Precise diagnosis of portal hypertension plays an important role in clinical decision-making and early interventions may prevent severe complications. The hepatic venous pressure gradient (HVPG) is considered the reference standard for the assessment of portal hypertension [4]. The HVPG is the difference between the wedged portal vein pressure and the free hepatic venous pressure. The invasive procedure of HVPG has clear disadvantages because it may be associated with procedural complications and, cannot be used as a follow-up method. Alternative non-invasive techniques are needed for the assessment and monitoring of portal pressure
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