Multi-organ assessment of compensated cirrhosis patients using quantitative magnetic resonance imaging
Author(s): ,
Indra Neil Guha
Affiliations:
Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
Corresponding author. Address: National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, E Floor, West Block QMC, Queens Medical Centre, Nottingham NG7 2UH,
,
Susan T. Francis
Affiliations:
NIHR Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
,
Guruprasad P. Aithal
Affiliations:
Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
,
Phillip Kaye
Affiliations:
NIHR Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
,
Martin W. James
Affiliations:
NIHR Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
,
Robert A. Scott
Affiliations:
NIHR Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
,
Eleanor F. Cox
Affiliations:
NIHR Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
Christopher R. Bradley
Affiliations:
NIHR Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
EASL LiverTree™. Guha I. Nov 1, 2018; 234536
Assoc. Prof. Indra Guha
Assoc. Prof. Indra Guha

Access to this content is an EASL members and LiverTree™ Privileged Users benefit.

Journal Abstract
References
Discussion Forum (0)
Rate & Comment (0)
Graphical abstract

Graphical abstract

Assessment of MRI parameters in a single scan session. Higher liver T1 and reduced liver perfusion with increasing disease severity and clinical outcomes. Reduced renal cortex T1 linked to disease severity and clinical outcomes.

Background & Aims

Advancing liver disease results in deleterious changes in a number of critical organs. The ability to measure structure, blood flow and tissue perfusion within multiple organs in a single scan has implications for determining the balance of benefit vs. harm for therapies. Our aim was to establish the feasibility of magnetic resonance imaging (MRI) to assess changes in Compensated Cirrhosis (CC), and relate this to disease severity and future liver-related outcomes (LROs).

Methods

A total of 60 patients with CC, 40 healthy volunteers and 7 patients with decompensated cirrhosis were recruited. In a single scan session, MRI measures comprised phase-contrast MRI vessel blood flow, arterial spin labelling tissue perfusion, T1 longitudinal relaxation time, heart rate, cardiac index, and volume assessment of the liver, spleen and kidneys. We explored the association between MRI parameters and disease severity, analysing differences in baseline MRI parameters in the 11 (18%) patients with CC who experienced future LROs.

Results

In the liver, compositional changes were reflected by increased T1 in progressive disease (p <0.001) and an increase in liver volume in CC (p = 0.006), with associated progressive reduction in liver (p <0.001) and splenic (p <0.001) perfusion. A significant reduction in renal cortex T1 and increase in cardiac index and superior mesenteric arterial blood flow was seen with increasing disease severity. Baseline liver T1 (p = 0.01), liver perfusion (p <0.01), and renal cortex T1 (p <0.01) were significantly different in patients with CC who subsequently developed negative LROs.

Conclusions

MRI enables the contemporaneous assessment of organs in liver cirrhosis in a single scan without the requirement for a contrast agent. MRI parameters of liver T1, renal T1, hepatic and splenic perfusion, and superior mesenteric arterial blood flow were related to the risk of LROs.

Lay summary

This study assesses the changes to structure, blood flow and perfusion that occur in the key organs (liver, spleen and kidney) associated with severe liver disease (Compensated Cirrhosis), using magnetic resonance imaging. The magnetic resonance imaging measures which changed with disease severity and were related to negative liver-related clinical outcomes are described.

Keyword(s)
Compensated Cirrhosis, Magnetic Resonance Imaging, Arterial Spin Labelling, Phase contrast, Longitudinal T relaxation time
[1]. Y. Iwakiri - The hyperdynamic circulation of chronic liver diseases: from the patient to the molecule
[2]. S. Møller - Cardiovascular complications of cirrhosis
[3]. R.W. Schrier - Peripheral arterial vasodilation hypothesis: a proposal for the initiation of renal sodium and water retention in cirrhosis
[4]. S. Moller - The pathophysiology of arterial vasodilatation and hyperdynamic circulation in cirrhosis
[5]. C.R. Taylor - Magnetic resonance imaging in the evaluation of the portal venous system
[6]. A. Krag - Low cardiac output predicts development of hepatorenal syndrome and survival in patients with cirrhosis and ascites
[7]. W.W. Lautt - Regulatory processes interacting to maintain hepatic blood flow constancy: vascular compliance, hepatic arterial buffer response, hepatorenal reflex, liver regeneration, escape from vasoconstriction
[8]. L. Blendis - The coeliac axis and its branches in splenomegaly and liver disease
[9]. D. Zeng - Abnormal splenic artery diameter/hepatic artery diameter ratio in cirrhosis-induced portal hypertension
[10]. A. Colecchia - Measurement of spleen stiffness to evaluate portal hypertension and the presence of esophageal varices in patients with HCV-related cirrhosis
[11]. Y. Takuma - Measurement of spleen stiffness by acoustic radiation force impulse imaging identifies cirrhotic patients with esophageal varices
[12]. T. Reiberger - Beta adrenergic blockade and decompensated cirrhosis
[13]. N. McDonald - Assessment of haemodynamic response to nonselective beta-blockers in portal hypertension by phase-contrast magnetic resonance angiography
[14]. G.R. Applegate - Blood flow in the portal vein: velocity quantitation with phase-contrast MR angiography
[15]. A.G. Gardener - Multislice perfusion of the kidneys using parallel imaging: image acquisition and analysis strategies
[16]. E.F. Cox - Multiparametric renal magnetic resonance imaging: validation, interventions, and alterations in chronic kidney disease
[17]. S. Agrawal - Visual morphometry and three non-invasive markers in the evaluation of liver fibrosis in chronic liver disease
[18]. T. Heye - MR relaxometry of the liver: significant elevation of T1 relaxation time in patients with liver cirrhosis
[19]. C.L. Hoad - A study of T(1) relaxation time as a measure of liver fibrosis and the influence of confounding histological factors
[20]. N. Palaniyappan - Non-invasive assessment of portal hypertension using quantitative magnetic resonance imaging
[21]. R.B. Buxton - A general kinetic model for quantitative perfusion imaging with arterial spin labeling
[22]. S. Natori - Cardiovascular function in multi-ethnic study of atherosclerosis: normal values by age, sex, and ethnicity
[23]. S.M. Banypersad - T1 mapping and survival in systemic light-chain amyloidosis
[24]. C. Tong - Assessment of liver volume variation to evaluate liver function
[25]. M.J. Williams - Links between hepatic fibrosis, ductular reaction, and progenitor cell expansion
[26]. M. Pavlides - Multiparametric magnetic resonance imaging predicts clinical outcomes in patients with chronic liver disease
[27]. J.X.Q. Pang - Liver stiffness by transient elastography predicts liver-related complications and mortality in patients with chronic liver disease
[28]. J. Parkes - Enhanced liver fibrosis test can predict clinical outcomes in patients with chronic liver disease
[29]. K.S. Lee - Corticomedullary differentiation on T1-Weighted MRI: comparison between cirrhotic and noncirrhotic patients
[30]. F. Yamada - Pseudonormal corticomedullary differentiation of the kidney assessed on T1-weighted imaging for chronic kidney disease patients with cirrhosis
[31]. M. Merli - Survival at 2 years among liver cirrhotic patients is influenced by left atrial volume and left ventricular mass
[32]. N.C. McAvoy - Editorial: increased cardiac output in cirrhosis - non-invasive assessment of regional blood flow by magnetic resonance angiography
[33]. M.D. Chouhan - Caval subtraction 2D phase-contrast MRI to measure total liver and hepatic arterial blood flow: proof-of-principle, correlation with portal hypertension severity and validation in patients with chronic liver disease
[34]. L. Annet - Hepatic flow parameters measured with MR imaging and Doppler US: correlations with degree of cirrhosis and portal hypertension
[35]. D. Popov - Doppler parameters of hepatic and renal hemodynamics in patients with liver cirrhosis
[36]. T. Iwao - Echo-Doppler measurements of portal vein and superior mesenteric artery blood flow in humans: inter- and intra-observer short-term reproducibility
[37]. T. Yzet - Hepatic vascular flow measurements by phase contrast MRI and doppler echography: a comparative and reproducibility study
[38]. A.H. Chowduhury - A randomized, controlled, double-blind crossover study on the effects of 2-L infusions of 0.9% saline and plasma-lyte(R) 148 on renal blood flow velocity and renal cortical tissue perfusion in healthy volunteers
[39]. M.A.R. Vermeulen - Accurate perioperative flow measurement of the portal vein and hepatic and renal artery: a role for preoperative MRI?
[40]. U. Motosugi - Multi-organ perfusion CT in the abdomen using a 320-detector row CT scanner: Preliminary results of perfusion changes in the liver, spleen, and pancreas of cirrhotic patients
[41]. V.K. Snowdon - Serelaxin as a potential treatment for renal dysfunction in cirrhosis: preclinical evaluation and results of a randomized phase 2 trial
[42]. P. Angulo - Simple noninvasive systems predict long-term outcomes of patients with nonalcoholic fatty liver disease
[43]. J. Vergniol - Noninvasive tests for fibrosis and liver stiffness predict 5-year outcomes of patients with chronic hepatitis C
[44]. M.D. Chouhan - Multiparametric magnetic resonance imaging to predict clinical outcomes in patients with chronic liver disease: a cautionary note on a promising technique
Code of conduct/disclaimer available in General Terms & Conditions

By continuing to browse or by clicking “Accept Terms & all Cookies”, you agree to the storing of third-party cookies on your device to enhance your user experience and agree to the user terms and conditions of this learning management system (LMS).

Cookie Settings
Accept Terms & all Cookies