Multiparametric MRI for Diagnosing Clinically Significant Portal Hypertension and Predicting Liver Decompensation

IF 5.2 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Liver International Pub Date : 2025-09-27 DOI:10.1111/liv.70368

Efe Ozkaya, Octavia Bane, Enamul Bhuiyan, Amine Geahchan, Emre Altinmakas, Stefanie J. Hectors, Paul Kennedy, Ghadi Abboud, Swathi Pavuluri, Richard L. Ehman, Meng Yin, Sara Lewis, Meena B. Bansal, Aaron Fischman, Swan Thung, Thomas D. Schiano, Bachir Taouli

{"title":"Multiparametric MRI for Diagnosing Clinically Significant Portal Hypertension and Predicting Liver Decompensation","authors":"Efe Ozkaya, Octavia Bane, Enamul Bhuiyan, Amine Geahchan, Emre Altinmakas, Stefanie J. Hectors, Paul Kennedy, Ghadi Abboud, Swathi Pavuluri, Richard L. Ehman, Meng Yin, Sara Lewis, Meena B. Bansal, Aaron Fischman, Swan Thung, Thomas D. Schiano, Bachir Taouli","doi":"10.1111/liv.70368","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background and Aims</h3>\n \n <p>Clinically significant portal hypertension (CSPH; hepatic venous pressure gradient (HVPG) ≥ 10 mmHg) is a severe complication of chronic liver disease, with increased risk of variceal bleeding and liver decompensation (at HVPG ≥ 12 mmHg). This study evaluated the performance of multiparametric (mp)MRI for diagnosing CSPH and predicting liver decompensation, compared to ultrasound-based shear wave elastography (SWE) and blood tests.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>In this prospective single-centre study (2018–2022), 59 patients (M 30, mean age 52.7 years) underwent mpMRI and HVPG measurement, with an average interval of 32 ± 31 days. The mpMRI protocol included 2D/3D MR elastography (MRE), T<sub>1</sub>/proprietary iron-compensated T<sub>1</sub> (cT<sub>1</sub>)/T<sub>1ρ</sub> mapping, gadoxetate-enhanced dynamic contrast-enhanced MRI (DCE-MRI) of the liver and spleen, SWE and blood tests. Statistical analyses included Mann–Whitney U tests, ROC analysis, logistic regression and Cox proportional hazards models.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>CSPH was present in 13 patients (22%). Several MRI parameters showed high diagnostic performance for CSPH (AUC ≥ 0.8), with spleen stiffness-2D MRE (AUC 0.88, 95% confidence interval (CI) 0.78–0.98) and liver uptake on DCE-MRI (AUC 0.83, 95% CI 0.70–0.96) performing best, while SWE had AUCs of 0.63 (95% CI 0.45–0.81) for liver and 0.67 (95% CI 0.44–0.89) for spleen. Combining spleen stiffness-2D MRE and liver uptake achieved an AUC of 0.93 (95% CI 0.86–1.00) for diagnosing CSPH. For predicting decompensation, spleen stiffness-3D MRE and liver uptake rate had AUCs of 0.83 (95% CI 0.68–0.99) and 0.83 (95% CI 0.70–0.95), respectively, outperforming SWE.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Spleen stiffness measured with MRE combined with gadoxetate liver uptake (measured with DCE-MRI) can diagnose CSPH and predict liver decompensation, with superior performance compared to SWE.</p>\n </section>\n \n <section>\n \n <h3> Trial Registration</h3>\n \n <p>ClinicalTrials.gov identifier: NCT03436550</p>\n </section>\n </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 11","pages":""},"PeriodicalIF":5.2000,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Liver International","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/liv.70368","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background and Aims

Clinically significant portal hypertension (CSPH; hepatic venous pressure gradient (HVPG) ≥ 10 mmHg) is a severe complication of chronic liver disease, with increased risk of variceal bleeding and liver decompensation (at HVPG ≥ 12 mmHg). This study evaluated the performance of multiparametric (mp)MRI for diagnosing CSPH and predicting liver decompensation, compared to ultrasound-based shear wave elastography (SWE) and blood tests.

Methods

In this prospective single-centre study (2018–2022), 59 patients (M 30, mean age 52.7 years) underwent mpMRI and HVPG measurement, with an average interval of 32 ± 31 days. The mpMRI protocol included 2D/3D MR elastography (MRE), T₁/proprietary iron-compensated T₁ (cT₁)/T_1ρ mapping, gadoxetate-enhanced dynamic contrast-enhanced MRI (DCE-MRI) of the liver and spleen, SWE and blood tests. Statistical analyses included Mann–Whitney U tests, ROC analysis, logistic regression and Cox proportional hazards models.

Results

CSPH was present in 13 patients (22%). Several MRI parameters showed high diagnostic performance for CSPH (AUC ≥ 0.8), with spleen stiffness-2D MRE (AUC 0.88, 95% confidence interval (CI) 0.78–0.98) and liver uptake on DCE-MRI (AUC 0.83, 95% CI 0.70–0.96) performing best, while SWE had AUCs of 0.63 (95% CI 0.45–0.81) for liver and 0.67 (95% CI 0.44–0.89) for spleen. Combining spleen stiffness-2D MRE and liver uptake achieved an AUC of 0.93 (95% CI 0.86–1.00) for diagnosing CSPH. For predicting decompensation, spleen stiffness-3D MRE and liver uptake rate had AUCs of 0.83 (95% CI 0.68–0.99) and 0.83 (95% CI 0.70–0.95), respectively, outperforming SWE.

Conclusions

Spleen stiffness measured with MRE combined with gadoxetate liver uptake (measured with DCE-MRI) can diagnose CSPH and predict liver decompensation, with superior performance compared to SWE.

Trial Registration

ClinicalTrials.gov identifier: NCT03436550

Abstract Image

查看原文本刊更多论文

多参数MRI诊断临床意义门脉高压及预测肝脏失代偿

临床显著门脉高压（CSPH，肝静脉压梯度(HVPG)≥10 mmHg）是慢性肝病的严重并发症，可增加静脉曲张出血和肝脏失代偿的风险（HVPG≥12 mmHg）。本研究评估了多参数（mp）MRI在诊断CSPH和预测肝脏失代偿方面的性能，并与基于超声的剪切波弹性成像（SWE）和血液检查进行了比较。方法在本前瞻性单中心研究（2018-2022）中，59例患者（m30，平均年龄52.7岁）接受mpMRI和HVPG检测，平均间隔时间为32±31天。mpMRI方案包括2D/3D MR弹性成像（MRE）， T1/专有铁补偿T1 (cT1)/T1ρ测绘，肝和脾的gadoxate增强动态对比增强MRI (DCE-MRI)， SWE和血液检查。统计分析包括Mann-Whitney U检验、ROC分析、logistic回归和Cox比例风险模型。结果CSPH 13例（22%）。多个MRI参数显示CSPH的高诊断效能（AUC≥0.8），其中脾脏刚度- 2d MRE （AUC 0.88, 95%可信区间（CI） 0.78-0.98）和肝脏摄取DCE-MRI （AUC 0.83, 95% CI 0.70-0.96）表现最佳，而SWE的AUC为0.63 (95% CI 0.45-0.81)，脾脏为0.67 （95% CI 0.44-0.89）。结合脾脏刚度- 2d MRE和肝脏摄取，诊断CSPH的AUC为0.93 （95% CI 0.86-1.00）。为了预测失代偿，脾脏刚度- 3d MRE和肝脏摄取率的auc分别为0.83 （95% CI 0.68-0.99）和0.83 (95% CI 0.70-0.95)，优于SWE。结论MRE联合gadoxetate肝摄取（DCE-MRI）测量脾脏刚度可诊断CSPH并预测肝脏失代偿，优于SWE。试验注册ClinicalTrials.gov标识符：NCT03436550

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Liver International 医学-胃肠肝病学

CiteScore

13.90

自引率

4.50%

发文量

348

审稿时长

2 months

期刊介绍： Liver International promotes all aspects of the science of hepatology from basic research to applied clinical studies. Providing an international forum for the publication of high-quality original research in hepatology, it is an essential resource for everyone working on normal and abnormal structure and function in the liver and its constituent cells, including clinicians and basic scientists involved in the multi-disciplinary field of hepatology. The journal welcomes articles from all fields of hepatology, which may be published as original articles, brief definitive reports, reviews, mini-reviews, images in hepatology and letters to the Editor.