Quantification of the Hemodynamic Changes of Cirrhosis with Free-Breathing Self-Navigated MRI. Journal of magnetic resonance imaging : JMRI Brunsing, R. L., Brown, D., Almahoud, H., Kono, Y., Loomba, R., Vodkin, I., Sirlin, C. B., Alley, M. T., Vasanawala, S. S., Hsiao, A. 2021


BACKGROUND: Non-invasive assessment of the hemodynamic changes of cirrhosis might help guide management of patients with liver disease but are currently limited.PURPOSE: To determine whether free-breathing 4D flow MRI can be used to quantify the hemodynamic effects of cirrhosis and introduce hydraulic circuit indexes of severity.STUDY TYPE: Retrospective.POPULATION: Forty-seven patients including 26 with cirrhosis.FIELD STRENGTH/SEQUENCE: 3T/free-breathing 4D flow MRI with soft gating and golden-angle view ordering.ASSESSMENT: Measurements of the supra-celiac abdominal aorta, supra-renal abdominal aorta (SRA), celiac trunk (CeT), superior mesenteric artery (SMA), splenic artery (SpA), common hepatic artery (CHA), portal vein (PV), and supra-renal inferior vena cava (IVC) were made by two radiologists. Measures of hepatic vascular resistance (hepatic arterial relative resistance [HARR]; portal resistive index [PRI]) were proposed and calculated.STATISTICAL ANALYSIS: Bland-Altman, Pearson's correlation, Tukey's multiple comparison, and Cohen's kappa. P<0.05 was considered significant.RESULTS: Forty-four of 47 studies yielded adequate image quality for flow quantification (94%). Arterial structures showed high inter-reader concordance (range; rho = 0.948-0.987) and the IVC (rho = 0.972), with moderate concordance in the PV (rho = 0.866). Conservation of mass analysis showed concordance between large vessels (SRA vs. IVC; rho = 0.806), small vessels (celiac vs. CHA+SpA; rho = 0.939), and across capillary beds (CeT+SMA vs. PV; rho = 0.862). Splanchnic flow was increased in patients with portosystemic shunting (PSS) relative to control patients and patients with cirrhosis without PSS (P<0.05, difference range 0.11-0.68liter/m). HARR was elevated and PRI was decreased in patients with PSS (3.55 and 1.49, respectively) compared to both the control (2.11/3.18) and non-PSS (2.11/2.35) cohorts.DATA CONCLUSION: 4D flow MRI with self-navigation was technically feasible, showing promise in quantifying the hemodynamic effects of cirrhosis. Proposed quantitative metrics of hepatic vascular resistance correlated with PSS.LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 2.

View details for DOI 10.1002/jmri.27488

View details for PubMedID 33594733