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Noninvasive diagnosis of portal hypertension using gadoxetate DCE-MRI of the liver and spleen

  • Hepatobiliary-Pancreas
  • Published:
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Abstract

Objectives

To assess the performance of gadoxetate dynamic contrast–enhanced (DCE) MRI of the liver and spleen for noninvasive diagnosis of portal hypertension (PH).

Methods

Thirty-five patients (M/F 22/13, mean age 55 years) with chronic liver disease who underwent hepatic venous pressure gradient (HVPG) measurements were prospectively enrolled in this IRB-approved study. All patients underwent multiparametric MRI including gadoxetate DCE-MRI acquisition. Model-based and model-free DCE-MRI analyses were performed. The correlation between DCE-MRI parameters and HVPG was assessed. ROC analysis was employed to determine the diagnostic performance of DCE-MRI parameters alone and in combination for prediction of PH and clinically significant (CS)PH (HVPG > 5 and ≥ 10 mmHg, respectively).

Results

Mean HVPG was 7.0 ± 5.0 mmHg (range 0–18 mmHg). Twenty-one (60%) patients had PH, of whom 9 had CSPH. Modeled liver uptake fraction fi and uptake rate ki and model-free parameters liver upslope and uptake were all significantly negatively correlated with HVPG (r range − 0.490 to − 0.398, p value range 0.003–0.018), while spleen interstitial fraction ve was significantly positively correlated with HVPG (r = 0.336, p = 0.048). For PH diagnosis, liver ki showed the best diagnostic performance with an AUC, sensitivity, and specificity of 0.74 (confidence interval (CI) 0.57–0.91), 71.4%, and 78.6%. The combination of liver ki and spleen ve was selected as the best classifier for diagnosis of CSPH with an AUC, sensitivity, and specificity of 0.87 (CI 0.75–0.99), 100%, and 73.1%.

Conclusions

Our results demonstrate the potential utility of hepatocyte uptake parameters and spleen interstitial fraction obtained with gadoxetate DCE-MRI for the diagnosis of PH and CSPH.

Key Points

• Liver uptake and spleen interstitial fraction estimates from gadoxetate DCE-MRI are significantly correlated with portal pressure measurements.

• Liver uptake rate shows good diagnostic performance for the diagnosis of portal hypertension.

• The combination of liver uptake rate with spleen interstitial fraction exhibits excellent diagnostic performance for the diagnosis of clinically significant portal hypertension.

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Abbreviations

ART:

Arterial fraction

CPA:

Collagen proportionate area

CSPH:

Clinically significant portal hypertension

DCE-MRI:

Dynamic contrast–enhanced MRI

F a :

Arterial flow

f i :

Uptake fraction

F p :

Portal flow

F t :

Total flow

HVPG:

Hepatic venous pressure gradient

k i :

Intracellular uptake rate

MTT:

Mean transit time

PH:

Portal hypertension

ROI:

Region of interest

SI:

Signal intensity

TTP:

Time to peak

v e :

Interstitial volume fraction

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Funding

This research was supported by NIDDK grant R01DK113272.

Author information

Authors and Affiliations

  1. Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Stefanie J. Hectors, Octavia Bane, Paul Kennedy, Jordan Cuevas & Bachir Taouli

  2. Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York, NY, 10029, USA

    Stefanie J. Hectors, Octavia Bane, Paul Kennedy, Jordan Cuevas, Aaron Fischman & Bachir Taouli

  3. Department of Radiology, Weill Cornell Medicine, New York, NY, USA

    Stefanie J. Hectors

  4. Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Swan Thung

  5. Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Scott L. Friedman & Thomas D. Schiano

Authors
  1. Stefanie J. Hectors
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  2. Octavia Bane
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  3. Paul Kennedy
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  9. Bachir Taouli
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Corresponding author

Correspondence to Bachir Taouli.

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Guarantor

The scientific guarantor of this publication is Bachir Taouli.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Twenty-five of the included patients have been previously reported in Hectors et al Splenic T1ρ as a noninvasive biomarker for portal hypertension. J Magn Reson Imaging. doi: 10.1002/jmri.27087.

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• observational

• performed at one institution

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Hectors, S.J., Bane, O., Kennedy, P. et al. Noninvasive diagnosis of portal hypertension using gadoxetate DCE-MRI of the liver and spleen. Eur Radiol 31, 4804–4812 (2021). https://doi.org/10.1007/s00330-020-07495-0

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  • DOI: https://doi.org/10.1007/s00330-020-07495-0

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