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Performance of native and gadoxetate-enhanced liver and spleen T1 mapping for noninvasive diagnosis of clinically significant portal hypertension: preliminary results

  • Hepatobiliary
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Abstract

Purpose

In this preliminary study, our aim was to assess the utility of quantitative native-T1 (T1-pre), iron-corrected T1 (cT1) of the liver/spleen and T1 mapping of the liver obtained during hepatobiliary phase (T1-HBP) post-gadoxetate disodium, compared to spleen size/volume and APRI (aspartate aminotransferase-to-platelet ratio index) for noninvasive diagnosis of clinically significant portal hypertension [CSPH, defined as hepatic venous pressure gradient (HVPG) ≥ 10 mm Hg].

Methods

Forty-nine patients (M/F: 27/22, mean age 53y) with chronic liver disease, HVPG measurement and MRI were included. Breath-held T1 and cT1 measurements were obtained using an inversion recovery Look-Locker sequence and a T2* corrected modified Look-Locker sequence, respectively. Liver T1-pre (n = 49), spleen T1 (obtained pre-contrast, n = 47), liver and spleen cT1 (both obtained pre-contrast, n = 30), liver T1-HBP (obtained 20 min post gadoxetate disodium injection, n = 36) and liver T1 uptake (ΔT1, n = 36) were measured. Spleen size/volume and APRI were also obtained. Spearman correlation coefficients were used to assess the correlation between each of liver/spleen T1/cT1 parameters, spleen size/volume and APRI with HVPG. ROC analysis was performed to determine the performance of measured parameters for diagnosis of CSPH.

Results

There were 12/49 (24%) patients with CSPH. Liver T1-pre (r = 0.287, p = 0.045), liver T1-HBP (r = 0.543, p = 0.001), liver ΔT1 (r =  − 0.437, p = 0.008), spleen T1 (r = 0.311, p = 0.033) and APRI (r = 0.394, p = 0.005) were all significantly correlated with HVPG, while liver cT1, spleen cT1 and spleen size/volume were not. The highest AUCs for the diagnosis of CSPH were achieved with liver T1-HBP, liver ΔT1 and spleen T1: 0.881 (95%CI 0.76–1.0, p = 0.001), 0.852 (0.72–0.98, p = 0.002) and 0.781 (0.60–0.95, p = 0.004), respectively.

Conclusion

Our preliminary results demonstrate the potential of liver T1 mapping obtained during HBP post gadoxetate disodium for the diagnosis of CSPH. These results require further validation.

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Abbreviations

APRI:

Aspartate aminotransferase-to-platelet ratio index

AST:

Aspartate aminotransferase

AUC:

Area under the curve

CSPH:

Clinically significant portal hypertension (defined by HVPG ≥ 10 mm Hg)

cT1:

Iron-corrected longitudinal relaxation time

HBP:

Hepatobiliary phase

HVPG:

Hepatic venous pressure gradient

LL IR:

Look-Locker Inversion Recovery

MRE:

Magnetic resonance elastography

PH:

Portal hypertension (defined by HVPG > 5 mmHg)

ROC:

Receiver operating characteristic

SWE:

Shear wave elastography

T1:

Longitudinal or spin–lattice relaxation time

TE:

Transient elastography

TI:

Inversion time

TJ:

Transjugular

VFA:

Variable flip angle

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Acknowledgements

None.

Funding

This study has received funding by National Institute of Diabetes and Kidney Diseases (NIDDK, Grant 1R01DK113272), Perspectum, and Siemens Healthineers. None of these sponsors were involved in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

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Authors and Affiliations

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

    Emre Altinmakas, Octavia Bane, Stefanie J. Hectors, Rayane Issa, Ghadi Abboud, Aaron Fischman, Paul Kennedy & Bachir Taouli

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

    Emre Altinmakas, Octavia Bane, Stefanie J. Hectors, Guillermo Carbonell, Ghadi Abboud, Paul Kennedy & Bachir Taouli

  3. Department of Radiology, Koc University School of Medicine, Istanbul, Turkey

    Emre Altinmakas

  4. Department of Radiology, Virgen de La Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain

    Guillermo Carbonell

  5. Icahn School of Medicine at Mount Sinai, Recanati/Miller Transplantation Institute, New York, NY, USA

    Thomas D. Schiano

  6. Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Swan Thung

  7. Perspectum, Oxford, UK

    Matthew D. Kelly

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

    Scott L. Friedman

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Conflict of interest

Bachir Taouli: consultancy and/or advisory roles for Bayer, Helio Health and research funding/support from Bayer, Takeda, Regeneron, Siemens Healthineers, Echosens, Stefanie Hectors: Employee of Regeneron, Matthew D. Kelly: Employee of Perspectum. The authors declare they have no non-financial interest.

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Altinmakas, E., Bane, O., Hectors, S.J. et al. Performance of native and gadoxetate-enhanced liver and spleen T1 mapping for noninvasive diagnosis of clinically significant portal hypertension: preliminary results. Abdom Radiol 47, 3758–3769 (2022). https://doi.org/10.1007/s00261-022-03645-8

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