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Clinical impact of preoperative brain MR angiography and MR imaging in candidates for liver transplantation: a propensity score-matching study in a single institution

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To investigate the prevalence of cerebrovascular stenosis and white matter lesions on preoperative magnetic resonance angiography (MRA) and magnetic resonance imaging (MRI) in liver transplantation candidates.

Methods

This retrospective study included 1,460 consecutive patients with liver cirrhosis (LC) who underwent MRA with/without brain MRI for pretransplantation evaluation. These patients were matched with 5,331 controls using propensity scores, and the prevalences of significant cerebrovascular stenosis and white matter lesions were compared.

Results

A matched analysis of 1,264 pairs demonstrated that the prevalence of significant stenosis was comparable between LC patients and controls (2.2% vs. 1.4%, P = 0.143). LC and most of LC-related parameters were not associated with stenosis. Significant white matter lesions were more common in LC patients (2.8% vs. 1.3%, P = 0.036). A high Model for End-Stage Liver Disease (MELD) score (OR 1.11, CI 1.03–1.20, P = 0.008, for infarction; OR 1.1, CI 1.04–1.16, P = 0.001, for haemorrhage) and stroke history (OR 179.06, CI 45.19–709.45, P < 0.001) were predictors of perioperative stroke.

Conclusions

LC patients and control subjects demonstrated similar cerebrovascular stenosis prevalences, whereas white matter lesions were more common in LC patients. A high MELD score and stroke history contribute as predictors of perioperative stroke.

Key points

• Routine preoperative MR imaging in liver transplantation candidates may not be necessary.

• Liver cirrhosis patients and control subjects had similar prevalences of significant cerebrovascular stenosis.

• Liver cirrhosis and cirrhosis-related parameters were not correlated with significant cerebrovascular stenosis.

• Significant white matter lesions were more frequent in liver cirrhosis patients.

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Abbreviations

CI:

Confidence interval

HBV:

Hepatitis B virus

HCV:

Hepatitis C virus

LC:

Liver cirrhosis

LT:

Liver transplantation

MRA:

Magnetic resonance angiography

MRI:

Magnetic resonance imaging

MELD:

Model for End-Stage Liver Disease

OR:

Odds ratio

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Song pa-gu, Seoul, 05505, Korea

    Mi Sun Chung, Ho Sung Kim, Seung Chai Jung, Choong Gon Choi & Sang Joon Kim

  2. Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

    Young-Suk Lim

  3. Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

    Sang-Beom Jeon

  4. Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

    Seon-Ok Kim

  5. Department of Preventive Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

    Hwa Jung Kim

  6. Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

    Shin Hwang

Authors
  1. Mi Sun Chung
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Corresponding author

Correspondence to Ho Sung Kim.

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Guarantor

The scientific guarantor of this publication is S.J. Kim.

Conflicts of interest

Y.S. Lim is a member of the advisory boards of Bayer Healthcare, Bristol-Myers Squibb and Gilead Sciences, and receives research funding from Bayer Healthcare, Bristol-Myers Squibb, Gilead Sciences and Novartis. The remaining authors of this article declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Funding

The authors state that this work has not received any funding.

Statistics and biometry

S. Kim and H.J. Kim have significant statistical expertise.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Methodology

• Retrospective

• Observational

• Performed at one institution

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Chung, M.S., Kim, H.S., Lim, YS. et al. Clinical impact of preoperative brain MR angiography and MR imaging in candidates for liver transplantation: a propensity score-matching study in a single institution. Eur Radiol 27, 3532–3541 (2017). https://doi.org/10.1007/s00330-017-4741-z

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  • DOI: https://doi.org/10.1007/s00330-017-4741-z

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