Changes in hepatic venous morphology with cirrhosis on MRI

Abstract

Purpose: To identify changes in vascular morphology on magnetic resonance imaging (MRI) in patients with cirrhosis and to compare these findings to liver donors. Materials and Methods:Patients undergoing liver transplantation with biopsy-proven cirrhosis (n ϭ 74) and liver donor candidates (n ϭ 85) underwent dynamic gadoliniumenhanced 3D MR at 1.5T. Vessel diameters were measured independently by three radiologists and features of cirrhosis were identified and correlated with cirrhosis.Results: Hepatic veins were smaller in patients with cirrhosis (4.9, 4.5, and 5.0 mm for right, middle, and left vs. 9.9, 7.6, and 8.9 mm in donors, P Ӷ 0.001) and were negatively correlated with cirrhosis (P Ͻ 0.001). Right hepatic vein (RHV) Ͻ5 mm diagnosed cirrhosis with 59% sensitivity and 99% specificity; the sensitivity and specificity were 88% and 85% for RHV Ͻ7 mm. Main portal vein was minimally larger in cirrhosis, 14 versus 12 mm (P Ͻ 0.001) in donors. Right portal veins were smaller in cirrhotic patients, 6.5 and 6.2 mm compared to 8.4 and 7.6 mm (P Ӷ 0.001), respectively, in donors. Conclusion:Vascular features of cirrhosis include small hepatic veins, minimally enlarged main portal vein, and small intrahepatic portal veins; these features may facilitate identification of cirrhosis.

A non‐invasive magnetic resonance imaging‐based model predicts portal venous pressure

“…The PVD and PVCSA were measured at the midpoint between the portal bifurcations and the venous confluences while the SVD was measured at the point 1 cm proximal to their confluence with portal veins . The LHVD, MHVD and RHVD were assessed at the section where they converged into the inferior vena caval . The ratio of LV to body mass index (BMI) (LV/BMI) and that of SV to BMI (SV/BMI) were calculated to correct for body size.…”

“…25,26 The LHVD, MHVD and RHVD were assessed at the section where they converged into the inferior vena caval. 27 The ratio of LV to body mass index (BMI) (LV/BMI) and that of SV to BMI (SV/BMI) were calculated to correct for body size. The ratio of LV to SV (LV/SV) was calculated for external assessment.…”

Evaluation of hepatic fibrosis: a review from the society of abdominal radiology disease focus panel

“…Morphologic features of cirrhosis can be assessed on US, CT, or MRI (Figure 1 A–F), and include an atrophic right lobe and segment IV, hypertrophy of the caudate and lateral left lobes, liver surface nodularity, a right hepatic posterior notch, an expanded gallbladder fossa, narrow hepatic veins <5 mm, an enlarged caudate to right lobe ratio (>0.90), and enlargement of the hilar periportal space >10 mm [33–46]. The sensitivity, specificity, accuracy, and positive predictive value of some of these morphologic features of cirrhosis are shown in Table 1[35,37–40,42,43,33,44–46].…”

“…The sensitivity, specificity, accuracy, and positive predictive value of some of these morphologic features of cirrhosis are shown in Table 1[35,37–40,42,43,33,44–46]. While these morphologic features are fairly good at diagnosing cirrhosis, they suffer from low sensitivity and are not always present at earlier stages of fibrosis.…”

Non-invasive detection of liver fibrosis: MR imaging features vs. MR elastography

“…However, liver fibrosis is reversible with specific treatment of the underlying hepatic disease (4-7) in almost the entire spectrum of chronic liver diseases (8). The early detection of clinically significant liver fibrosis may facilitate a prompt intervention with specific therapies and risk factor modifications (9). Liver biopsy, the current gold standard for detecting liver fibrosis, is limited by reduced patient acceptance, sampling error and inter-observer variation with interpretation (10-13), and a small but important risk for morbidity (3%) (14).…”