MR-based Measurements of Portal Vein Flow and Liver Stiffness for Predicting Gastroesophageal Varices

Abstract

Objectives: We evaluated ‰ow parameters measured by phase-contrast magnetic resonance (MR) imaging (PC-MRI) of the portal venous system and liver stiŠness measured by MR elastography (MRE) to determine the usefulness of these methods in predicting gastroesophageal varices (GEV) in patients with chronic liver disease (CLD).Methods: In patients with CLD and controls, we performed PC-MRI on the portal (PV) and superior mesenteric veins; calculated mean velocity (V, cm/s), cross-sectional area (S, mm 2 ), and ‰ow volume (Q, mL/min); and determined markers of liverˆbrosis (liver stiŠ-ness [kPa]) and aspartate aminotransferase (AST) platelet ratio index [APRI]). We visually assessed GEV and development of collateral pathways of the PV on routine contrast-enhanced dynamic MR imaging and compared patient characteristics, ‰ow parameters, liver stiŠness markers, and visual analysis among 3GEV groups, those with mild, severe, or no GEV with reference to endoscopicˆndings.Results: Child-Pugh grade, V PV , S PV , liver stiŠness, APRI, and visually identiˆed GEV (visible GEV) diŠered signiˆcantly among the 3 groups (Pº0.05). We investigated V PV , S PV , liver stiŠness, and visible GEV as independent markers to distinguish patients with and without GEV and examined V PV and visible GEV to predict severe GEV. Visible GEV showed low sensitivity (14 to 30z) and high speciˆcity (98z) for predicting GEV in patients with CLD. A subgroup analysis that excluded cases with collateral pathway demonstrated slightly improved diagnostic performance of V PV and liver stiŠness.Conclusions: Portal vein ‰ow parameters and liver stiŠness can be useful markers for predicting GEV in patients with CLD.

Utility of magnetic resonance elastography for predicting ascites in patients with chronic liver disease

“…Several studies have shown that the LS values measured by MRE can be used to identify the presence of varices in CLD patients . Consistent with this result, we found significantly higher LS values among patients with varices.…”

Usefulness of Contrast-Enhanced Ultrasonography for Predicting Esophageal Varices in Patients with Hepatitis B Virus (HBV)-Related Cirrhosis

“…In addition, CT has high cost, static imaging (non-dynamitic), and radioactive by-effects. In addition, MRI [33] is not a dynamic imaging system, which was reported as “the robustness of PV flow measurement on only 1 slice at a specific time point”. Moreover, these methods can be affected by factors unrelated to the liver [1].…”

Shear-Wave Elastography: A Noninvasive Tool for Monitoring Changing Hepatic Venous Pressure Gradients in Patients with Cirrhosis

“…To the best of our knowledge, the longitudinal assessment of LS for estimation of DHVPG has not been published previously. Instead of HVPG measurement, elastography including transient elastography has emerged as a noninvasive method to estimate the severity of portal hypertension (8,14,15,(22)(23)(24). Recently, Robic et al (14) reported that all patients with LS of less than 21.1 kPa showed no portal hypertensive complications, and some investigators (12,25) have proposed that transient elastography is able to help predict forthcoming complications, including the development of varices and variceal bleeding.…”