The Role of Magnetic Resonance Elastography in the Diagnosis of Noncirrhotic Portal Hypertension

Navin, Patrick J.; Gidener, Tolga; Allen, Alina M.; Yin, Min-Jean; Takahashi, Naoki; Torbenson, Michael; Kamath, Patrick S.; Ehman, Richard L.; Venkatesh, Sudhakar K.

doi:10.1016/j.cgh.2019.10.018

Cited by 16 publications

(4 citation statements)

References 8 publications

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“…Abdominal magnetic resonance elastography (MRE) is gaining in importance for the clinical diagnosis of a large variety of diseases that alter the mechanical properties of tissues such as liver fibrosis, [1][2][3][4][5] portal hypertension, 6,7 renal dysfunction, [8][9][10] and tumors. [11][12][13][14] Since the introduction of MRE in 1995 by Muthupillai et al, 15 various MRE methods tailored for clinical examinations of the abdomen have been proposed.…”

Section: Introductionmentioning

confidence: 99%

Reduction of breathing artifacts in multifrequency magnetic resonance elastography of the abdomen

Shahryari

Meyer

Warmuth

et al. 2020

Magnetic Resonance in Med

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Section: Introductionmentioning

confidence: 99%

Reduction of breathing artifacts in multifrequency magnetic resonance elastography of the abdomen

Shahryari

Meyer

Warmuth

et al. 2020

Magnetic Resonance in Med

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“…Magnetic resonance (MR)-based methods including MR elastography (MRE) in the detection of portal hypertension are also rapidly emerging [73,74]. In a small cohort of patients with cirrhosis due to various etiologies including NASH, 2-dimensional (gradient-recalled echo) MRE showed excellent correlation with a wide range of HVPG (3-16 mmHg) [75], and may differentiate between noncirrhotic and cirrhotic portal hypertension [76]. In a recent proof-of-concept study, for non-invasive assessment of portal hypertension by multiparametric MR imaging, iron-corrected T1 relaxation time of the spleen has shown an excellent diagnostic accuracy for both portal hypertension (HVPG > 5 mmHg) and CSPH (HVPG ≥ 10 mmHg) with an AUROC of 0.92 for both conditions [77].…”

Section: Methods For the Detection Of Portal Pressure In Nafldmentioning

confidence: 99%

Nonalcoholic fatty liver disease and portal hypertension

Ryou

Stylopoulos

Baffy

2020

Exploration of Medicine

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Nonalcoholic fatty liver disease (NAFLD) is a substantial and growing problem worldwide and has become the second most common indication for liver transplantation as it may progress to cirrhosis and develop complications from portal hypertension primarily caused by advanced fibrosis and erratic tissue remodeling. However, elevated portal venous pressure has also been detected in experimental models of fatty liver and in human NAFLD when fibrosis is far less advanced and cirrhosis is absent. Early increases in intrahepatic vascular resistance may contribute to the progression of liver disease. Specific pathophenotypes linked to the development of portal hypertension in NAFLD include hepatocellular lipid accumulation and ballooning injury, capillarization of liver sinusoidal endothelial cells, enhanced contractility of hepatic stellate cells, activation of Kupffer cells and pro-inflammatory pathways, adhesion and entrapment of recruited leukocytes, microthrombosis, angiogenesis and perisinusoidal fibrosis. These pathological events are amplified in NAFLD by concomitant visceral obesity, insulin resistance, type 2 diabetes and dysbiosis, promoting aberrant interactions with adipose tissue, skeletal muscle and gut microbiota. Measurement of the hepatic venous pressure gradient by retrograde insertion of a balloon-tipped central vein catheter is the current reference method for predicting outcomes of cirrhosis associated with clinically significant portal hypertension and guiding interventions. This invasive technique is rarely considered in the absence of cirrhosis where currently available clinical, imaging and laboratory correlates of portal hypertension may not reflect early changes in liver hemodynamics. Availability of less invasive but sufficiently sensitive methods for the assessment of portal venous pressure in NAFLD remains therefore an unmet need. Recent efforts to develop new biomarkers and endoscopy-based approaches such as endoscopic ultrasound-guided measurement of portal pressure gradient may help achieve this goal. In addition, cellular and molecular targets are being identified to guide emerging therapies in the prevention and management of portal hypertension.

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“…The study also showed that liver stiffness measurement was markedly lower in portal hypertension without cirrhosis, while the ratio between spleen stiffness measurement and liver stiffness measurement was markedly higher in portal hypertension without cirrhosis. 15 In addition, MR-based methods have been well-correlated with a wide range of HVPG measurements (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). A study by Gharib et al 16 demonstrated an independent significant correlation (p=0.015) between HVPG and MRE of the liver, with a median HVPG of 6 mmHg from 23 subjects.…”

Section: Assessment Of Portal Hypertension In Non-alcoholic Fatty Liver Disease Without Cirrhosismentioning

confidence: 97%

Portal Hypertension in Non-alcoholic Fatty Liver Disease in the Era of Non-invasive Assessment

Lesmana

Paramitha

Hasan

et al. 2021

EMJ

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Non-alcoholic fatty liver disease (NAFLD) is one of the emerging global health problems due to an increase of burden worldwide. It has been known that NAFLD is strongly associated with metabolic syndrome. The progression of NAFLD is a complex and multifactorial mechanism. Portal hypertension is still the main key in liver disease progression management. In NAFLD, portal hypertension might occur in the non-cirrhotic condition. Hepatic vein pressure gradient measurement has been considered as the gold standard for portal pressure assessment; however, due to its invasiveness and the need for a high-expertise centre, it is considered a non-practical measurement tool in clinical practice. Many other non-invasive parameters have been developed to replace the invasive measurement; however, there are still some limitations with regard to the technical issue, patient’s condition, and its accuracy in the different stages of the disease. Therefore, the authors review portal hypertension related to the clinical course of NAFLD, and the development of portal pressure evaluation in patients with NAFLD.

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The Role of Magnetic Resonance Elastography in the Diagnosis of Noncirrhotic Portal Hypertension

Cited by 16 publications

References 8 publications

Reduction of breathing artifacts in multifrequency magnetic resonance elastography of the abdomen

Reduction of breathing artifacts in multifrequency magnetic resonance elastography of the abdomen

Nonalcoholic fatty liver disease and portal hypertension

Portal Hypertension in Non-alcoholic Fatty Liver Disease in the Era of Non-invasive Assessment

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