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Yamakuni R, Ishikawa H, Ishii S, Kakamu T, Hara J, Sugawara S, Sekino H, Seino S, Fukushima K, Ito H. The Relationship Between Conventionally Obtained Serum-Based Liver Function Indices and Intravoxel Incoherent Motion Diffusion-Weighted Imaging and Magnetic Resonance Elastography in Patients With Hepatocellular Carcinoma. J Comput Assist Tomogr 2024; 48:194-199. [PMID: 37965744 DOI: 10.1097/rct.0000000000001561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
OBJECTIVES To investigate the relationship between conventionally obtained serum-based biochemical indices and intravoxel incoherent motion imaging (IVIM) parameters compared with magnetic resonance elastography (MRE). METHODS Patients with hepatocellular carcinoma who underwent ≥2 liver magnetic resonance imaging (MRI) scan, including IVIM and MRE, between 2017 and 2020 and biochemical testing within 1 week before or after MRI were included in this study. Biochemical tests were performed to determine the albumin-bilirubin (ALBI) score and modified ALBI (mALBI) grade, aspartate aminotransferase to platelet ratio index (APRI), and fibrosis-4 index (FIB-4). The diffusion coefficient ( D ), pseudo-diffusion coefficient ( D *), fractional volume occupied by flowing spins ( f ), and apparent diffusion coefficient were calculated for IVIM. The correlations between (1) the imaging parameters and biochemical indices and (2) the changes in mALBI grades and imaging parameters were evaluated. RESULTS This study included 98 scans of 40 patients (31 men; mean age, 67.7 years). The correlation analysis between the biochemical and IVIM parameters showed that ALBI score and D* had the best correlation ( r = -0.3731, P < 0.001), and the correlation was higher than that with MRE ( r = 0.3289, P < 0.001). However, among FIB-4, APRI, and MRI parameters, MRE outperformed IVIM parameters (MRE and FIB-4, r = 0.3775, P < 0.001; MRE and APRI, r = 0.4687, P < 0.001). There were significant differences in the changes in MRE among the 3 groups (improved, deteriorated, and unchanged mALBI groups) in the analysis of covariance ( P = 0.0434). There were no significant changes in IVIM. CONCLUSIONS Intravoxel incoherent motion imaging has the potential to develop into a more readily obtainable method of liver function assessment.
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Affiliation(s)
- Ryo Yamakuni
- From the Department of Radiology and Nuclear Medicine, Fukushima Medical University School of Medicine
| | | | - Shiro Ishii
- From the Department of Radiology and Nuclear Medicine, Fukushima Medical University School of Medicine
| | - Takeyasu Kakamu
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Junko Hara
- From the Department of Radiology and Nuclear Medicine, Fukushima Medical University School of Medicine
| | - Shigeyasu Sugawara
- From the Department of Radiology and Nuclear Medicine, Fukushima Medical University School of Medicine
| | | | - Shinya Seino
- Department of Radiology, Fukushima Medical University Hospital
| | - Kenji Fukushima
- From the Department of Radiology and Nuclear Medicine, Fukushima Medical University School of Medicine
| | - Hiroshi Ito
- From the Department of Radiology and Nuclear Medicine, Fukushima Medical University School of Medicine
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Zheng Y, Huang K, He X, Chen T, Jiang W, Zhou J, Liu Y, Guo D. Diagnostic Accuracy of Liver and Spleen Stiffness in Magnetic Resonance Elastography for the Detection of Gastroesophageal Varices: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2023; 13:3527. [PMID: 38066768 PMCID: PMC10706337 DOI: 10.3390/diagnostics13233527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/16/2023] [Accepted: 11/22/2023] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND The aim of this meta-analysis was to assess the performance of magnetic resonance elastography (MRE) in detecting gastroesophageal varices (GEV) in patients with chronic liver disease (CLD). METHODS A literature search in English and Chinese databases such as PubMed, EMBASE, Cochrane Library, Web of Science, and China National Knowledge Infrastructure was conducted. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) of the summary receiver-operating characteristic (SROC) curve with a 95% CI were calculated. A quality analysis of the included study was conducted using the QUADAS-2 tool, and a meta-analysis was performed using Stata16. The clinical practical value of MRE in detecting GEV was evaluated using the Fagan plot. Heterogeneity across studies was explored through meta-regression and subgroup analyses. RESULTS A total of nine relevant articles that compared liver stiffness (LS) or spleen stiffness (SS) using MRE with esophagogastroduodenoscopy (EGD) to detect the existence of GEV were identified. The pooled summary sensitivity, specificity, PLR, NLR, and DOR of LS or SS for the detection of GEV were 81% (95% CI: 74%, 87%), 72% (95% CI: 62%, 80%), 2.89 (95% CI: 2.12, 3.94), 0.26 (95% CI: 0.19, 0.36), and 10.91 (95% CI: 6.53, 18.24), respectively. The year of publication, study design, and MR equipment are the sources of heterogeneity. There was no significant difference in the publication bias (p > 0.05). CONCLUSIONS Based on these findings, MRE demonstrates good diagnostic accuracy for detecting GEV in patients with CLD.
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Affiliation(s)
- You Zheng
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Rd., Yuzhong District, Chongqing 400010, China; (Y.Z.); (X.H.); (T.C.); (W.J.); (J.Z.); (Y.L.)
| | - Kaifeng Huang
- Department of Ultrasound, The Cancer Hospital of Chongqing University, Chongqing 400044, China;
| | - Xiaojing He
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Rd., Yuzhong District, Chongqing 400010, China; (Y.Z.); (X.H.); (T.C.); (W.J.); (J.Z.); (Y.L.)
| | - Tianwu Chen
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Rd., Yuzhong District, Chongqing 400010, China; (Y.Z.); (X.H.); (T.C.); (W.J.); (J.Z.); (Y.L.)
| | - Wei Jiang
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Rd., Yuzhong District, Chongqing 400010, China; (Y.Z.); (X.H.); (T.C.); (W.J.); (J.Z.); (Y.L.)
| | - Jun Zhou
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Rd., Yuzhong District, Chongqing 400010, China; (Y.Z.); (X.H.); (T.C.); (W.J.); (J.Z.); (Y.L.)
| | - Yangyang Liu
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Rd., Yuzhong District, Chongqing 400010, China; (Y.Z.); (X.H.); (T.C.); (W.J.); (J.Z.); (Y.L.)
| | - Dajing Guo
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Rd., Yuzhong District, Chongqing 400010, China; (Y.Z.); (X.H.); (T.C.); (W.J.); (J.Z.); (Y.L.)
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Maatman IT, Ypma S, Kachelrieß M, Berker Y, van der Bijl E, Block KT, Hermans JJ, Maas MC, Scheenen TWJ. Single-spoke binning: Reducing motion artifacts in abdominal radial stack-of-stars imaging. Magn Reson Med 2023; 89:1931-1944. [PMID: 36594436 DOI: 10.1002/mrm.29576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/23/2022] [Accepted: 12/19/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE To increase the effectiveness of respiratory gating in radial stack-of-stars MRI, particularly when imaging at high spatial resolutions or with multiple echoes. METHODS Free induction decay (FID) navigators were integrated into a three-dimensional gradient echo radial stack-of-stars pulse sequence. These navigators provided a motion signal with a high temporal resolution, which allowed single-spoke binning (SSB): each spoke at each phase encode step was sorted individually to the corresponding motion state of the respiratory signal. SSB was compared with spoke-angle binning (SAB), in which all phase encode steps of one projection angle were sorted without the use of additional navigator data. To illustrate the benefit of SSB over SAB, images of a motion phantom and of six free-breathing volunteers were reconstructed after motion-gating using either method. Image sharpness was quantitatively compared using image gradient entropies. RESULTS The proposed method resulted in sharper images of the motion phantom and free-breathing volunteers. Differences in gradient entropy were statistically significant (p = 0.03) in favor of SSB. The increased accuracy of motion-gating led to a decrease of streaking artifacts in motion-gated four-dimensional reconstructions. To consistently estimate respiratory signals from the FID-navigator data, specific types of gradient spoiler waveforms were required. CONCLUSION SSB allowed high-resolution motion-corrected MR imaging, even when acquiring multiple gradient echo signals or large acquisition matrices, without sacrificing accuracy of motion-gating. SSB thus relieves restrictions on the choice of pulse sequence parameters, enabling the use of motion-gated radial stack-of-stars MRI in a broader domain of clinical applications.
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Affiliation(s)
- Ivo T Maatman
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sjoerd Ypma
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marc Kachelrieß
- Division of X-Ray Imaging and Computed Tomography, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Yannick Berker
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
| | - Erik van der Bijl
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kai Tobias Block
- Department of Radiology, NYU Langone Health, New York, New York, USA
| | - John J Hermans
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marnix C Maas
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tom W J Scheenen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
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Luo R, Gao J, Gan W, Xie WB. Clinical-radiomics nomogram for predicting esophagogastric variceal bleeding risk noninvasively in patients with cirrhosis. World J Gastroenterol 2023; 29:1076-1089. [PMID: 36844133 PMCID: PMC9950861 DOI: 10.3748/wjg.v29.i6.1076] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/13/2022] [Accepted: 01/31/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Esophagogastric variceal bleeding (EGVB) is a serious complication of patients with decompensated cirrhosis and is associated with high mortality and morbidity. Early diagnosis and screening of cirrhotic patients at risk for EGVB is crucial. Currently, there is a lack of noninvasive predictive models widely available in clinical practice.
AIM To develop a nomogram based on clinical variables and radiomics to facilitate the noninvasive prediction of EGVB in cirrhotic patients.
METHODS A total of 211 cirrhotic patients hospitalized between September 2017 and December 2021 were included in this retrospective study. Patients were divided into training (n = 149) and validation (n = 62) groups at a 7:3 ratio. Participants underwent three-phase computed tomography (CT) scans before endoscopy, and radiomic features were extracted from portal venous phase CT images. The independent sample t-test and least absolute shrinkage and selection operator logistic regression were used to screen out the best features and establish a radiomics signature (RadScore). Univariate and multivariate analyses were performed to determine the independent predictors of EGVB in clinical settings. A noninvasive predictive nomogram for the risk of EGVB was built using independent clinical predictors and RadScore. Receiver operating characteristic, calibration, clinical decision, and clinical impact curves were applied to evaluate the model’s performance.
RESULTS Albumin (P = 0.001), fibrinogen (P = 0.001), portal vein thrombosis (P = 0.002), aspartate aminotransferase (P = 0.001), and spleen thickness (P = 0.025) were selected as independent clinical predictors of EGVB. RadScore, constructed with five CT features of the liver region and three of the spleen regions, performed well in training (area under the receiver operating characteristic curve (AUC) = 0.817) as well as in validation (AUC = 0.741) cohorts. There was excellent predictive performance in both the training and validation cohorts for the clinical-radiomics model (AUC = 0.925 and 0.912, respectively). Compared with the existing noninvasive models such as ratio of aspartate aminotransferase to platelets and Fibrosis-4 scores, our combined model had better predictive accuracy with the Delong's test less than 0.05. The Nomogram had a good fit in the calibration curve (P > 0.05), and the clinical decision curve further supported its clinical utility.
CONCLUSION We designed and validated a clinical-radiomics nomogram able to noninvasively predict whether cirrhotic patients will develop EGVB, thus facilitating early diagnosis and treatment.
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Affiliation(s)
- Rui Luo
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, Chongqing, China
| | - Jian Gao
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, Chongqing, China
| | - Wei Gan
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, Chongqing, China
| | - Wei-Bo Xie
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, Chongqing, China
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Altinmakas E, Bane O, Hectors SJ, Issa R, Carbonell G, Abboud G, Schiano TD, Thung S, Fischman A, Kelly MD, Friedman SL, Kennedy P, Taouli B. Performance of native and gadoxetate-enhanced liver and spleen T 1 mapping for noninvasive diagnosis of clinically significant portal hypertension: preliminary results. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:3758-3769. [PMID: 36085378 DOI: 10.1007/s00261-022-03645-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/03/2022] [Accepted: 08/03/2022] [Indexed: 01/18/2023]
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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Affiliation(s)
- Emre Altinmakas
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York, NY, 10029, USA.,BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Koc University School of Medicine, Istanbul, Turkey
| | - Octavia Bane
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York, NY, 10029, USA.,BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stefanie J Hectors
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York, NY, 10029, USA.,BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rayane Issa
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York, NY, 10029, USA
| | - Guillermo Carbonell
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Virgen de La Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain
| | - Ghadi Abboud
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York, NY, 10029, USA.,BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Thomas D Schiano
- Icahn School of Medicine at Mount Sinai, Recanati/Miller Transplantation Institute, New York, NY, USA
| | - Swan Thung
- Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aaron Fischman
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York, NY, 10029, USA
| | | | - Scott L Friedman
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul Kennedy
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York, NY, 10029, USA.,BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bachir Taouli
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York, NY, 10029, USA. .,BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Comparison of T2 Quantification Strategies in the Abdominal-Pelvic Region for Clinical Use. Invest Radiol 2022; 57:412-421. [PMID: 34999669 DOI: 10.1097/rli.0000000000000852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of the study was to compare different magnetic resonance imaging (MRI) acquisition strategies appropriate for T2 quantification in the abdominal-pelvic area. The different techniques targeted in the study were chosen according to 2 main considerations: performing T2 measurement in an acceptable time for clinical use and preventing/correcting respiratory motion. MATERIALS AND METHODS Acquisitions were performed at 3 T. To select sequences for in vivo measurements, a phantom experiment was conducted, for which the T2 values obtained with the different techniques of interest were compared with the criterion standard (single-echo SE sequence, multiple acquisitions with varying echo time). Repeatability and temporal reproducibility studies for the different techniques were also conducted on the phantom. Finally, an in vivo study was conducted on 12 volunteers to compare the techniques that offer acceptable acquisition time for clinical use and either address or correct respiratory motion. RESULTS For the phantom study, the DESS and T2-preparation techniques presented the lowest precision (ρ2 = 0.9504 and ρ2 = 0.9849 respectively), and showed a poor repeatability/reproducibility compared with the other techniques. The strategy relying on SE-EPI showed the best precision and accuracy (ρ2 = 0.9994 and Cb = 0.9995). GRAPPATINI exhibited a very good precision (ρ2 = 0.9984). For the technique relying on radial TSE, the precision was not as good as GRAPPATINI (ρ2 = 0.9872). The in vivo study demonstrated good respiratory motion management for all of the selected techniques. It also showed that T2 estimate ranges were different from one method to another. For GRAPPATINI and radial TSE techniques, there were significant differences between all the different types of organs of interest. CONCLUSIONS To perform T2 measurement in the abdominal-pelvic region, one should favor a technique with acceptable acquisition time for clinical use, with proper respiratory motion management, with good repeatability, reproducibility, and precision. In this study, the techniques relying respectively on SE-EPI, radial TSE, and GRAPPATINI appeared as good candidates.
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Natarajan Y, Loomba R. Magnetic Resonance Elastography for the Clinical Risk Assessment of Fibrosis, Cirrhosis, and Portal Hypertension in Patients With NAFLD. J Clin Exp Hepatol 2022; 12:174-179. [PMID: 35068797 PMCID: PMC8766685 DOI: 10.1016/j.jceh.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/01/2021] [Indexed: 01/03/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is rapidly becoming one of the most common causes of liver disease. The progressive subtype of NAFLD, nonalcoholic steatohepatitis (NASH), leads to cirrhosis, hepatocellular carcinoma, and mortality. Fibrosis is the strongest predictor for complications. Due to the invasive nature of liver biopsy, noninvasive testing methods have emerged to detect fibrosis and predict outcomes. Of these modalities, magnetic resonance elastography (MRE) has demonstrated the highest accuracy to detect fibrosis. In this review, we will focus on the emerging data regarding MRE and liver fibrosis, cirrhosis, and portal hypertension in NAFLD.
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Affiliation(s)
- Yamini Natarajan
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, USA,Clinical Epidemiology and Comparative Effectiveness Program, Section of Health Services Research (IQuESt), Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA,Address for correspondence. Yamini Natarajan, MD, 2002 Holcombe Blvd (111-D), Houston, TX, 77030, USA.
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, CA, USA,Address for correspondence. Rohit Loomba, MD, MHSc, 9500 Gilman Drive, ACTRI Building, 2W202, La Jolla, CA, 92093-0887, USA. http://fattyliver.ucsd.edu
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Synthetic extracellular volume fraction without hematocrit sampling for hepatic applications. Abdom Radiol (NY) 2021; 46:4637-4646. [PMID: 34109447 PMCID: PMC8435519 DOI: 10.1007/s00261-021-03140-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 05/03/2021] [Accepted: 05/22/2021] [Indexed: 02/06/2023]
Abstract
Purpose Calculation of extracellular volume fraction (ECV) currently receives increasing interest as a potential biomarker for non-invasive assessment of liver fibrosis. ECV calculation requires hematocrit (Hct) sampling, which might be difficult to obtain in a high-throughput radiology department. The aim of this study was to generate synthetic ECV for hepatic applications without the need for Hct sampling. Methods In this prospective study participants underwent liver MRI. T1 mapping was performed before and after contrast administration. Blood Hct was obtained prior to MRI. We hypothesized that the relationship between Hct and longitudinal relaxation rate of blood (R1 = 1/T1blood) could be calibrated and used to generate the equation for synthetic Htc and ECV calculation. Conventional and synthetic ECV were calculated. Pearson correlation, linear regression and Bland–Altman method were used for statistical analysis. Results 180 consecutive patients were divided into derivation (n = 90) and validation (n = 90) cohorts. In the derivation cohort, native R1blood and Hct showed a linear relationship (HctMOLLI = 98.04 × (1/T1blood) − 33.17, R2 = 0.75, P < 0.001), which was used to calculate synthetic ECV in the validation and whole study cohorts. Synthetic and conventional ECV showed significant correlations in the derivation, validation and in the whole study cohorts (r = 0.99, 0.97 and 0.99, respectively, P < 0.001, respectively) with minimal bias according to the Bland–Altman analysis. Conclusion Synthetic ECV seems to offer an alternative method for non-invasive quantification of the hepatic ECV. It may potentially overcome an important barrier to clinical implementation of ECV and thus, enable broader use of hepatic ECV in routine clinical practice.
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Lunova M, Frankova S, Gottfriedova H, Senkerikova R, Neroldova M, Kovac J, Kieslichova E, Lanska V, Sticova E, Spicak J, Jirsa M, Sperl J. Portal hypertension is the main driver of liver stiffness in advanced liver cirrhosis. Physiol Res 2021; 70:563-577. [PMID: 34062072 DOI: 10.33549/physiolres.934626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Liver stiffness (LS) is a novel non-invasive parameter widely used in clinical hepatology. LS correlates with liver fibrosis stage in non-cirrhotic patients. In cirrhotic patients it also shows good correlation with Hepatic Venous Pressure Gradient (HVPG). Our aim was to assess the contribution of liver fibrosis and portal hypertension to LS in patients with advanced liver cirrhosis. Eighty-one liver transplant candidates with liver cirrhosis of various aetiologies underwent direct HVPG and LS measurement by 2D shear-wave elastography (Aixplorer Multiwave, Supersonic Imagine, France). Liver collagen content was assessed in the explanted liver as collagen proportionate area (CPA) and hydroxyproline content (HP). The studied cohort included predominantly patients with Child-Pugh class B and C (63/81, 77.8%), minority of patients were Child-Pugh A (18/81, 22.2%). LS showed the best correlation with HVPG (r=0.719, p< 0.001), correlation of LS with CPA (r=0.441, p< 0.001) and HP/Amino Acids (r=0.414, p< 0.001) was weaker. Both variables expressing liver collagen content showed good correlation with each other (r=0.574, p<0.001). Multiple linear regression identified the strongest association between LS and HVPG (p < 0.0001) and weaker association of LS with CPA (p = 0.01883). Stepwise modelling showed minimal increase in r2 after addition of CPA to HVPG (0.5073 vs. 0.5513). The derived formula expressing LS value formation is: LS = 2.48 + (1.29 x HVPG) + (0.26 x CPA). We conclude that LS is determined predominantly by HVPG in patients with advanced liver cirrhosis whereas contribution of liver collagen content is relatively low.
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Affiliation(s)
- M Lunova
- Department of Hepatogastroenterology, Transplant Centre; Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
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Huang SS, Boyacioglu R, Bolding R, MacAskill C, Chen Y, Griswold MA. Free-Breathing Abdominal Magnetic Resonance Fingerprinting Using a Pilot Tone Navigator. J Magn Reson Imaging 2021; 54:1138-1151. [PMID: 33949741 DOI: 10.1002/jmri.27673] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Quantitative T1 and T2 mapping in the abdomen provides valuable information in tissue characterization but is technically challenging due to respiratory motions. The proposed technique integrates magnetic resonance fingerprinting (MRF) and pilot tone (PT) navigator with retrospective gating to provide simultaneous quantification of multiple tissue properties in a single acquisition without breath-holding or patient set-up. PURPOSE To develop a free-breathing abdominal MRF technique for quantitative mapping in the abdomen. STUDY TYPE Prospective. POPULATION Twelve healthy volunteers. FIELD STRENGTH/SEQUENCE A 3 T, two-dimensional (2D) and three-dimensional (3D) spiral MRF sequence with fast imaging with steady-state free precession (FISP) readout. ASSESSMENT The PT navigator was compared to standard respiratory belt performance. The T1 and T2 values acquired using 2D and 3D MRF with and without PT were obtained in a phantom and compared to reference values. Digital phantom simulation was performed to evaluate PT MRF reconstruction with varying breathing patterns. In the in vivo studies, T1 and T2 values derived from PT 2D MRF were compared to 2D breath-hold MRF. T1 and T2 values derived from PT 3D MRF were compared to published values. STATISTICAL TESTS Principal component analysis (PCA), linear regression, relative error, Pearson correlation, paired Student's t-test, Bland-Altman Analysis. RESULTS The phantom study showed PT MRF T1 values had a mean difference of 0.2% ± 0.1%, and T2 values had a mean difference of 0.1% ± 0.4% when compared to no-PT MRF values. The digital phantom experiment suggested the T1 and T2 maps at both end-exhalation and end-inhalation states resemble the corresponding ground-truth maps. DATA CONCLUSION The phantom study showed good agreement between MRF T1 and T2 values and with reference values. In vivo studies demonstrated that 2D and 3D quantitative imaging in the abdomen could be achieved with integration of PT navigation with MRF reconstruction using retrospective gating of respiratory motion. EVIDENCE LEVEL: 1 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Sherry S Huang
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Rasim Boyacioglu
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Reid Bolding
- Department of Physics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Christina MacAskill
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Yong Chen
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Mark A Griswold
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA
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Kumada T, Toyoda H, Yasuda S, Sone Y, Ogawa S, Takeshima K, Tada T, Ito T, Sumida Y, Tanaka J. Prediction of Hepatocellular Carcinoma by Liver Stiffness Measurements Using Magnetic Resonance Elastography After Eradicating Hepatitis C Virus. Clin Transl Gastroenterol 2021; 12:e00337. [PMID: 33888672 PMCID: PMC8078363 DOI: 10.14309/ctg.0000000000000337] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/05/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Liver fibrosis stage is one of the most important factors in stratifying the risk of developing hepatocellular carcinoma (HCC). We evaluated the usefulness of liver stiffness measured by magnetic resonance elastography (MRE) to stratify the risk of developing HCC in patients who underwent MRE before receiving direct-acting antivirals (DAAs) and subsequently achieved sustained virological response (SVR). METHODS A total of 537 consecutive patients with persistent hepatitis C virus who underwent initial MRE before DAA therapy and achieved SVR were enrolled. Factors associated with HCC development were analyzed by univariate and multivariate Cox proportional hazards models. RESULTS Albumin-bilirubin score ≥ -2.60 (adjusted hazard ratio [aHR] 6.303), fibrosis-4 (FIB-4) score >3.25 (aHR 7.676), and MRE value ≥4.5 kPa (aHR 13.190) were associated with HCC development according to a univariate Cox proportional hazards model. A multivariate Cox proportional hazards model showed that an MRE value ≥4.5 kPa (aHR 7.301) was the only factor independently associated with HCC development. Even in patients with an FIB-4 score >3.25, the cumulative incidence rate of HCC development in those with an MRE value <4.5 kPa was significantly lower than that in patients with an MRE value ≥4.5 kPa. DISCUSSION Liver stiffness measured by MRE before DAA therapy was an excellent marker for predicting subsequent HCC development in patients with hepatitis C virus infection who achieved SVR. The same results were observed in patients with high FIB-4 scores.
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Affiliation(s)
- Takashi Kumada
- Department of Nursing, Faculty of Nursing, Gifu Kyoritsu University, Ogaki, Gifu, Japan
| | - Hidenori Toyoda
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Satoshi Yasuda
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Yasuhiro Sone
- Department of Radiology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Sadanobu Ogawa
- Department of Imaging Diagnosis, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Kenji Takeshima
- Department of Imaging Diagnosis, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Toshifumi Tada
- Department of Internal Medicine, Himeji Red Cross Hospital, Himeji, Hyougo, Japan
| | - Takanori Ito
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoshio Sumida
- Division of Hepatology and Pancreatology, Department of Internal Medicine, Aichi Medical University, Nagakute, Aichi, Japan
| | - Junko Tanaka
- Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
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Frankova S, Lunova M, Gottfriedova H, Senkerikova R, Neroldova M, Kovac J, Kieslichova E, Lanska V, Urbanek P, Spicak J, Jirsa M, Sperl J. Liver stiffness measured by two-dimensional shear-wave elastography predicts hepatic vein pressure gradient at high values in liver transplant candidates with advanced liver cirrhosis. PLoS One 2021; 16:e0244934. [PMID: 33411729 PMCID: PMC7790429 DOI: 10.1371/journal.pone.0244934] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/20/2020] [Indexed: 12/15/2022] Open
Abstract
Liver stiffness is a reliable non-invasive predictor of Hepatic Venous Pressure Gradient (HVPG) above 10 mm Hg. However, it failed to predict higher thresholds of HVPG. Our aim was to investigate whether liver stiffness and selected previously published non-invasive blood biomarkers could predict higher HVPG thresholds in liver transplant candidates without ongoing alcohol use. One hundred and nine liver transplant candidates with liver cirrhosis of various aetiologies underwent direct HVPG measurement, liver stiffness measurement by 2D shear-wave elastography (Aixplorer Multiwave, Supersonic Imagine, France) and assessment of blood HVPG biomarkers (osteopontin, VCAM-1, IL-6, TNF-α, IL-1ra/IL-1F3 and ELF score). The correlation between liver stiffness and HVPG was linear up to 30 mm Hg of HVPG (r = 0.765, p < 0.0001). The regression lines had similar slopes for HVPG values below and above 16 mm Hg (p > 0.05) and the correlation in patients with HVPG <16 mm Hg (r = 0.456, p = 0.01) was similar to patients with HVPG ≥ 16 mm Hg (r = 0.499, p < 0.0001). The correlation was similar in the subgroup patients with alcoholic (r = 0.718, p < 0.0001), NASH (r = 0.740, p = 0.008), cryptogenic (r = 0.648, p = 0,0377), cholestatic and autoimmune (r = 0.706, p < 0.0001) and viral cirrhosis (r = 0.756, p < 0.0001). Liver stiffness distinguished patients with HVPG above 16, and 20 mm Hg with AUROCs 0.90243, and 0.86824, sensitivity 0.7656, and 0.7027, and specificity 0.9333, and 0.8750. All studied blood biomarkers correlated better with liver stiffness than with HVPG and their AUROCs did not exceed 0.8 at both HVPG thresholds. Therefore, a composite predictor superior to liver stiffness could not be established. We conclude that liver stiffness is a clinically reliable predictor of higher HVPG thresholds in non-drinking subjects with advanced liver cirrhosis.
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Affiliation(s)
- Sona Frankova
- Department of Hepatogastroenterology, Transplant Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Mariia Lunova
- Laboratory of Experimental Hepatology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Halima Gottfriedova
- Department of Hepatogastroenterology, Transplant Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Renata Senkerikova
- Department of Hepatogastroenterology, Transplant Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Charles University, First Faculty of Medicine, Prague, Czech Republic
| | - Magdalena Neroldova
- Laboratory of Experimental Hepatology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jozef Kovac
- Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Eva Kieslichova
- Anaesthesiology, Resuscitation and Intensive Care Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Vera Lanska
- Department of Biostatistics, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petr Urbanek
- Charles University, First Faculty of Medicine, Prague, Czech Republic
- Department of Internal Medicine, Central Military Hospital, Prague, Czech Republic
| | - Julius Spicak
- Department of Hepatogastroenterology, Transplant Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Milan Jirsa
- Laboratory of Experimental Hepatology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Charles University, First Faculty of Medicine, Prague, Czech Republic
| | - Jan Sperl
- Department of Hepatogastroenterology, Transplant Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Charles University, First Faculty of Medicine, Prague, Czech Republic
- * E-mail:
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13
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Mesropyan N, Isaak A, Faron A, Praktiknjo M, Jansen C, Kuetting D, Meyer C, Pieper CC, Sprinkart AM, Chang J, Maedler B, Thomas D, Kupczyk P, Attenberger U, Luetkens JA. Magnetic resonance parametric mapping of the spleen for non-invasive assessment of portal hypertension. Eur Radiol 2021; 31:85-93. [PMID: 32749584 PMCID: PMC7755629 DOI: 10.1007/s00330-020-07080-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/25/2020] [Accepted: 07/16/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES In patients with advanced liver disease, portal hypertension is an important risk factor, leading to complications such as esophageal variceal bleeding, ascites, and hepatic encephalopathy. This study aimed to determine the diagnostic value of T1 and T2 mapping and extracellular volume fraction (ECV) for the non-invasive assessment of portal hypertension. METHODS In this prospective study, 50 participants (33 patients with indication for trans-jugular intrahepatic portosystemic shunt (TIPS) and 17 healthy volunteers) underwent MRI. The derivation and validation cohorts included 40 and 10 participants, respectively. T1 and T2 relaxation times and ECV of the liver and the spleen were assessed using quantitative mapping techniques. Direct hepatic venous pressure gradient (HVPG) and portal pressure measurements were performed during TIPS procedure. ROC analysis was performed to compare diagnostic performance. RESULTS Splenic ECV correlated with portal pressure (r = 0.72; p < 0.001) and direct HVPG (r = 0.50; p = 0.003). No significant correlations were found between native splenic T1 and T2 relaxation times with portal pressure measurements (p > 0.05, respectively). In the derivation cohort, splenic ECV revealed a perfect diagnostic performance with an AUC of 1.000 for the identification of clinically significant portal hypertension (direct HVPG ≥ 10 mmHg) and outperformed other parameters: hepatic T2 (AUC, 0.731), splenic T2 (AUC, 0.736), and splenic native T1 (AUC, 0.806) (p < 0.05, respectively). The diagnostic performance of mapping parameters was comparable in the validation cohort. CONCLUSION Splenic ECV was associated with portal pressure measurements in patients with advanced liver disease. Future studies should explore the diagnostic value of parametric mapping accross a broader range of pressure values. KEY POINTS • Non-invasive assessment and monitoring of portal hypertension is an area of unmet interest. • Splenic extracellular volume fraction is strongly associated with portal pressure in patients with end-stage liver disease. • Quantitative splenic and hepatic MRI-derived parameters have a potential to become a new non-invasive diagnostic parameter to assess and monitor portal pressure.
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Affiliation(s)
- Narine Mesropyan
- Department of Diagnostic and Interventional Radiology and Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology and Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Anton Faron
- Department of Diagnostic and Interventional Radiology and Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Michael Praktiknjo
- Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Christian Jansen
- Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology and Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Carsten Meyer
- Department of Diagnostic and Interventional Radiology and Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Claus C Pieper
- Department of Diagnostic and Interventional Radiology and Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Alois M Sprinkart
- Department of Diagnostic and Interventional Radiology and Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Johannes Chang
- Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Burkhard Maedler
- Philips GmbH Germany, Roentgenstrasse 22, 22335, Hamburg, Germany
| | - Daniel Thomas
- Department of Diagnostic and Interventional Radiology and Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Patrick Kupczyk
- Department of Diagnostic and Interventional Radiology and Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology and Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology and Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
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14
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Kennedy P, Bane O, Hectors SJ, Fischman A, Schiano T, Lewis S, Taouli B. Noninvasive imaging assessment of portal hypertension. Abdom Radiol (NY) 2020; 45:3473-3495. [PMID: 32926209 PMCID: PMC10124623 DOI: 10.1007/s00261-020-02729-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/16/2020] [Accepted: 08/30/2020] [Indexed: 02/07/2023]
Abstract
Portal hypertension (PH) is a spectrum of complications of chronic liver disease (CLD) and cirrhosis, with manifestations including ascites, gastroesophageal varices, splenomegaly, hypersplenism, hepatic hydrothorax, hepatorenal syndrome, hepatopulmonary syndrome and portopulmonary hypertension. PH can vary in severity and is diagnosed via invasive hepatic venous pressure gradient measurement (HVPG), which is considered the reference standard. Accurate diagnosis of PH and assessment of severity are highly relevant as patients with clinically significant portal hypertension (CSPH) are at higher risk for developing acute variceal bleeding and mortality. In this review, we discuss current and upcoming noninvasive imaging methods for diagnosis and assessment of severity of PH.
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