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- Title
Quantification of the Hemodynamic Changes of Cirrhosis with Free-Breathing Self-Navigated MRI.
- Authors
Brunsing, Ryan L.; Brown, Dustin; Almahoud, Hashem; Kono, Yuko; Loomba, Rohit; Vodkin, Irene; Sirlin, Claude B.; Alley, Marcus T.; Vasanawala, Shreyas S.; Hsiao, Albert
- Abstract
<bold>Background: </bold>Non-invasive assessment of the hemodynamic changes of cirrhosis might help guide management of patients with liver disease but are currently limited.<bold>Purpose: </bold>To determine whether free-breathing 4D flow MRI can be used to quantify the hemodynamic effects of cirrhosis and introduce hydraulic circuit indexes of severity.<bold>Study Type: </bold>Retrospective.<bold>Population: </bold>Forty-seven patients including 26 with cirrhosis.<bold>Field Strength/sequence: </bold>3 T/free-breathing 4D flow MRI with soft gating and golden-angle view ordering.<bold>Assessment: </bold>Measurements of the supra-celiac abdominal aorta, supra-renal abdominal aorta (SRA), celiac trunk (CeT), superior mesenteric artery (SMA), splenic artery (SpA), common hepatic artery (CHA), portal vein (PV), and supra-renal inferior vena cava (IVC) were made by two radiologists. Measures of hepatic vascular resistance (hepatic arterial relative resistance [HARR]; portal resistive index [PRI]) were proposed and calculated.<bold>Statistical Analysis: </bold>Bland-Altman, Pearson's correlation, Tukey's multiple comparison, and Cohen's kappa. P < 0.05 was considered significant.<bold>Results: </bold>Forty-four of 47 studies yielded adequate image quality for flow quantification (94%). Arterial structures showed high inter-reader concordance (range; ρ = 0.948-0.987) and the IVC (ρ = 0.972), with moderate concordance in the PV (ρ = 0.866). Conservation of mass analysis showed concordance between large vessels (SRA vs. IVC; ρ = 0.806), small vessels (celiac vs. CHA + SpA; ρ = 0.939), and across capillary beds (CeT + SMA vs. PV; ρ = 0.862). Splanchnic flow was increased in patients with portosystemic shunting (PSS) relative to control patients and patients with cirrhosis without PSS (P < 0.05, difference range 0.11-0.68 liter/m). HARR was elevated and PRI was decreased in patients with PSS (3.55 and 1.49, respectively) compared to both the control (2.11/3.18) and non-PSS (2.11/2.35) cohorts.<bold>Data Conclusion: </bold>4D flow MRI with self-navigation was technically feasible, showing promise in quantifying the hemodynamic effects of cirrhosis. Proposed quantitative metrics of hepatic vascular resistance correlated with PSS.<bold>Level Of Evidence: </bold>3 TECHNICAL EFFICACY STAGE: 2.
- Subjects
CIRRHOSIS of the liver; VENA cava inferior; VASCULAR resistance; ABDOMINAL aorta; SPLENIC artery; MAGNETIC resonance imaging; RETROSPECTIVE studies; PORTAL vein; HEMODYNAMICS; BLOOD flow measurement
- Publication
Journal of Magnetic Resonance Imaging, 2021, Vol 53, Issue 5, p1410
- ISSN
1053-1807
- Publication type
journal article
- DOI
10.1002/jmri.27488