Non-invasive assessment of portal hypertension using quantitative magnetic resonance imaging.
Non-invasive assessment of portal hypertension using quantitative magnetic resonance imaging.
复制标题
DOI：
10.1016/j.jhep.2016.07.021
复制
发表时间：
2016-12
影响因子：
25.7
通讯作者：
Aithal GP
中科院分区：
文献类型：
--
作者：
Palaniyappan N;Cox E;Bradley C;Scott R;Austin A;O'Neill R;Ramjas G;Travis S;White H;Singh R;Thurley P;Guha IN;Francis S;Aithal GP
肝静脉压力梯度（HVPG）测量是目前唯一经过验证的准确评估门静脉压力变化的技术。在这项研究中，我们评估使用非对比定量磁共振成像（MRI）作为门静脉压力的替代措施。前瞻性招募了30例接受HVPG测量的患者。纵向弛豫时间（T1），灌注的肝脏和脾脏（动脉自旋标记），并在门静脉，内脏和侧支循环（相位对比MRI）的血流量的MR参数进行了评估。我们估计了肝硬度测量（LSM）和增强的肝纤维化（ELF）评分。评估所有无创参数与HVPG的相关性。患者的平均HVPG为9.8（1-22）mmHg，14例患者（48%）有临床显著的门静脉高压症（CSPH，HVPG> 10 mmHg）。肝T1弛豫时间、脾动脉和上级肠系膜动脉血流速度与HVPG显著相关。多元线性回归分析显示，肝T1和脾动脉血流速度仍是HVPG的两个多变量相关参数（R = 0.90，p <0.001）。这种相关性在CSPH患者中保持（R = 0.85，p <0.001）。验证队列（n = 10）显示该线性模型提供了HVPG的良好预测。LSM和ELF评分与HVPG在整个人群中显著相关，但在CSPH中相关性不存在。与肝脏结构和内脏血流动力学相关的MR参数与HVPG显著相关。在验证队列中证实的该拟议模型可以取代侵入性HVPG测量。在肝硬化患者中，门静脉高压症的发展和进展与更差的结局相关。然而，评估门静脉压力的标准技术是有创的，在临床实践中没有广泛使用。在这里，我们研究了无创MRI在评估门静脉压力方面的应用。MRI测量的肝脏结构和脾动脉血流量与门静脉压力相关性良好。因此，这种非侵入性的方法可以潜在地用于在临床试验中评估门静脉压力和在实践中监测治疗。
Hepatic venous pressure gradient (HVPG) measurement is currently the only validated technique to accurately evaluate changes in portal pressure. In this study, we evaluate the use of non-contrast quantitative magnetic resonance imaging (MRI) as a surrogate measure of portal pressure. Thirty patients undergoing HVPG measurement were prospectively recruited. MR parameters of longitudinal relaxation time (T1), perfusion of the liver and spleen (by arterial spin labelling), and blood flow in the portal, splanchnic and collateral circulation (by phase contrast MRI) were assessed. We estimated the liver stiffness measurement (LSM) and enhanced liver fibrosis (ELF) score. The correlation of all non-invasive parameters with HVPG was evaluated. The mean (range) HVPG of the patients was 9.8 (1–22) mmHg, and 14 patients (48%) had clinically significant portal hypertension (CSPH, HVPG ⩾10 mmHg). Liver T1 relaxation time, splenic artery and superior mesenteric artery velocity correlated significantly with HVPG. Using multiple linear regression, liver T1 and splenic artery velocity remained as the two parameters in the multivariate model significantly associated with HVPG (R = 0.90, p <0.001). This correlation was maintained in patients with CSPH (R = 0.85, p <0.001). A validation cohort (n = 10) showed this linear model provided a good prediction of HVPG. LSM and ELF score correlated significantly with HVPG in the whole population but the correlation was absent in CSPH. MR parameters related to both hepatic architecture and splanchnic haemodynamics correlate significantly with HVPG. This proposed model, confirmed in a validation cohort, could replace the invasive HVPG measurement. In patients with cirrhosis, the development and progression of portal hypertension is related to worse outcomes. However, the standard technique of assessing portal pressure is invasive and not widely used in clinical practice. Here, we have studied the use of non-invasive MRI in evaluating portal pressure. The MRI measures of liver architecture and blood flow in the splenic artery correlated well with portal pressure. Therefore, this non-invasive method can potentially be used to assess portal pressure in clinical trials and monitoring treatment in practice.