Prediction of portal pressure with liver and spleen MR Elastography and 4D flow phase-contrast MRI

利用肝脏和脾脏 MR 弹性成像和 4D 流相衬 MRI 预测门静脉压力

• 批准号: 10065001
• 负责人: Bachir Taouli
• 金额: $ 47.08万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-12-01 至 2022-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10065001
• 关键词: 3-Dimensional; Affect; Alcoholic Liver Cirrhosis; Ascites; Biological Markers; Blood Vessels; Blood flow; Buffers; Catheters; Cicatrix; Cirrhosis; Clinical; Complication; Data; Detection; Development; Diagnosis; Diagnostic; Doppler Ultrasound; Echo-Planar Imaging; Esophageal Varix; Failure; Fibrosis; Frequencies; Gastrointestinal Endoscopy; Goals; Hemorrhage; Hepatic; Hepatic artery; Image; Imaging Techniques; Internal jugular vein structure; Liver; Liver Cirrhosis; Liver Fibrosis; Liver diseases; Liver parenchyma; Magnetic Resonance Imaging; Measurement; Measures; Microcirculation; Modeling; Modulus; Organ; Patient Education; Patients; Performance; Phase; Physiological; Portal Hypertension; Portal Pressure; Portal vein structure; Pre-Clinical Model; Predictive Value of Tests; Property; Protocols documentation; Reproducibility; Resistance; Risk; Sampling; Sampling Errors; Secondary to; Severities; Spleen; System; Techniques; Testing; Tissues; Training; Validation; Varicosity; Vascular resistance; Venous; Venous Pressure level; accurate diagnosis; base; care costs; chronic liver disease; clinically significant; cohort; cost; diagnostic accuracy; elastography; hemodynamics; hepatic vein; high risk; imaging biomarker; intrahepatic; kidney dysfunction; non-invasive imaging; novel; patient population; potential biomarker; pressure; prospective; response; risk stratification; viscoelasticity

Project Summary Liver cirrhosis has been historically classified as a single histopathologic entity, as it is considered to be the latest fibrosis stage; however it is well known that cirrhosis encompasses different degrees of clinical severity. Advanced liver fibrosis and cirrhosis are commonly associated with portal hypertension, which is due to increased hemodynamic resistance of the liver leading to an increase in portal venous pressure. Portal hypertension leads to the development of esophageal varices associated with a high risk of bleeding, ascites and renal dysfunction. The definite diagnosis of portal hypertension is based on the measurement hepatic venous pressure gradient (HVPG), which is an indirect measure of portal pressure. This technique is invasive and not widely available. Portal hypertension may also associated with a decrease in portal venous flow/velocity due to a higher parenchymal resistance to flow, and an increase in hepatic arterial flow secondary to an arterial buffer response that can be measured with phase-contrast magnetic resonance imaging (MRI). According to our recent data, the increased vascular pressure observed in portal hypertension affects liver and spleen stiffness as well as other viscoelastic properties measured with advanced 3D MR elastography, which may potentially be used as biomarkers of portal hypertension. In this proposal, we would like to validate noninvasive imaging biomarkers based on a short multiparametric MRI protocol for the quantification of changes in viscoelastic properties and flow metrics in the liver and spleen in relation with portal hypertension. This protocol could potentially be integrated in routine clinical MRI exams, and could significantly reduce the cost of care by decreasing the need for HVPG measurement, upper gastrointestinal endoscopies, and could provide a novel risk stratification scoring system of liver disease and portal hypertension based on MRI. This will be a highly significant progress in patients with liver disease.

项目摘要 历史上，肝硬化一直被归类为单一的组织病理学实体，因为它被认为是肝硬化的主要病因。 最新的纤维化阶段;然而，众所周知，肝硬化包括不同程度的临床严重性。 晚期肝纤维化和肝硬化通常与门静脉高压症有关，这是由于 肝脏的血流动力学阻力增加，导致门静脉压力增加。门户 高血压导致食管静脉曲张的发展，与出血、腹水的高风险相关。 和肾功能障碍。肝硬化门脉高压症的确诊主要依靠肝动脉造影 静脉压力梯度（HVPG），这是门静脉压力的间接测量。这种技术是侵入性的 并且不广泛可用。门静脉高压症也可能与门静脉高压症的发生有关。 由于实质对血流的阻力较高，以及继发性肝动脉血流增加， 动脉缓冲反应，可以用相衬磁共振成像（MRI）测量。 根据我们最近的数据，门静脉高压症中观察到的血管压力增加影响肝脏， 脾脏硬度以及其他粘弹性用先进的3D MR弹性成像测量， 可能作为门静脉高压症的生物标志物。 在这个提议中，我们希望基于一个简短的多参数模型来验证非侵入性成像生物标志物。 用于量化肝脏和脾脏中粘弹性和流量指标变化的MRI方案 与门静脉高压症有关。该方案有可能整合到常规临床MRI检查中， 并且可以通过减少HVPG测量的需要来显著降低护理成本， 胃肠道内镜检查，并可以提供一种新的肝脏疾病风险分层评分系统， 门静脉高压的MRI表现。这对于肝脏疾病患者来说将是一个非常重大的进展。

项目成果

Noninvasive imaging assessment of portal hypertension.

• DOI: 10.1007/s00261-020-02729-7
• 发表时间: 2020-11
• 期刊: ABDOMINAL RADIOLOGY
• 影响因子: 2.4
• 作者: Kennedy, Paul;Bane, Octavia;Hectors, Stefanie J.;Fischman, Aaron;Schiano, Thomas;Lewis, Sara;Taouli, Bachir
• 通讯作者: Taouli, Bachir

4D flow MRI in abdominal vessels: prospective comparison of k-t accelerated free breathing acquisition to standard respiratory navigator gated acquisition.

• DOI: 10.1038/s41598-022-23864-9
• 发表时间: 2022-11-18
• 期刊: Scientific reports
• 影响因子: 4.6

Quantitative chest computed tomography combined with plasma cytokines predict outcomes in COVID-19 patients.

• DOI: 10.1016/j.heliyon.2022.e10166
• 发表时间: 2022-08
• 期刊: HELIYON
• 影响因子: 4
• 作者: Carbonell, Guillermo;Del Valle, Diane Marie;Gonzalez-Kozlova, Edgar;Marinelli, Brett;Klein, Emma;El Homsi, Maria;Stocker, Daniel;Chung, Michael;Bernheim, Adam;Simons, Nicole W.;Xiang, Jiani;Nirenberg, Sharon;Kovatch, Patricia;Lewis, Sara;Merad, Miriam;Gnjatic, Sacha;Taouli, Bachir
• 通讯作者: Taouli, Bachir

Collagen-targeted MRI contrast agent for liver fibrosis detection.

• DOI: 10.1038/s41575-020-0266-z
• 发表时间: 2020-04
• 期刊: Nature reviews. Gastroenterology & hepatology
• 作者: Kennedy P;Taouli B
• 通讯作者: Taouli B

MR elastography outperforms shear wave elastography for the diagnosis of clinically significant portal hypertension.

• DOI: 10.1007/s00330-022-08935-9
• 发表时间: 2022-12
• 期刊: EUROPEAN RADIOLOGY
• 影响因子: 5.9
• 作者: Kennedy, Paul;Stocker, Daniel;Carbonell, Guillermo;Said, Daniela;Bane, Octavia;Hectors, Stefanie;Abboud, Ghadi;Cuevas, Jordan;Bolster, Bradley D., Jr.;Friedman, Scott L.;Lewis, Sara;Schiano, Thomas;Bhattacharya, Dipankar;Fischman, Aaron;Thung, Swan;Taouli, Bachir
• 通讯作者: Taouli, Bachir