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

项目摘要 在历史上，肝硬变被归类为单一的组织病理学实体，因为它被认为是 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程度。 晚期肝纤维化和肝硬变通常与门脉高压有关，这是由于 肝脏血流动力学阻力增加导致门静脉压力增加。传送门 高血压导致食道静脉曲张的发展，与出血、腹水的高风险相关。 和肾功能不全。门静脉高压症的明确诊断是基于肝脏的测量 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。 而且不是随处可见的。门静脉高压症也可能与门静脉减少有关。 血流/速度是由于较高的血流实质阻力和继发性肝动脉血流增加所致。 到可以用相位对比磁共振成像(MRI)测量的动脉缓冲反应。 根据我们最近的数据，在门静脉高压症中观察到的血管压力增加影响肝脏和 使用先进的3D MR弹性成像技术测量脾硬度和其他粘弹性特性， 可作为门静脉高压症的生物标志物。 在这项建议中，我们希望验证基于短多参数的非侵入性成像生物标记物 磁共振成像方法用于量化肝和脾的粘弹性和血流参数的变化 与门静脉高压症的关系。这一方案可能会被整合到常规的临床MRI检查中， 并可以通过减少对HVPG测量的需求来显著降低护理成本 胃肠道内窥镜检查，并可提供一种新的肝病风险分层评分系统 门静脉高压症的MRI表现。这将是肝病患者的一个非常重要的进步。

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.