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Quantification of the Hemodynamic Changes of Cirrhosis with Free‐Breathing Self‐Navigated MRI
Author(s) -
Brunsing Ryan L.,
Brown Dustin,
Almahoud Hashem,
Kono Yuko,
Loomba Rohit,
Vodkin Irene,
Sirlin Claude B.,
Alley Marcus T.,
Vasanawala Shreyas S.,
Hsiao Albert
Publication year - 2021
Publication title -
journal of magnetic resonance imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 160
eISSN - 1522-2586
pISSN - 1053-1807
DOI - 10.1002/jmri.27488
Subject(s) - medicine , cirrhosis , hemodynamics , inferior vena cava , superior mesenteric artery , population , cardiology , radiology , environmental health
Background Non‐invasive assessment of the hemodynamic changes of cirrhosis might help guide management of patients with liver disease but are currently limited. Purpose 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. Study Type Retrospective. Population Forty‐seven patients including 26 with cirrhosis. Field Strength/Sequence 3 T/free‐breathing 4D flow MRI with soft gating and golden‐angle view ordering. Assessment 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. Statistical Analysis Bland–Altman, Pearson's correlation, Tukey's multiple comparison, and Cohen's kappa. P < 0.05 was considered significant. Results 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. Data Conclusion 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. Level of Evidence 3 Technical Efficacy Stage 2