Multiparametric MRI for Diagnosing Clinically Significant Portal Hypertension and Predicting Liver Decompensation

Area of Science:

• Hepatology and advanced medical imaging techniques.
• Diagnostic performance of multiparametric MRI (mpMRI) in liver disease.
• Predictive capabilities of imaging biomarkers for liver decompensation.

Background:

• Clinically significant portal hypertension (CSPH), defined by hepatic venous pressure gradient (HVPG) ≥ 10 mmHg, is a severe complication of chronic liver disease.
• CSPH increases the risk of variceal bleeding and liver decompensation (HVPG ≥ 12 mmHg).
• Accurate diagnosis and risk stratification are crucial for managing patients with chronic liver disease.

Purpose of the Study:

• To evaluate the diagnostic performance of mpMRI for CSPH.
• To assess the ability of mpMRI to predict liver decompensation.
• To compare the efficacy of mpMRI against ultrasound-based shear wave elastography (SWE) and blood tests.

Main Methods:

• Prospective single-center study involving 59 patients (2018-2022).
• Patients underwent mpMRI (including 2D/3D MR elastography, T1/cT1/T1ρ mapping, DCE-MRI of liver and spleen) and HVPG measurement.
• Statistical analyses included ROC analysis and Cox proportional hazards models to compare diagnostic and predictive performances.

Main Results:

• mpMRI parameters demonstrated high diagnostic performance for CSPH (AUC ≥ 0.8).
• Spleen stiffness (2D MRE) and liver uptake (DCE-MRI) showed the best performance, with combined AUC of 0.93 for CSPH diagnosis.
• Spleen stiffness (3D MRE) and liver uptake rate predicted decompensation with AUCs of 0.83, outperforming SWE.

Conclusions:

• Spleen stiffness measured by MRE, combined with gadoxetate liver uptake from DCE-MRI, accurately diagnoses CSPH.
• This mpMRI combination effectively predicts liver decompensation.
• mpMRI demonstrates superior diagnostic and predictive performance compared to SWE for CSPH and decompensation risk.