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

Clinically significant portal hypertension (CSPH; hepatic venous pressure gradient (HVPG) ≥ 10 mmHg) is a severe complication of chronic liver disease, with increased risk of variceal bleeding and liver decompensation (at HVPG ≥ 12 mmHg). This study evaluated the performance of multiparametric (mp)MRI for diagnosing CSPH and predicting liver decompensation, compared to ultrasound-based shear wave elastography (SWE) and blood tests.

In this prospective single-centre study (2018-2022), 59 patients (M 30, mean age 52.7 years) underwent mpMRI and HVPG measurement, with an average interval of 32 ± 31 days. The mpMRI protocol included 2D/3D MR elastography (MRE), T₁/proprietary iron-compensated T₁ (cT₁)/T_1ρ mapping, gadoxetate-enhanced dynamic contrast-enhanced MRI (DCE-MRI) of the liver and spleen, SWE and blood tests. Statistical analyses included Mann-Whitney U tests, ROC analysis, logistic regression and Cox proportional hazards models.

CSPH was present in 13 patients (22%). Several MRI parameters showed high diagnostic performance for CSPH (AUC ≥ 0.8), with spleen stiffness-2D MRE (AUC 0.88, 95% confidence interval (CI) 0.78-0.98) and liver uptake on DCE-MRI (AUC 0.83, 95% CI 0.70-0.96) performing best, while SWE had AUCs of 0.63 (95% CI 0.45-0.81) for liver and 0.67 (95% CI 0.44-0.89) for spleen. Combining spleen stiffness-2D MRE and liver uptake achieved an AUC of 0.93 (95% CI 0.86-1.00) for diagnosing CSPH. For predicting decompensation, spleen stiffness-3D MRE and liver uptake rate had AUCs of 0.83 (95% CI 0.68-0.99) and 0.83 (95% CI 0.70-0.95), respectively, outperforming SWE.

Spleen stiffness measured with MRE combined with gadoxetate liver uptake (measured with DCE-MRI) can diagnose CSPH and predict liver decompensation, with superior performance compared to SWE.

ClinicalTrials.gov identifier: NCT03436550.