Non-invasive assessment of portal hypertension by multi-parametric magnetic resonance imaging of the spleen: A proof of concept study

• Published in: PloS one Vol. 14; no. 8; p. e0221066
• Main Authors: Levick, Christina, Phillips-Hughes, Jane, Collier, Jane, Banerjee, Rajarshi, Cobbold, Jeremy F., Wang, Lai Mun, Piechnik, Stefan K., Robson, Matthew D., Neubauer, Stefan, Barnes, Eleanor, Pavlides, Michael
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 20.08.2019; Public Library of Science (PLoS)
• Subjects: Aged; Algorithms; Bile; Biological markers; Biology and Life Sciences; Biomarkers; Biomedical research; Biopsy; Clinical outcomes; Diagnostic systems; Elasticity Imaging Techniques; Encephalopathy; Esophagus; Fatty liver; Female; Fibrosis; Gastroenterology; Hepatic vein; Hepatic Veins - physiopathology; Hepatitis; Hepatology; Hospitals; Humans; Hypertension; Hypertension, Portal - diagnosis; Hypertension, Portal - etiology; Hypertension, Portal - physiopathology; Image Processing, Computer-Assisted; Iron; Liver; Liver - diagnostic imaging; Liver - pathology; Liver cirrhosis; Liver Cirrhosis - complications; Liver Cirrhosis - pathology; Liver diseases; Magnetic resonance; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medical research; Medicine; Medicine and Health Sciences; Middle Aged; Moisture content; NMR; Nuclear magnetic resonance; Patients; Portal hypertension; Portal Pressure - physiology; Proof of Concept Study; Prospective Studies; Resonance; Risk factors; ROC Curve; Spleen; Spleen - diagnostic imaging; Systematic review; Technology; Venous pressure; Viral hepatitis; Virus diseases; Water content; England; United Kingdom > UK; France; United States > US; Baltimore Maryland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0221066

Non-invasive assessment of portal hypertension is an area of unmet need. This proof of concept study aimed to evaluate the diagnostic accuracy of a multi-parametric magnetic resonance technique in the assessment of portal hypertension. Comparison to other non-invasive technologies was a secondary aim. T1 and T2* maps through the liver and spleen were acquired prior to trans-jugular liver biopsy and hepatic vein pressure gradient (HVPG) measurement. T1 measurements reflect changes in tissue water content, but this relationship is confounded by the presence of iron, which in turn can be quantified accurately from T2* maps. Data were analysed using LiverMultiScan (Perspectum Diagnostics, Oxford, UK) which applies an algorithm to remove the confounding effect of iron, yielding the "iron corrected T1" (cT1). Sensitivity, specificity, diagnostic values and area under the curve were derived for spleen cT1, liver cT1, transient elastography, and serum fibrosis scores. HVPG was the reference standard. Nineteen patients (15 men) with median age 57 years were included. Liver disease aetiologies included non-alcoholic fatty liver disease (n = 9; 47%) and viral hepatitis (n = 4; 21%). There was strong correlation between spleen cT1 and HVPG (r = 0.69; p = 0.001). Other non-invasive biomarkers did not correlate with HVPG. Spleen cT1 had excellent diagnostic accuracy for portal hypertension (HVPG >5 mmHg) and clinically significant portal hypertension (HVPG ≥10 mmHg) with an area under the receiver operating characteristic curve of 0.92 for both. Spleen cT1 is a promising biomarker of portal pressure that outperforms other non-invasive scores and should be explored further.