Magnetic Resonance Elastography Shear Wave Velocity Correlates with Liver Fibrosis and Hepatic Venous Pressure Gradient in Adults with Advanced Liver Disease

Abstract

Background. Portal hypertension, an elevation in the hepatic venous pressure gradient (HVPG), can be used to monitor disease progression and response to therapy in cirrhosis. Since obtaining HVPG measurements is invasive, reliable noninvasive methods of assessing portal hypertension are needed. Methods. Noninvasive markers of fibrosis, including magnetic resonance elastography (MRE) shear wave velocity, were correlated with histologic fibrosis and HVPG measurements in hepatitis C (HCV) and/or HIV-infected patients with advanced liver disease enrolled in a clinical trial of treatment with simtuzumab, an anti-LOXL2 antibody. Results. This exploratory analysis includes 23 subjects: 9 with HCV monoinfection, 9 with HIV and HCV, and 5 with HIV and nonalcoholic steatohepatitis. Median Ishak fibrosis score was 4 (range 1–6); 11 subjects (48%) had cirrhosis. Median HVPG was 6 mmHg (range 3–16). Liver stiffness measured by MRE correlated with HVPG (r = 0.64, p = 0.01), histologic fibrosis score (r = 0.71, p = 0.004), noninvasive fibrosis indices, including APRI (r = 0.81, p < 0.001), and soluble LOXL2 (r = 0.82, p = 0.001). On stepwise multivariate regression analysis, MRE was the only variable independently associated with HVPG (R2 = 0.377, p = 0.02). Conclusions. MRE of the liver correlated independently with HVPG. MRE is a valid noninvasive measure of liver disease severity and may prove to be a useful tool for noninvasive portal hypertension assessment. Trial Registration Number. This trial is registered with NCT01707472.

Origins of Portal Hypertension in Nonalcoholic Fatty Liver Disease

“…Thus, quantitative MR measures of liver T 1 longitudinal relaxation time and splenic artery velocity may accurately estimate HVPG values on a continuous scale in patients with cirrhosis and PVP ranging from normal to the level of clinically significant PHT [79]. Moreover, liver stiffness measured by 2-dimensional (gradient-recalled echo) MR elastography showed good correlation with portal venous pressure in a small cohort of patients with cirrhosis with various etiologies including steatohepatitis and HVPG ranging from as low as 3-16 mm Hg [80].…”

Magnetic resonance elastography of liver and spleen: Methods and applications

“…Several animal studies have shown significant correlations between portal venous pressure and liver and spleen stiffness . Similarly, in patients, several studies have shown strong correlations between liver and spleen stiffness and the degree of portal hypertension or the presence of esophageal varices …”

“…2,3,98,154 Similarly, in patients, several studies have shown strong correlations between liver and spleen stiffness and the degree of portal hypertension or the presence of esophageal varices. 5,[155][156][157][158][159][160][161][162] The link between portal pressure and liver and spleen stiffness is also evident when observing mechanical parameters decreasing as the pressure stimulus decreases. Indeed, a decrease in portal pressure was associated with a decrease in the magnitude of the liver and spleen shear modulus IG*I without any change of the phase angle α after transjugular intrahepatic portosystemic shunt placement.…”

Noninvasive Diagnostics for Portal Hypertension: A Comprehensive Review

“…Similar to US elastography methods, magnetic resonance elastography (MRE) may also be applied as a surrogate of portal hypertension. [60][61][62] Ronot et al investigated the use of liver and spleen MRE in 36 patients who were evaluated for liver transplantation. 60 Accordingly, the majority of patients had decompensated disease (53% CTP stage B/C; 69% ascites).…”