Splenic T_1ρ as a noninvasive biomarker for portal hypertension

Abstract

BackgroundThere is a need for noninvasive methods for the diagnosis and monitoring of portal hypertension (PH).PurposeTo 1) assess the correlation of liver and spleen T1 and T1ρ measurements with portal pressures in patients with chronic liver disease, and 2) to compare the diagnostic performance of the relaxation parameters with radiological assessment of PH.Study TypeProspective.SubjectsTwenty‐five patients (M/F 16/9, mean age 56 years, range 21–78 years) undergoing portal pressure (hepatic venous pressure gradient [HVPG]) measurements.Field Strength/Sequence1.5T abdominal MRI scan, including T1ρ and T1 mapping.AssessmentLiver and spleen T1ρ and T1, radiological PH score, and (normalized) spleen length were evaluated.Statistical TestsSpearman correlation of all MRI parameters with HVPG was assessed. The diagnostic performance of the assessed parameters for prediction of PH (HVPG ≥5 mmHg) and clinically significant PH (CSPH, HVPG ≥10 mmHg) was determined by receiver operating characteristic (ROC) analysis.ResultsThe mean HVPG measurement was 7.8 ± 5.3 mmHg (PH, n = 18 [72%] including CSPH, n = 9 [36%]). PH score, (normalized) spleen length and spleen T1ρ significantly correlated with HVPG, with the strongest correlation found for spleen T1ρ (r = 0.613, P = 0.001). Spleen T1ρ was the only parameter that showed significant diagnostic performance for assessment of PH (area under the curve [AUC] 0.817, P = 0.015) and CSPH (AUC = 0.778, P = 0.024). Normalized spleen length also showed significant diagnostic performance for prediction of CSPH, with a slightly lower AUC (= 0.764, P = 0.031). The radiological PH score, T1ρ and T1 of the liver and T1 of the spleen, did not show significant diagnostic performance for assessment of CSPH (P > 0.075).Data ConclusionSpleen T1ρ showed a significant correlation with portal pressure and showed improved diagnostic performance for prediction of CSPH compared to radiological assessment. These initial results need confirmation in a larger cohort.Level of Evidence: 1Technical Efficacy Stage: 2J. Magn. Reson. Imaging 2020;52:787–794.

Collagen deposition in the liver is strongly and positively associated with T1rho elongation while fat deposition is associated with T1rho shortening: an experimental study of methionine and choline-deficient (MCD) diet rat model

“…Renal allograft fibrosis, associated with the deposition of collagen in the cortical interstitial space, is considered an important factor for allograft prognosis. In another study, Hector et al (27) reported that spleen T1rho showed a significant correlation with portal pressure and clinically significant poral hypertension. It was suggested that the elevation in T1rho in the spleen with increased poral hypertension severity may reflect the deposition of collagen associate with fibrogenesis (27).…”

“…In another study, Hector et al (27) reported that spleen T1rho showed a significant correlation with portal pressure and clinically significant poral hypertension. It was suggested that the elevation in T1rho in the spleen with increased poral hypertension severity may reflect the deposition of collagen associate with fibrogenesis (27).…”

Spleen in viral Hepatitis-B liver fibrosis patients may have a reduced level of per unit micro-circulation: non-invasive diffusion MRI evidence with a surrogate marker

“…They reported that, in the spleens of the liver cirrhosis patients, there were diffuse 𝛼-smooth muscle actin expression of sinusoidal mesenchymal cells and deposition of collagen fibers on the perisinusoidal wall. Hectors et al [30] studied a prospective cohort of 25 patients with hepatic venous pressure gradient measurement. They found spleen T1rho significantly correlated with hepatic venous pres- Patients with liver fibrosis in Shenzhen data-1 have a trend of lower spleen DDVD values than those of healthy volunteers.…”

MRI in liver cirrhosis

“…Among all relaxometry parameters, only spleen T1ρ significantly correlated with HVPG ( r = 0.613, p = 0.001) and demonstrated a significant ability to detect PH (0.817, p = 0.015) and CSPH (0.778, p = 0.024). Authors suggested that the better performance of spleen relaxometry measurements when compared to hepatic measurements could be related to possible cofounders preventing accurate hepatic assessment such as hepatic iron deposition and inflammation 116,119 . Furthermore, the large variability in pathophysiological characteristics between liver diseases may introduce inaccuracies when compared with the pathophysiological changes of PH in the spleen that may be less influenced by differences in disease etiology.…”