Vascular assessment of liver disease—towards a new frontier in MRI

Chouhan, Manil; Lythgoe, Mark F.; Mookerjee, Rajeshwar P.; Taylor, Stuart A.

doi:10.1259/bjr.20150675

Cited by 17 publications

(19 citation statements)

References 83 publications

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“…The measurement of hepatic vascular parameters has important potential applications in the evaluation of chronic liver disease (Mookerjee 2011 ) and focal liver lesions (Jackson et al 2002 ). The haemodynamic changes underpinning these conditions however remain poorly understood because of highly invasive methods required for accurate measurement (Chouhan et al 2016b ).…”

Section: Discussionmentioning

confidence: 99%

Improved hepatic arterial fraction estimation using cardiac output correction of arterial input functions for liver DCE MRI

et al. 2017

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Liver dynamic contrast enhanced (DCE) MRI pharmacokinetic modelling could be useful in the assessment of diffuse liver disease and focal liver lesions, but is compromised by errors in arterial input function (AIF) sampling. In this study, we apply cardiac output correction to arterial input functions (AIFs) for liver DCE MRI and investigate the effect on dual-input single compartment hepatic perfusion parameter estimation and reproducibility.Thirteen healthy volunteers (28.7 ± 1.94 years, seven males) underwent liver DCE MRI and cardiac output measurement using aortic root phase contrast MRI (PCMRI), with reproducibility (n = 9) measured at 7 d. Cardiac output AIF correction was undertaken by constraining the first pass AIF enhancement curve using the indicator-dilution principle. Hepatic perfusion parameters with and without cardiac output AIF correction were compared and 7 d reproducibility assessed.Differences between cardiac output corrected and uncorrected liver DCE MRI portal venous (PV) perfusion (p = 0.066), total liver blood flow (TLBF) (p = 0.101), hepatic arterial (HA) fraction (p = 0.895), mean transit time (MTT) (p = 0.646), distribution volume (DV) (p = 0.890) were not significantly different. Seven day corrected HA fraction reproducibility was improved (mean difference 0.3%, Bland–Altman 95% limits-of-agreement (BA95%LoA) ±27.9%, coefficient of variation (CoV) 61.4% versus 9.3%, ±35.5%, 81.7% respectively without correction). Seven day uncorrected PV perfusion was also improved (mean difference 9.3 ml min−1/100 g, BA95%LoA ±506.1 ml min−1/100 g, CoV 64.1% versus 0.9 ml min−1/100 g, ±562.8 ml min−1/100 g, 65.1% respectively with correction) as was uncorrected TLBF (mean difference 43.8 ml min−1/100 g, BA95%LoA ±586.7 ml min−1/ 100 g, CoV 58.3% versus 13.3 ml min−1/100 g, ±661.5 ml min−1/100 g, 60.9% respectively with correction). Reproducibility of uncorrected MTT was similar (uncorrected mean difference 2.4 s, BA95%LoA ±26.7 s, CoV 60.8% uncorrected versus 3.7 s, ±27.8 s, 62.0% respectively with correction), as was and DV (uncorrected mean difference 14.1%, BA95%LoA ±48.2%, CoV 24.7% versus 10.3%, ±46.0%, 23.9% respectively with correction).Cardiac output AIF correction does not significantly affect the estimation of hepatic perfusion parameters but demonstrates improvements in normal volunteer 7 d HA fraction reproducibility, but deterioration in PV perfusion and TLBF reproducibility. Improved HA fraction reproducibility maybe important as arterialisation of liver perfusion is increased in chronic liver disease and within malignant liver lesions.

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Section: Discussionmentioning

confidence: 99%

Improved hepatic arterial fraction estimation using cardiac output correction of arterial input functions for liver DCE MRI

et al. 2017

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“…The relationship between hepatic blood flow measurements and CLD are complex, not least because short-term fluctuations in portal venous flow are closely related to prandial state [89,90]. Hepatic blood flow measurements are therefore normally made in the fasted state, but in this study, logistic factors were prioritised over ensuring a 4-h interval after HPN disconnection.…”

Section: Discussionmentioning

confidence: 99%

Serum Scoring and Quantitative Magnetic Resonance Imaging in Intestinal Failure-Associated Liver Disease: A Feasibility Study

et al. 2020

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(1) Background: Intestinal failure-associated liver disease (IFALD) in adults is characterized by steatosis with variable progression to fibrosis/cirrhosis. Reference standard liver biopsy is not feasible for all patients, but non-invasive serological and quantitative MRI markers for diagnosis/monitoring have not been previously validated. Here, we examine the potential of serum scores and feasibility of quantitative MRI used in non-IFALD liver diseases for the diagnosis of IFALD steatosis; (2) Methods: Clinical and biochemical parameters were used to calculate serum scores in patients on home parenteral nutrition (HPN) with/without IFALD steatosis. A sub-group underwent multiparameter quantitative MRI measurements of liver fat fraction, iron content, tissue T1, liver blood flow and small bowel motility; (3) Results: Compared to non-IFALD (n = 12), patients with IFALD steatosis (n = 8) demonstrated serum score elevations in Enhanced Liver Fibrosis (p = 0.032), Aspartate transaminase-to-Platelet Ratio Index (p < 0.001), Fibrosis-4 Index (p = 0.010), Forns Index (p = 0.001), Gamma-glutamyl transferase-to-Platelet Ratio Index (p = 0.002) and Fibrosis Index (p = 0.001). Quantitative MRI scanning was feasible in all 10 sub-group patients. Median liver fat fraction was higher in IFALD steatosis patients (10.9% vs 2.1%, p = 0.032); other parameter differences were non-significant; (4) Conclusion: Serum scores used for non-IFALD liver diseases may be useful in IFALD steatosis. Multiparameter MRI is feasible in patients on HPN.

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“…We agree with the authors that hepatic T 1 mapping is definitely a promising approach for the quantification of liver pathology and that with high quality, well-powered supporting data could yield an important biomarker for all aetiologies of patients with chronic liver disease. Indeed multiparametric MRI as a whole, inclusive of other techniques that assess perfusion, biomechanical properties and whole liver (rather than voxel-based) fat quantification has transformative potential in liver diagnostics [10].…”

Section: Multiparametric Magnetic Resonance Imaging To Predict Clinicmentioning

confidence: 99%

“…Our scans are quick to acquire and analyse without the need for additional hardware or injection of intravenous contrast. Recent studies using contrast-enhanced computed tomography have shown that ECV can be measured in a variety of manners, but ionising radiation, prolonged acquisition time and the requirement for intravenous contrast are all barriers to translation [10]. Acquisi-…”

Section: Conflict Of Interestmentioning

confidence: 99%

Multiparametric magnetic resonance imaging to predict clinical outcomes in patients with chronic liver disease: A cautionary note on a promising technique

Chouhan

Ambler

Mookerjee

et al. 2017

Journal of Hepatology

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the follow-up period, and 46.5% of our patients died or underwent LT during the median follow-up of 49 weeks, compared to 37.2% during 27.2 months of mean follow-up in the study by Kalambokis. Thus, although the mean MELD score for our study group was comparable to the score in Kalambokis et al.'s study, patients in our cohort had more advanced liver disease compared to their patient group. It is possible that the effect in procoagulant status is more pronounced in patients with less advanced cirrhosis, with a lesser effect in patients with advanced cirrhosis who will ultimately either die or undergo LT. The results of decreased survival in patients with a procoagulant imbalance warrants further investigations, keeping in mind that a prospective study of prophylactic low-dose enoxaparin has provided quality evidence of increased survival of patients with cirrhosis [7]. However, considering findings from our cohort, future studies should aim to differentiate the subset of patients who might potentially benefit from prophylactic anticoagulant therapy.

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Vascular assessment of liver disease—towards a new frontier in MRI

Cited by 17 publications

References 83 publications

Improved hepatic arterial fraction estimation using cardiac output correction of arterial input functions for liver DCE MRI

Improved hepatic arterial fraction estimation using cardiac output correction of arterial input functions for liver DCE MRI

Serum Scoring and Quantitative Magnetic Resonance Imaging in Intestinal Failure-Associated Liver Disease: A Feasibility Study

Multiparametric magnetic resonance imaging to predict clinical outcomes in patients with chronic liver disease: A cautionary note on a promising technique

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