Karen Vagner Danielsen1,2, Jens Dahlgaard Hove3,4, Puria Nabilou1, Meng Yin5, Jun Chen5, Mirabella Zhao1, Thomas Kallemose6, Ane Søgaard Teisner7, Hartwig Roman Siebner4,8, Richard L Ehman5, Søren Møller2,4, Flemming Bendtsen1,4. 1. Centre of Gastroenterology, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark. 2. Department of Clinical Physiology and Nuclear Medicine, Centre of Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark. 3. Department of Cardiology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark. 4. Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark. 5. Department of Radiology, Mayo Clinic, Rochester, MN, USA. 6. Clinical Research Department, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark. 7. Centre of Gastroenterology, Medical Division, Copenhagen University Hospital Herlev, Herlev, Denmark. 8. Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
Abstract
BACKGROUND: MR elastography can determine organ-related stiffness, which reflects the degree of fibrosis. Liver stiffness increases in cirrhosis, and stiffness increases further post-prandially due to increased portal blood in-flow. Non-selective beta-blockers (NSBB) reduce the portal venous inflow, but their effect on liver and spleen stiffness are disputed. AIMS: To assess whether MR elastography of the liver or spleen reflects the severity of cirrhosis, whether treatment with NSBB changes liver and spleen stiffness and whether changes in stiffness can predict the effect of NSBB on portal pressure. METHODS: Fifty-two patients with cirrhosis underwent liver vein catheterization and two-dimensional (2D) MR elastography on separate days. Thirty-six of the patients had a hepatic venous pressure gradient (HVPG) of ≥12 mmHg and were tested prior to, and after, intravenous infusion of NSBB using HVPG measurement and MR elastography. RESULTS: HVPG showed a strong, positive, linear relationship with liver stiffness (r2 = 0.92; P < .001) and spleen stiffness (r2 = 0.94; P < .001). The cut-off points for identifying patients with a HVPG ≥ 12 mmHg were 7.7 kPa for liver stiffness (sensitivity 0.78, specificity 0.64) and 10.5 kPa for spleen stiffness (sensitivity 0.8, specificity 0.79). Intravenous administration of NSBB significantly decreased spleen stiffness by 6.9% (CI: 3.5-10.4, P < .001), but NSBB had no consistent effect on liver stiffness. However, changes in spleen stiffness were not related to the HVPG response (P = .75). CONCLUSIONS: Two-dimensional MR elastographic estimation of liver or spleen stiffness reflects the degree of portal hypertension in patients with liver cirrhosis, but changes in stiffness after NSBB do not predict the effect on HVPG.
BACKGROUND: MR elastography can determine organ-related stiffness, which reflects the degree of fibrosis. Liver stiffness increases in cirrhosis, and stiffness increases further post-prandially due to increased portal blood in-flow. Non-selective beta-blockers (NSBB) reduce the portal venous inflow, but their effect on liver and spleen stiffness are disputed. AIMS: To assess whether MR elastography of the liver or spleen reflects the severity of cirrhosis, whether treatment with NSBB changes liver and spleen stiffness and whether changes in stiffness can predict the effect of NSBB on portal pressure. METHODS: Fifty-two patients with cirrhosis underwent liver vein catheterization and two-dimensional (2D) MR elastography on separate days. Thirty-six of the patients had a hepatic venous pressure gradient (HVPG) of ≥12 mmHg and were tested prior to, and after, intravenous infusion of NSBB using HVPG measurement and MR elastography. RESULTS: HVPG showed a strong, positive, linear relationship with liver stiffness (r2 = 0.92; P < .001) and spleen stiffness (r2 = 0.94; P < .001). The cut-off points for identifying patients with a HVPG ≥ 12 mmHg were 7.7 kPa for liver stiffness (sensitivity 0.78, specificity 0.64) and 10.5 kPa for spleen stiffness (sensitivity 0.8, specificity 0.79). Intravenous administration of NSBB significantly decreased spleen stiffness by 6.9% (CI: 3.5-10.4, P < .001), but NSBB had no consistent effect on liver stiffness. However, changes in spleen stiffness were not related to the HVPG response (P = .75). CONCLUSIONS: Two-dimensional MR elastographic estimation of liver or spleen stiffness reflects the degree of portal hypertension in patients with liver cirrhosis, but changes in stiffness after NSBB do not predict the effect on HVPG.
Authors: Maxime Ronot; Simon Lambert; Laure Elkrief; Sabrina Doblas; Pierre-Emmanuel Rautou; Laurent Castera; Valérie Vilgrain; Ralph Sinkus; Bernard E Van Beers; Philippe Garteiser Journal: Eur Radiol Date: 2014-03-14 Impact factor: 5.315
Authors: Ahmed M Gharib; Ma Ai Thanda Han; Eric G Meissner; David E Kleiner; Xiongce Zhao; Mary McLaughlin; Lindsay Matthews; Bisharah Rizvi; Khaled Z Abd-Elmoniem; Ralph Sinkus; Elliot Levy; Christopher Koh; Robert P Myers; G Mani Subramanian; Shyam Kottilil; Theo Heller; Joseph A Kovacs; Caryn G Morse Journal: Biomed Res Int Date: 2017-04-05 Impact factor: 3.411