Four-dimensional flow magnetic resonance imaging for noninvasive diagnosis of clinically significant portal hypertension and high-risk gastroesophageal varices in patients with cirrhosis
Jiachen Ji,
Yi Xiang,
Jinghui Dong,
Hanyu Jiang,
Tianyi Xia,
Yunduo Li,
Mengmeng Zhang,
Changchun Liu,
Xijun Gong,
Bo Jin,
Wen Shen,
Gangfeng Zhu,
Jianming Cai,
Rui Li,
Xiaolong Qi
Affiliations
Jiachen Ji
Center for Biomedical Imaging Research, Tsinghua University, Beijing, China
Yi Xiang
Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University), Nanjing 210009, Jiangsu Province, China; Basic Medicine Research and Innovation Center of Ministry of Education, Zhongda Hospital, Southeast University, State Key Laboratory of Digital Medical Engineering, Nanjing, China; The First Affiliated Hospital, Gannan Medical University, Ganzhou, Jiangxi Province, China
Jinghui Dong
Department of Radiology, The Fifth Medical Centre of Chinese PLA General Hospital, Beijing, China
Hanyu Jiang
Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
Tianyi Xia
Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu Province, China
Yunduo Li
Center for Biomedical Imaging Research, Tsinghua University, Beijing, China
Mengmeng Zhang
Department of Radiology, The Fifth Medical Centre of Chinese PLA General Hospital, Beijing, China
Changchun Liu
Department of Radiology, The Fifth Medical Centre of Chinese PLA General Hospital, Beijing, China
Xijun Gong
Department of Radiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
Bo Jin
First Liver Cirrhosis Diagnosis and Treatment Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
Wen Shen
Department of Radiology, First Center Hospital of Tianjin, Tianjin, China
Gangfeng Zhu
The First Affiliated Hospital, Gannan Medical University, Ganzhou, Jiangxi Province, China
Jianming Cai
Department of Radiology, The Fifth Medical Centre of Chinese PLA General Hospital, Beijing, China; Corresponding author. Department of Radiology, The Fifth Medical Centre of Chinese PLA General Hospital, Beijing 100039, China.
Rui Li
Center for Biomedical Imaging Research, Tsinghua University, Beijing, China; Corresponding author. Center for Biomedical Imaging Research, Tsinghua University, Beijing 100084, China.
Xiaolong Qi
Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University), Nanjing 210009, Jiangsu Province, China; Basic Medicine Research and Innovation Center of Ministry of Education, Zhongda Hospital, Southeast University, State Key Laboratory of Digital Medical Engineering, Nanjing, China; Corresponding author. Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University), Nanjing 210009, Jiangsu Province, China.
Introduction: Noninvasive diagnoses of clinically significant portal hypertension (CSPH) and high-risk gastroesophageal varices are clinically relevant but challenging. Four-dimensional (4D) flow magnetic resonance imaging (MRI) provides comprehensive flow information and is a promising alternative. This study evaluated the efficacy of 4D flow MRI as a noninvasive method for diagnosing CSPH and high-risk varices in patients with liver cirrhosis. Methods: This prospective study enrolled consecutive patients diagnosed with liver cirrhosis at a tertiary referral center between October 2020 and March 2021. Each participant underwent abdominal 4D flow MRI. Hemodynamic parameters within the portal vein, including the average and peak flow velocities, normalized flow volume (Qnormal), and regurgitant fraction (R%), were extracted and compared between healthy individuals and patients with CSPH and between participants with high- and low-risk varices. Subsequently, these parameters were incorporated into a logistic regression (LR) model refined using L1 regularization and validated using five-fold cross-validation. The diagnostic efficacy was evaluated using receiver operating characteristic (ROC) curves. Results: Eighty-two participants were enrolled (71 patients diagnosed with liver cirrhosis and 11 healthy individuals serving as controls). Among hemodynamic parameters, patients with CSPH exhibited a notable increase in Qnormal of 0.66 ± 0.19 ml∗m2/[cycle∗kg] (P = 0.001) and an R% of 1.98 (2.05) (P = 0.002). Similarly, patients with high-risk varices showed a higher Qnormal of 0.61 ± 0.15 ml∗m2/[cycle∗kg] (P < 0.001) and R% of 1.88 (2.81) (P = 0.006). ROC analysis revealed an area under the curve (AUC) for Qnormal of 0.93 and 0.91 for R% for diagnosing CSPH, while the LR model showcased a superior AUC of 0.95. For high-risk varices, Qnormal and R% showed AUC values of 0.75 and 0.70, respectively, whereas the LR model showed a higher AUC of 0.84. Conclusion: As a noninvasive imaging modality, 4D flow MRI exhibits considerable potential for the diagnosis of CSPH and high-risk gastroesophageal varices; thus, it may minimize the reliance on invasive procedures in patients with cirrhosis.
