Multi-organ assessment of compensated cirrhosis patients using quantitative magnetic resonance imaging

Abstract

Background & aims: Advancing liver disease results in deleterious changes in a number of critical organs. The ability to measure structure, blood flow and tissue perfusion within multiple organs in a single scan has implications for determining the balance of benefit vs. harm for therapies. Our aim was to establish the feasibility of magnetic resonance imaging (MRI) to assess changes in Compensated Cirrhosis (CC), and relate this to disease severity and future liver-related outcomes (LROs).

Methods: A total of 60 patients with CC, 40 healthy volunteers and 7 patients with decompensated cirrhosis were recruited. In a single scan session, MRI measures comprised phase-contrast MRI vessel blood flow, arterial spin labelling tissue perfusion, T₁ longitudinal relaxation time, heart rate, cardiac index, and volume assessment of the liver, spleen and kidneys. We explored the association between MRI parameters and disease severity, analysing differences in baseline MRI parameters in the 11 (18%) patients with CC who experienced future LROs.

Results: In the liver, compositional changes were reflected by increased T₁ in progressive disease (p <0.001) and an increase in liver volume in CC (p = 0.006), with associated progressive reduction in liver (p <0.001) and splenic (p <0.001) perfusion. A significant reduction in renal cortex T₁ and increase in cardiac index and superior mesenteric arterial blood flow was seen with increasing disease severity. Baseline liver T₁ (p = 0.01), liver perfusion (p <0.01), and renal cortex T₁ (p <0.01) were significantly different in patients with CC who subsequently developed negative LROs.

Conclusions: MRI enables the contemporaneous assessment of organs in liver cirrhosis in a single scan without the requirement for a contrast agent. MRI parameters of liver T_1, renal T_1, hepatic and splenic perfusion, and superior mesenteric arterial blood flow were related to the risk of LROs.

Lay summary: This study assesses the changes to structure, blood flow and perfusion that occur in the key organs (liver, spleen and kidney) associated with severe liver disease (Compensated Cirrhosis), using magnetic resonance imaging. The magnetic resonance imaging measures which changed with disease severity and were related to negative liver-related clinical outcomes are described.

Keywords: Arterial Spin Labelling; Compensated Cirrhosis; Longitudinal T(1) relaxation time; Magnetic Resonance Imaging; Phase contrast.