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Non-invasive assessment of portal hypertension by multi-parametric magnetic resonance imaging of the spleen: A proof of concept study.
PLoS One 2019; 14(8):e0221066Plos

Abstract

BACKGROUND AND AIMS

Non-invasive assessment of portal hypertension is an area of unmet need. This proof of concept study aimed to evaluate the diagnostic accuracy of a multi-parametric magnetic resonance technique in the assessment of portal hypertension. Comparison to other non-invasive technologies was a secondary aim.

METHODS

T1 and T2* maps through the liver and spleen were acquired prior to trans-jugular liver biopsy and hepatic vein pressure gradient (HVPG) measurement. T1 measurements reflect changes in tissue water content, but this relationship is confounded by the presence of iron, which in turn can be quantified accurately from T2* maps. Data were analysed using LiverMultiScan (Perspectum Diagnostics, Oxford, UK) which applies an algorithm to remove the confounding effect of iron, yielding the "iron corrected T1" (cT1). Sensitivity, specificity, diagnostic values and area under the curve were derived for spleen cT1, liver cT1, transient elastography, and serum fibrosis scores. HVPG was the reference standard.

RESULTS

Nineteen patients (15 men) with median age 57 years were included. Liver disease aetiologies included non-alcoholic fatty liver disease (n = 9; 47%) and viral hepatitis (n = 4; 21%). There was strong correlation between spleen cT1 and HVPG (r = 0.69; p = 0.001). Other non-invasive biomarkers did not correlate with HVPG. Spleen cT1 had excellent diagnostic accuracy for portal hypertension (HVPG >5 mmHg) and clinically significant portal hypertension (HVPG ≥10 mmHg) with an area under the receiver operating characteristic curve of 0.92 for both.

CONCLUSION

Spleen cT1 is a promising biomarker of portal pressure that outperforms other non-invasive scores and should be explored further.

Authors+Show Affiliations

Translational Gastroenterology Unit, University of Oxford, Oxford, England, United Kingdom.Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, England, United Kingdom.Translational Gastroenterology Unit, University of Oxford, Oxford, England, United Kingdom.Perspectum Diagnostics, Oxford, England, United Kingdom.Translational Gastroenterology Unit, University of Oxford, Oxford, England, United Kingdom.Department of Histopathology, Oxford University Hospitals NHS Trust, Oxford, England, United Kingdom.Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, England, United Kingdom.Perspectum Diagnostics, Oxford, England, United Kingdom.Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, England, United Kingdom. Oxford National Institute of Health Research Biomedical Research Centre, John Radcliffe Hospital, Oxford, England, United Kingdom.Translational Gastroenterology Unit, University of Oxford, Oxford, England, United Kingdom. Oxford National Institute of Health Research Biomedical Research Centre, John Radcliffe Hospital, Oxford, England, United Kingdom. University of Oxford, Oxford, England, United Kingdom.Translational Gastroenterology Unit, University of Oxford, Oxford, England, United Kingdom. Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, England, United Kingdom. Oxford National Institute of Health Research Biomedical Research Centre, John Radcliffe Hospital, Oxford, England, United Kingdom.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31430314

Citation

Levick, Christina, et al. "Non-invasive Assessment of Portal Hypertension By Multi-parametric Magnetic Resonance Imaging of the Spleen: a Proof of Concept Study." PloS One, vol. 14, no. 8, 2019, pp. e0221066.
Levick C, Phillips-Hughes J, Collier J, et al. Non-invasive assessment of portal hypertension by multi-parametric magnetic resonance imaging of the spleen: A proof of concept study. PLoS ONE. 2019;14(8):e0221066.
Levick, C., Phillips-Hughes, J., Collier, J., Banerjee, R., Cobbold, J. F., Wang, L. M., ... Pavlides, M. (2019). Non-invasive assessment of portal hypertension by multi-parametric magnetic resonance imaging of the spleen: A proof of concept study. PloS One, 14(8), pp. e0221066. doi:10.1371/journal.pone.0221066.
Levick C, et al. Non-invasive Assessment of Portal Hypertension By Multi-parametric Magnetic Resonance Imaging of the Spleen: a Proof of Concept Study. PLoS ONE. 2019;14(8):e0221066. PubMed PMID: 31430314.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Non-invasive assessment of portal hypertension by multi-parametric magnetic resonance imaging of the spleen: A proof of concept study. AU - Levick,Christina, AU - Phillips-Hughes,Jane, AU - Collier,Jane, AU - Banerjee,Rajarshi, AU - Cobbold,Jeremy F, AU - Wang,Lai Mun, AU - Piechnik,Stefan K, AU - Robson,Matthew D, AU - Neubauer,Stefan, AU - Barnes,Eleanor, AU - Pavlides,Michael, Y1 - 2019/08/20/ PY - 2019/04/18/received PY - 2019/07/29/accepted PY - 2019/8/21/entrez PY - 2019/8/21/pubmed PY - 2019/8/21/medline SP - e0221066 EP - e0221066 JF - PloS one JO - PLoS ONE VL - 14 IS - 8 N2 - BACKGROUND AND AIMS: Non-invasive assessment of portal hypertension is an area of unmet need. This proof of concept study aimed to evaluate the diagnostic accuracy of a multi-parametric magnetic resonance technique in the assessment of portal hypertension. Comparison to other non-invasive technologies was a secondary aim. METHODS: T1 and T2* maps through the liver and spleen were acquired prior to trans-jugular liver biopsy and hepatic vein pressure gradient (HVPG) measurement. T1 measurements reflect changes in tissue water content, but this relationship is confounded by the presence of iron, which in turn can be quantified accurately from T2* maps. Data were analysed using LiverMultiScan (Perspectum Diagnostics, Oxford, UK) which applies an algorithm to remove the confounding effect of iron, yielding the "iron corrected T1" (cT1). Sensitivity, specificity, diagnostic values and area under the curve were derived for spleen cT1, liver cT1, transient elastography, and serum fibrosis scores. HVPG was the reference standard. RESULTS: Nineteen patients (15 men) with median age 57 years were included. Liver disease aetiologies included non-alcoholic fatty liver disease (n = 9; 47%) and viral hepatitis (n = 4; 21%). There was strong correlation between spleen cT1 and HVPG (r = 0.69; p = 0.001). Other non-invasive biomarkers did not correlate with HVPG. Spleen cT1 had excellent diagnostic accuracy for portal hypertension (HVPG >5 mmHg) and clinically significant portal hypertension (HVPG ≥10 mmHg) with an area under the receiver operating characteristic curve of 0.92 for both. CONCLUSION: Spleen cT1 is a promising biomarker of portal pressure that outperforms other non-invasive scores and should be explored further. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/31430314/Non-invasive_assessment_of_portal_hypertension_by_multi-parametric_magnetic_resonance_imaging_of_the_spleen:_A_proof_of_concept_study L2 - http://dx.plos.org/10.1371/journal.pone.0221066 DB - PRIME DP - Unbound Medicine ER -