Using MR elastography to assess portal hypertension and response to beta-blockers in patients with cirrhosis

Karen Vagner Danielsen, Jens Dahlgaard Hove, Puria Nabilou, Meng Yin, Jun Chen, Mirabella Zhao, Thomas Kallemose, Ane Søgaard Teisner, Hartwig Roman Siebner, Richard L. Ehman, Søren Møller, Flemming Bendtsen

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)2149-2158
Number of pages10
JournalLiver International
Issue number9
StatePublished - Sep 2021


  • beta-blockers
  • imaging
  • liver cirrhosis
  • magnetic resonance elastography
  • portal hypertension

ASJC Scopus subject areas

  • Hepatology


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