TY - JOUR
T1 - Using MR elastography to assess portal hypertension and response to beta-blockers in patients with cirrhosis
AU - Danielsen, Karen Vagner
AU - Hove, Jens Dahlgaard
AU - Nabilou, Puria
AU - Yin, Meng
AU - Chen, Jun
AU - Zhao, Mirabella
AU - Kallemose, Thomas
AU - Teisner, Ane Søgaard
AU - Siebner, Hartwig Roman
AU - Ehman, Richard L.
AU - Møller, Søren
AU - Bendtsen, Flemming
N1 - Funding Information:
We sincerely thank the staff at the Centre for Functional and Diagnostic Imaging and Research and the Gastro Unit at Hvidovre University Hospital for their support. We would especially like to thank the excellent MR technicians, and the MR physicist Lasse R Søndergaard, for their impressive work with the MR elastography measurements. Furthermore, we wish to thank the Gastro Unit of Herlev Hospital for referring patients to the study coordinators. This project has received financial support from Amager Hvidovre University Hospital Research Foundation and Ferring Pharmaceuticals A/S.
Funding Information:
The study was supported by an independent research grant from Ferring Pharmaceuticals A/S and from Amager Hvidovre University Hospital Research Foundation. The Mayo Clinic and authors RLE, MY, and JC have intellectual property and a financial interest related to this research. Furthermore, they are supported by the National Institutes of Health with NIH grants EB017197 (Yin) and EB001981 (Ehman). Hartwig R. Siebner has received honoraria as a speaker from Sanofi Genzyme, Denmark and Novartis, Denmark, as consultant from Sanofi Genzyme, Denmark, Lophora, Denmark, and Lundbeck AS, Denmark, and as editor‐in‐chief () and senior editor () from Elsevier Publishers, Amsterdam, The Netherlands. He has received royalties as book editor from Springer Publishers, Stuttgart, Germany and from Gyldendal Publishers, Copenhagen, Denmark. Hartwig R. Siebner holds a 5‐year professorship in precision medicine at the Faculty of Health Sciences and Medicine, University of Copenhagen, which is sponsored by the Lundbeck Foundation (Grant Nr R186‐2015‐2138). The remaining authors have no conflicts of interest to declare. Neuroimage Clinical NeuroImage
Funding Information:
We sincerely thank the staff at the Centre for Functional and Diagnostic Imaging and Research and the Gastro Unit at Hvidovre University Hospital for their support. We would especially like to thank the excellent MR technicians, and the MR physicist Lasse R S?ndergaard, for their impressive work with the MR elastography measurements. Furthermore, we wish to thank the Gastro Unit of Herlev Hospital for referring patients to the study coordinators. This project has received financial support from Amager Hvidovre University Hospital Research Foundation and Ferring Pharmaceuticals A/S.
Publisher Copyright:
© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
PY - 2021/9
Y1 - 2021/9
N2 - 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.
AB - 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.
KW - beta-blockers
KW - imaging
KW - liver cirrhosis
KW - magnetic resonance elastography
KW - portal hypertension
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U2 - 10.1111/liv.14981
DO - 10.1111/liv.14981
M3 - Article
C2 - 34060714
AN - SCOPUS:85107981646
SN - 1478-3223
VL - 41
SP - 2149
EP - 2158
JO - Liver International
JF - Liver International
IS - 9
ER -