Performance of native and gadoxetate-enhanced liver and spleen t-1 mapping for noninvasive diagnosis of clinically significant portal hypertension: preliminary results

Abstract

Purpose In this preliminary study, our aim was to assess the utility of quantitative native-T1 (T1-pre), iron-corrected T1 (cT1) of the liver/spleen and T1 mapping of the liver obtained during hepatobiliary phase (T1-HBP) post-gadoxetate disodium, compared to spleen size/volume and APRI (aspartate aminotransferase-to-platelet ratio index) for noninvasive diagnosis of clinically signifcant portal hypertension [CSPH, defned as hepatic venous pressure gradient (HVPG)≥10 mm Hg]. Methods Forty-nine patients (M/F: 27/22, mean age 53y) with chronic liver disease, HVPG measurement and MRI were included. Breath-held T1 and cT1 measurements were obtained using an inversion recovery Look-Locker sequence and a T2* corrected modifed Look-Locker sequence, respectively. Liver T1-pre (n=49), spleen T1 (obtained pre-contrast, n=47), liver and spleen cT1 (both obtained pre-contrast, n=30), liver T1-HBP (obtained 20 min post gadoxetate disodium injection, n=36) and liver T1 uptake (ΔT1, n=36) were measured. Spleen size/volume and APRI were also obtained. Spearman correlation coefcients were used to assess the correlation between each of liver/spleen T1/cT1 parameters, spleen size/volume and APRI with HVPG. ROC analysis was performed to determine the performance of measured parameters for diagnosis of CSPH. Results There were 12/49 (24%) patients with CSPH. Liver T1-pre (r=0.287, p=0.045), liver T1-HBP (r=0.543, p=0.001), liver ΔT1 (r= −0.437, p=0.008), spleen T1 (r=0.311, p=0.033) and APRI (r=0.394, p=0.005) were all signifcantly correlated with HVPG, while liver cT1, spleen cT1 and spleen size/volume were not. The highest AUCs for the diagnosis of CSPH were achieved with liver T1-HBP, liver ΔT1 and spleen T1: 0.881 (95%CI 0.76–1.0, p=0.001), 0.852 (0.72–0.98, p=0.002) and 0.781 (0.60–0.95, p=0.004), respectively. Conclusion Our preliminary results demonstrate the potential of liver T1 mapping obtained during HBP post gadoxetate disodium for the diagnosis of CSPH. These results require further validation.