Hemodynamic measurements with an abdominal 4D flow MRI sequence with spiral sampling and compressed sensing in patients with chronic liver disease

Background The test-retest/interobserver repeatability and diagnostic value of 4D flow MRI in liver disease is underreported. Purpose To determine the reproducibility/repeatability of flow quantification in abdominal vessels using a spiral 4D flow MRI sequence; to assess the value of 4D flow parameters in diagnosing cirrhosis and degree of portal hypertension. Study Type Prospective. Subjects Fifty-two patients with chronic liver disease. Field Strength/Sequence 1.5T/spiral 4D flow acquired in one breath-hold. Assessment Thirteen abdominal vessels were identified and segmented by two independent observers to measure maximum and time-averaged through-plane velocity, net flow, and vessel cross-section area. Interobserver agreement and test-retest repeatability were evaluated in 15 and 4 cases, respectively. Prediction of the presence and severity of cirrhosis and portal hypertension was assessed using 4D flow parameters. Statistical Tests Cohen's kappa coefficient, coefficient of variation (CV), Bland-Altman, Mann-Whitney tests, logistic regression. Results For all vessels combined, measurements showed acceptable agreement between observers, with Cohen's kappa = 0.70 (P < 0.001), CV < 21%, Bland-Altman bias <5%, but high limits of agreement ([-75%,75%]). Test-retest repeatability was excellent in large vessels (CV = 1-15%, bias = 1-25%, Bland-Altman limits of agreement [BALA] = [4%,150%]), and poor in small vessels (CV = 7-130%, bias = 10-200%, BALA = [8%,190%]). Average velocity in the right hepatic vein and average area of the splenic vein were higher in cirrhosis (P = 0.027/0.0039). Flow in the middle hepatic vein strongly correlated with Child-Pugh score (rho = 0.84, P = 0.0238), while flow in the splenic vein (rho = 0.43, P = 0.032), time-average (rho = 0.46, P = 0.02) and peak velocity in the superior mesenteric vein (rho = 0.45, P = 0.032), and peak velocity in the infrarenal IVC (rho = 0.39, P = 0.032) positively correlated with an imaging-based portal hypertension score. Average area of the splenic vein predicted cirrhosis (P = 0.019; area under the curve AUC [95% confidence interval, CI] = 0.87 [0.71,1.00]) and clinically significant portal hypertension (P = 0.042; AUC [95% CI] = 0.78 [0.57-0.99]). Data Conclusion Spiral 4D flow allows comprehensive assessment of abdominal vessels in one breath-hold, with substantial interobserver reproducibility, but variable test-retest repeatability. 4D flow may potentially reflect vascular changes due to cirrhosis and portal hypertension.