Multi-organ assessment of compensated cirrhosis patients using quantitative magnetic resonance imaging

Background & Aims: Advancing liver disease results in deleterious changes in a number of critical organs. The ability to measure structure, blood flow and tissue perfusion within multiple organs in a single scan has implications for determining the balance of benefit vs. harm for therapies. Our aim was to establish the feasibility of magnetic resonance imaging (MRI) to assess changes in Compensated Cirrhosis (CC), and relate this to disease severity and future liver-related outcomes (LROs). Methods: A total of 60 patients with CC, 40 healthy volunteers and 7 patients with decompensated cirrhosis were recruited. In a single scan session, MRI measures comprised phasecontrast MRI vessel blood flow, arterial spin labelling tissue perfusion, T-1 longitudinal relaxation time, heart rate, cardiac index, and volume assessment of the liver, spleen and kidneys. We explored the association between MRI parameters and disease severity, analysing differences in baseline MRI parameters in the 11 (18%) patients with CC who experienced future LROs. Results: In the liver, compositional changes were reflected by increased T-1 in progressive disease (p < 0.001) and an increase in liver volume in CC (p = 0.006), with associated progressive reduction in liver (p < 0.001) and splenic (p < 0.001) perfusion. A significant reduction in renal cortex T-1 and increase in cardiac index and superior mesenteric arterial blood flow was seen with increasing disease severity. Baseline liver T-1 (p = 0.01), liver perfusion (p < 0.01), and renal cortex T-1 (p < 0.01) were significantly different in patients with CC who subsequently developed negative LROs. Conclusions: MRI enables the contemporaneous assessment of organs in liver cirrhosis in a single scan without the requirement for a contrast agent. MRI parameters of liver T-1, renal T-1, hepatic and splenic perfusion, and superior mesenteric arterial blood flow were related to the risk of LROs. (C) 2018 European Association for the Study of the Liver. Published by Elsevier B.V.