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

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  • Karen Vagner Danielsen
  • Jens Dahlgaard Hove
  • Puria Nabilou
  • Yin Meng
  • Jun Chen
  • Mirabella Zhao
  • Thomas Kallemose
  • Ane Søgaard Teisner
  • Hartwig Roman Siebner
  • Richard L Ehman
  • Søren Møller
  • Flemming Bendtsen
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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 (r 2 = 0.92; P <.001) and spleen stiffness (r 2 = 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
Article number14981
JournalLiver international : official journal of the International Association for the Study of the Liver
Volume41
Issue number9
Pages (from-to)2149-2158
Number of pages10
ISSN1478-3223
DOIs
Publication statusPublished - Sep 2021

    Research areas

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

ID: 65945836