Quantitative MRI to Assess Portal Pressure in Patients With Liver Disease: Validation at 3 T.

Authors

Christopher R Bradley, Robert Scott, Eleanor F Cox, Naaventhan Palaniyappan, Simon Travis, Indra Neil Guha, Guruprasad P Aithal, Susan T Francis

Published in

NMR in biomedicine. Volume 39. Issue 9. Pages e70363.

Abstract

Hepatic venous pressure gradient (HVPG) is the gold standard for assessing portal hypertension (PH). We previously demonstrated that a bivariate MRI model combining liver T₁ and splenic artery velocity at 1.5 T correlates with HVPG. This study aimed to evaluate this model at 3 T and investigate additional splanchnic MRI measures as potential non-invasive markers of portal pressure. Data from 40 participants (15 metabolic dysfunction-associated steatotic liver disease [MASLD]/13 alcohol-related liver disease [ArLD]/12 other, 55 ± 14 years) scanned at 1.5 T (retrospective) and 42 participants (21 MASLD/14 ArLD/7 other, 60 ± 12 years) scanned prospectively at 3 T who underwent clinical HVPG measurement were analysed. Liver and spleen iron-corrected T₁ (cT₁) were acquired using fat-suppressed spin-echo echo-planar T₁ mapping, and splanchnic haemodynamics were assessed using phase-contrast MRI. Correlations between MRI parameters and HVPG were assessed, and previously derived univariate (liver cT₁) and bivariate (liver cT₁ + splenic artery velocity) models were evaluated using receiver operating characteristic (ROC) analysis for PH (HVPG ≥ 5 mmHg), clinically significant PH (CSPH; HVPG ≥ 10 mmHg) and increased risk of mortality (HVPG ≥ 15 mmHg). Liver cT₁ at 3 T showed a strong positive correlation with HVPG across the full range (0-23 mmHg; R = 0.73, p < 0.0001). After field adjustment, pooled 1.5 and 3 T liver cT₁ maintained a strong correlation with HVPG (R = 0.76, p < 0.0001). At 3 T, the univariate liver cT₁ model outperformed the bivariate model, achieving AUROCs of 0.74, 0.86 and 0.91 for detecting PH, CSPH and HVPG ≥ 15 mmHg, respectively. In contrast, spleen cT₁ and superior mesenteric artery velocity correlated with HVPG only up to ~15 mmHg, after which values plateaued or declined. Liver cT₁ MRI at 3 T provides a surrogate of portal pressure across the full HVPG range and outperforms a previously proposed bivariate model. Spleen and splanchnic haemodynamic measures demonstrate a ceiling effect at higher portal pressures > 15 mmHg.

PMID:
42503440
Bibliographic data and abstract were imported from PubMed on 27 Jul 2026.

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