Multiparametric MRI Combining MR Elastography, Quantitative Magnetization Transfer and 4D Flow MRI in the Diagnosis and Staging of Portal Hypertension and Liver Fibrosis

Chronic liver disease is a burgeoning health issue worldwide. It is estimated that 0.15% of the population (approximately 450,000 people in the United States) has clinical cirrhosis. Currently diagnosis and assessment for cirrhosis and portal hypertension are reliant on invasive procedures with limitations and possible complications. Our goal is to improve quality of care in these patients, by providing a non-invasive imaging test that can diagnose and stage fibrosis and portal hypertension, using a multi parametric MRI examination, comprised of magnetic resonance elastography (MRE), quantitative magnetization transfer and 4D flow MRI. We will recruit 20 adult patients who underwent HVPG measurements and liver biopsy. These subjects will undergo a multiparametric MRI examination, including MRE, 4D flow and magnetization transfer. MRI results will be compared to biopsy and hepatic venous pressure gradient (HVPG) measurements. A generalized linear model will be constructed to predict HVPG by using baseline demographic characteristics and all measurements by MRE and 4D flow. A Poisson regression model will be constructed to predict histological staging of hepatic fibrosis by using baseline demographic characteristics and all measurements by MRE and 4D flow. The overall diagnostic performance will be determined in terms of sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio. We anticipate the following results: 1) Combined MRI results will correlate with HVPG, and may be used in lieu of hepatic vein catheterization for assessing PHT; 2) MRE and qMT will have a strong diagnostic accuracy for detecting and staging fibrosis and 4D flow measurements will correlate with the stage of fibrosis, yielding an excellent diagnostic accuracy for fibrosis. This study is of great interest to the applicant, who wishes to pursue an academic career and will start a clinical abdominal imaging fellowship after completion of the research fellowship.