Four-dimensional flow MRI-based splenic flow index for predicting cirrhosis-associated hypersplenism

Eric J. Keller*, Laura M Kulik, Zoran Stankovic, Robert J Lewandowski, Riad Salem, James Carr, Susanne Schnell, Michael Markl, Jeremy D. Collins

*Corresponding author for this work

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

OBJECTIVE. The objective of this study is to evaluate the ability of spleen volume, blood flow, and an index incorporating multiple measures to predict cirrhosis-associated hypersplenism. MATERIALS AND METHODS. A total of 39 patients (14 women and 25 men; mean [± SD] age, 52 ± 10 years) with cirrhosis and sequelae of portal hypertension underwent 4D flow MRI and anatomic 3-T MRI performed before and after contrast administration. Unenhanced 4D flow MRI was used to assess abdominal hemodynamics, and splenic volumes were measured on T1-weighted gradient-recalled echo MRI. Relationships among demographic characteristics, blood component counts, splenic volume, arterial flow, venous flow, and the percentage of shunted portal flow were assessed in 29 consecutive patients (i.e., the derivation group), to develop a splenic flow index. This index was assessed along with splenic volume and blood flow alone in 10 additional consecutive patients (i.e., the validation group) via ROC curve analysis, to identify platelet counts of less than 50 × 103 cells/μL, leukocyte counts of less than 3.0 × 103 cells/μL, or both. RESULTS. In the derivation cohort (platelet count, 129 ± 76 × 103 cells/μL), splenic volume, arterial flow, venous flow, and the percentage of shunted portal flow were inversely correlated with platelet counts (ρ = -0.68, -0.68, -0.56, and -0.36, respectively; p < 0.05). Adding splenic volume to arterial flow and the product of venous flow and the percentage of shunted portal flow indexed to the body surface area yielded superior correlations with platelet counts, leukocyte counts, and the degree of severity of hypersplenism (? = -0.75, -0.48, and -0.75, respectively; p ≤ 0.001) and predicted severe hypersplenism (sensitivity, 100%; specificity, 100%) in the validation cohort (platelet count, 93 ± 71 × 103 cells/μL). CONCLUSION. A splenic flow index that incorporates both splenic volume and blood flow is a better indicator of hypersplenism than is splenic volume alone.

Original languageEnglish (US)
Pages (from-to)46-54
Number of pages9
JournalAmerican Journal of Roentgenology
Volume209
Issue number1
DOIs
StatePublished - Jul 1 2017

Fingerprint

Hypersplenism
Platelet Count
Fibrosis
Blood Volume
Leukocyte Count
ROC Curve
Body Surface Area
Portal Hypertension
Spleen
Hemodynamics
Demography

Keywords

  • 4D flow MRI
  • Abdominal hemodynamics
  • Cirrhosis
  • Hypersplenism
  • Thrombocytopenia

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{099de89ca3dc48eda7933339c373886c,
title = "Four-dimensional flow MRI-based splenic flow index for predicting cirrhosis-associated hypersplenism",
abstract = "OBJECTIVE. The objective of this study is to evaluate the ability of spleen volume, blood flow, and an index incorporating multiple measures to predict cirrhosis-associated hypersplenism. MATERIALS AND METHODS. A total of 39 patients (14 women and 25 men; mean [± SD] age, 52 ± 10 years) with cirrhosis and sequelae of portal hypertension underwent 4D flow MRI and anatomic 3-T MRI performed before and after contrast administration. Unenhanced 4D flow MRI was used to assess abdominal hemodynamics, and splenic volumes were measured on T1-weighted gradient-recalled echo MRI. Relationships among demographic characteristics, blood component counts, splenic volume, arterial flow, venous flow, and the percentage of shunted portal flow were assessed in 29 consecutive patients (i.e., the derivation group), to develop a splenic flow index. This index was assessed along with splenic volume and blood flow alone in 10 additional consecutive patients (i.e., the validation group) via ROC curve analysis, to identify platelet counts of less than 50 × 103 cells/μL, leukocyte counts of less than 3.0 × 103 cells/μL, or both. RESULTS. In the derivation cohort (platelet count, 129 ± 76 × 103 cells/μL), splenic volume, arterial flow, venous flow, and the percentage of shunted portal flow were inversely correlated with platelet counts (ρ = -0.68, -0.68, -0.56, and -0.36, respectively; p < 0.05). Adding splenic volume to arterial flow and the product of venous flow and the percentage of shunted portal flow indexed to the body surface area yielded superior correlations with platelet counts, leukocyte counts, and the degree of severity of hypersplenism (? = -0.75, -0.48, and -0.75, respectively; p ≤ 0.001) and predicted severe hypersplenism (sensitivity, 100{\%}; specificity, 100{\%}) in the validation cohort (platelet count, 93 ± 71 × 103 cells/μL). CONCLUSION. A splenic flow index that incorporates both splenic volume and blood flow is a better indicator of hypersplenism than is splenic volume alone.",
keywords = "4D flow MRI, Abdominal hemodynamics, Cirrhosis, Hypersplenism, Thrombocytopenia",
author = "Keller, {Eric J.} and Kulik, {Laura M} and Zoran Stankovic and Lewandowski, {Robert J} and Riad Salem and James Carr and Susanne Schnell and Michael Markl and Collins, {Jeremy D.}",
year = "2017",
month = "7",
day = "1",
doi = "10.2214/AJR.16.17620",
language = "English (US)",
volume = "209",
pages = "46--54",
journal = "American Journal of Roentgenology",
issn = "0361-803X",
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Four-dimensional flow MRI-based splenic flow index for predicting cirrhosis-associated hypersplenism. / Keller, Eric J.; Kulik, Laura M; Stankovic, Zoran; Lewandowski, Robert J; Salem, Riad; Carr, James; Schnell, Susanne; Markl, Michael; Collins, Jeremy D.

In: American Journal of Roentgenology, Vol. 209, No. 1, 01.07.2017, p. 46-54.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Four-dimensional flow MRI-based splenic flow index for predicting cirrhosis-associated hypersplenism

AU - Keller, Eric J.

AU - Kulik, Laura M

AU - Stankovic, Zoran

AU - Lewandowski, Robert J

AU - Salem, Riad

AU - Carr, James

AU - Schnell, Susanne

AU - Markl, Michael

AU - Collins, Jeremy D.

PY - 2017/7/1

Y1 - 2017/7/1

N2 - OBJECTIVE. The objective of this study is to evaluate the ability of spleen volume, blood flow, and an index incorporating multiple measures to predict cirrhosis-associated hypersplenism. MATERIALS AND METHODS. A total of 39 patients (14 women and 25 men; mean [± SD] age, 52 ± 10 years) with cirrhosis and sequelae of portal hypertension underwent 4D flow MRI and anatomic 3-T MRI performed before and after contrast administration. Unenhanced 4D flow MRI was used to assess abdominal hemodynamics, and splenic volumes were measured on T1-weighted gradient-recalled echo MRI. Relationships among demographic characteristics, blood component counts, splenic volume, arterial flow, venous flow, and the percentage of shunted portal flow were assessed in 29 consecutive patients (i.e., the derivation group), to develop a splenic flow index. This index was assessed along with splenic volume and blood flow alone in 10 additional consecutive patients (i.e., the validation group) via ROC curve analysis, to identify platelet counts of less than 50 × 103 cells/μL, leukocyte counts of less than 3.0 × 103 cells/μL, or both. RESULTS. In the derivation cohort (platelet count, 129 ± 76 × 103 cells/μL), splenic volume, arterial flow, venous flow, and the percentage of shunted portal flow were inversely correlated with platelet counts (ρ = -0.68, -0.68, -0.56, and -0.36, respectively; p < 0.05). Adding splenic volume to arterial flow and the product of venous flow and the percentage of shunted portal flow indexed to the body surface area yielded superior correlations with platelet counts, leukocyte counts, and the degree of severity of hypersplenism (? = -0.75, -0.48, and -0.75, respectively; p ≤ 0.001) and predicted severe hypersplenism (sensitivity, 100%; specificity, 100%) in the validation cohort (platelet count, 93 ± 71 × 103 cells/μL). CONCLUSION. A splenic flow index that incorporates both splenic volume and blood flow is a better indicator of hypersplenism than is splenic volume alone.

AB - OBJECTIVE. The objective of this study is to evaluate the ability of spleen volume, blood flow, and an index incorporating multiple measures to predict cirrhosis-associated hypersplenism. MATERIALS AND METHODS. A total of 39 patients (14 women and 25 men; mean [± SD] age, 52 ± 10 years) with cirrhosis and sequelae of portal hypertension underwent 4D flow MRI and anatomic 3-T MRI performed before and after contrast administration. Unenhanced 4D flow MRI was used to assess abdominal hemodynamics, and splenic volumes were measured on T1-weighted gradient-recalled echo MRI. Relationships among demographic characteristics, blood component counts, splenic volume, arterial flow, venous flow, and the percentage of shunted portal flow were assessed in 29 consecutive patients (i.e., the derivation group), to develop a splenic flow index. This index was assessed along with splenic volume and blood flow alone in 10 additional consecutive patients (i.e., the validation group) via ROC curve analysis, to identify platelet counts of less than 50 × 103 cells/μL, leukocyte counts of less than 3.0 × 103 cells/μL, or both. RESULTS. In the derivation cohort (platelet count, 129 ± 76 × 103 cells/μL), splenic volume, arterial flow, venous flow, and the percentage of shunted portal flow were inversely correlated with platelet counts (ρ = -0.68, -0.68, -0.56, and -0.36, respectively; p < 0.05). Adding splenic volume to arterial flow and the product of venous flow and the percentage of shunted portal flow indexed to the body surface area yielded superior correlations with platelet counts, leukocyte counts, and the degree of severity of hypersplenism (? = -0.75, -0.48, and -0.75, respectively; p ≤ 0.001) and predicted severe hypersplenism (sensitivity, 100%; specificity, 100%) in the validation cohort (platelet count, 93 ± 71 × 103 cells/μL). CONCLUSION. A splenic flow index that incorporates both splenic volume and blood flow is a better indicator of hypersplenism than is splenic volume alone.

KW - 4D flow MRI

KW - Abdominal hemodynamics

KW - Cirrhosis

KW - Hypersplenism

KW - Thrombocytopenia

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