Abstract
Background: The test–retest/interobserver repeatability and diagnostic value of 4D flow MRI in liver disease is underreported. Purpose: To determine the reproducibility/repeatability of flow quantification in abdominal vessels using a spiral 4D flow MRI sequence; to assess the value of 4D flow parameters in diagnosing cirrhosis and degree of portal hypertension. Study Type: Prospective. Subjects: Fifty-two patients with chronic liver disease. Field Strength/Sequence: 1.5T/spiral 4D flow acquired in one breath-hold. Assessment: Thirteen abdominal vessels were identified and segmented by two independent observers to measure maximum and time-averaged through-plane velocity, net flow, and vessel cross-section area. Interobserver agreement and test–retest repeatability were evaluated in 15 and 4 cases, respectively. Prediction of the presence and severity of cirrhosis and portal hypertension was assessed using 4D flow parameters. Statistical Tests: Cohen's kappa coefficient, coefficient of variation (CV), Bland–Altman, Mann–Whitney tests, logistic regression. Results: For all vessels combined, measurements showed acceptable agreement between observers, with Cohen's kappa = 0.70 (P < 0.001), CV < 21%, Bland–Altman bias <5%, but high limits of agreement ([–75%,75%]). Test–retest repeatability was excellent in large vessels (CV = 1–15%, bias = 1–25%, Bland–Altman limits of agreement [BALA] = [4%,150%]), and poor in small vessels (CV = 7–130%, bias = 10–200%, BALA = [8%,190%]). Average velocity in the right hepatic vein and average area of the splenic vein were higher in cirrhosis (P = 0.027/0.0039). Flow in the middle hepatic vein strongly correlated with Child–Pugh score (ρ = 0.84, P = 0.0238), while flow in the splenic vein (ρ = 0.43, P = 0.032), time-average (ρ = 0.46, P = 0.02) and peak velocity in the superior mesenteric vein (ρ = 0.45, P = 0.032), and peak velocity in the infrarenal IVC (ρ = 0.39, P = 0.032) positively correlated with an imaging-based portal hypertension score. Average area of the splenic vein predicted cirrhosis (P = 0.019; area under the curve AUC [95% confidence interval, CI] = 0.87 [0.71,1.00]) and clinically significant portal hypertension (P = 0.042; AUC [95% CI] = 0.78 [0.57–0.99]). Data Conclusion: Spiral 4D flow allows comprehensive assessment of abdominal vessels in one breath-hold, with substantial interobserver reproducibility, but variable test–retest repeatability. 4D flow may potentially reflect vascular changes due to cirrhosis and portal hypertension. Level of Evidence: 2. Technical Efficacy: Stage 2. J. Magn. Reson. Imaging 2019;49:994–1005.
Original language | English (US) |
---|---|
Pages (from-to) | 994-1005 |
Number of pages | 12 |
Journal | Journal of Magnetic Resonance Imaging |
Volume | 49 |
Issue number | 4 |
DOIs | |
State | Published - Apr 2019 |
Funding
Contract grant sponsor: National Institutes of Health National Institute of Diabetes, Digestive and Kidney Diseases; Contract grant numbers: 1R01DK08787, 1F32DK109591 (fellowship, O.B.); Contract grant sponsor: Société Française de Radiologie (fellowship, M.W.). Contract grant sponsor: National Institutes of Health National Institute of Diabetes, Digestive and Kidney Diseases; Contract grant numbers: 1R01DK08787, 1F32DK109591 (fellowship, O.B.); Contract grant sponsor: Soci?t? Fran?aise de Radiologie (fellowship, M.W.).
Keywords
- 4D flow
- cirrhosis
- liver fibrosis
- phase contrast MRI
- portal hypertension
- spiral
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging