Korean J Radiol.  2019 May;20(5):773-780. 10.3348/kjr.2018.0767.

Segmental Liver Stiffness Evaluated with Magnetic Resonance Elastography Is Responsive to Endovascular Intervention in Patients with Budd-Chiari Syndrome

• Xu P
• Lyu L
• Ge H
• Sami MU
• Liu P
• Hu C
• Xu K

• KMID: 2442711
• DOI: http://doi.org/10.3348/kjr.2018.0767

Abstract

OBJECTIVE
To assess segmental liver stiffness (LS) with MRI before and after endovascular intervention in patients with Budd-Chiari syndrome (BCS).
MATERIALS AND METHODS
Twenty-three patients (13 males and 10 females; mean age, 42.6 ± 12.6 years; age range, 31-56 years) with BCS as a primary liver disease were recruited for this study. Two consecutive magnetic resonance elastography (MRE) examinations were performed before the endovascular treatment. Fifteen patients who underwent endovascular intervention treatment also had follow-up MRE scans within three days after the procedure. LS was measured in three liver segments: the right posterior, right anterior, and left medial segments. Inter-reader and inter-exam repeatability were analyzed with intraclass correlation coefficients (ICCs) and Bland-Altman analysis. Segmental LS and clinical characteristics before and after the intervention were also compared.
RESULTS
Within three days of the endovascular intervention, all three segmental LS values decreased: LS of the right posterior segment = 7.23 ± 0.88 kPa (before) vs. 4.94 ± 0.84 kPa (after), LS of the right anterior segment = 7.30 ± 1.06 kPa (before) vs. 4.77 ± 0.85 kPa (after), and LS of the left medial segment = 7.22 ± 0.87 kPa (before) vs. 4.87 ± 0.72 kPa (after) (all p = 0.001). There was a significant correlation between LS changes and venous pressure gradient changes before and after treatments (r = 0.651, p = 0.009). The clinical manifestations of all 15 patients significantly improved after therapy. The MRE repeatability was excellent, with insignificant variations (inter-reader, ICC = 0.839-0.943: inter-examination, ICC = 0.765-0.869). Bland-Altman analysis confirmed excellent agreement (limits of agreement, 13.4-19.4%).
CONCLUSION
Segmental LS measured by MRE is a promising repeatable quantitative biomarker for monitoring the treatment response to minimally invasive endovascular intervention in patients with BCS.

Keyword

Budd-Chiari syndrome; Magnetic resonance elastography; Liver stiffness; Endovascular treatment

MeSH Terms

Budd-Chiari Syndrome*
Elasticity Imaging Techniques*
Female
Follow-Up Studies
Humans
Liver Diseases
Liver*
Magnetic Resonance Imaging
Male
Venous Pressure

Figure

• 

  Fig. 1 Three liver segments of interest.ROIs include majority of liver parenchyma in each segment, excluding large blood vessels. ROIs = regions of interest

• 

  Fig. 2 MRE measurement of LS.Two liver MRE scans were performed to assess reproducibility in patient with BCS. First (A, B) and second (C, D) MRE results are shown. A, C. Wave images. B, D. MREs. There were no significant differences between two elastograms. BCS = Budd-Chiari syndrome, LS = liver stiffness, MRE = magnetic resonance elastography

• 

  Fig. 3 Bland-Altman analysis between two MRE scans for each reader (A–C, Reader 1; D–F, Reader 2) and for each measured segment.X-axes show means of measured LS values, and Y-axes show differences between LS values as percentage of their mean.

• 

  Fig. 4 LS values decreased significantly after intervention in all three segments.A. Right posterior segment. B. Right anterior segment. C. Left medial segment. *p < 0.05.

• 

  Fig. 5 Changes in digital subtraction angiography (A. before, B. after) and MRE (C. before, D. after) in patient with BCS who underwent interventional treatment.A. IVC obstruction. B. Free blood flow in IVC after balloon dilation. C, D. Post-procedural LS values (6.17 kPa) were lower than pre-procedural measurements (7.53 kPa). IVC = Inferior vena cava

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