Four-dimensional flow magnetic resonance imaging for noninvasive diagnosis of clinically significant portal hypertension and high-risk gastroesophageal varices in patients with cirrhosis

Introduction:Noninvasive diagnoses of clinically significant portal hypertension(CSPH)and high-risk gastroesophageal varices are clinically relevant but challenging.Four-dimensional(4D)flow magnetic resonance imaging(MRI)provides comprehensive flow information and is a promising alternative.This study evaluated the efficacy of 4D flow MRI as a noninvasive method for diagnosing CSPH and high-risk varices in patients with liver cirrhosis.Methods:This prospective study enrolled consecutive patients diagnosed with liver cirrhosis at a tertiary referral center between October 2020 and March 2021.Each participant underwent abdominal 4D flow MRI.Hemodynamic parameters within the portal vein,including the average and peak flow velocities,normalized flow volume(Q_(normal)),and regurgitant fraction(R%),were extracted and compared between healthy individuals and patients with CSPH and between participants with high-and low-risk varices.Subsequently,these parameters were incorporated into a logistic regression(LR)model refined using L1 regularization and validated using five-fold cross-validation.The diagnostic efficacy was evaluated using receiver operating characteristic(ROC)curves.Results:Eighty-two participants were enrolled(71 patients diagnosed with liver cirrhosis and 11 healthy individuals serving as controls).Among hemodynamic parameters,patients with CSPH exhibited a notable increase in Q_(normal)of 0.66±0.19 ml*m^(2)/[cycle*kg](P=0.001)and an R%of 1.98(2.05)(P=0.002).Similarly,patients with high-risk varices showed a higher Q_(normal)of 0.61±0.15 ml*m^(2)/[cycle*kg](P<0.001)and R%of 1.88(2.81)(P=0.006).ROC analysis revealed an area under the curve(AUC)for Q_(normal)of 0.93 and 0.91 for R%for diagnosing CSPH,while the LR model showcased a superior AUC of 0.95.For high-risk varices,Q_(normal)and R%showed AUC values of 0.75 and 0.70,respectively,whereas the LR model showed a higher AUC of 0.84.Conclusion:As a noninvasive imaging modality,4D flow MRI exhibits considerable potential for the diagnosis of CSPH and high-risk gastroesophageal varices;thus,it may minimize the reliance on invasive procedures in patients with cirrhosis.