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Magnetic resonance elastography in the detection of hepatorenal syndrome in patients with cirrhosis and ascites

  • Gastrointestinal
  • Published:
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Abstract

Objective

Hepatorenal syndrome (HRS) is the most lethal cause of renal impairment in cirrhosis. Magnetic resonance elastography (MRE) is a diagnostic test that characterises tissues based on their biomechanical properties. The aim of this study was to assess the feasibility of MRE for detecting HRS in cirrhotic patients.

Methods

A prospective diagnostic investigation was performed. Renal MRE was performed on 21 hospitalised patients with cirrhosis and ascites. Six patients had HRS, one patient had non-HRS renal impairment, and 14 patients had normal renal function. The MRE-measured renal stiffness was compared against the clinical diagnosis as determined by clinical review alongside laboratory and radiologic results.

Results

The MRE-measured renal stiffness was significantly lower in patients with HRS (median stiffness of 3.30 kPa at 90 Hz and 2.62 kPa at 60 Hz) compared with patients with normal renal function (median stiffness of 5.08 kPa at 90 Hz and 3.41 kPa at 60 Hz) (P ≤ 0.014). For the detection of HRS, MRE had an area under the receiver operating characteristic curve of 0.94 at 90 Hz and 0.89 at 60 Hz. MRE had excellent inter-rater agreement, as assessed by Bland-Altman and intraclass correlation coefficient (> 0.9).

Conclusion

MRE shows potential in the detection of HRS.

Key Points

• Magnetic resonance elastography (MRE) shows promise in the detection of hepatorenal syndrome.

• MRE has the potential to track renal disease in a clinical population.

• MRE is a reliable diagnostic test with excellent inter-rater agreement.

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Abbreviations

HRS:

Hepatorenal syndrome

IAC:

International Ascites Club

MRE:

Magnetic resonance elastography

MRI:

Magnetic resonance imaging

IQR:

Interquartile range

BMI:

Body mass index

MAP:

Mean arterial pressure

UKELD:

United Kingdom Model for End-Stage Liver Disease

MELD:

Model for End-Stage Liver Disease

CP:

Child-Pugh

ROI:

Region of interest

ROC:

Receiver operating characteristic

ICC:

Intraclass correlation coefficient

AZ :

Area under the receiver operating characteristic curve

CKD:

Chronic kidney disease

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Acknowledgments

The scientific guarantor of this publication is Prof David Lomas. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. Dr Ross Tsuyuki kindly provided statistical advice for this manuscript. One of the authors has significant statistical expertise. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, diagnostic study, performed at one institution.

The authors wish to thank Dr. Jun Chen, Dr. Kevin Glaser and Dr. Richard Ehman, for technical advice on the project and assistance with both hardware and software for the elastography examinations. Thanks also to the MR radiographers of our unit: Ms. Sally Hunter, Ms. Laura McCartney, Ms. Soraia Sousa and Mr. Dario Prudencio, for technical assistance with performing the MRE examinations. Finally, we also wish to acknowledge NIHR CBRC funding (National Institute of Health Research Cambridge Biomedical Research Centre), Addenbrooke’s Charitable Trust and NIH grant EB001981 for support with the project.

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Authors and Affiliations

  1. Department of Radiology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust Hospital, England, UK

    Gavin Low, Ilse Joubert, Andrew J. Patterson, Martin J. Graves & David J. Lomas

  2. Division of Gastroenterology & Hepatology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust Hospital, England, UK

    Nicola E. Owen & Graeme J. M. Alexander

  3. University of Alberta, Edmonton, Alberta, Canada

    Gavin Low

  4. Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218 Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK

    Gavin Low & David J. Lomas

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  1. Gavin Low
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  2. Nicola E. Owen
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  3. Ilse Joubert
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  4. Andrew J. Patterson
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  5. Martin J. Graves
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  6. Graeme J. M. Alexander
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  7. David J. Lomas
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Correspondence to Gavin Low.

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Low, G., Owen, N.E., Joubert, I. et al. Magnetic resonance elastography in the detection of hepatorenal syndrome in patients with cirrhosis and ascites. Eur Radiol 25, 2851–2858 (2015). https://doi.org/10.1007/s00330-015-3723-2

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  • DOI: https://doi.org/10.1007/s00330-015-3723-2

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