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

• Published in: European radiology Vol. 25; no. 10; pp. 2851 - 2858
• Main Authors: Low, Gavin, Owen, Nicola E., Joubert, Ilse, Patterson, Andrew J., Graves, Martin J., Alexander, Graeme J. M., Lomas, David J.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-10-2015; Springer Nature B.V
• Subjects: Adult; Ascites; Ascites - complications; Ascites - pathology; Biomechanics; Diagnostic Radiology; Diagnostic tests; Elasticity Imaging Techniques - methods; Female; Gastroenterology; Gastrointestinal; Hepatology; Hepatorenal Syndrome - diagnostic imaging; Hospitals; Humans; Hypertension; Imaging; Internal Medicine; Interventional Radiology; Liver cirrhosis; Liver Cirrhosis - complications; Liver Cirrhosis - pathology; Liver diseases; Magnetic resonance imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Neuroradiology; Patients; Prospective Studies; Radiology; Renal Insufficiency - diagnostic imaging; Renal Insufficiency - pathology; ROC Curve; Ultrasound; United Kingdom > UK; England; Magnetic resonance imaging; Elasticity imaging techniques; Liver cirrhosis; Hepatorenal syndrome; Diagnostic tests
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-015-3723-2

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
.