Department of Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama, 710-0192, Japan.
Philips Japan, 2-13-37 Konan, Minato-Ku, Tokyo, 108-8507, Japan.
Jpn J Radiol. 2023 Jun;41(6):625-636. doi: 10.1007/s11604-023-01388-0. Epub 2023 Jan 19.
The mechanisms underlying the morphological changes in liver cirrhosis remain unknown. This study aimed to clarify the relationship between fibrotic hepatic morphology and portal hemodynamic changes using four-dimensional flow magnetic resonance imaging (MRI).
Overall, 100 patients with suspected liver disease who underwent 3-T MRI were evaluated in this retrospective study. Liver fibrosis was assessed using a combination of visual assessment of the hepatic morphology and quantitative measures, including the fibrosis-4 index and aspartate transaminase-to-platelet ratio. It was classified into three groups according to the severity of fibrosis as follows: A (normal), B (mild-to-moderate), and C (severe). Quantitative indices, including area (mm), net flow (mL/s), and average velocity (cm/s), were measured in the right portal vein (RPV) and left portal vein (LPV), and were compared across the groups using the Kruskal-Wallis and Mann-Whitney U tests.
Among the 100 patients (69.1 ± 12.1 years; 59 men), 45, 35, and 20 were categorized into groups A, B, and C, respectively. The RPV area significantly differed among the groups (from p < 0.001 to p = 0.001), showing a gradual decrease with fibrosis progression. Moreover, the net flow significantly differed between groups A and B and between groups A and C (p < 0.001 and p < 0.001, respectively), showing a decrease during the early stage of fibrosis. In the LPV, the net flow significantly differed among the groups (from p = 0.001 to p = 0.030), revealing a gradual increase with fibrosis progression.
The atrophy-hypertrophy complex, which is a characteristic imaging finding in advanced cirrhosis, was closely associated with decreased RPV flow in the early stage of fibrosis and a gradual increase in LPV flow across all stages of fibrosis progression.
肝硬化形态变化的机制尚不清楚。本研究旨在使用四维血流磁共振成像（MRI）阐明纤维化肝形态与门脉血流动力学变化之间的关系。
在这项回顾性研究中，共评估了 100 例疑似肝病患者的 3-T MRI。使用肝形态的视觉评估和包括纤维化 4 指数和天冬氨酸转氨酶与血小板比值在内的定量测量相结合来评估肝纤维化。根据纤维化的严重程度将其分为三组：A（正常）、B（轻度至中度）和 C（重度）。在右门静脉（RPV）和左门静脉（LPV）中测量定量指标，包括面积（mm）、净流量（mL/s）和平均速度（cm/s），并使用 Kruskal-Wallis 和 Mann-Whitney U 检验比较各组间的差异。
在 100 例患者（69.1±12.1 岁；59 名男性）中，45、35 和 20 例分别归入 A、B 和 C 组。RPV 面积在各组之间差异显著（p<0.001 至 p=0.001），随纤维化进展逐渐减小。此外，净流量在 A 组和 B 组之间以及 A 组和 C 组之间差异显著（p<0.001 和 p<0.001），在纤维化早期呈下降趋势。在 LPV 中，净流量在各组之间差异显著（p=0.001 至 p=0.030），随着纤维化进展逐渐增加。
在晚期肝硬化中是一种特征性影像学表现的萎缩-肥大复合征，与纤维化早期 RPV 流量减少以及所有纤维化进展阶段 LPV 流量逐渐增加密切相关。
