title: Portal hypertension in patients with cirrhosis: indirect assessment of hepatic venous pressure gradient by measuring azygos flow with 2D-cine phase-contrast magnetic resonance imaging.
abstract: OBJECTIVE
  To measure azygos, portal and aortic flow by two-dimensional cine phase-contrast magnetic resonance imaging (2D-cine PC MRI), and to compare the MRI values to hepatic venous pressure gradient (HVPG) measurements, in patients with cirrhosis.
  
  
  METHODS
  Sixty-nine patients with cirrhosis were prospectively included. All patients underwent HVPG measurements, upper gastrointestinal endoscopy and 2D-cine PC MRI measurements of azygos, portal and aortic blood flow. Univariate and multivariate regression analyses were used to evaluate the correlation between the blood flow and HVPG. The performance of 2D-cine PC MRI to diagnose severe portal hypertension (HVPG ≥ 16 mmHg) was determined by receiver operating characteristic curve (ROC) analysis, and area under the curves (AUC) were compared.
  
  
  RESULTS
  Azygos and aortic flow values were associated with HVPG in univariate linear regression model. Azygos flow (p < 10(-3)), aortic flow (p = 0.001), age (p = 0.001) and presence of varices (p < 10(-3)) were independently associated with HVPG. Azygos flow (AUC = 0.96 (95 % CI [0.91-1.00]) had significantly higher AUC than aortic (AUC = 0.64 (95 % CI [0.51-0.77]) or portal blood flow (AUC = 0.40 (95 % CI [0.25-0.54]).
  
  
  CONCLUSIONS
  2D-cine PC MRI is a promising technique to evaluate significant portal hypertension in patients with cirrhosis.
  
  
  CONCLUSIONS
  • Noninvasive HVPG assessment can be performed with MRI azygos flow. • Azygos MRI flow is an easy-to-measure marker to detect significant portal hypertension. • MRI flow is more specific that varice grade to detect portal hypertension.
authors.affiliation: Department of Radiology, Hôpital Cochin and Paris-Descartes University, Assistance Publique-Hôpitaux de Paris, 27 rue du faubourg St Jacques, 75014, Paris, France. princetgouya@yahoo.fr.
authors.forename: Hervé
authors.initials: H
authors.lastname: Gouya
authors.affiliation: Biostatistics and Epidemiology Unit, Hotel-Dieu and Paris-Descartes University, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 rue du faubourg St Jacques, 75014, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Grabar
authors.affiliation: Department of Radiology, Hôpital Cochin and Paris-Descartes University, Assistance Publique-Hôpitaux de Paris, 27 rue du faubourg St Jacques, 75014, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Vignaux
authors.affiliation: Department of Radiology, Hôpital Cochin and Paris-Descartes University, Assistance Publique-Hôpitaux de Paris, 27 rue du faubourg St Jacques, 75014, Paris, France.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Saade
authors.affiliation: Liver Unit, Hôpital Cochin and Inserm U-1016, Paris-Descartes University, Assistance Publique-Hôpitaux de Paris, 27 rue du faubourg St Jacques, 75014, Paris, France.
authors.forename: Stanislas
authors.initials: S
authors.lastname: Pol
authors.affiliation: Department of Radiology, Hôpital Cochin and Paris-Descartes University, Assistance Publique-Hôpitaux de Paris, 27 rue du faubourg St Jacques, 75014, Paris, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Legmann
authors.affiliation: Liver Unit, Hôpital Cochin and Inserm U-1016, Paris-Descartes University, Assistance Publique-Hôpitaux de Paris, 27 rue du faubourg St Jacques, 75014, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Sogni
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000503:physiopathology; D019540:Area Under Curve; D001401:Azygos Vein / Q000503:physiopathology*; D005260:Female; D006503:Hepatic Veins / Q000502:physiology*; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016014:Linear Models; D008099:Liver / Q000098:blood supply*; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008858:Microscopy, Phase-Contrast / Q000379:methods; D008875:Middle Aged; D017082:Portal Pressure / Q000502:physiology; D011446:Prospective Studies; D012372:ROC Curve; D012039:Regional Blood Flow / Q000502:physiology; D012044:Regression Analysis; D014690:Venous Pressure / Q000502:physiology
keywords: Azygos vein; Flow; Liver; Magnetic resonance imaging; Portal hypertension