title: Clinical impact of preoperative brain MR angiography and MR imaging in candidates for liver transplantation: a propensity score-matching study in a single institution.
abstract: OBJECTIVE
  To investigate the prevalence of cerebrovascular stenosis and white matter lesions on preoperative magnetic resonance angiography (MRA) and magnetic resonance imaging (MRI) in liver transplantation candidates.
  
  
  METHODS
  This retrospective study included 1,460 consecutive patients with liver cirrhosis (LC) who underwent MRA with/without brain MRI for pretransplantation evaluation. These patients were matched with 5,331 controls using propensity scores, and the prevalences of significant cerebrovascular stenosis and white matter lesions were compared.
  
  
  RESULTS
  A matched analysis of 1,264 pairs demonstrated that the prevalence of significant stenosis was comparable between LC patients and controls (2.2% vs. 1.4%, P = 0.143). LC and most of LC-related parameters were not associated with stenosis. Significant white matter lesions were more common in LC patients (2.8% vs. 1.3%, P = 0.036). A high Model for End-Stage Liver Disease (MELD) score (OR 1.11, CI 1.03-1.20, P = 0.008, for infarction; OR 1.1, CI 1.04-1.16, P = 0.001, for haemorrhage) and stroke history (OR 179.06, CI 45.19-709.45, P < 0.001) were predictors of perioperative stroke.
  
  
  CONCLUSIONS
  LC patients and control subjects demonstrated similar cerebrovascular stenosis prevalences, whereas white matter lesions were more common in LC patients. A high MELD score and stroke history contribute as predictors of perioperative stroke.
  
  
  CONCLUSIONS
  • Routine preoperative MR imaging in liver transplantation candidates may not be necessary. • Liver cirrhosis patients and control subjects had similar prevalences of significant cerebrovascular stenosis. • Liver cirrhosis and cirrhosis-related parameters were not correlated with significant cerebrovascular stenosis. • Significant white matter lesions were more frequent in liver cirrhosis patients.
authors.affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Song pa-gu, Seoul, 05505, Korea.
authors.forename: Mi Sun
authors.initials: MS
authors.lastname: Chung
authors.affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Song pa-gu, Seoul, 05505, Korea. radhskim@gmail.com.
authors.forename: Ho Sung
authors.identifier: http://orcid.org/0000-0002-9477-7421
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Young-Suk
authors.initials: YS
authors.lastname: Lim
authors.affiliation: Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Sang-Beom
authors.initials: SB
authors.lastname: Jeon
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Seon-Ok
authors.initials: SO
authors.lastname: Kim
authors.affiliation: Department of Preventive Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Hwa Jung
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Shin
authors.initials: S
authors.lastname: Hwang
authors.affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Song pa-gu, Seoul, 05505, Korea.
authors.forename: Seung Chai
authors.initials: SC
authors.lastname: Jung
authors.affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Song pa-gu, Seoul, 05505, Korea.
authors.forename: Choong Gon
authors.initials: CG
authors.lastname: Choi
authors.affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Song pa-gu, Seoul, 05505, Korea.
authors.forename: Sang Joon
authors.initials: SJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D001921:Brain / Q000000981:diagnostic imaging*; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects; D018810:Magnetic Resonance Angiography / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D015995:Prevalence; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D055815:Young Adult
keywords: Cerebrovascular stenosis; Liver cirrhosis; Liver transplantation; Magnetic resonance angiography; Perioperative stroke