Assessment of four-dimensional flow MRI for prediction of varices risk in cirrhotic patients

This study aims to validate the application of abdominal four-dimensional flow magnetic resonance imaging (MRI) for cirrhotic patients and quantify its effectiveness in assessing the hemodynamic impacts of cirrhosis to evaluate varices.

All consecutive patients who underwent MRIs between September 2022 and June 2023 were enrolled. Groups were divided into varicose, non-varicose, and healthy groups. ANOVA and post hoc LSD-t tests were used for statistical analysis. The correlation between hemodynamic parameters and liver function grade was evaluated using Kendall’s correlation coefficient.

A total of 80 patients were included (53 cirrhotic, 27 healthy). Significant disparities were found in main portal vein flow (MPV-FR), splenic vein flow (SV-FR), and vessel diameters (MPV-VD, SV-VD) among the groups (p < 0.05). MPV-FR was higher in the varicose group (24.81 ± 8.52) compared to non-varicose (19.52 ± 5.07) and healthy groups (17.26 ± 5.48). The most robust assessment of variceal risk was achieved by combining the flow rates (FRs) and VDs of MPV and SV (AUC 0.83, 95% CI 0.72–0.94).

The combined indices of FRs and VDs of MPV and SV effectively predict the occurrence of varicose veins in cirrhotic patients.

Question Non-invasive prediction of variceal risk is essential for the clinical management of advanced chronic cirrhosis, yet existing clinical examinations are inadequate.

Findings The effective assessment of variceal risk was achieved by combining the flow rates and vessel diameters of the main portal vein and splenic vein.

Clinical relevance Four-dimensional flow MRI can reveal hemodynamic changes in cirrhotic patients and assist in identifying gastroesophageal varices, serving as a marker for varices risk prediction.