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Observational Study
. 2019 Jun;29(6):3100-3107.
doi: 10.1007/s00330-018-5788-1. Epub 2018 Nov 30.

Short-term changes observed in multiparametric liver MRI following therapy with direct-acting antivirals in chronic hepatitis C virus patients

C Bradley  1   2 , R A Scott  2 , E Cox  1   2 , N Palaniyappan  2 , B J Thomson  2 , S D Ryder  2 , W L Irving  2 , G P Aithal  2   3 , I N Guha  2   3 , S Francis  4   5
Affiliations
Observational Study

Short-term changes observed in multiparametric liver MRI following therapy with direct-acting antivirals in chronic hepatitis C virus patients

C Bradley et al. Eur Radiol. 2019 Jun.

Abstract

Methods: We applied multiparametric MRI to assess changes in liver composition, perfusion and blood flow in 17 patients before direct-acting antiviral (DAA) therapy and after treatment completion (within 12 weeks of last DAA tablet swallowed).

Results: We observed changes in hepatic composition indicated by a reduction in both liver longitudinal relaxation time (T1, 35 ± 4 ms), transverse relaxation time (T2, 2.5 ± 0.8 ms; T2* 3.0 ± 0.7 ms), and liver perfusion (28.1 ± 19.7 ml/100 g/min) which we suggest are linked to reduced pro-inflammatory milieu, including interstitial oedema, within the liver. No changes were observed in liver or spleen blood flow, splenic perfusion, or superior mesenteric artery blood flow.

Conclusion: For the first time, our study has shown that treatment of HCV with DAAs in patients with cirrhosis leads to an acute reduction in liver T1, T2 and T2* and an increase in liver perfusion measured using MR parameters. The ability of MRI to characterise changes in the angio-architecture of patients with cirrhosis after intervention in the short term will enhance our understanding of the natural history of regression of liver disease and potentially influence clinical decision algorithms.

Key points: • DAAs have revolutionised the treatment of hepatitis C and achieve sustained virological response in over 95% of patients, even with liver cirrhosis. • Currently available non-invasive measures of liver fibrosis are not accurate after HCV treatment with DAAs, this prospective single-centre study has shown that MRI can sensitively measure changes within the liver, which could reflect the reduction in inflammation with viral clearance. • The ability of MRI to characterise changes in structural and haemodynamic MRI measures in the liver after intervention will enhance our understanding of the progression/regression of liver disease and could potentially influence clinical decision algorithms.

Keywords: Echo-planar imaging; Hepatitis C; Magnetic resonance imaging; Sustained virologic response.

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Conflict of interest statement

Guarantor

The scientific guarantor of this publication is Professor Susan Francis.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

The HCV MRI study received ethical approval by the NRES Committee East Midlands - Derby 1 (Research Ethics Committee reference 11/EM/0314).

Methodology

• Prospective

• Observational

• Performed at one institution

Figures

Fig. 1
Fig. 1
Liver function test markers of all 17 participants (16 of whom achieved SVR) pre-treatment and post-treatment. a A significant reduction in ALT of 54 ± 25. b Fib4 reduced by 1.6 ± 0.5.c APRI score showed a significant reduction of 31.0 ± 0.3
Fig. 2
Fig. 2
Post-treatment with DAA therapy showed (a) a reduction in liver T1 of 35 ± 4 ms, (b) a reduction in liver T2 of 2.5 ± 0.8 ms and (c) a reduction in liver T2* by 3 ± 0.7 ms. d–f No significant difference is observed in spleen T1, liver volume or spleen volume between pre- and post-DAA treatments
Fig. 3
Fig. 3
Example axial T1 map, T2 map and T2* map showing the liver pre- and post-DAA treatment
Fig. 4
Fig. 4
Bulk flow to the liver in the (b) portal vein and (a) hepatic artery as well as (d) superior mesenteric and (c) splenic artery flow shows no significant changes between pre- and post-DAA therapies. e An increase in liver perfusion of mean change 28.1 ± 19.7 ml/100 g/min is observed following DAA therapy
See this image and copyright information in PMC

References

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