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. 2021 Dec 28;9(6):818-827.
doi: 10.14218/JCTH.2021.00177. Epub 2021 Sep 30.

Noncontrast-enhanced MRI-based Noninvasive Score for Portal Hypertension (CHESS1802): An International Multicenter Study

Yanna Liu  1   2   3   4 , Tianyu Tang  5 , Necati Örmeci  6 , Yifei Huang  1 , Jitao Wang  7 , Xiaoguo Li  1 , Zhiwei Li  8 , Weimin An  9 , Dengxiang Liu  7 , Chunqing Zhang  10 , Changchun Liu  9 , Jinqiang Liu  5 , Chuan Liu  1 , Guangchuan Wang  10 , Cristina Mosconi  11 , Alberta Cappelli  11 , Antonio Bruno  11 , Seray Akçalar  12 , Emrecan Çelebioğlu  12 , Evren Üstüner  12 , Sadık Bilgiç  12 , Zeynep Ellik  13 , Özgün Ömer Asiller  13 , Lei Li  1 , Haijun Zhang  1 , Ning Kang  1 , Dan Xu  1 , Ruiling He  1 , Yan Wang  2 , Yang Bu  14 , Ye Gu  2 , Shenghong Ju  5 , Rita Golfieri  11 , Xiaolong Qi  1   2
Affiliations

Noncontrast-enhanced MRI-based Noninvasive Score for Portal Hypertension (CHESS1802): An International Multicenter Study

Yanna Liu et al. J Clin Transl Hepatol. .

Abstract

Background and aims: This study aimed to determine the performance of the non-invasive score using noncontrast-enhanced MRI (CHESS-DIS score) for detecting portal hypertension in cirrhosis.

Methods: In this international multicenter, diagnostic study (ClinicalTrials.gov, NCT03766880), patients with cirrhosis who had hepatic venous pressure gradient (HVPG) measurement and noncontrast-enhanced MRI were prospectively recruited from four university hospitals in China (n=4) and Turkey (n=1) between December 2018 and April 2019. A cohort of patients was retrospectively recruited from a university hospital in Italy between March 2015 and November 2017. After segmentation of the liver on fat-suppressed T1-weighted MRI maps, CHESS-DIS score was calculated automatically by an in-house developed code based on the quantification of liver surface nodularity.

Results: A total of 149 patients were included, of which 124 were from four Chinese hospitals (training cohort) and 25 were from two international hospitals (validation cohort). A positive correlation between CHESS-DIS score and HVPG was found with the correlation coefficients of 0.36 (p<0.0001) and 0.55 (p<0.01) for the training and validation cohorts, respectively. The area under the receiver operating characteristic curve of CHESS-DIS score in detection of clinically significant portal hypertension (CSPH) was 0.81 and 0.9 in the training and validation cohorts, respectively. The intraclass correlation coefficients for assessing the inter- and intra-observer agreement were 0.846 and 0.841, respectively.

Conclusions: A non-invasive score using noncontrast-enhanced MRI was developed and proved to be significantly correlated with invasive HVPG. Besides, this score could be used to detect CSPH in patients with cirrhosis.

Keywords: Advanced chronic liver disease; Hepatic venous pressure gradient; Imaging; Liver cirrhosis; Liver surface nodularity.

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Conflict of interest statement

The authors have no conflict of interests related to this publication.

Figures

Fig. 1
Fig. 1. Flow chart for the study’s enrollment.
Fig. 2
Fig. 2. Interpretation of the CHESS-DIS score.
(A) MRI image of a patient without CSPH, with an HVPG value of 8.2 mmHg. (B) Magnified ROI of the patient in panel A for calculation of the CHESS-DIS score (blue lines), with the value of 2.96. (C) MRI image of a patient with CSPH, with an HVPG value of 12.0 mmHg. (D) Magnified ROI of the patient in panel C for calculation of the CHESS-DIS score (blue lines), with the value of 6.69. CSPH, clinically significant portal hypertension; HVPG, hepatic venous pressure gradient; ROI, region of interest.
Fig. 3
Fig. 3. Correlation between the CHESS-DIS score and HVPG.
Scatterplot graph showing the correlation between CHESS-DIS score and HVPG in the training cohort (A) (n=124) and validation cohort (B) (n=25). Bland-Altman plots for assessment of inter- (C) (n=30) and intra- (D) (n=30) observer agreement. HVPG, hepatic venous pressure gradient.
Fig. 4
Fig. 4. Receiver operating characteristics curves.
(A) CHESS-DIS score in the training and validation cohorts (n=124 and 25, respectively). Conventional serum-based (B) and image-based (C) non-invasive models for detection of CSPH. AUC, area under receiver operating characteristics curve; CSPH, clinically significant portal hypertension.
See this image and copyright information in PMC

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