Gadoxetic acid enhanced MRI distinguishes advanced chronic liver disease patients with improving liver function after sustained virologic response and patients with persistent liver damage

Background and aims:

There is an unmet need for non-invasive markers to facilitate individualized surveillance strategies after hepatitis C virus (HCV) eradication.

We evaluated changes in relative liver enhancement (RLE; indicating hepatic fibrosis and inflammation) obtained by gadoxetic acid enhanced MRI (GA-MRI) in the hepatobiliary phase, as well as the changes in splenic volume (SV; indicating portal hypertension) as indicators of liver function in patients before and after sustained virologic response (SVR) to interferon-free therapy. In addition, we assessed their predictive value for (further) hepatic decompensation during follow-up (FU).

Methods:

We enrolled 31 consecutive HCV patients with advanced chronic liver disease who underwent GA-MRI before and after SVR to interferon-free treatment and were followed for the development of (further) hepatic decompensation.

Fourteen untreated chronic HCV patients with paired GA-MRI served as a control group.

Results:

RLE increased significantly by 66%(95%CI: 20%-94%; P< 0.001) from pre- to post-treatment. SV decreased by -16%(95CI:-28%– 8%; P< 0.001). However, SV increased in 5/31 (16%), the identical patients who showed a decrease in RLE ('GA-MRI non-response'). There was an inverse correlation of moderate strength between the changes in RLE and SV (ρ=-0.608; P< 0.001).

In contrast, in the untreated control group, we observed a decrease in RLE by -11%(95%CI:-25%– 3%; P= 0.019) and an increase in SV by 23%(95%CI: 7%-43%; P= 0.004) (both P< 0.001 vs. treated patients).

During a median post-treatment FU of 25.2 (IQR: 16.9) months, 6 patients developed (further) hepatic decompensation (variceal bleeding (n = 1), ascites (n = 2), and HE (n = 3)). Interestingly, GA-MRI non-response was associated with a substantially increased risk of (further) hepatic decompensation at 2 years (80% vs. 8%; P< 0.001).

Conclusions:

This is the first study demonstrating that GA-MRI might be able to distinguish between individuals with improving liver function (i.e. regression of liver fibrosis and portal hypertension) and those with persistent liver damage despite HCV eradication. If its prognostic value is confirmed by larger studies, GA-MRI might facilitate individualized post-SVR surveillance.