Skeletal Muscle Enhancement on Contrast-Enhanced MRI: A Potential Imaging Biomarker for Severity of Systemic Inflammation and Liver Dysfunction in Cirrhotic Patients .

Sunday, March 5, 2023

3:54 PM – 4:03 PM

Location: Phoenix Convention Center, 224AB

Abstract Speaker(s)

Jd

Johannes du Pisanie, Jr., MD (he/him/his)

Integrated Interventional Radiology Resident
UNC School of Medicine

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Venki Ramakrishnan, MD

Resident
University of North Carolina
VP

Vedang Patel, Medical student

medical student
University of North Carolina Chapel Hill
CC

Clayton Commander, MD, PhD

Assistant Professor
UNC Hospitals
Hyeon Yu, MD FSIR

Professor
University of North Carolina At Chapel Hill

Disclosure(s):

Johannes du Pisanie, MD, Jr.: No financial relationships to disclose

Venki Ramakrishnan, MD: No financial relationships to disclose

Clayton Commander, MD, PhD: W.L. Gore & Associates: Speaking and Teaching (Ongoing)

Hyeon Yu, MD FSIR: No financial relationships to disclose

Purpose: To evaluate the relationship between skeletal muscle enhancement (SME) in cirrhotic patients and clinical cirrhosis severity utilizing gadolinium-enhanced abdominal magnetic resonance imaging (MRI).

Materials and Methods: A retrospective review of 672 sequential patients who underwent abdominal MRI for HCC screening between August 2021 and May 2022 was performed. Inclusion criteria; a diagnosis of cirrhosis and age ≥18. Exclusion criteria; a history of malignancy, autoimmune disease, inflammatory bowel disease, chronic kidney disease ≥ stage 4, portal vein thrombosis, and congestive heart failure. 255 patient were included post exclusion and 116 were analyzed to date (mean age 58.9 ± 9.4 years, male, n = 69; female, n = 47). Patient demographic information as well as cirrhosis etiology, varices on imaging, ascites on imaging, MELD score, and TIPS history was collected from the medical record. Manual segmentation of the paraspinous muscles at the level of the SMA origin was utilized to calculate skeletal muscle index (SMI; cm²m^-2) and signal fat fraction (sFF) using in and opposed phase sequences. Manual regions of interest were placed in the paraspinous muscles at the SMA origin to assess SME intensity on various phases of contrast enhanced abdominal MRI.

Results: Cirrhotic patients with ascites were shown to have higher MELD scores, higher incidences of varices (p< 0.001) and sarcopenia (SMI; 5.9 ± 2.5 vs 4.8 ± 1.6; p=0.005) and a lower incidence of myosteatosis (sFF; 0.14 ± 0.1 vs 0.1 ± 0.1; p=0.007). Cirrhotic patients with ascites and MELD scores >18 had lower SME on arterial, portal venous and delayed phase images as compared to those with low MELD scores (5.2 ± 15.9 vs 19.8 ± 32.5, p = 0.05). Males with ascites had lower fat fractions than females with ascites (0.11 ± 0.1 vs 0.15 ± 0.1; p = 0.003).

Conclusion: Cirrhotic patients with ascites have lower SMI and sFF. Among those with ascites, higher MELD score is associated with lower SME on all three phases. These results may suggest a relationship between SME and cirrhosis severity.