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

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 indica...

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Bibliographic Details
Published in:European radiology 2019-06, Vol.29 (6), p.3100-3107
Main Authors: Bradley, C., Scott, R. A., Cox, E., Palaniyappan, N., Thomson, B. J., Ryder, S. D., Irving, W. L., Aithal, G. P., Guha, I. N., Francis, S.
Format: Article
Language:English
Subjects:
Adult
Algorithms
Antiviral agents
Antiviral Agents - therapeutic use
Antiviral drugs
Blood flow
Cirrhosis
Composition
Diagnostic Radiology
Disease Progression
Edema
Female
Fibrosis
Gastrointestinal
Hemodynamics
Hepacivirus - isolation & purification
Hepatitis
Hepatitis C
Hepatitis C, Chronic - complications
Hepatitis C, Chronic - diagnostic imaging
Hepatitis C, Chronic - drug therapy
Hepatitis C, Chronic - virology
Humans
Imaging
Inflammation
Internal Medicine
Intervention
Interventional Radiology
Liver
Liver - diagnostic imaging
Liver Circulation
Liver cirrhosis
Liver Cirrhosis - virology
Liver diseases
Magnetic Resonance Imaging
Male
Medicine
Medicine & Public Health
Middle Aged
Neuroradiology
Patients
Perfusion
Prospective Studies
Radiology
Reduction
Relaxation time
Spleen
Sustained Virologic Response
Therapy
Ultrasound
Viruses
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Summary: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.
ISSN:0938-7994
1432-1084
DOI:10.1007/s00330-018-5788-1