T-slip and ASL Perfusion: New in the Algorithm of Management of Patients with Liver Cirrhosis

Objective. To determine the place of T-SLIP and ASL-perfusion in the algorithm of management of patients with liver cirrhosis.

Materials and Methods. 83 patients with liver cirrhosis who were hospitalized in the gastroenterological and infectious departments were observed. All patients underwent abdominal ultrasound with Doppler imaging and transient liver elastography. The abdominal MRI was performed on a Vantage Titan 1.5 T (Toshiba) according to the standard protocol with additional inclusion of non-contrast ASL-perfusion of the liver and non-contrast MR-portography (T-SLIP) of the arterial and venous blood flow. The reference group consisted of 37 healthy individuals. A retrospective analysis group was also selected, which did not undergo ASL-perfusion and T-Slip (n = 15).

Results. Statistically significant differences in perfusion parameters of the hepatic parenchyma were revealed in patients between liver cirrhosis and healthy individuals (p < 0.01). In our study, a hyperperfusion map with liver cirrhosis occurred in 24 (28.9 %) cases. It should be noted that patients with hyperperfusion according to ASL-liver data required correction of medical monitoring, which consisted in increasing the frequency of observation in accordance with clinical recommendations. According to the results of T-SLIP in this patient, according to the severity of the violation of the architectonics of the blood flow, stage F4 of liver fibrosis was divided into categories: F4a (n = 12) — disruption of architectonics in the peripheral parts; F4b (n = 5) — disruption of architectonics in the central parts; F4c (n = 7) — disruption of architectonics in the peripheral and central parts. Based on the data obtained, an algorithm was developed for managing patients with liver cirrhosis with hyperperfusion, indicating the timing of follow up, and the frequency of prescribing antifibrotic therapy.

Conclusion. Quantitative indicators of ASL-perfusion of the liver allow us to suspect liver cirrhosis (p < 0.01). 2. ASL hyperperfusion map is an indication for liver T-SLIP and F4-stage category determination. 3. The inclusion of liver T-SLIP in the MR examination algorithm makes it possible to prescribe antifibrotic therapy on time and recommend monitoring time. 

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