Liver Micro Flow - MRI

The overall goal of this project is to develop a next-generation, confounder-corrected Intravoxel incoherent motion (IVIM)-MRI method for quantification of tissue perfusion and microstructure, and to validate this method in patients with CLD. This protocol will address these unmet needs through the following specific aims:

Aim 1: Develop and optimize confounder-corrected IVIM to enable precise quantification over the entire liver.

Aim 2: Validate the technical and clinical performance of confounder-corrected IVIM in patients with CLD.

Aim 3: Demonstrate confounder-corrected IVIM as a marker of intrahepatic vascular resistance in patients with CLD, including those with and without portal hypertension.

Primary Objectives:

• Repeatability of confounder-corrected IVIM [repeatability coefficient]
• Reproducibility of IVIM across acquisition parameters [coefficient of reproducibility]
• Ability to predict histological features (fibrosis stage) of CLD [area under the curve (AUC), optimal cutoffs, sensitivity, specificity]
• Determine the response to a meal challenge in patients without and with portal hypertension [pre vs post meal change of IVIM parameters evaluated using mixed effects modeling]

Inclusion criteria

(Healthy Volunteers):

• Age 7 years or older
• Willing and able to complete study procedures

Exclusion criteria

(Healthy Volunteers):

• Patients with contraindication to MRI (e.g. pacemaker, contraindicated metallic implants, claustrophobia, etc)
• Pregnant or trying to become pregnant (as determined by self-report during MRI safety screening)
• Received ferumoxytol injection within previous one year (clinical or research)
• Patients requiring intravenous (IV) conscious sedation for imaging are not eligible; patients requiring mild, oral anxiolytics for the MRI will be allowed to participate as long as the following criteria are met:

• The person has their own prescription for the medication.
• The informed consent process is conducted prior to the self-administration of this medication
• They come to the research visit with a driver

Inclusion criteria

(Participants with CLD):

• Age 7 years or older
• Willing and able to complete study procedures
• Clinical evidence of MASLD, MASH, cirrhosis or liver fibrosis

Exclusion criteria

(Participants with CLD):

• Patients with contraindication to MRI (e.g. pacemaker, contraindicated metallic implants, claustrophobia, etc)
• Pregnant or trying to become pregnant (as determined by self-report during MRI safety screening)
• Received ferumoxytol injection within previous one year (clinical or research)
• Patients requiring intravenous (IV) conscious sedation for imaging are not eligible; patients requiring mild, oral anxiolytics for the MRI will be allowed to participate as long as the following criteria are met:

• The person has their own prescription for the medication.
• The informed consent process is conducted prior to the self-administration of this medication
• They come to the research visit with a driver

Inclusion criteria

(Liver Fibrosis Spectrum):

• Age 7 years or older
• Willing and able to complete study procedures
• Known or suspected liver steatosis, steatohepatitis, fibrosis, cirrhosis, or portal hypertension, based on clinical imaging from the previous 6 months or histology over the previous 12 months.

• At least N=50 will be selected based on having a clinically indicated liver biopsy
• If taking beta blocker medication, willing to temporarily discontinue the medication for three days prior to the research visit after providing informed consent and in consultation with their treating physician.

Exclusion criteria

(Liver Fibrosis Spectrum):

• Patients with contraindication to MRI (e.g. pacemaker, contraindicated metallic implants, claustrophobia, etc)
• Pregnant or trying to become pregnant (as determined by self-report during MRI safety screening)
• Received ferumoxytol injection within previous one year (clinical or research)
• Patients requiring intravenous (IV) conscious sedation for imaging are not eligible; patients requiring mild, oral anxiolytics for the MRI will be allowed to participate as long as the following criteria are met:

• The person has their own prescription for the medication.
• The informed consent process is conducted prior to the self-administration of this medication
• They come to the research visit with a driver