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Clinical hepatology
P07 Splanchnic steal in patients with liver disease: a 3T MRI study of visceral blood flow
  1. N McAvoy,
  2. K A Leyland,
  3. J M J Richards,
  4. S I K Semple,
  5. D Patel,
  6. D E Newby,
  7. P C Hayes
  1. Liver Unit, Univeristy of Edinburgh, UK

Abstract

Introduction Liver cirrhosis and the development of portal hypertension is associated with significant morbidity and mortality. It is widely accepted that patients with liver disease have a hyperdynamic circulation that is associated with an increased cardiac output. We have previously proposed that, rather than a generalised systemic vasodilatation, there is selective splanchnic vasodilatation with concomitant vasoconstriction in other vascular beds: the so-called “splanchnic steal” phenomenon.

Aim To measure regional visceral blood flow using 3T magnetic resonance imaging in patients with liver disease.

Method Single centre pilot study of 19 subjects (10 healthy controls, nine patients with liver disease). Arterial and venous phase magnetic resonance angiograms were obtained using a Siemens 3T Verio MR scanner with gadolinium contrast. From these MRA's, ECG-gated phase contrast flow measurement MR data were then positioned and measured in the hepatic artery, portal vein, superior mesenteric artery, descending thoracic aorta, distal abdominal aorta, and the renal and carotid arteries.

Results Mean MELD score in patient group was 14 (range 7–21) with a range of aetiologies: alcoholic (6), non-alcoholic fatty (1), autoimmune (1), hepatitis C virus (1). In comparison to controls, flow in the descending thoracic aorta was increased by 43% in patients with liver disease (4.74 vs 3.32 L/min; p=0.021) consistent with an increased cardiac output. Hepatic artery flow showed a trend towards increase in patients (0.47 vs 0.27 L/min; p=0.11) whereas portal vein flow decreased dramatically (0.20 vs 1.20 L/min; p=0.006). Overall, in patients with liver disease, there was a 46% reduction in total liver blood flow (0.67 vs 1.47 L/min; p=0.037) and a reversal of hepatic artery/portal vein flow ratio (4.15 vs 0.33 L/min; p=0.009). Although superior mesenteric artery flow was three times greater in patients (0.54 vs 0.15 L/min; p=0.001), renal blood flow showed a trend towards reduction of 32% (0.42 vs 0.62 L/min; p=0.053), no change in carotid blood flow (0.75 vs 0.62 L/min; p=0.129) and no change in inferior aortic flow (1.45 vs 1.12 L/min; p=0.28).

Conclusion There are marked derangements in regional visceral blood flow in patients with liver cirrhosis. Our findings strongly support the splanchnic steal hypothesis that dysregulated splanchnic vasodilatation and porto-systemic shunting induce a high cardiac output state associated with extra-splanchnic vasoconstriction including the renal circulation.

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