MR-guided Hepatic Venous Catheterisation Feasibility Study (MR-HVC)
Research type
Research Study
Full title
MR-guided Hepatic Venous Catheterisation Feasibility Study (MR-HVC)
IRAS ID
257005
Contact name
Daniel Knight
Contact email
Sponsor organisation
Royal Free London NHS Foundation Trust
Duration of Study in the UK
2 years, 0 months, 1 days
Research summary
Patients with chronic liver disease and suspected portal hypertension often require invasive measurements of the blood pressure gradient between the hepatic and portal veins, by means of vascular catheterisation (hepatic vein catheterisation, HVC). These measurements provide prognostic information and guide treatment.
This procedure is normally performed under fluoroscopic (X-ray) guidance, and requires central venous access from the internal jugular vein.
Right heart catheterisation (RHC) is a conceptually similar procedure to hepatic vein catheterisation, and is also usually performed under fluoroscopic guidance. We have shown at the Royal Free Hospital that RHC is safe and feasible in terms of procedure acceptability, duration, and complication/failure rate when performed under magnetic resonance imaging guidance (so called MR-RHC). MR-RHC was approved by the New Interventional Procedures Committee in 2017, and more than 50 cases have been performed since 23/11/17.
We propose adapting this technique in order to perform hepatic vein catheterisation under MRI-guidance.
There are benefits of using MRI-guidance compared with fluoroscopy. Firstly, MRI-guidance limits exposure to ionising radiation. Secondly, MRI with real-time imaging sequences also allows measurement of blood flow through blood vessels, something which is not possible with fluoroscopy. When this flow information is combined with pressure measurements from the catheters, we can calculate resistance in the vessel. Measurements of hepatic vein resistance have not been studied, but we believe they are a putative biomarker of disease severity (for example increased resistance may result from more severe liver disease). If it is feasible to perform these measurements, their clinical utility in diagnosis and tracking response to treatment could be assessed in future studies.
REC name
London - Central Research Ethics Committee
REC reference
19/LO/1198
Date of REC Opinion
11 Oct 2019
REC opinion
Further Information Favourable Opinion