# Development of 4D Flow MRI for Risk Stratification of Variceal Bleeding in Cirrhosis

> **NIH NIH R01** · UNIVERSITY OF WISCONSIN-MADISON · 2021 · $521,185

## Abstract

PROJECT SUMMARY:
 The overarching goal of our research is to improve the management and health of an estimated 1 million
Americans suffering from end-stage liver disease (cirrhosis) through non-invasive MRI-based blood flow
measurements. In cirrhosis, increased resistance to blood flow leads to formation of collateral vessels that shunt
blood away from the liver. Many forms of collaterals can develop, but gastroesophageal varices (GEV) are the
most important to monitor - GEV are fragile submucosal vessels that can rupture without warning and cause
fatal internal bleeding. Once bleeding starts, mortality is extraordinarily high: 1/3 of patients who bleed will die.
Current clinical guidelines recommend esophagogastroduodenoscopy (EGD) surveillance every 1-3 years, to
facilitate prophylactic treatment and avoid life-threatening bleeding. Unfortunately. EDG is invasive, expensive,
and requires sedation. Importantly, most patients undergoing EGD do not have treatable varices, and compliance
with surveillance is very poor. For these reasons, the AASLD has identified the development of non-invasive
markers that predict the presence of high-risk varices as a major unmet need in the management of
cirrhosis. We aim to address this need through development of non-invasive MRI-based markers of portal blood
flow that leverage the primary biological mechanism for development and rupture of GEV: reversed flow from
the portal circulation into GEV via the left gastric vein. Currently available markers include catheter-based hepatic
venous pressure gradient measurements, and emerging non-invasive markers such as platelet-to-spleen ratio,
and liver and spleen stiffness (using ultrasound or MRI). Unfortunately, these markers only provide a global
assessment of liver disease, and do not have the specificity necessary to identify high-risk GEV. The
investigative team at UW are pioneers in radial 4D flow MRI for comprehensive hemodynamic characterization
of blood flow in the liver. Our pilot data demonstrates that radial 4D flow MRI can accurately identify high-risk
GEV, by quantifying reversed flow in the LGV, with high sensitivity and specificity. We propose to translate
advanced 4D flow MRI to address this unmet clinical need by overcoming remaining technical challenges,
performing preclinical validation and optimization, and determining its diagnostic performance. Aim 1:
Technical development of velocity-optimized, accelerated 4D flow MRI, to quantify flow in the portal circulation,
in < 3 minutes. Aim 2: Rigorous validation of the proposed method in anatomically correct 3D-printed flow
phantoms. Aim 3: Determine the diagnostic performance of the proposed method in cirrhotic adults
undergoing EGD, to assess diagnostic accuracy and test-retest repeatability. Aim 4: evaluate the effects and
added value of a meal challenge to assess for high-risk GEV. If successful, the proposed strategy would
transform the management of cirrhosis, through: 1) prompt triage of patient...

## Key facts

- **NIH application ID:** 10211545
- **Project number:** 1R01DK125783-01A1
- **Recipient organization:** UNIVERSITY OF WISCONSIN-MADISON
- **Principal Investigator:** Scott B. Reeder
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $521,185
- **Award type:** 1
- **Project period:** 2021-04-01 → 2024-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10211545

## Citation

> US National Institutes of Health, RePORTER application 10211545, Development of 4D Flow MRI for Risk Stratification of Variceal Bleeding in Cirrhosis (1R01DK125783-01A1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10211545. Licensed CC0.

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