Acute alcoholic hepatitis (AAH) is a common condition with short-term mortality exceeding 25 to 50%. Severe cases can present with complications of portal hypertension, including gastrointestinal bleeding and ascites. Other signs of liver failure in these patients include jaundice, coagulopathy and hepatic encephalopathy. AAH patients are routinely admitted to the hospital due to severity of illness. Appropriate supportive (nutritional) and medical therapy (including prednisone, treatment of infections and bleeding) coupled with abstinence from alcohol can result in clinical improvement within weeks in a significant proportion. However a significant proportion as noted above progress without improvement in clinical status and are at risk for mortality within 30 days or less.
Current laboratory-based scoring models for prediction of short-term prognosis (MELD, Lille, Maddreys discriminant function scores) are limited by low sensitivity and specificity for early prediction of recovery of liver function and mortality. Invasively measured portal hypertension in AAH is independently associated with mortality but is limited in applicability in patients with liver failure and coagulopathy. 4D flow magnetic resonance imaging (MRI) is a new imaging technique that provides a comprehensive evaluation of hepatic and mesenteric vasculature. Relevant to our proposal this test non-invasively quantifies portal venous blood flow and hemodynamics of hepatic blood flow in patients with chronic liver disease, and has been shown by our team to correlate with clinically significant portal hypertension and with changes in portal flow in cirrhosis. To the best of our knowledge 4D flow MRI characterization of hepatic and mesenteric blood flow in patients with AAH has never been described.