Real Time Evaluation of Whole Organ Perfusion by Magnetic Resonance Imaging in Ex Vivo Machine‐Perfused Liver

ABSTRACT Machine perfusion is an emerging technique in organ preservation and transplantation, with broader potential for studying disease mechanisms and testing novel therapeutics. Magnetic resonance imaging (MRI) offers non‐invasive, quantitative assessment of tissue perfusion and microstructure. This study demonstrates the feasibility of acquiring high‐resolution MRI sequences from porcine livers undergoing ex vivo perfusion using a custom MRI‐compatible rig. Seven porcine livers were retrieved from the abattoir and perfused with oxygenated autologous blood inside a 3 T clinical MRI scanner. MRI sequences acquired included T2‐weighted imaging, diffusion weighted imaging (DWI) and Dynamic Contrast Enhanced (DCE) imaging following gadolinium injection into the portal vein and hepatic artery. Histological assessment was performed to evaluate preservation injury, with comparison to static cold storage (SCS) controls. MRI during perfusion enabled dynamic measurement of tissue perfusion, including generation of gadolinium enhancement curves and apparent diffusion coefficient (ADC) maps. Vascular segmentation down to 0.45 mm resolution allowed quantification of morphological features such as vessel tortuosity. Histological analysis demonstrated superior preservation in perfused livers compared to SCS. This platform enables detailed, quantitative evaluation of vascular morphology and flow in whole organs, with translational relevance for modelling vascular disease and evaluating targeted drug‐delivery strategies.