Portal hypertension (PH) is a common complication of liver cirrhosis. Definitive diagnosis of PH is based on hepatic venous pressure gradient (HVPG) measurement (1-3), an indirect surrogate for portal pressure, which is invasive and not widely available. The goal of this study was to assess whether DCE-MRI and MR elastography (MRE) of liver and spleen provide quantitative biomarkers for the prediction of PH. Twenty-six patients (M/F 11/15, mean age 50y) who underwent HVPG measurement were included in this prospective IRB-approved study. MRI examination (1.5T and/or 3.0T) was performed within 3 months of HVPG and consisted of MRE of liver and spleen (n=25) and/or DCE-MRI (n=20). 2D GRE-MRE parameters were TE 22 ms, TR 50 ms, FA 20-25°, FOV 360x260-360 mm², mechanical motion and motion encoding gradients frequency 60 Hz, matrix 128-256x96, 4 slices, slice thickness 7-10 mm. DCE-MRI was acquired using a 3D FLASH sequence (TE 1.06 ms, TR 2.74 ms, FA 11.5°, FOV 400x275-400 mm2, slice thickness 4 mm, 40 slices, temporal resolution 2.3-2.7 s, 64-100 dynamics, contrast agent 0.05 mmol/kg Gd-BOPTA). Liver (LS) and spleen (SS) stiffness were determined from stiffness maps. DCE-MRI data were analyzed using model-free parameters (time-to-peak TTP, peak concentration Cpeak, area-under-the-curve at 60 s AUC60 and upslope) and pharmacokinetic modeling [dual-input single compartment model for liver (parameters: arterial flow F_a, portal flow F_p, arterial fraction ART, distribution volume DV, mean transit time MTT), Tofts model for spleen (parameters: transfer constant K^trans, extravascular extracellular space v_e, rate constant k_ep)]. Differences in MRI parameters between patients with and without PH were tested for significance with a Mann Whitney U test. MRI parameters were correlated with HVPG using Spearman correlation analysis. ROC and sensitivity/specificity analysis for prediction of HVPG ≥5 (PH) and ≥10 mmHg (significant PH) were performed for individual and combinations of parameters. Mean HVPG was 8.0 ± 7.5 mmHg. There were 14 patients with PH, and 11 with clinically significant PH. Representative liver and spleen stiffness maps of a patient without PH and a patient with clinically significant PH are shown in Figure 1. LS, SS, liver TTP, spleen TTP and liver upslope were significantly different between patients with and without clinically significant PH, while only LS was significantly different between patients with and without PH (Table 1). There were significant positive correlations between HVPG and liver TTP, liver MTT and LS, while liver upslope was negatively correlated with HVPG (Fig. 2) and there was a trend toward significant correlation between HVPG and SS (r=0.380, P=0.081). ROC analysis provided significant AUCs for HVPG ≥5mmHg (LS and SS; Fig. 3 a) and HVPG ≥10mmHg (LS, SS, liver TTP, liver upslope, spleen TTP, spleen upslope and liver MTT; Fig. 3 b). Sensitivity-specificity of LS were 64%-91% and 71%-89% for the detection of PH and significant PH respectively, while the combination of LS and spleen TTP yielded the highest sensitivity-specificity for both the detection of PH and significant PH (92%-86% and 100%-92%, respectively).The liver and spleen perfusion and stiffness metrics can be combined into a multiparametric analysis to maximize diagnostic performance for the prediction of portal pressure.