Dataset Information

Longitudinal Monitoring of Hepatic Blood Flow before and after TIPS by Using 4D-Flow MR Imaging.

ABSTRACT: Purpose To demonstrate the feasibility of four-dimensional (4D)-flow magnetic resonance (MR) imaging for noninvasive longitudinal hemodynamic monitoring of hepatic blood flow before and after transjugular intrahepatic portosystemic shunt (TIPS) placement. Materials and Methods The institutional review board approved this prospective Health Insurance Portability and Accountability Act compliant study with written informed consent. Four-dimensional-flow MR imaging was performed in seven patients with portal hypertension and refractory ascites before and 2 and 12 weeks after TIPS placement by using a time-resolved three-dimensional radial phase-contrast acquisition. Flow and peak velocity measurements were obtained in the superior mesenteric vein (SMV), splenic vein (SV), portal vein (PV), and the TIPS. Flow volumes and peak velocities in each vessel, as well as the ratio of in-stent to PV flow, were compared before and after TIPS placement by using analysis of variance. Results Flow volumes significantly increased in the SMV (0.24 L/min; 95% confidence interval [CI]: 0.07, 0.41), SV (0.31 L/min; 95% CI: 0.07, 0.54), and PV (0.88 L/min; 95% CI: 0.06, 1.70) after TIPS placement (all P < .05), with no significant difference between the first and second post-TIPS placement acquisitions (all P > .11). Ascites resolved in six of seven patients. In those with resolved ascites, the TIPS-to-PV flow ratio was 0.8 ± 0.2 and 0.9 ± 0.2 at the two post-TIPS time points, respectively, while the observed ratios were 4.6 and 4.3 in the patient with refractory ascites at the two post-TIPS time points, respectively. In this patient, 4D-flow MR imaging demonstrated arterio-portal-venous shunting, with draining into the TIPS. Conclusion Four-dimensional-flow MR imaging is feasible for noninvasive longitudinal hemodynamic monitoring of hepatic blood flow before and after TIPS placement. © RSNA, 2016 Online supplemental material is available for this article.

SUBMITTER: Bannas P

PROVIDER: S-EPMC5069148 | biostudies-literature | 2016 Nov

REPOSITORIES: biostudies-literature

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Longitudinal Monitoring of Hepatic Blood Flow before and after TIPS by Using 4D-Flow MR Imaging.

Bannas Peter P Roldán-Alzate Alejandro A Johnson Kevin M KM Woods Michael A MA Ozkan Orhan O Motosugi Utaroh U Wieben Oliver O Reeder Scott B SB Kramer Harald H

Radiology 20160512 2

Purpose To demonstrate the feasibility of four-dimensional (4D)-flow magnetic resonance (MR) imaging for noninvasive longitudinal hemodynamic monitoring of hepatic blood flow before and after transjugular intrahepatic portosystemic shunt (TIPS) placement. Materials and Methods The institutional review board approved this prospective Health Insurance Portability and Accountability Act compliant study with written informed consent. Four-dimensional-flow MR imaging was performed in seven patients w ...[more]

PMID: 27171019

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Project description:PurposeTo develop a highly accelerated phase-contrast cardiac-gated volume flow measurement (four-dimensional [4D] flow) magnetic resonance (MR) imaging technique based on spiral sampling and dynamic compressed sensing and to compare this technique with established phase-contrast imaging techniques for the quantification of blood flow in abdominal vessels.Materials and methodsThis single-center prospective study was compliant with HIPAA and approved by the institutional review board. Ten subjects (nine men, one woman; mean age, 51 years; age range, 30-70 years) were enrolled. Seven patients had liver disease. Written informed consent was obtained from all participants. Two 4D flow acquisitions were performed in each subject, one with use of Cartesian sampling with respiratory tracking and the other with use of spiral sampling and a breath hold. Cartesian two-dimensional (2D) cine phase-contrast images were also acquired in the portal vein. Two observers independently assessed vessel conspicuity on phase-contrast three-dimensional angiograms. Quantitative flow parameters were measured by two independent observers in major abdominal vessels. Intertechnique concordance was quantified by using Bland-Altman and logistic regression analyses.ResultsThere was moderate to substantial agreement in vessel conspicuity between 4D flow acquisitions in arteries and veins (κ = 0.71 and 0.61, respectively, for observer 1; κ = 0.71 and 0.44 for observer 2), whereas more artifacts were observed with spiral 4D flow (κ = 0.30 and 0.20). Quantitative measurements in abdominal vessels showed good equivalence between spiral and Cartesian 4D flow techniques (lower bound of the 95% confidence interval: 63%, 77%, 60%, and 64% for flow, area, average velocity, and peak velocity, respectively). For portal venous flow, spiral 4D flow was in better agreement with 2D cine phase-contrast flow (95% limits of agreement: -8.8 and 9.3 mL/sec, respectively) than was Cartesian 4D flow (95% limits of agreement: -10.6 and 14.6 mL/sec).ConclusionThe combination of highly efficient spiral sampling with dynamic compressed sensing results in major acceleration for 4D flow MR imaging, which allows comprehensive assessment of abdominal vessel hemodynamics in a single breath hold.

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Project description:To examine regional cerebral blood flow (rCBF) in incident mild cognitive impairment (MCI) and Alzheimer disease (AD) by using continuous arterial spin-labeling (CASL) magnetic resonance (MR) imaging.This study was approved by the local institutional review board and was compliant with HIPAA regulations. Informed consent was obtained. rCBF was measured in 38 control subjects, 29 MCI patients, and 37 AD patients who were participating in a longitudinal epidemiologic study. Multisection CASL MR imaging with alternating single and double adiabatic inversion pulses and ramp-sampled echo-planar imaging were performed to acquire 19 contiguous axial sections. Voxel-level rCBF was compared among groups by using an analysis of variance design; clusters of voxels with significant group differences were identified. Multiple regression models controlled for age, sex, and presence of hypertension and related the mean rCBF in those clusters to the presence of MCI and AD.MCI and AD patients had decreased rCBF in the posterior cingulate gyrus (P = .01) with extension to the medial precuneus compared with that in control subjects. MCI patients had increased rCBF in the left hippocampus (P < .001), right amygdala (P = .007), and rostral head of the right caudate nucleus and ventral putamen and globus pallidus (P = .003) compared with that in control subjects. AD patients had decreased rCBF relative to that in control subjects and MCI patients in the left inferior parietal (P = .005), left lateral frontal (P < .001), left superior temporal (P = .001), and left orbitofrontal (P = .003) cortices. AD patients had increased rCBF in the right anterior cingulate gyrus (P = .02) compared with that in control subjects.The transition from normal cognition to AD is associated with dynamic pathologic processes in the brain, and this is reflected by both decreases and increases in rCBF. Increases in rCBF suggest a cellular and vascular compensatory process associated with incipient AD.http://radiology.rsnajnls.org/cgi/content/full/2503080751/DC1.

Dataset Information

Longitudinal Monitoring of Hepatic Blood Flow before and after TIPS by Using 4D-Flow MR Imaging.

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Longitudinal Monitoring of Hepatic Blood Flow before and after TIPS by Using 4D-Flow MR Imaging.

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