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01-09-2015 | Vascular-Interventional

Effect of TIPS placement on portal and splanchnic arterial blood flow in 4-dimensional flow MRI

Authors: Zoran Stankovic, Martin Rössle, Wulf Euringer, Michael Schultheiss, Riad Salem, Alex Barker, James Carr, Mathias Langer, Michael Markl, Jeremy D. Collins

Published in: European Radiology | Issue 9/2015

Abstract

Objectives

To assess changes in portal and splanchnic arterial haemodynamics in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) using four-dimensional (4D) flow MRI, a non-invasive, non-contrast imaging technique.

Methods

Eleven patients undergoing TIPS implantation were enrolled. K-t GRAPPA accelerated non-contrast 4D flow MRI of the liver vasculature was applied with acceleration factor R = 5 at 3Tesla. Flow analysis included three-dimensional (3D) blood flow visualization using time-resolved 3D particle traces and semi-quantitative flow pattern grading. Quantitative evaluation entailed peak velocities and net flows throughout the arterial and portal venous (PV) systems. MRI measurements were taken within 24 h before and 4 weeks after TIPS placement.

Results

Three-dimensional flow visualization with 4D flow MRI revealed good image quality with minor limitations in PV flow. Quantitative analysis revealed a significant increase in PV flow (562 ± 373 ml/min before vs. 1831 ± 965 ml/min after TIPS), in the hepatic artery (176 ± 132 ml/min vs. 354 ± 140 ml/min) and combined flow in splenic and superior mesenteric arteries (770 ml/min vs. 1064 ml/min). Shunt-flow assessment demonstrated stenoses in two patients confirmed and treated at TIPS revision.

Conclusions

Four-dimensional flow MRI might have the potential to give new information about the effect of TIPS placement on hepatic perfusion. It may explain some unexpected findings in clinical observation studies.

Key Points

• 4D flow MRI, a non-invasive, non-contrast imaging technique, is feasible after TIPS.

• Provides visualization and quantification of hepatic arterial, portal venous, collateral and TIPS haemodynamics.

• Better understanding of liver blood flow changes after TIPS and patient management.

D’Amico G, Garcia-Tsao G (2001) Diagnosis of portal hypertension. How and when? In: de Franchis R (ed) Portal hypertension. Proceedings of the third Baveno international consensus workshop on definitions, methodology and therapeutic strategies. Blackwell Science, Oxford (UK), pp 36–64

Bradley SE, Ingelfinger FJ, Bradley GP (1952) Hepatic circulation in cirrhosis of the liver. Circulation 5:419–429PubMedCrossRef

Moreno AH, Burchell AR, Rousselot LM, Panke WF, Slafsky F, Burke JH (1967) Portal blood flow in cirrhosis of the liver. J Clin Investig 46:436–445PubMedCentralPubMedCrossRef

Gatta A, Bolognesi M, Merkel C (2008) Vasoactive factors and hemodynamic mechanisms in the pathophysiology of portal hypertension in cirrhosis. Mol Asp Med 29:119–129CrossRef

Wiest R (2007) Splanchnic and systemic vasodilation: the experimental models. J Clin Gastroenterol 41(Suppl 3):S272–S287PubMedCrossRef

Groszmann RJ, Atterbury CE (1982) The pathophysiology of portal hypertension: a basis for classification. Semin Liver Dis 2:177–186PubMedCrossRef

Benoit JN, Womack WA, Hernandez L, Granger DN (1985) "Forward" and "backward" flow mechanisms of portal hypertension. Relative contributions in the rat model of portal vein stenosis. Gastroenterology 89:1092–1096PubMed

Schrier RW, Arroyo V, Bernardi M, Epstein M, Henriksen JH, Rodes J (1988) Peripheral arterial vasodilation hypothesis: a proposal for the initiation of renal sodium and water retention in cirrhosis. Hepatology 8:1151–1157PubMedCrossRef

Vallance P, Moncada S (1991) Hyperdynamic circulation in cirrhosis: a role for nitric oxide? Lancet 337:776–778PubMedCrossRef

10.

Iwakiri Y, Groszmann RJ (2006) The hyperdynamic circulation of chronic liver diseases: from the patient to the molecule. Hepatology 43:S121–S131PubMedCrossRef

11.

Stankovic Z, Frydrychowicz A, Csatari Z et al (2010) MR-based visualization and quantification of three-dimensional flow characteristics in the portal venous system. J Magn Reson Imaging 32:466–475PubMedCrossRef

12.

Frydrychowicz A, Landgraf BR, Niespodzany E et al (2011) Four-dimensional velocity mapping of the hepatic and splanchnic vasculature with radial sampling at 3 tesla: a feasibility study in portal hypertension. J Magn Reson Imaging. doi:10.1002/jmri.22712

13.

Stankovic Z, Csatari Z, Deibert P et al (2012) Normal and altered three-dimensional portal venous hemodynamics in patients with liver cirrhosis. Radiology 262:862–873PubMedCrossRef

14.

Roldan-Alzate A, Frydrychowicz A, Niespodzany E et al (2013) In vivo validation of 4D flow MRI for assessing the hemodynamics of portal hypertension. J Magn Reson Imaging 37:1100–1108PubMedCentralPubMedCrossRef

15.

Stankovic Z, Csatari Z, Deibert P et al (2013) A feasibility study to evaluate splanchnic arterial and venous hemodynamics by flow-sensitive 4D MRI compared with Doppler ultrasound in patients with cirrhosis and controls. Eur J Gastroenterol Hepatol 25:669–675PubMedCrossRef

16.

Stankovic Z, Jung B, Collins J et al (2013) Reproducibility study of four-dimensional flow MRI of arterial and portal venous liver hemodynamics: influence of spatio-temporal resolution. Magn Reson Med. doi:10.1002/mrm.24939

17.

Landgraf BR, Johnson KM, Roldan-Alzate A, Francois CJ, Wieben O, Reeder SB (2014) Effect of temporal resolution on 4D flow MRI in the portal circulation. J Magn Reson Imaging 39:819–826PubMedCentralPubMedCrossRef

18.

Stankovic Z, Blanke P, Markl M (2012) Usefulness of 4D MRI flow imaging to control TIPS function. Am J Gastroenterol 107:327–328PubMedCrossRef

19.

Lum DP, Johnson KM, Paul RK et al (2007) Transstenotic pressure gradients: measurement in swine – retrospectively ECG-gated 3D phase-contrast MR angiography versus endovascular pressure-sensing guidewires. Radiology 245:751–760PubMedCrossRef

20.

Bley TA, Johnson KM, Francois CJ et al (2011) Noninvasive assessment of transstenotic pressure gradients in porcine renal artery stenoses by using vastly undersampled phase-contrast MR angiography. Radiology 261:266–273PubMedCentralPubMedCrossRef

21.

Markl M, Harloff A, Bley TA et al (2007) Time-resolved 3D MR velocity mapping at 3T: improved navigator-gated assessment of vascular anatomy and blood flow. J Magn Reson Imaging 25:824–831PubMedCrossRef

22.

Stankovic Z, Allen BD, Garcia J, Jarvis KB, Markl M (2014) 4D flow imaging with MRI. Cardiovasc Diagn Ther 4:173–192PubMedCentralPubMed

23.

Bernstein MA, Zhou XJ, Polzin JA et al (1998) Concomitant gradient terms in phase contrast MR: analysis and correction. Magn Reson Med 39:300–308PubMedCrossRef

24.

Bock J, Kreher BW, Hennig J, Markl M (2007) Optimized pre-processing of time-resolved 2D and 3D Phase Contrast MRI data15th Annual Meeting of ISMRM. Abstract 3138, Berlin, Germany

25.

Walker PG, Cranney GB, Scheidegger MB, Waseleski G, Pohost GM, Yoganathan AP (1993) Semiautomated method for noise reduction and background phase error correction in MR phase velocity data. J Magn Reson Imaging 3:521–530PubMedCrossRef

26.

Bock J, Frydrychowicz A, Stalder AF et al (2010) 4D phase contrast MRI at 3T: effect of standard and blood-pool contrast agents on SNR, PC-MRA, and blood flow visualization. Magn Reson Med 63:330–338PubMedCrossRef

27.

Buonocore MH (1998) Visualizing blood flow patterns using streamlines, arrows, and particle paths. Magn Reson Med 40:210–226PubMedCrossRef

28.

Likert R (1932) A technique for the measurement of attitudes. Arch Psychol 1932:1–55

29.

Haag K (1996) Duplex sonographic evaluation before and after TIPS: monitoring of shunt function. In: Transjugular intrahepatic portosystemic shunts. Edited by Conn HO, Palmaz JC, Rösch J, Rössle M. New York, Tokio: Igaku-Shoin 1996:319–30

30.

Foshager MC, Ferral H, Nazarian GK, Castaneda-Zuniga WR, Letourneau JG (1995) Duplex sonography after transjugular intrahepatic portosystemic shunts (TIPS): normal hemodynamic findings and efficacy in predicting shunt patency and stenosis. AJR Am J Roentgenol 165:1–7PubMedCrossRef

31.

Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174PubMedCrossRef

32.

Johnson KM, Lum DP, Turski PA, Block WF, Mistretta CA, Wieben O (2008) Improved 3D phase contrast MRI with off-resonance corrected dual echo VIPR. Magn Reson Med 60:1329–1336PubMedCentralPubMedCrossRef

33.

Rossle M (2013) TIPS: 25 years later. J Hepatol 59:1081–1093PubMedCrossRef

34.

Patel NH, Sasadeusz KJ, Seshadri R et al (2001) Increase in hepatic arterial blood flow after transjugular intrahepatic portosystemic shunt creation and its potential predictive value of postprocedural encephalopathy and mortality. J Vasc Interv Radiol 12:1279–1284PubMedCrossRef

35.

Nanashima A, Shibasaki S, Sakamoto I et al (2006) Clinical evaluation of magnetic resonance imaging flowmetry of portal and hepatic veins in patients following hepatectomy. Liver Int 26:587–594PubMedCrossRef

36.

Harloff A, Albrecht F, Spreer J et al (2009) 3D blood flow characteristics in the carotid artery bifurcation assessed by flow-sensitive 4D MRI at 3T. Magn Reson Med 61:65–74PubMedCrossRef

Title: Effect of TIPS placement on portal and splanchnic arterial blood flow in 4-dimensional flow MRI
Authors: Zoran Stankovic
Martin Rössle
Wulf Euringer
Michael Schultheiss
Riad Salem
Alex Barker
James Carr
Mathias Langer
Michael Markl
Jeremy D. Collins
Publication date: 01-09-2015
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 9/2015
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-015-3663-x

At a glance: The STEP trials

Springer Medicine

Effect of TIPS placement on portal and splanchnic arterial blood flow in 4-dimensional flow MRI

Abstract

Objectives

Methods

Results

Conclusions

Key Points

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

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