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

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

*Corresponding author for this work

Research output: Contribution to journalArticle

15 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)2634-2640
Number of pages7
JournalEuropean Radiology
Volume25
Issue number9
DOIs
StatePublished - Sep 10 2015

Keywords

  • 4D flow MRI
  • Liver cirrhosis
  • Liver haemodynamics
  • Splanchnic system
  • TIPS

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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    Stankovic, Z., Rössle, M., Euringer, W., Schultheiss, M., Salem, R., Barker, A., Carr, J., Langer, M., Markl, M., & Collins, J. D. (2015). Effect of TIPS placement on portal and splanchnic arterial blood flow in 4-dimensional flow MRI. European Radiology, 25(9), 2634-2640. https://doi.org/10.1007/s00330-015-3663-x