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

doi:10.1007/s00330-015-3663-x

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

Radiology

Research output: Contribution to journal › Article › peer-review

39 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 language	English (US)
Pages (from-to)	2634-2640
Number of pages	7
Journal	European Radiology
Volume	25
Issue number	9
DOIs	https://doi.org/10.1007/s00330-015-3663-x
State	Published - Sep 10 2015

Funding

The scientific guarantor of this publication is Michael Markl. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study has received funding by German Research Foundation (DFG) under Award Number STA 1288/ 2-1. Supported by the RSNA Research & Education Foundation, Seed Grant #1218 (JDC). No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, case-control, multicentre study. We thank Adriana Komancsek, Marie Wasielewski and Maria Carr for their technical contributions.

Keywords

4D flow MRI
Liver cirrhosis
Liver haemodynamics
Splanchnic system
TIPS

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging

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10.1007/s00330-015-3663-x

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

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.",

keywords = "4D flow MRI, Liver cirrhosis, Liver haemodynamics, Splanchnic system, TIPS",

author = "Zoran Stankovic and Martin R{\"o}ssle and Wulf Euringer and Michael Schultheiss and Riad Salem and Alex Barker and James Carr and Mathias Langer and Michael Markl and Collins, {Jeremy D.}",

note = "Publisher Copyright: {\textcopyright} 2015, European Society of Radiology.",

year = "2015",

month = sep,

day = "10",

doi = "10.1007/s00330-015-3663-x",

language = "English (US)",

volume = "25",

pages = "2634--2640",

journal = "European Radiology",

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T1 - Effect of TIPS placement on portal and splanchnic arterial blood flow in 4-dimensional flow MRI

AU - Stankovic, Zoran

AU - Rössle, Martin

AU - Euringer, Wulf

AU - Schultheiss, Michael

AU - Salem, Riad

AU - Barker, Alex

AU - Carr, James

AU - Langer, Mathias

AU - Markl, Michael

AU - Collins, Jeremy D.

PY - 2015/9/10

Y1 - 2015/9/10

N2 - 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.

AB - 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.

KW - 4D flow MRI

KW - Liver cirrhosis

KW - Liver haemodynamics

KW - Splanchnic system

KW - TIPS

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

Abstract

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