title: 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.
abstract: OBJECTIVE
  To evaluate the feasibility of time-resolved flow-sensitive four-dimensional (4D) MRI for the visualization and quantification of splanchnic arterial and portal venous hemodynamics in patients with cirrhosis and in controls.
  
  
  METHODS
  We applied flow-sensitive 4D MRI to evaluate arterial and portal venous three-dimensional blood flow in patients with advanced liver cirrhosis (n=5) and in healthy controls (n=10) using 3T MRI (spatial resolution=1.7×2.1×2.4 mm, temporal resolution=62.4 ms). The qualitative flow was analyzed using three-dimensional streamlines and time-resolved particle traces. Retrospective flow was quantified in nine predefined anatomic regions evaluating maximum and mean velocities, the flow volume, the vessel lumen area, pulsatility indices, and resistance indices. Doppler ultrasound (US) was our reference standard.
  
  
  RESULTS
  Flow-sensitive 4D MRI visualized liver hemodynamics successfully in 91% of patients and 96% of volunteers with limitations for the patients' extrahepatic vessels (one case of splenic and superior mesenteric veins each) and intrahepatic portal vein branches (in five vessels). Healthy control individuals revealed reduced velocities and larger vessel areas in MRI than in Doppler US. We found no significant differences in the flow volume, pulsatility indices, and resistance indices on comparing MRI with US. Regional flow quantification within the splanchnic system of healthy volunteers and liver cirrhosis patients revealed an increase in the inflow (up to 65%), but a decrease in the patients' outflow (up to 37%).
  
  
  CONCLUSIONS
  Flow-sensitive 4D MRI is feasible for profound evaluation of arterial and portal venous hemodynamics in liver cirrhosis patients, providing additional information on the pathophysiology of the altered splanchnic system.
authors: Departments of Radiology and Biomedical Engineering, Northwestern University, Chicago, IL 60611, USA. zoran.stankovic@northwestern.edu
authors: Zoran
authors: Z
authors: Stankovic
authors: Zoltan
authors: Z
authors: Csatari
authors: Peter
authors: P
authors: Deibert
authors: Wulf
authors: W
authors: Euringer
authors: Bernd
authors: B
authors: Jung
authors: Wolfgang
authors: W
authors: Kreisel
authors: Julia
authors: J
authors: Geiger
authors: Maximilian F
authors: MF
authors: Russe
authors: Mathias
authors: M
authors: Langer
authors: Michael
authors: M
authors: Markl
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D016022:Case-Control Studies; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging / Q000503:physiopathology; D008642:Mesenteric Veins / Q000000981:diagnostic imaging / Q000503:physiopathology; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology*; D013152:Splanchnic Circulation / Q000502:physiology*; D013162:Splenic Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D018608:Ultrasonography, Doppler / Q000379:methods