title: Effect of TIPS placement on portal and splanchnic arterial blood flow in 4-dimensional flow MRI.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  • 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.
authors: Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA, zoran.stankovic@uniklinik-freiburg.de.
authors: Zoran
authors: Z
authors: Stankovic
authors: Martin
authors: M
authors: Rössle
authors: Wulf
authors: W
authors: Euringer
authors: Michael
authors: M
authors: Schultheiss
authors: Riad
authors: R
authors: Salem
authors: Alex
authors: A
authors: Barker
authors: James
authors: J
authors: Carr
authors: Mathias
authors: M
authors: Langer
authors: Michael
authors: M
authors: Markl
authors: Jeremy D
authors: JD
authors: Collins
mesh_terms: D001012:Aorta, Abdominal / Q000503:physiopathology; D001783:Blood Flow Velocity / Q000502:physiology; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006499:Hepatic Artery / Q000503:physiopathology; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008102:Liver Circulation / Q000502:physiology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D017538:Mesenteric Artery, Superior / Q000503:physiopathology; D008875:Middle Aged; D011169:Portal Vein / Q000503:physiopathology*; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D011446:Prospective Studies; D013152:Splanchnic Circulation / Q000502:physiology*; D013157:Splenic Artery / Q000503:physiopathology; D014682:Vena Cava, Inferior / Q000503:physiopathology