Four-Dimensional Flow MRI of Abdominal Veins: A Systematic Review

Abstract

The aim of this systematic review is to provide an overview of the use of Four-Dimensional Magnetic Resonance Imaging of vector blood flow (4D Flow MRI) in the abdominal veins. This study was composed according to the PRISMA guidelines 2009. The literature search was conducted in MEDLINE, Cochrane Library, EMBASE, and Web of Science. Quality assessment of the included studies was performed using the QUADAS-2 tool. The initial search yielded 781 studies and 21 studies were included. All studies successfully applied 4D Flow MRI in abdominal veins. Four-Dimensional Flow MRI was capable of discerning between healthy subjects and patients with cirrhosis and/or portal hypertension. The visual quality and inter-observer agreement of 4D Flow MRI were rated as excellent and good to excellent, respectively, and the studies utilized several different MRI data sampling strategies. By applying spiral sampling with compressed sensing to 4D Flow MRI, the blood flow of several abdominal veins could be imaged simultaneously in 18–25 s, without a significant loss of visual quality. Four-Dimensional Flow MRI might be a useful alternative to Doppler sonography for the diagnosis of cirrhosis and portal hypertension. Further clinical studies need to establish consensus regarding MRI sampling strategies in patients and healthy subjects.

Fat mitigation strategies to improve image quality of radial 4D flow MRI in obese subjects

“…6,7 4D flow MRI has provided quantitative blood flow with high spatial resolution in the hepatic and splanchnic vasculature with good interobserver variability, test-retest repeatability, and internal consistency. [8][9][10] Abdominal 4D flow MRI has substantial potential for hepatic applications, [11][12][13] as well as for other applications 14,15 such as mesenteric ischemia 16,17 and renal artery disease. 18 Unfortunately, achieving sufficient image quality in the abdomen using 4D flow MRI is challenging.…”

Four-dimensional flow magnetic resonance imaging for assessment of hemodynamic changes in the portal venous system before and after balloon-occluded retrograde transvenous obliteration: a pilot feasibility study

“…Four-dimensional (4D) flow magnetic resonance imaging (MRI) is a feasible non-invasive test for hemodynamic assessment (14) and is mainly used to investigate patients with cardiovascular and cerebrovascular diseases (15,16). Recent studies have demonstrated the clinical utility of 4D flow MRI in the abdominal region (17)(18)(19), including assessment of the portal venous system (20)(21)(22). Hyodo et al demonstrated the feasibility of 4D flow MRI for evaluating portal venous blood flow before and after shunt embolization in patients with portosystemic shunt-related hepatic encephalopathy (20).…”