Portal Vein Stenosis Following Liver Transplantation Hemodynamically Assessed with 4D-flow MRI before and after Portal Vein Stenting

Abstract

We present a case of a patient who underwent portal vein (PV) stenting for PV stenosis after a living-donor liver transplantation. A pretreatment 3D cine phase-contrast (4D-flow) MRI showed decreased, though hepatopetal, blood flow in the PV. After stenting, 4D-flow MRI confirmed an improvement in PV flow, with a more homogeneous flow distribution to each hepatic segment. 4D-flow MRI are valuable for understanding the hemodynamics of this area, planning for treatments, and evaluating the outcome of the interventions.

Time‐resolved 3D cine phase‐contrast magnetic resonance imaging (4D‐flow MRI) can quantitatively assess portosystemic shunt severity and confirm normalization of portal flow after embolization of large portosystemic shunts

“…However, US has some limitations, such as relatively low intra‐ and interobserver agreement, relatively poor reproducibility, limited field of view, limited visualization of complex structures, and image quality hampered by obesity or gastrointestinal gas 7–9 ,. 13–16 In contrast, 4D‐flow MRI is characterized by comprehensive data sampling of complete velocity and morphology, followed by objective retrospective data analysis 6–11 . No special expertise is needed in collecting and analyzing the data of 4D‐flow.…”

“…[7][8][9][13][14][15][16] In contrast, 4D-flow MRI is characterized by comprehensive data sampling of complete velocity and morphology, followed by objective retrospective data analysis. [6][7][8][9][10][11] No special expertise is needed in collecting and analyzing the data of 4D-flow. The acquired data can be displayed in a 3D cine fashion, thereby facilitating the understanding of the pathology and treatment effects.…”

“…This technique also allows for simultaneous measurements of 3D flow velocity vectors in the PV system, including the SMV, SV and collateral circulations 5–8 . The usefulness of 4D‐flow MRI in the PV area has been reported, and the procedural indications and therapeutic effects of portal intervention have been evaluated 9–11 . To our knowledge, there have been no reports describing the usefulness of 4D‐flow MRI for the evaluation of portal hemodynamic patterns in PSS‐related HE before and after PSS embolization.…”

“…[5][6][7][8] The usefulness of 4Dflow MRI in the PV area has been reported, and the procedural indications and therapeutic effects of portal intervention have been evaluated. [9][10][11] To our knowledge, there have been no reports describing the usefulness of 4D-flow MRI for the evaluation of portal hemodynamic patterns in PSS-related HE before and after PSS embolization. Here, we present our evaluation and management of two such cases.…”

Assessing the Complicated Venous Hemodynamics and Therapeutic Outcomes of Budd-Chiari Syndrome with Respiratory-gated 4D Flow MR Imaging During the Expiratory and Inspiratory Phases

“…4,5 Recently, the usefulness of 4D Flow MRI for assessing the indications for endovascular treatment and its outcomes has been reported; however, there are few reports regarding the assessment of the portal and venous systems. [6][7][8] For hemodynamic assessments of torso venous systems, care should be taken not to be affected by the respiratory cycle or Valsalva effect during breath-holding. 3 We present a case of Budd-Chiari syndrome with complex venous hemodynamics, in which 4D Flow MRI acquired in two respiratory phases (i.e., expiratory and inspiratory phases) was useful in assessing the hemodynamics, therapeutic indications, and treatment outcomes.…”