Non-invasive assessment of mesenteric hemodynamics in patients with suspected chronic mesenteric ischemia using 4D flow MRI

Roberts, Grant S.; François, Christopher J.; Starekova, Jitka; Roldán-Alzate, Alejandro; Wieben, Oliver

doi:10.1007/s00261-020-02900-0

Cited by 17 publications

(16 citation statements)

References 40 publications

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“…22 They showed strong repeatability and reproducibility, 25 as well as internal consistency. [26][27][28][29] Two acquisitions that were at least five months apart yielded average differences of 5% for mean velocities and of 6% for flow volume for the portal venous system. 25…”

Section: Imaging Of the Portal Venous Systemmentioning

confidence: 99%

“…Prior to 4D flow MRI, the subject should be instructed to fast (typically 3-5 hours 26,27,32 ) since there is a significant increase in flow volume and velocity after a meal, which can introduce considerable variability into quantitative results, 27,28 and thus may impede comparisons to reference values and long-term follow-up studies.…”

Section: Patient Preparationmentioning

confidence: 99%

“…34 In our experience, a delay of 20 mins after ingestion of a standardized meal (e.g., a readily available nutrition shake) is sufficient to induce a strong hyperemic response. 27,28 Other authors prefer delays of up to 60 mins. 35…”

Section: Patient Preparationmentioning

confidence: 99%

“…Using an adaptive window, the acceptance rate is typically set to 50% during expiration. 27,28,32,45,46 Using a gating navigator at the liver-lung interface, an acceptance window of 6-8 mm 21,24,47 typically corresponds to 50%-60% acceptance. If needed, the navigator can be placed on the spleen-lung interface to avoid interference with the main ROI.…”

Section: D Flow Mri In the Portal Venous Systemmentioning

confidence: 99%

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Clinical Applications of 4D Flow MRI in the Portal Venous System

et al. 2022

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Evaluation of the hemodynamics in the portal venous system plays an essential role in many hepatic pathologies. Changes in portal flow and vessel morphology are often indicative of disease. Routinely used imaging modalities, such as CT, ultrasound, invasive angiography, and MRI, often focus on either hemodynamics or anatomical imaging. In contrast, 4D flow MRI facilitiates a more comprehensive understanding of pathophysiological mechanisms by simultaneously and noninvasively acquiring time-resolved flow and anatomical information in a 3D imaging volume.Though promising, 4D flow MRI in the portal venous system is especially challenging due to small vessel calibers, slow flow velocities, and breathing motion. In this review article, we will discuss how to account for these challenges when planning and conducting 4D flow MRI acquisitions in the upper abdomen. We will address patient preparation, sequence acquisition, postprocessing, quality control, and analysis of 4D flow data.In the second part of this article, we will review potential clinical applications of 4D flow MRI in the portal venous system. The most promising area for clinical utilization is the diagnosis and grading of liver cirrhosis and its complications. Relevant parameters acquired by 4D flow MRI include the detection of reduced or reversed flow in the portal venous system, characterization of portosystemic collaterals, and impaired response to a meal challenge. In patients with cirrhosis, 4D flow MRI has the potential to address the major unmet need of noninvasive detection of gastroesophageal varices at high risk for bleeding. This could replace many unnecessary, purely diagnostic, and invasive esophagogastroduodenoscopy procedures, thereby improving patient compliance with follow-up. Moreover, 4D flow MRI offers unique insights and added value for surgical planning and follow-up of multiple hepatic interventions, including transjugular intrahepatic portosystemic shunts, liver transplantation, and hepatic disease in children. Lastly, we will discuss the path to clinical implementation and remaining challenges.

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Section: Imaging Of the Portal Venous Systemmentioning

confidence: 99%

Section: Patient Preparationmentioning

confidence: 99%

Section: Patient Preparationmentioning

confidence: 99%

Section: D Flow Mri In the Portal Venous Systemmentioning

confidence: 99%

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Clinical Applications of 4D Flow MRI in the Portal Venous System

et al. 2022

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“…The technique has found applications in adult patients with arterial, venous, and cardiac valve pathology assessments. [2][3][4][5] In children with congenital heart disease, 4D-MRI has been used to assess proximal aortic flow dynamics following aortic valve surgery, tetralogy of Fallot repair, and the Fontan procedure. [6][7][8][9][10][11][12] Beyond assessment of a patient's current hemodynamic state, 4D-MRI may also be applied to preoperative hemodynamic modeling of expected velocities and pressure gradients, although several limitations to these simulations remain.…”

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confidence: 99%

Commentary: Advanced assessments of flow velocity to optimize surgical repair and clinical outcomes in single-ventricle congenital heart disease

Hornik

2021

The Journal of Thoracic and Cardiovascular Surgery

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

Shamim

Panagiotopoulos

Spahic

et al. 2023

Magnetic Resonance in Med

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This study addresses the challenges in obtaining abdominal 4D flow MRI of obese patients. We aimed to evaluate spectral saturation and inner volume excitation as methods to mitigating artifacts originating from adipose signals, with the goal of enhancing image quality and improving quantification. Methods: Radial 4D flow MRI acquisitions with fat mitigation (inner volume excitation [IVE] and intermittent fat saturation [FS]) were compared to a standard slab selective excitation (SSE) in a test-retest study of 15 obese participants. IVE selectively excited a cylindrical region of interest, avoiding contamination from peripheral adipose tissue, while FS globally suppressed fat based on spectral selection. Acquisitions were evaluated qualitatively based on expert ratings and quantitatively based on conservation of mass, test-retest repeatability, and a divergence free quality metric. Errors were evaluated statistically using the absolute and relative errors, regression, and Bland-Altman analysis.Results: IVE demonstrated superior performance quantitatively in the conservation of mass analysis in the portal vein, with higher correlation and lower bias in regression analysis. IVE also produced flow fields with the lowest divergence error and was rated best in overall image quality, delineating small vessels, and producing the least streaking artifacts. Evaluation results did not differ significantly between FS and SSE. Test-retest reproducibility was similarly high for all sequences, with data suggesting biological variations dominate the technical variability. Conclusion:IVE improved hemodynamic assessment of radial 4D flow MRI in the abdomen of obese participants while FS did not lead to significant improvements in image quality or flow metrics.

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Non-invasive assessment of mesenteric hemodynamics in patients with suspected chronic mesenteric ischemia using 4D flow MRI

Cited by 17 publications

References 40 publications

Clinical Applications of 4D Flow MRI in the Portal Venous System

Clinical Applications of 4D Flow MRI in the Portal Venous System

Commentary: Advanced assessments of flow velocity to optimize surgical repair and clinical outcomes in single-ventricle congenital heart disease

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

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