Four-dimensional Flow MRI-based Computational Fluid Dynamic…

Abstract

Background Transjugular intrahepatic portosystemic shunt (TIPS) dysfunction in patients with liver cirrhosis and recurrent symptoms of portal hypertension is primarily assessed with US and confirmed with invasive catheter venography, which can be used to measure the portosystemic pressure gradient (PSPG) to identify TIPS-refractory portal hypertension. To avoid the risks and costs of invasive catheter venography, noninvasive PSPG evaluation strategies are needed. Purpose To demonstrate the feasibility of the combination of four-dimensional (4D) flow MRI with computational fluid dynamics (CFD) for noninvasive PSPG assessment in participants with cirrhosis and TIPS. Materials and Methods Abdominal 4D flow MRI was performed prospectively in participants with cirrhosis and TIPS between January 2019 and September 2020. Flow rates were measured within the TIPS and inferior vena cava (IVC). The portal vein (PV), TIPS, right hepatic vein, and IVC were segmented on MRI scans to create a CFD mesh. The PV and infrahepatic IVC were defined as inflows for 4D flow MRI-derived flow rates. The suprahepatic IVC was defined as the outflow. CFD simulations were used to noninvasively estimate PSPG as the difference between the simulated pressures in the PV and suprahepatic IVC. Invasive venographic measurements of the PSPG served as the reference standard, and Pearson correlation analysis was conducted to evaluate the relationship between noninvasive estimates and invasive measurements. Results In all 20 participants with cirrhosis (mean age, 58 years ± 9 [SD]; 11 men), 4D flow MRI-based CFD simulations enabled visualization of flow velocities and pressure distributions within the segmented vasculature and TIPS. Noninvasive estimates and invasive measures of PSPG were strongly correlated (r = 0.77; P < .001). The 4D flow MRI-based CFD simulations correctly classified the presence or absence of a post-TIPS PSPG greater than 12 mm Hg in 16 of 20 participants (80%). Conclusion The combination of 4D flow MRI and CFD was feasible for noninvasive PSPG assessment in participants with cirrhosis, portal hypertension, and TIPS. © RSNA, 2024 See also the editorial by Motosugi and Watanabe in this issue.

MeSH 主题词

Humans Portasystemic Shunt, Transjugular Intrahepatic/methods Liver Cirrhosis/diagnostic imaging,complications,physiopathology Male Female Middle Aged Magnetic Resonance Imaging/methods Hydrodynamics Hypertension, Portal/diagnostic imaging,physiopathology,surgery Prospective Studies Feasibility Studies Aged Computer Simulation

作者与单位

共 12 位作者，点击展开单位 / ORCID

Riedel Christoph ORCID

From the Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.R., A.L., I.R., G.A., B.P.S., P.B.) and I. Department of Medicine (F.P., J.K.), University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Institute of Multiphase Flows, Hamburg University of Technology, Hamburg, Germany (M.H., M.I., M.S.); and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin-Madison, Madison, Wis (S.B.R.).

Hoffmann Marko

From the Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.R., A.L., I.R., G.A., B.P.S., P.B.) and I. Department of Medicine (F.P., J.K.), University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Institute of Multiphase Flows, Hamburg University of Technology, Hamburg, Germany (M.H., M.I., M.S.); and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin-Madison, Madison, Wis (S.B.R.).

Ismahil Muhammad

From the Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.R., A.L., I.R., G.A., B.P.S., P.B.) and I. Department of Medicine (F.P., J.K.), University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Institute of Multiphase Flows, Hamburg University of Technology, Hamburg, Germany (M.H., M.I., M.S.); and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin-Madison, Madison, Wis (S.B.R.).

Lenz Alexander ORCID

From the Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.R., A.L., I.R., G.A., B.P.S., P.B.) and I. Department of Medicine (F.P., J.K.), University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Institute of Multiphase Flows, Hamburg University of Technology, Hamburg, Germany (M.H., M.I., M.S.); and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin-Madison, Madison, Wis (S.B.R.).

Piecha Felix

From the Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.R., A.L., I.R., G.A., B.P.S., P.B.) and I. Department of Medicine (F.P., J.K.), University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Institute of Multiphase Flows, Hamburg University of Technology, Hamburg, Germany (M.H., M.I., M.S.); and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin-Madison, Madison, Wis (S.B.R.).

Ristow Inka ORCID

From the Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.R., A.L., I.R., G.A., B.P.S., P.B.) and I. Department of Medicine (F.P., J.K.), University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Institute of Multiphase Flows, Hamburg University of Technology, Hamburg, Germany (M.H., M.I., M.S.); and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin-Madison, Madison, Wis (S.B.R.).

Kluwe Johannes

From the Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.R., A.L., I.R., G.A., B.P.S., P.B.) and I. Department of Medicine (F.P., J.K.), University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Institute of Multiphase Flows, Hamburg University of Technology, Hamburg, Germany (M.H., M.I., M.S.); and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin-Madison, Madison, Wis (S.B.R.).

Schlüter Michael

From the Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.R., A.L., I.R., G.A., B.P.S., P.B.) and I. Department of Medicine (F.P., J.K.), University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Institute of Multiphase Flows, Hamburg University of Technology, Hamburg, Germany (M.H., M.I., M.S.); and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin-Madison, Madison, Wis (S.B.R.).

Adam Gerhard ORCID

From the Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.R., A.L., I.R., G.A., B.P.S., P.B.) and I. Department of Medicine (F.P., J.K.), University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Institute of Multiphase Flows, Hamburg University of Technology, Hamburg, Germany (M.H., M.I., M.S.); and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin-Madison, Madison, Wis (S.B.R.).

Schoennagel Bjoern P

From the Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.R., A.L., I.R., G.A., B.P.S., P.B.) and I. Department of Medicine (F.P., J.K.), University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Institute of Multiphase Flows, Hamburg University of Technology, Hamburg, Germany (M.H., M.I., M.S.); and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin-Madison, Madison, Wis (S.B.R.).

Reeder Scott B ORCID

From the Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.R., A.L., I.R., G.A., B.P.S., P.B.) and I. Department of Medicine (F.P., J.K.), University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Institute of Multiphase Flows, Hamburg University of Technology, Hamburg, Germany (M.H., M.I., M.S.); and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin-Madison, Madison, Wis (S.B.R.).

Bannas Peter

From the Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.R., A.L., I.R., G.A., B.P.S., P.B.) and I. Department of Medicine (F.P., J.K.), University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Institute of Multiphase Flows, Hamburg University of Technology, Hamburg, Germany (M.H., M.I., M.S.); and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin-Madison, Madison, Wis (S.B.R.).

Four-dimensional Flow MRI-based Computational Fluid Dynamics Simulation for Noninvasive Portosystemic Pressure Gradient Assessment in Patients with Cirrhosis and Transjugular Intrahepatic Portosystemic Shunt.

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