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4D flow MR imaging of the portal venous system: a feasibility study in children

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Abstract

Objectives

To determine the feasibility of 4D flow MRI for visualization and quantification of the portal venous haemodynamics in children and young adults.

Methods

4D flow was performed in 28 paediatric patients (median age, 8.5 years; interquartile range, 5.2–16.5), 15 with non-operated native portal system and 13 with surgically created portal shunt. Image quality assessment for 3D flow visualization and flow pattern analyses was performed. Regional 4D flow peak velocity and net flow were compared with 2D-cine phase contrast MRI (2D-PC MR) in the post-surgical patients.

Results

Mean 3D flow visualization quality score was excellent (mean ± SD, 4.2 ± 0.9) with good inter-rater agreement (κ,0.67). Image quality in children aged >10 years was better than children ≤10 years (p < 0.05). Flow pattern was defined for portal, superior mesenteric, splenic veins and splenic artery in all patients. 4D flow and 2D-PC MR peak velocity and net flow were similar with good correlation (peak velocity: 4D flow 22.2 ± 9.1 cm/s and 2D-PC MR 25.2 ± 11.2 cm/s, p = 0.46; r = 0.92, p < 0.0001; net flow: 4D flow 9.5 ± 7.4 ml/s and 2D-PC MR 10.1 ± 7.3 ml/s, p = 0.65; r = 0.81, p = 0.0007).

Conclusions

4D flow MRI is feasible and holds promise for the comprehensive 3D visualization and quantification of portal venous flow dynamics in children and young adults.

Key Points

4D flow MRI is feasible in children and young adults.

4D flow MRI has the ability to non-invasively characterize portal haemodynamics.

Image quality of 4D flow MRI is better is older children.

4D flow MRI can accurately quantify portal flow compared to 2D-cine PC MRI.

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Abbreviations

2D-PC MR:

2D-cine phase contrast MR imaging

4D flow MRI:

3D-cine phase contrast MRI with three-directional velocity encoding (flow)

GRAPPA:

Generalized autocalibrating partially parallel acquisitions

VENC:

Velocity encoding

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Acknowledgements

A scientific paper with partial material was presented at the annual meeting of The Society for Pediatric Radiology (SPR) in April 2014.

The scientific guarantor of this publication is Keyur Parekh. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding.

No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. No study subjects or cohorts have been previously reported. Methodology: prospective, diagnostic or prognostic study, performed at one institution.

Author information

Correspondence to Keyur Parekh.

Electronic supplementary material

Below is the link to the electronic supplementary material.

File format -.mov. Twelve-year-old male patient with history of extrahepatic portal vein thrombosis treated with meso-Rex bypass surgery. Movie 1 shows mild flow acceleration proximal to the narrowing at meso-Rex/left portal vein anastomosis and reduced flow at the site of narrowing on 4D flow MRI. Turbulent flow in the dilated left portal vein can be seen (MPG 1738 kb)

File format -.mov. Eight-year-old female patient with surgically corrected extrahepatic portal vein thrombosis with a meso-Rex bypass. Patient was treated with balloon dilation for severe narrowing of meso-Rex bypass at left portal vein anastomosis. On follow-up imaging, transient flow acceleration (red coloured pathlines at 358 ms, heart rate 90 bpm) was seen at the left portal vein anastomosis on 4D flow MRI images. (MPG 1734 kb)

Movie 1

File format -.mov. Twelve-year-old male patient with history of extrahepatic portal vein thrombosis treated with meso-Rex bypass surgery. Movie 1 shows mild flow acceleration proximal to the narrowing at meso-Rex/left portal vein anastomosis and reduced flow at the site of narrowing on 4D flow MRI. Turbulent flow in the dilated left portal vein can be seen (MPG 1738 kb)

Movie 2

File format -.mov. Eight-year-old female patient with surgically corrected extrahepatic portal vein thrombosis with a meso-Rex bypass. Patient was treated with balloon dilation for severe narrowing of meso-Rex bypass at left portal vein anastomosis. On follow-up imaging, transient flow acceleration (red coloured pathlines at 358 ms, heart rate 90 bpm) was seen at the left portal vein anastomosis on 4D flow MRI images. (MPG 1734 kb)

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Parekh, K., Markl, M., Rose, M. et al. 4D flow MR imaging of the portal venous system: a feasibility study in children. Eur Radiol 27, 832–840 (2017) doi:10.1007/s00330-016-4396-1

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Keywords

  • Children
  • Portal vein
  • Magnetic resonance imaging
  • 4D flow MRI
  • Phase contrast MRI