Four-dimensional flow magnetic resonance imaging in cirrhosis

Figure 1 Particle traces visualization of portal venous flow in a healthy volunteer. Blue emitter planes were positioned in the splenic vein and superior mesenteric vein (sup.-mes. vein), portal vein, right (right PV) and left (left PV) intrahepatic portal vein branch. The gray-shaded iso-surface three-dimensional angiogram has been calculated from the 4D flow magnetic resonance imaging data. Color-coded peak velocities in the inflow of the portal vein from the splenic and superior mesenteric veins and the intrahepatic part of the portal vein.

Figure 2 The portal venous system visualized by particle traces in a 68-year-old male patient with liver cirrhosis (Child-Pugh stage B). Blue emitter planes were positioned in the splenic vein and superior mesenteric vein (sup.-mes. vein), portal vein, right (right PV) and left (left PV) intrahepatic portal vein branch. Time-resolved particle traces illustrate physiological flow in the extrahepatic portal venous system with inflow in the portal vein from the splenic and superior mesenteric veins. Flow over the left branch of the intrahepatic portal vein into a re-opened umbilical vein is visible (arrowhead).

Figure 3 Four-dimensional flow magnetic resonance imaging in a 63-yr-old female with liver cirrhosis after TIPS placement. Small lower left corner: three-dimensional (3D) segmentation of the liver and splanchnic hemodynamics (red: arterial system; orange: portal venous system; blue: venous system). Large figure: Color-coded 3D particle-traces visualization demonstrates increased velocities within the TIPS and the arteries. Blue analysis planes were positioned throughout the arterial and portal venous systems as well as TIPS to quantify liver hemodynamics. abd. aorta: Abdominal aorta; hep. artery: Hepatic artery; sma: Superior mesenteric artery; smv: Superior mesenteric vein; Right PV: Right portal vein branch; IVC: Inferior vena cava.