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Huang A, Roberts GS, Roldán-Alzate A, Wieben O, Reeder SB, Oechtering TH. Reference values for 4D flow magnetic resonance imaging of the portal venous system. Abdom Radiol (NY) 2023; 48:2049-2059. [PMID: 37016247 PMCID: PMC10518803 DOI: 10.1007/s00261-023-03892-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/17/2023] [Accepted: 03/19/2023] [Indexed: 04/06/2023]
Abstract
PURPOSE The purpose of this work was to establish normal reference values for 4D flow MRI-derived flow, velocity, and vessel diameters, and to define characteristic flow patterns in the portal venous system of healthy adult subjects. METHODS For this retrospective study, we screened all available 4D flow MRI exams of the upper abdomen in healthy adults acquired at our institution between 2012 and 2022 at either 1.5 T or 3.0 T MRI after ≥ 5 h fasting. Flow, velocity, and effective diameter were quantified in the 8 planes in the portal venous system (splenic vein, superior mesenteric vein, main, right, and left portal veins). Vessel delineation was manually adjusted over time. Reference ranges for were defined as the mean ± 2 standard deviations. Three readers noted helical and vortical flow on time-resolved pathline visualizations. Conservation of mass flow analysis was performed for quality assurance. RESULTS We included 44 healthy subjects (26 female, 18-74 years) in the analysis. We report reference values for mean and peak flow, mean velocity, and vessel diameter in the healthy portal vein using 4D flow MRI. Normal flow patterns in the portal vein included faint helical (66%) or linear flow (34%). Conservation of mass analysis demonstrated a relative error of 1.1 ± 4.6% standard deviation (SD) at the splenomesenteric confluence and - 1.4 ± 4.1% SD at the portal bifurcation. CONCLUSION We have reported normal hemodynamic values that are necessary baseline data for emerging clinical applications of 4D flow MRI in the portal venous system. Results are consistent with previously published values from smaller cohorts.
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Affiliation(s)
- Andrew Huang
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Grant S Roberts
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Alejandro Roldán-Alzate
- Department of Mechanical Engineering, University of Wisconsin, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA
| | - Oliver Wieben
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Scott B Reeder
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA
- Department of Medicine, University of Wisconsin, Madison, WI, USA
- Department of Emergency Medicine, University of Wisconsin, Madison, WI, USA
| | - Thekla H Oechtering
- Department of Radiology, University of Wisconsin, Madison, WI, USA.
- Department of Radiology and Nuclear Medicine, Universität zu Lübeck, Lübeck, Germany.
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Liver cirrhosis: relationship between fibrosis-associated hepatic morphological changes and portal hemodynamics using four-dimensional flow magnetic resonance imaging. Jpn J Radiol 2023; 41:625-636. [PMID: 36656540 DOI: 10.1007/s11604-023-01388-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023]
Abstract
PURPOSE The mechanisms underlying the morphological changes in liver cirrhosis remain unknown. This study aimed to clarify the relationship between fibrotic hepatic morphology and portal hemodynamic changes using four-dimensional flow magnetic resonance imaging (MRI). MATERIALS AND METHODS Overall, 100 patients with suspected liver disease who underwent 3-T MRI were evaluated in this retrospective study. Liver fibrosis was assessed using a combination of visual assessment of the hepatic morphology and quantitative measures, including the fibrosis-4 index and aspartate transaminase-to-platelet ratio. It was classified into three groups according to the severity of fibrosis as follows: A (normal), B (mild-to-moderate), and C (severe). Quantitative indices, including area (mm2), net flow (mL/s), and average velocity (cm/s), were measured in the right portal vein (RPV) and left portal vein (LPV), and were compared across the groups using the Kruskal-Wallis and Mann-Whitney U tests. RESULTS Among the 100 patients (69.1 ± 12.1 years; 59 men), 45, 35, and 20 were categorized into groups A, B, and C, respectively. The RPV area significantly differed among the groups (from p < 0.001 to p = 0.001), showing a gradual decrease with fibrosis progression. Moreover, the net flow significantly differed between groups A and B and between groups A and C (p < 0.001 and p < 0.001, respectively), showing a decrease during the early stage of fibrosis. In the LPV, the net flow significantly differed among the groups (from p = 0.001 to p = 0.030), revealing a gradual increase with fibrosis progression. CONCLUSION The atrophy-hypertrophy complex, which is a characteristic imaging finding in advanced cirrhosis, was closely associated with decreased RPV flow in the early stage of fibrosis and a gradual increase in LPV flow across all stages of fibrosis progression.
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Ozaki K, Kozaka K, Kosaka Y, Kimura H, Gabata T. Morphometric changes and imaging findings of diffuse liver disease in relation to intrahepatic hemodynamics. Jpn J Radiol 2020; 38:833-852. [PMID: 32347423 DOI: 10.1007/s11604-020-00978-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/13/2020] [Indexed: 01/20/2023]
Abstract
Diffuse hepatic diseases have a variety of etiologies, with each showing characteristic morphometric changes. These changes are closely related to micro- and macro-level intrahepatic hemodynamics, in addition to the specific underlying pathophysiology. Short-term disorders in intrahepatic hemodynamics caused by each pathophysiological condition are compensated for by the balance of blood perfusion systems using potential trans-sinusoidal, transversal, and transplexal routes of communication (micro-hemodynamics), while long-term alterations to the intrahepatic hemodynamics result in an increase in total hepatic vascular resistance. Blood flow disorders induced by this increased vascular resistance elicit hepatic cellular necrosis and fibrosis. These changes should be uniformly widespread throughout the whole liver. However, morphometric changes do not occur uniformly, with shrinkage or enlargement not occurring homogeneously. Against this background, several macro-intrahepatic hemodynamic effects arise, such as asymmetrical and complicating morphometric structures of the liver, intricate anatomy of portal venous flow and hepatic venous drainage, and zonal differentiation between central and peripheral zones. These hemodynamic factors and pathophysiological changes are related to characteristic morphometric changes in a complicated manner, based on the combination of selective atrophy and compensatory hypertrophy (atrophy-hypertrophy complex). These changes can be clearly depicted on CT and MR imaging.
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Affiliation(s)
- Kumi Ozaki
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan.
| | - Kazuto Kozaka
- Department of Radiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Yasuo Kosaka
- Department of Radiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Hirohiko Kimura
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
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4
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de Araujo EM, Torres US, Racy DJ, Torres LR, Chojniak R, D’Ippolito G. The "streamline phenomenon" of the portal vein flow and its influence on liver involvement by gastrointestinal diseases: current concepts and imaging-based review. Abdom Radiol (NY) 2020; 45:403-415. [PMID: 31768597 DOI: 10.1007/s00261-019-02335-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The streamline flow in the portal system is a phenomenon by which blood from superior mesenteric vein goes preferentially to the right hepatic lobe, while splenic and inferior mesenteric veins divert preferentially to the left lobe. Such a phenomenon results in different patterns of distribution of several liver diseases. The purpose of this article is to discuss the concepts behind the theory of streamline flow and to perform an imaging-based review of representative cases, demonstrating how it may influence the patterns of liver involvement in different gastrointestinal diseases.
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5
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MRI-based modeling of spleno-mesenteric confluence flow. J Biomech 2019; 88:95-103. [PMID: 30928204 DOI: 10.1016/j.jbiomech.2019.03.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 03/06/2019] [Accepted: 03/16/2019] [Indexed: 12/11/2022]
Abstract
Characterization of hepatic blood flow magnitude and distribution can lead to a better understanding of the pathophysiology of liver disease. However, the underlying patterns and dynamics of hepatic flow, such as the helical flow structure that often develops following the spleno-mesenteric confluence (SMC) of the hepatic portal vein, have not yet been comprehensively studied. In this study, we used magnetic resonance image (MRI)-based computational models to study the effects of the helical flow structure and SMC geometry on portal blood flow distribution. Additionally, we examined these flow dynamics with four-dimensional (4D) flow MRI in a group of 12 cirrhotic patients and healthy subjects. A validation model was also created to compare computational data to particle image velocimetry (PIV) data. We found significant correlations between flow structure development, vessel geometry, and blood flow distribution in both virtually modified models and in healthy and cirrhotic subjects. However, the direction of these correlations varied among vessel configuration types. Nonetheless, validation model results displayed good qualitative agreement with computational model data.
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6
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Abstract
Color and spectral Doppler are used to evaluate flow characteristics in the portal and hepatic vessels. On occasion, suprahepatic pathologies are reflected in the flow characteristics of the hepatic veins and transmitted to the portal venous system across the hepatic sinusoids. Few definitive duplex findings are pathognomic for portal hypertension. Evaluation of the portal venous system is analogous to a puzzle. A picture of the processes can only be attained after many of the pieces are assembled.
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7
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Iranpour P, Lall C, Houshyar R, Helmy M, Yang A, Choi JI, Ward G, Goodwin SC. Altered Doppler flow patterns in cirrhosis patients: an overview. Ultrasonography 2015; 35:3-12. [PMID: 26169079 PMCID: PMC4701371 DOI: 10.14366/usg.15020] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 05/27/2015] [Accepted: 05/27/2015] [Indexed: 12/12/2022] Open
Abstract
Doppler ultrasonography of the hepatic vasculature is an integral part of evaluating precirrhotic and cirrhotic patients. While the reversal of the portal venous flow is a well-recognized phenomenon, other flow patterns, although not as easily understood, may play an important role in assessing the disease status. This article discusses the different characteristic flow patterns observed from the portal vein, hepatic artery, and hepatic vein in patients with liver cirrhosis or related complications and procedures. Knowledge of these different flow patterns provides additional information that may reinforce the diagnosis of cirrhosis, help in staging, and offer prognostic information for determining the direction of therapy. Doppler ultrasonography is invaluable when liver transplantation is being considered and aids in the diagnosis of cirrhosis and portal hypertension.
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Affiliation(s)
- Pooya Iranpour
- Department of Radiology, University of California Irvine, Orange, CA, USA
| | - Chandana Lall
- Department of Radiology, University of California Irvine, Orange, CA, USA
| | - Roozbeh Houshyar
- Department of Radiology, University of California Irvine, Orange, CA, USA
| | - Mohammad Helmy
- Department of Radiology, University of California Irvine, Orange, CA, USA
| | - Albert Yang
- Department of Radiology, University of California Irvine, Orange, CA, USA
| | - Joon-Il Choi
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Garrett Ward
- Department of Radiology, University of California Irvine, Orange, CA, USA
| | - Scott C Goodwin
- Department of Radiology, University of California Irvine, Orange, CA, USA
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Kokkalis E, Cookson AN, Stonebridge PA, Corner GA, Houston JG, Hoskins PR. Comparison of vortical structures induced by arteriovenous grafts using vector Doppler ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:760-774. [PMID: 25683221 DOI: 10.1016/j.ultrasmedbio.2014.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 08/18/2014] [Accepted: 10/18/2014] [Indexed: 06/04/2023]
Abstract
Arteriovenous prosthetic grafts are used in hemodialysis. Stenosis in the venous anastomosis is the main cause of occlusion and the role of local hemodynamics in this is considered significant. A new spiral graft design has been proposed to stabilize the flow phenomena in the host vein. Cross-flow vortical structures in the outflow of this graft were compared with those from a control device. Both grafts were integrated in identical in-house ultrasound-compatible flow phantoms with realistic surgical configurations. Constant flow rates were applied. In-plane 2-D velocity and vorticity mapping was developed using a vector Doppler technique. One or two vortices were detected for the spiral graft and two to four for the control, along with reduced stagnation points for the former. The in-plane peak velocity and circulation were calculated and found to be greater for the spiral device, implying increased in-plane mixing, which is believed to inhibit thrombosis and neo-intimal hyperplasia.
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Affiliation(s)
- Efstratios Kokkalis
- Institute for Medical Science and Technology, University of Dundee, Dundee, UK; Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
| | - Andrew N Cookson
- Department of Biomedical Engineering, King's College London, London, UK
| | - Peter A Stonebridge
- Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - George A Corner
- Medical Physics, Ninewells Hospital and Medical School, Dundee, UK
| | - J Graeme Houston
- Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Peter R Hoskins
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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Girometti R, Como G, Bazzocchi M, Zuiani C. Post-operative imaging in liver transplantation: State-of-the-art and future perspectives. World J Gastroenterol 2014; 20:6180-6200. [PMID: 24876739 PMCID: PMC4033456 DOI: 10.3748/wjg.v20.i20.6180] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
Orthotopic liver transplantation (OLT) represents a major treatment for end-stage chronic liver disease, as well as selected cases of hepatocellular carcinoma and acute liver failure. The ever-increasing development of imaging modalities significantly contributed, over the last decades, to the management of recipients both in the pre-operative and post-operative period, thus impacting on graft and patients survival. When properly used, imaging modalities such as ultrasound, multidetector computed tomography, magnetic resonance imaging (MRI) and procedures of direct cholangiography are capable to provide rapid and reliable recognition and treatment of vascular and biliary complications occurring after OLT. Less defined is the role for imaging in assessing primary graft dysfunction (including rejection) or chronic allograft disease after OLT, e.g., hepatitis C virus (HCV) recurrence. This paper: (1) describes specific characteristic of the above imaging modalities and the rationale for their use in clinical practice; (2) illustrates main imaging findings related to post-OLT complications in adult patients; and (3) reviews future perspectives emerging in the surveillance of recipients with HCV recurrence, with special emphasis on MRI.
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10
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Kokkalis E, Hoskins PR, Corner GA, Stonebridge PA, Doull AJ, Houston JG. Secondary flow in peripheral vascular prosthetic grafts using vector Doppler imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:2295-2307. [PMID: 24120412 DOI: 10.1016/j.ultrasmedbio.2013.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 06/25/2013] [Accepted: 07/29/2013] [Indexed: 06/02/2023]
Abstract
Prosthetic grafts are used for the treatment of peripheral arterial disease. Re-stenosis in the distal anastomosis of these grafts is a common reason for graft occlusion. The role of local hemodynamics in development of neo-intimal hyperplasia is well known. A new graft design has been proposed for the induction of optimized spiral flow in the host vessel. The secondary flow motions induced by this graft were compared with those of a control device. Both types of grafts were connected with vessel mimic and positioned in ultrasound flow phantoms with identical geometry. Constant flow rates were applied. Data collected in the cross-sectional view distal from the graft outflow and dual-beam vector Doppler was applied to create 2-D velocity maps. A single-spiral flow pattern was found for the flow-modified graft, and double or triple spirals for the control graft. In-plane maximum velocity was greater for the flow-modified graft than for the control device.
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Affiliation(s)
- Efstratios Kokkalis
- Institute for Medical Science and Technology, University of Dundee, Dundee, United Kingdom; Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom.
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11
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Confluent hepatic fibrosis in liver cirrhosis: possible relation with middle hepatic venous drainage. Jpn J Radiol 2013; 31:530-7. [DOI: 10.1007/s11604-013-0222-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 05/22/2013] [Indexed: 01/30/2023]
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12
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Cirrhotic right and left portal veins: how slow do they go? Identification of threshold velocities associated with subsequent development of hepatofugal flow. Ultrasound Q 2013; 29:131-5. [PMID: 23698619 DOI: 10.1097/ruq.0b013e3182915830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to identify threshold right and left portal vein sonographic velocities that are correlated with subsequent development of hepatofugal flow in the main portal vein (MPV), a marker of portal hypertension. METHODS A database containing 6019 Doppler liver ultrasound reports from an academic hospital was parsed using a Visual Basic computer algorithm. Right and left portal vein velocities were identified from 65 patients who developed hepatofugal MPV flow. Patients with a liver transplant or transjugular intrahepatic portosystemic shunt were excluded. Similarly, right and left portal vein velocities were identified from 195 patients free of chronic hepatic disease. The right and left portal vein velocities of these 2 groups were analyzed using a receiver operating characteristic curve to identify threshold velocities with the optimal sensitivity and specificity for patients who will develop hepatofugal flow in the MPV. RESULTS A threshold velocity of 11 cm/s in the right portal vein is associated with 81.8% sensitivity and 93.5% specificity in distinguishing patients who develop hepatofugal flow from otherwise healthy control subjects. Likewise, a threshold velocity of 8 cm/s in the left portal vein is associated with a 62.3% sensitivity and a 94.5% specificity. CONCLUSIONS A threshold right portal vein velocity of 11 cm/s can be used with high sensitivity and specificity to identify patients who may develop hepatofugal flow in the MPV. A left portal vein velocity less than 8 cm/s is 94.5% specific for the development of hepatofugal flow.
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Kraft G, Coate KC, Dardevet D, Farmer B, Donahue EP, Williams PE, Cherrington AD, Moore MC. Portal glucose delivery stimulates muscle but not liver protein metabolism. Am J Physiol Endocrinol Metab 2012; 303:E1202-11. [PMID: 23011060 PMCID: PMC3774325 DOI: 10.1152/ajpendo.00140.2012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Portal vein glucose delivery (the portal glucose signal) stimulates glucose uptake and glycogen storage by the liver, whereas portal amino acid (AA) delivery (the portal AA signal) induces an increase in protein synthesis by the liver. During a meal, both signals coexist and may interact. In this study, we compared the protein synthesis rates in the liver and muscle in response to portal or peripheral glucose infusion during intraportal infusion of a complete AA mixture. Dogs were surgically prepared with hepatic sampling catheters and flow probes. After a 42-h fast, they underwent a 3-h hyperinsulinemic (4× basal) hyperglucagonemic (3× basal) hyperglycemic (≈160 mg/dl) hyperaminoacidemic (hepatic load 1.5× basal; delivered intraportally) clamp (postprandial conditions). Glucose was infused either via a peripheral (PeG; n = 7) or the portal vein (PoG; n = 8). Protein synthesis was assessed with a primed, continuous [(14)C]leucine infusion. Net hepatic glucose uptake was stimulated by portal glucose infusion (+1 mg·kg(-1)·min(-1), P < 0.05) as expected, but hepatic fractional AA extraction and hepatic protein synthesis did not differ between groups. There was a lower arterial AA concentration in the PoG group (-19%, P < 0.05) and a significant stimulation (+30%) of muscle protein synthesis associated with increased expression of LAT1 and ASCT2 AA transporters and p70S6 phosphorylation. Concomitant portal glucose and AA delivery enhances skeletal muscle protein synthesis compared with peripheral glucose and portal AA delivery. These data suggest that enteral nutrition support may have an advantage over parenteral nutrition in stimulating muscle protein synthesis.
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Affiliation(s)
- Guillaume Kraft
- Dept. of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN 37232-6015, USA
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Shim JH, Yu JS, Chung JJ, Kim JH, Kim KW. Segmental difference of the hepatic fibrosis from chronic viral hepatitis due to hepatitis B versus C virus infection: comparison using dual contrast material-enhanced MRI. Korean J Radiol 2011; 12:431-8. [PMID: 21852903 PMCID: PMC3150670 DOI: 10.3348/kjr.2011.12.4.431] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Accepted: 03/02/2011] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE We wanted to identify the geographic differences in hepatic fibrosis and their associations with the atrophy-hypertrophy complex in patients with chronic viral hepatitis using the dual-contrast material-enhanced MRI (DC-MRI) with gadopentetate dimeglumine and ferucarbotran. MATERIALS AND METHODS Patients with chronic C (n = 22) and B-viral hepatitis (n = 35) were enrolled for determining the subjective grade of fibrosis (the extent and thickness of fibrotic reticulations) in the right lobe (RL), the caudate lobe (CL), the medial segment (MS) and the lateral segment (LS) of the liver, with using a 5-grade scale, on the gradient echo T2(*)-weighted images of DC-MRI. The fibrosis grades of different segments were compared using the Kruskal-Wallis test followed by post-hoc analysis to establish the segment-by-segment differences. The incidences of two pre-established morphologic signs of cirrhosis were also compared with each other between the two groups of patients. RESULTS There were significant intersegmental differences in fibrosis grades of the C-viral group (p = 0.005), and the CL showed lower fibrosis grades as compared with the grades of the RL and MS, whereas all lobes were similarly affected in the B-viral group (p = 0.221). The presence of a right posterior hepatic notch was significantly higher in the patients with intersegmental differences of fibrosis between the RL and the CL (19 out of 25, 76%) than those without such differences (6 out of 32, 19%) (p < 0.001). An expanded gallbladder fossa showed no significant relationship (p = 0.327) with the segmental difference of the fibrosis grades between the LS and the MS. CONCLUSION The relative lack of fibrosis in the CL with more advanced fibrosis in the RL can be a distinguishing feature to differentiate chronic C-viral hepatitis from chronic B-viral hepatitis and this is closely related to the presence of a right posterior hepatic notch.
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Affiliation(s)
- Jae Ho Shim
- Department of Radiology and the Research Institute of Radiological Science, Yonsei University College of Medicine, Gangnam Severance Hospital, 712 Eonjuro, Gangnam-Gu, Seoul, Korea
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15
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Ozaki K, Matsui O, Kobayashi S, Sanada J, Koda W, Minami T, Kawai K, Gabata T. Selective Atrophy of the Middle Hepatic Venous Drainage Area in Hepatitis C–related Cirrhotic Liver: Morphometric Study by Using Multidetector CT. Radiology 2010; 257:705-14. [DOI: 10.1148/radiol.10100468] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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16
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Yu JS, Shim JH, Chung JJ, Kim JH, Kim KW. Double contrast-enhanced MRI of viral hepatitis-induced cirrhosis: correlation of gross morphological signs with hepatic fibrosis. Br J Radiol 2009; 83:212-7. [PMID: 19505965 DOI: 10.1259/bjr/70974553] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The purpose of this study was to evaluate the diagnostic ability of the expanded gallbladder fossa and right posterior hepatic notch signs for hepatic fibrosis determined by double contrast-enhanced MRI. For patients with chronic viral hepatitis B (n = 96) or hepatitis C (n = 13) who underwent gadopentate dimeglumine-enhanced dynamic MRI followed by ferucarbotran-enhanced gradient-echo imaging, the degree of parenchymal fibrosis was categorised into three groups based on the extent of reticulation and nodularity: (1) pre-cirrhotic or minimal fibrosis; (2) mild to moderate fibrosis; (3) advanced cirrhosis. Each group was evaluated for the presence of a sharp notch in the posterior-medial surface of the right lobe of the liver and expanded gallbladder fossa. The expanded gallbladder fossa sign gradually increased with an increasing degree of fibrosis (Group 1, 50%; Group 2, 61%; Group 3, 78%), and there was no significant difference (p>0.5) between hepatitis B (67%) and C (73%). In the case of the right posterior hepatic notch sign, only 6% of Group 1 and Group 2 patients were positive; 27% of hepatitis B patients and 90% of hepatitis C patients in Group 3 exhibited the sign (p<0.05). Owing to its low prevalence, even in advanced cirrhosis, the right posterior hepatic notch sign is of little value in the diagnosis of cirrhosis due to chronic hepatitis B virus infection, whereas an expanded gallbladder fossa could be used as a non-specific indicator of early fibrosis before the gross appearance of advanced hepatic fibrosis.
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Affiliation(s)
- J S Yu
- Department of Radiology and the Research Institute of Radiological Science, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea.
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Abstract
Doppler sonography is frequently obtained in patients with chronic liver disease, patients with suspected portal hypertension, and patients with known portal hypertension. In this clinical setting, it is important to understand both the normal hemodynamics of the liver and the morphological and hemodynamic changes that occur with portal hypertension. Among the many findings of portal hypertension are enlargement of the portal vein, decreased portal vein velocity, increased congestion index, development of portosystemic collaterals, and reversal of portal vein flow. The most important portal systemic collaterals to focus on with Doppler are the coronary vein and the umbilical vein. Using all of these clues, it is possible to diagnose portal hypertension with a high degree of sensitivity and specificity in most patients.
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Portal Vein Embolization with Radiolabeled Polyvinyl Alcohol Particles in a Swine Model: Hepatic Distribution and Implications for Pancreatic Islet Cell Transplantation. Cardiovasc Intervent Radiol 2009; 32:499-507. [DOI: 10.1007/s00270-009-9544-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Revised: 01/13/2009] [Accepted: 01/28/2009] [Indexed: 11/26/2022]
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Spectrum of normal or near-normal sonographic findings after orthotopic liver transplantation. Ultrasound Q 2008; 24:257-65. [PMID: 19060715 DOI: 10.1097/ruq.0b013e3181896d40] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The initial imaging immediately after orthotopic liver transplantation is generally performed with ultrasound. Although significant posttransplant complications do occur, many abnormal findings including minor vascular waveform abnormalities, anastomotic mismatches, and fluid collections can be seen in asymptomatic patients. It is important to differentiate these benign findings from more serious complications to avoid unnecessary intervention.
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Affiliation(s)
- Kok Chye Tan
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Republic of Singapore.
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21
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Kruskal JB, Newman PA, Sammons LG, Kane RA. Optimizing Doppler and color flow US: application to hepatic sonography. Radiographics 2004; 24:657-75. [PMID: 15143220 DOI: 10.1148/rg.243035139] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In the imaging of patients with chronic liver disease or portal hypertension or who have undergone liver transplantation or surgery, accurate evaluation of the hepatic vasculature is usually necessary. Because Doppler ultrasonography (US) is capable of accurately characterizing the nature of flow within the major hepatic arteries and the portal and hepatic veins, it is widely used for imaging the liver vasculature. An informed choice of transducer and scanning techniques is important in the evaluation of the liver vasculature. In addition, there are a variety of operator-dependent technical parameters (eg, baseline, frame rate, wall filters, gain, velocity range, angle correction, gate size and position) that must be optimized when performing Doppler US of the liver. Changes in these parameters independently influence both the color and spectral components of the Doppler US examination; therefore, the parameters should be optimized separately for each patient. Failure to appropriately adjust these parameters may result in artifacts or misinterpretation of the study, which will frequently affect patient treatment. In contrast, knowledge of these operator-dependent parameters will permit optimization of the study and improve the overall utility of liver Doppler US.
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Affiliation(s)
- Jonathan B Kruskal
- Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Rd, Boston, MA 02215, USA.
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22
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Thein E, Becker M, Anetzberger H, Hammer C, Messmer K. Direct assessment and distribution of regional portal blood flow in the pig by means of fluorescent microspheres. J Appl Physiol (1985) 2003; 95:1808-16. [PMID: 12819221 DOI: 10.1152/japplphysiol.00362.2003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Measurement of regional organ blood flow by means of fluorescent microspheres (FM) is an accepted method. However, determination of regional portal blood flow (RPBF) cannot be performed by microspheres owing to the entrapment of the spheres in the upstream capillary bed of the splanchnic organs. We hypothesized that an adequate experimental setting would enable us to measure RPBF by means of FM and to analyze its distribution within the pig liver. A mixing chamber for the injection of FM was developed, and its capability to distribute FM homogeneously in the blood was evaluated in vitro. The chamber was implanted into the portal vein of six anesthetized pigs (23.5 +/- 2.9 kg body wt). Three consecutive, simultaneous injections of FM of two different colors into the chamber were performed. Reference portal blood samples were collected by means of a Harvard pump. At the end of the experiment, the liver was explanted and fixed in formalin before dissection. FM were isolated from the tissue samples by an automated process, and fluorescence intensity was determined. Comparison of 5,458 single RPBF values, determined by simultaneously injected FM, revealed good agreement (bias 2.5%, precision 12.7%) and high correlation (r = 0.97, r2 = 0,95, slope = 1.04, intercept = 0.05). Median RPBF was 1.07 +/- 0.78 ml x min(-1) x g(-1). Allocation of the blood flow values to the anatomic regions of the liver revealed a significantly higher RPBF (P = 0.01) in the liver tissue located close to the diaphragm compared with the rest of the organ and a significantly lower RPBF (P = 0.01) in the left liver lobe compared with the median and right lobes. The results show that the model presented makes it possible to measure RPBF by means of FM reliably and that RPBF is distributed heterogeneously in the porcine liver.
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Affiliation(s)
- E Thein
- Institute for Surgical Research, University of Munich, 81377 Munich, Germany.
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23
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Abstract
The current literature reflects controversy regarding the accuracy of Doppler ultrasound for the detection of transjugular intrahepatic portosystemic shunt (TIPS) malfunction. Experience has revealed many pitfalls and artifacts that can potentially interfere with the proper performance and interpretation of Doppler studies in patients with TIPS. In this article the author discusses and illustrates the spectrum of pitfalls that may be encountered during Doppler evaluation of TIPS function.
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24
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Affiliation(s)
- Hiroyuki Sugimoto
- Department of Surgery II, Nagoya University School of Medicine, Tsurumai-cho 65, Showa-ku, Nagoya, 466-8550, Japan
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25
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Abstract
Imaging studies are becoming essential in the management of orthotopic liver transplantation (LT). They have a very important role in the preoperative evaluation and selection of suitable candidates. At the same time, they are essential in the early detection of postoperative complications, the recognition of which allows the prompt institution of appropriate therapeutic measures. Timely recognition of complications improves the success of LT; furthermore, some complications can be treated with interventional radiologic procedures, avoiding additional surgery. This article reviews the current application of diagnostic and interventional imaging in liver transplantation, both for cadaveric and living donor transplants.
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Affiliation(s)
- Angeles García-Criado
- Ultrasound Unit, Diagnosing Imaging Center, Hospital Clínic, University of Barcelona, Villarroel, Spain
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26
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Wachsberg RH, Bahramipour P, Sofocleous CT, Barone A. Hepatofugal flow in the portal venous system: pathophysiology, imaging findings, and diagnostic pitfalls. Radiographics 2002; 22:123-40. [PMID: 11796903 DOI: 10.1148/radiographics.22.1.g02ja20123] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Hepatofugal flow (ie, flow directed away from the liver) is abnormal in any segment of the portal venous system and is more common than previously believed. Hepatofugal flow can be demonstrated at angiography, Doppler ultrasonography (US), magnetic resonance imaging, and computed tomography (CT). The current understanding of hepatofugal flow recognizes the role of the hepatic artery and the complementary phenomena of arterioportal and portosystemic venovenous shunting. Detection of hepatofugal flow is clinically important for diagnosis of portal hypertension, for determination of portosystemic shunt patency and overall prognosis in patients with cirrhosis, as a potential pitfall at invasive arteriography performed to evaluate the patency of the portal vein, and as a contraindication to specialized imaging procedures (ie, transarterial hepatic chemoembolization and CT during arterial portography). Hepatofugal flow is generally diagnosed at Doppler US without much difficulty, but radiologists should beware of pitfalls that can impede correct determination of flow direction in the portal venous system.
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Affiliation(s)
- Ronald H Wachsberg
- Department of Radiology, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, USA.
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27
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Abstract
The purpose of this study was to determine whether the finding of an enlarged hilar periportal space is a sign for early cirrhosis at magnetic resonance (MR) imaging. Forty-one pathologically proved cirrhotic patients in the early stage of disease who did not show conventional imaging findings of cirrhosis (early cirrhosis group) and 47 patients without history of chronic liver diseases (control group) were included in this study. MR images were qualitatively and quantitatively evaluated for the presence of enlargement of the periportal space. Enlargement of the periportal space was seen in 98% of patients in the early cirrhosis group, while this finding was seen in 11% of patients in the control group (P < 0.0001). The mean value of the hilar periportal fat thickness was significantly greater (P < 0.0001) in the early cirrhosis group (15.5 +/- 6.2 mm) than in the control group (5.3 +/- 3.1 mm). The sensitivity, specificity, accuracy, and positive predictive value of this finding for the MR diagnosis of cirrhosis with a cutoff value of 10 mm were 93%, 92%, 92%, and 91%, respectively. Enlargement of the hilar periportal space is a helpful sign at MR imaging in the discrimination between normal and early cirrhotic livers.
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Affiliation(s)
- K Ito
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA.
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28
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Abstract
Color Doppler sonography is an important modality in the non-invasive evaluation of the liver. It is commonly used to evaluate vascular changes which accompany cirrhosis. Doppler techniques are also used to evaluate patients who have undergone liver transplantation or transjugular intrahepatic portosystemic shunt (TIPS) placement. This review describes the various applications of color Doppler in hepatic imaging.
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Affiliation(s)
- R S Shapiro
- Department of Radiologoy, Mount Sinai Medical Center, City University of New York, NY 10029-6574, USA
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29
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Sonography of the right upper quadrant. Emerg Radiol 1997. [DOI: 10.1007/bf01451071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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