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Published on: February 25, 2022
Four-dimensional Flow MRI-based Computational Fluid Dynamics Simulation for Noninvasive Portosystemic Pressure
Christoph Riedel1, Marko Hoffmann1, Muhammad Ismahil1
1From 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.).
Noninvasive assessment of portosystemic pressure gradient (PSPG) in patients with cirrhosis and transjugular intrahepatic portosystemic shunt (TIPS) is feasible using four-dimensional (4D) flow MRI and computational fluid dynamics (CFD). This method shows strong correlation with invasive measurements, offering a risk-free alternative.
Area of Science:
- Medical Imaging
- Cardiovascular Imaging
- Interventional Radiology
Background:
- Transjugular intrahepatic portosystemic shunt (TIPS) dysfunction in cirrhosis patients requires accurate portosystemic pressure gradient (PSPG) measurement.
- Current assessment relies on invasive catheter venography, posing risks and costs.
- Noninvasive PSPG evaluation is needed to avoid these limitations.
Purpose of the Study:
- To demonstrate the feasibility of combining four-dimensional (4D) flow MRI and computational fluid dynamics (CFD) for noninvasive PSPG assessment.
- To evaluate this novel approach in patients with cirrhosis and TIPS.
Main Methods:
- Prospective abdominal 4D flow MRI in 20 participants with cirrhosis and TIPS.
- Segmentation of vessels (PV, TIPS, hepatic veins, IVC) for CFD mesh creation.
- CFD simulations to estimate noninvasive PSPG, compared with invasive venography.
Main Results:
- 4D flow MRI-CFD enabled visualization of flow and pressure within the TIPS and vasculature.
- Strong correlation (r=0.77, P<.001) between noninvasive PSPG estimates and invasive measurements.
- 80% accuracy in classifying post-TIPS PSPG >12 mm Hg.
Conclusions:
- The combination of 4D flow MRI and CFD is feasible for noninvasive PSPG assessment.
- This approach offers a viable, noninvasive alternative for evaluating portal hypertension in TIPS patients.
- Further validation may support its clinical adoption.
