Porto-mesenteric four-dimensional flow MRI: a novel non-invasive technique for assessment of gastro-oesophageal varices.

IF 4.1 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Insights into Imaging Pub Date : 2024-09-27 DOI:10.1186/s13244-024-01805-6

Rasha Karam, Basma A Elged, Omar Elmetwally, Shahira El-Etreby, Mostafa Elmansy, Mohammed Elhawary

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Abstract

Objectives: To assess the role of 4D flow MRI in the assessment of gastro-oesophageal varices and in the prediction of high-risk varices in patients with chronic liver disease.

Methods: Thirty-eight patients diagnosed with either oesophageal or gastric varices were included in this single-centre prospective study. 4D flow MRI was used to calculate peak flow, average flow and peak velocity at the portal vein confluence (PV1) and hilum (PV2), splenic vein hilum (SV1) and confluence (SV2), and superior mesenteric vein (SMV). PV and SV fractional flow changes were also measured.

Results: ROC analysis revealed that both PV2 average flow and PV fractional average flow change had 100% sensitivity to predict high-risk patients with the PV fractional peak flow change having the widest area under the curve (AUC) and the highest specificity (92.3%). SV1 average flow, SV2 average flow, SV2 peak flow, and SV2 peak velocity increased significantly in patients with oesophageal compared to gastric varices included (p = 0.022, < 0.001, < 0.001 and 0.001, respectively).

Conclusion: Based on certain porto-mesenteric blood flow, velocity, and fractional flow change parameters, 4D flow MRI showed excellent performance in identifying high-risk patients and giving an idea about the grade and location of varices.

Critical relevance statement: Variceal bleeding is a major consequence of unidentified risky upper GI varices. Thus, by identifying and locating high-risk varices early, either oesophageal or gastric, using a non-invasive method like MRI, adverse events might be avoided.

Key points: 4D flow MRI can be used as a potential alternative for endoscopy to predict patients with high-risk varices. Based on portal vein fractional flow change, splenic flow and velocity, 4D MRI can predict and locate high-risk varices. Earlier identification of high-risk varices can allow for interventions to prevent adverse events.

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肠门四维血流磁共振成像：评估胃食管静脉曲张的新型无创技术。

目的评估四维血流 MRI 在评估慢性肝病患者胃食管静脉曲张和预测高风险静脉曲张中的作用：这项单中心前瞻性研究纳入了 38 名确诊为食管或胃静脉曲张的患者。采用四维血流磁共振成像计算门静脉汇合处（PV1）和腹端（PV2）、脾静脉腹端（SV1）和汇合处（SV2）以及肠系膜上静脉（SMV）的峰值血流、平均血流和峰值速度。同时还测量了PV和SV的分流量变化：ROC 分析显示，PV2 平均流量和 PV 分段平均流量变化预测高危患者的敏感性均为 100%，其中 PV 分段峰值流量变化的曲线下面积（AUC）最宽，特异性最高（92.3%）。与胃静脉曲张患者相比，食道静脉曲张患者的 SV1 平均血流量、SV2 平均血流量、SV2 峰值血流量和 SV2 峰值速度明显增加（P = 0.022，结论：食道静脉曲张患者的 SV1 平均血流量、SV2 平均血流量、SV2 峰值血流量和 SV2 峰值速度明显增加）：基于某些肠胃道血流、速度和分流变化参数，四维血流磁共振成像在识别高危患者以及了解静脉曲张的等级和位置方面表现出色：静脉曲张出血是不明高危上消化道静脉曲张的主要后果。因此，通过使用磁共振成像等无创方法及早识别和定位高危食道或胃静脉曲张，可避免不良事件的发生：四维血流磁共振成像可作为内窥镜检查的潜在替代方法，用于预测高危静脉曲张患者。基于门静脉分数流量变化、脾脏流量和速度，四维磁共振成像可预测和定位高危静脉曲张。及早发现高危静脉曲张可以采取干预措施，防止不良事件的发生。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Insights into Imaging Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

7.30

自引率

4.30%

发文量

182

审稿时长

13 weeks

期刊介绍： Insights into Imaging (I³) is a peer-reviewed open access journal published under the brand SpringerOpen. All content published in the journal is freely available online to anyone, anywhere! I³ continuously updates scientific knowledge and progress in best-practice standards in radiology through the publication of original articles and state-of-the-art reviews and opinions, along with recommendations and statements from the leading radiological societies in Europe. Founded by the European Society of Radiology (ESR), I³ creates a platform for educational material, guidelines and recommendations, and a forum for topics of controversy. A balanced combination of review articles, original papers, short communications from European radiological congresses and information on society matters makes I³ an indispensable source for current information in this field. I³ is owned by the ESR, however authors retain copyright to their article according to the Creative Commons Attribution License (see Copyright and License Agreement). All articles can be read, redistributed and reused for free, as long as the author of the original work is cited properly. The open access fees (article-processing charges) for this journal are kindly sponsored by ESR for all Members. The journal went open access in 2012, which means that all articles published since then are freely available online.