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Case Reports
. 2021 Sep 1;20(3):231-235.
doi: 10.2463/mrms.ici.2020-0057. Epub 2020 Aug 12.

Portal Vein Stenosis Following Liver Transplantation Hemodynamically Assessed with 4D-flow MRI before and after Portal Vein Stenting

Ryota Hyodo  1 , Yasuo Takehara  1 , Takashi Mizuno  2 , Kazushige Ichikawa  2 , Yasuhiro Ogura  3 , Shinji Naganawa  1
Affiliations
Case Reports

Portal Vein Stenosis Following Liver Transplantation Hemodynamically Assessed with 4D-flow MRI before and after Portal Vein Stenting

Ryota Hyodo et al. Magn Reson Med Sci. .

Abstract

We present a case of a patient who underwent portal vein (PV) stenting for PV stenosis after a living-donor liver transplantation. A pretreatment 3D cine phase-contrast (4D-flow) MRI showed decreased, though hepatopetal, blood flow in the PV. After stenting, 4D-flow MRI confirmed an improvement in PV flow, with a more homogeneous flow distribution to each hepatic segment. 4D-flow MRI are valuable for understanding the hemodynamics of this area, planning for treatments, and evaluating the outcome of the interventions.

Keywords: 4D-flow MRI; living-donor liver transplantation; portal vein stenosis; portal vein stenting.

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Conflict of interest statement

Conflicts of Interest

The second author Yasuo Takehara is an endowed chair of Nagoya University supported by a private company Himedic Nagoya; however, the status is irrelevant to the contents of this paper. The other authors have no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Streamline analysis utilizing the velocity data obtained by 3D cine phase-contrast (4D-flow) MRI before the intervention. Severe stenosis was observed in the main portal trunk (arrowhead), and an increase in blood flow immediately before the stenosis was observed (encoded red portion). The flow volume of the portal trunk was 6.6 mL/s upstream of the stenosis (measured at the line). The coronary vein (inside the circle) was developed, and hepatofugal flow was observed inside. Post-stenotic dilation and vortex flow were observed in the anterior branch. P7 blood flow was relatively maintained, while the flow in other portal branches was reduced in volume. 4D-flow, 3D cine phase-contrast; AB, anterior branch of the portal vein; P7, posterior superior branch of the portal vein; SMV, superior mesenteric vein.
Fig. 2
Fig. 2
Streamline analysis using 4D-flow MRI after stent placement. High blood flow was observed in the main portal trunk, with a flow volume of 26.6 mL/s (measured at the line). Blood flow in the intrahepatic portal branches was homogeneously increased, with inconspicuous vortex flow in the anterior branch (arrow) and an improvement in blood flow disproportionality to each segmented portal vein. The blood flow in the coronary vein was markedly reduced (inside the circle), which reflected an improvement of portal hypertension. 4D-flow, 3D cine phase-contrast; AB, anterior branch of the portal vein.
See this image and copyright information in PMC

References

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