4D flow MRI-guided treatment of portal-hypertensive complications in a patient with multiple extrahepatic arterioportal shunts.

Autor: Riedel C; Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany. Electronic address: ch.riedel@uke.de., Bannas P; Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany., Lenz A; Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany., Ittrich H; Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany., Perez D; Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany., Adam G; Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany., Lohse AW; I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany., Kluwe J; I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany., Piecha F; I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany.
Jazyk: angličtina
Zdroj: Magnetic resonance imaging [Magn Reson Imaging] 2023 Sep; Vol. 101, pp. 54-56. Date of Electronic Publication: 2023 Apr 01.
DOI: 10.1016/j.mri.2023.03.018
Abstrakt: Portal hypertension is the underlying reason for complications like ascites or gastrointestinal varices in end-stage liver disease. On rare occasions, portal hypertension may be caused by extrahepatic arterioportal shunts. This report illustrates an outstanding case of extrahepatic arterioportal shunting as an uncommon cause of TIPS-refractory portal hypertension. Four-dimensional flow magnetic resonance imaging (4D flow MRI) is a novel non-invasive technique that enables the visualization of complex vascular disorders but has not been put into daily clinical practice in hepatology. In this case, 4D flow MRI enabled the visualization of three abdominal arterioportal shunts as the reason for TIPS-refractory portal hypertension. The quantification of individual shunt flow rates by 4D flow MRI guided our treatment strategy consisting of embolization during interventional angiography and surgical resection of all three arterioportal shunts. In conclusion, this case highlights the usefulness of 4D flow MRI for evaluating shunt flow in cases of complex vascular disorders and portal-hypertensive complications, thus helping to guide therapeutic decisions and monitoring the therapeutic success.
Competing Interests: Declaration of Competing Interest None.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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