Evaluation of the portal venous system before liver transplantation

Value of phase-contrast MR angiography

H. Vu Nghiem, T. C. Winter, M. C. Mountford, L. A. Mack, C. Yuan, D. M. Coldwell, S. J. Althaus, R. L. Carithers, John McVicar, P. C. Freeny

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

OBJECTIVE. The purpose of this study was to assess the accuracy of phase- contrast MR angiography with gasdolinium in evaluating the patency and blood flow direction of the portal venous system; the presence, extent, and type of varices; and the patency of surgical decompressive shunts in patients before liver transplantation. This information is essential in management and care of patients with chronic liver disease and portal hypertension and those who are candidates for liver transplantation. SUBJECTS AND METHODS. Twenty-four patients with portal venous hypertension were evaluated with phase-contrast MR angiography. Two patients had surgical splenorenal shunts and one had a mesocaval shunt. Phase-contrast angiograms were acquired as a series of two- dimensional sequential coronal sections during breath-holding and after IV administration of gadopentetate dimeglumine. Correlative findings from color flow Doppler sonography, contrast-enhanced CT scanning, and conventional angiography were available in 23, 20, and 10 g patients, respectively, and were used as standards. The images from each technique were analyzed independently for patency of and flow direction in the portal vein, splenic vein, superior mesenteric vein, and surgically created shunts, and for detection, distribution, and extent of five variceal groups. RESULTS. Findings from phase-contrast MR angiography completely agreed with those of sonography, CT scanning, and conventional angiography. The main portal vein was patent in 18 patients, stenosed in one, partially thrombosed in one, and occluded in four. Phase-contrast MR angiography correctly showed hepatofugal flow in three patients and hepatopetal flow in 17 patients. Both the splenic and superior mesenteric veins were patent in 20, partially thrombosed in one, and occluded in three cases. Phase-contrast MR angiograms showed 85% of the variceal groups, and MR rating of variceal size was not significantly different from that of CT rating. Phase-contrast MR angiography correctly showed the patency of all three surgical decompressive shunts. CONCLUSION. Phase-contrast MR angiography is accurate for evaluating the patency and flow direction of the portal venous system, detecting and determining the distribution and extent of varices, and assessing the patency of surgically created shunts. Therefore, it is a reliable and noninvasive technique that can provide crucial information in the preoperative workup of liver transplant recipients.

Original languageEnglish (US)
Pages (from-to)871-878
Number of pages8
JournalAmerican Journal of Roentgenology
Volume164
Issue number4
StatePublished - 1995
Externally publishedYes

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Portal System
Liver Transplantation
Angiography
Mesenteric Veins
Varicose Veins
Portal Hypertension
Portal Vein
Thrombosis
Surgical Splenorenal Shunt
Patient Care Management
Splenic Vein
Breath Holding
Doppler Color Ultrasonography
Gadolinium DTPA
Liver Diseases
Ultrasonography
Chronic Disease

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Vu Nghiem, H., Winter, T. C., Mountford, M. C., Mack, L. A., Yuan, C., Coldwell, D. M., ... Freeny, P. C. (1995). Evaluation of the portal venous system before liver transplantation: Value of phase-contrast MR angiography. American Journal of Roentgenology, 164(4), 871-878.

Evaluation of the portal venous system before liver transplantation : Value of phase-contrast MR angiography. / Vu Nghiem, H.; Winter, T. C.; Mountford, M. C.; Mack, L. A.; Yuan, C.; Coldwell, D. M.; Althaus, S. J.; Carithers, R. L.; McVicar, John; Freeny, P. C.

In: American Journal of Roentgenology, Vol. 164, No. 4, 1995, p. 871-878.

Research output: Contribution to journalArticle

Vu Nghiem, H, Winter, TC, Mountford, MC, Mack, LA, Yuan, C, Coldwell, DM, Althaus, SJ, Carithers, RL, McVicar, J & Freeny, PC 1995, 'Evaluation of the portal venous system before liver transplantation: Value of phase-contrast MR angiography', American Journal of Roentgenology, vol. 164, no. 4, pp. 871-878.
Vu Nghiem H, Winter TC, Mountford MC, Mack LA, Yuan C, Coldwell DM et al. Evaluation of the portal venous system before liver transplantation: Value of phase-contrast MR angiography. American Journal of Roentgenology. 1995;164(4):871-878.
Vu Nghiem, H. ; Winter, T. C. ; Mountford, M. C. ; Mack, L. A. ; Yuan, C. ; Coldwell, D. M. ; Althaus, S. J. ; Carithers, R. L. ; McVicar, John ; Freeny, P. C. / Evaluation of the portal venous system before liver transplantation : Value of phase-contrast MR angiography. In: American Journal of Roentgenology. 1995 ; Vol. 164, No. 4. pp. 871-878.
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abstract = "OBJECTIVE. The purpose of this study was to assess the accuracy of phase- contrast MR angiography with gasdolinium in evaluating the patency and blood flow direction of the portal venous system; the presence, extent, and type of varices; and the patency of surgical decompressive shunts in patients before liver transplantation. This information is essential in management and care of patients with chronic liver disease and portal hypertension and those who are candidates for liver transplantation. SUBJECTS AND METHODS. Twenty-four patients with portal venous hypertension were evaluated with phase-contrast MR angiography. Two patients had surgical splenorenal shunts and one had a mesocaval shunt. Phase-contrast angiograms were acquired as a series of two- dimensional sequential coronal sections during breath-holding and after IV administration of gadopentetate dimeglumine. Correlative findings from color flow Doppler sonography, contrast-enhanced CT scanning, and conventional angiography were available in 23, 20, and 10 g patients, respectively, and were used as standards. The images from each technique were analyzed independently for patency of and flow direction in the portal vein, splenic vein, superior mesenteric vein, and surgically created shunts, and for detection, distribution, and extent of five variceal groups. RESULTS. Findings from phase-contrast MR angiography completely agreed with those of sonography, CT scanning, and conventional angiography. The main portal vein was patent in 18 patients, stenosed in one, partially thrombosed in one, and occluded in four. Phase-contrast MR angiography correctly showed hepatofugal flow in three patients and hepatopetal flow in 17 patients. Both the splenic and superior mesenteric veins were patent in 20, partially thrombosed in one, and occluded in three cases. Phase-contrast MR angiograms showed 85{\%} of the variceal groups, and MR rating of variceal size was not significantly different from that of CT rating. Phase-contrast MR angiography correctly showed the patency of all three surgical decompressive shunts. CONCLUSION. Phase-contrast MR angiography is accurate for evaluating the patency and flow direction of the portal venous system, detecting and determining the distribution and extent of varices, and assessing the patency of surgically created shunts. Therefore, it is a reliable and noninvasive technique that can provide crucial information in the preoperative workup of liver transplant recipients.",
author = "{Vu Nghiem}, H. and Winter, {T. C.} and Mountford, {M. C.} and Mack, {L. A.} and C. Yuan and Coldwell, {D. M.} and Althaus, {S. J.} and Carithers, {R. L.} and John McVicar and Freeny, {P. C.}",
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T1 - Evaluation of the portal venous system before liver transplantation

T2 - Value of phase-contrast MR angiography

AU - Vu Nghiem, H.

AU - Winter, T. C.

AU - Mountford, M. C.

AU - Mack, L. A.

AU - Yuan, C.

AU - Coldwell, D. M.

AU - Althaus, S. J.

AU - Carithers, R. L.

AU - McVicar, John

AU - Freeny, P. C.

PY - 1995

Y1 - 1995

N2 - OBJECTIVE. The purpose of this study was to assess the accuracy of phase- contrast MR angiography with gasdolinium in evaluating the patency and blood flow direction of the portal venous system; the presence, extent, and type of varices; and the patency of surgical decompressive shunts in patients before liver transplantation. This information is essential in management and care of patients with chronic liver disease and portal hypertension and those who are candidates for liver transplantation. SUBJECTS AND METHODS. Twenty-four patients with portal venous hypertension were evaluated with phase-contrast MR angiography. Two patients had surgical splenorenal shunts and one had a mesocaval shunt. Phase-contrast angiograms were acquired as a series of two- dimensional sequential coronal sections during breath-holding and after IV administration of gadopentetate dimeglumine. Correlative findings from color flow Doppler sonography, contrast-enhanced CT scanning, and conventional angiography were available in 23, 20, and 10 g patients, respectively, and were used as standards. The images from each technique were analyzed independently for patency of and flow direction in the portal vein, splenic vein, superior mesenteric vein, and surgically created shunts, and for detection, distribution, and extent of five variceal groups. RESULTS. Findings from phase-contrast MR angiography completely agreed with those of sonography, CT scanning, and conventional angiography. The main portal vein was patent in 18 patients, stenosed in one, partially thrombosed in one, and occluded in four. Phase-contrast MR angiography correctly showed hepatofugal flow in three patients and hepatopetal flow in 17 patients. Both the splenic and superior mesenteric veins were patent in 20, partially thrombosed in one, and occluded in three cases. Phase-contrast MR angiograms showed 85% of the variceal groups, and MR rating of variceal size was not significantly different from that of CT rating. Phase-contrast MR angiography correctly showed the patency of all three surgical decompressive shunts. CONCLUSION. Phase-contrast MR angiography is accurate for evaluating the patency and flow direction of the portal venous system, detecting and determining the distribution and extent of varices, and assessing the patency of surgically created shunts. Therefore, it is a reliable and noninvasive technique that can provide crucial information in the preoperative workup of liver transplant recipients.

AB - OBJECTIVE. The purpose of this study was to assess the accuracy of phase- contrast MR angiography with gasdolinium in evaluating the patency and blood flow direction of the portal venous system; the presence, extent, and type of varices; and the patency of surgical decompressive shunts in patients before liver transplantation. This information is essential in management and care of patients with chronic liver disease and portal hypertension and those who are candidates for liver transplantation. SUBJECTS AND METHODS. Twenty-four patients with portal venous hypertension were evaluated with phase-contrast MR angiography. Two patients had surgical splenorenal shunts and one had a mesocaval shunt. Phase-contrast angiograms were acquired as a series of two- dimensional sequential coronal sections during breath-holding and after IV administration of gadopentetate dimeglumine. Correlative findings from color flow Doppler sonography, contrast-enhanced CT scanning, and conventional angiography were available in 23, 20, and 10 g patients, respectively, and were used as standards. The images from each technique were analyzed independently for patency of and flow direction in the portal vein, splenic vein, superior mesenteric vein, and surgically created shunts, and for detection, distribution, and extent of five variceal groups. RESULTS. Findings from phase-contrast MR angiography completely agreed with those of sonography, CT scanning, and conventional angiography. The main portal vein was patent in 18 patients, stenosed in one, partially thrombosed in one, and occluded in four. Phase-contrast MR angiography correctly showed hepatofugal flow in three patients and hepatopetal flow in 17 patients. Both the splenic and superior mesenteric veins were patent in 20, partially thrombosed in one, and occluded in three cases. Phase-contrast MR angiograms showed 85% of the variceal groups, and MR rating of variceal size was not significantly different from that of CT rating. Phase-contrast MR angiography correctly showed the patency of all three surgical decompressive shunts. CONCLUSION. Phase-contrast MR angiography is accurate for evaluating the patency and flow direction of the portal venous system, detecting and determining the distribution and extent of varices, and assessing the patency of surgically created shunts. Therefore, it is a reliable and noninvasive technique that can provide crucial information in the preoperative workup of liver transplant recipients.

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