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1.
J Vasc Interv Radiol ; 31(12): 2081-2088, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33261743

RESUMO

PURPOSE: To quantitatively analyze the impact of intrahepatic venovenous shunt (IHVS) on hepatic venous pressure gradient (HVPG) measurement. MATERIALS AND METHODS: From 2015 to 2019, 222 HVPG measurements performed during transjugular intrahepatic portosystemic shunt creation were eligible for this study. Digital subtraction angiography (DSA) software color-coded each pixel of a two-dimensional DSA series by time-intensity curve to classify IHVS. Different degrees of IHVS were found in 36.5% of patients (81/222). Mild IHVS was found in 10.8% of patients (24/222), moderate IHVS was found in 10.8% of patients (24/222), and severe IVHS was found in 14.9% of patients (33/222). RESULTS: Mean wedged hepatic vein pressure (WHVP) and HVPG were significantly lower in patients with IHVS compared with patients without IHVS (WHVP: 17.78 mm Hg ± 7.00 vs 24.89 mm Hg ± 8.69, P = .001; HVPG: 11.93 mm Hg ± 5.76 vs 18.6 mm Hg ± 6.85, P < .001). Mild IHVS had little effect on WHVP and HVPG. Mean WHVP and HVPG were 11 mm Hg lower in patients with moderate IHVS (WHVP: 20.38 mm Hg ± 8.38 vs 31.5 mm Hg ± 9.39, P = .026; HVPG: 13.88 mm Hg ± 6.33 vs 25.00 mm Hg ± 9.81, P < .001) and 15 mm Hg lower in patients with severe IHVS (WHVP: 13.45 mm Hg ± 5.28 vs 28.64 mm Hg ± 6.38, P = .017; HVPG: 8.27 mm Hg ± 3.85 vs 23.45 mm Hg ± 6.95, P < .001) than mean portal vein pressure and portal vein gradient. CONCLUSIONS: For patients with moderate or severe IHVS, HVPG might greatly underestimate the actual value of portal vein pressure, and the portal vein should be catheterized to measure portal pressure.


Assuntos
Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/cirurgia , Veias Hepáticas/cirurgia , Hipertensão Portal/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática , Pressão Venosa , Adulto , Idoso , Angiografia Digital , Angiografia por Tomografia Computadorizada , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Varizes Esofágicas e Gástricas/fisiopatologia , Feminino , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/fisiopatologia , Veias Hepáticas/diagnóstico por imagem , Veias Hepáticas/fisiopatologia , Humanos , Hipertensão Portal/diagnóstico por imagem , Hipertensão Portal/fisiopatologia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Flebografia , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento
2.
J Vasc Interv Radiol ; 31(12): 2098-2103, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33261744

RESUMO

PURPOSE: To investigate an augmented reality (AR)-guided endovascular puncture to facilitate successful transjugular intrahepatic portosystemic shunt (TIPS). MATERIALS AND METHODS: An AR navigation system for TIPS was designed. Three-dimensional (3D) liver models including portal and hepatic vein anatomy were extracted from preoperative CT images. The 3D models, intraoperative subjects, and electromagnetic tracking information of the puncture needles were integrated through the system calibration. In the AR head-mounted display, the 3D models were overlaid on the subjects, which was a liver phantom in the first phase and live beagle dogs in the second phase. One life-size liver phantom and 9 beagle dogs were used in the experiments. Imaging after puncture was performed to validate whether the needle tip accessed the target hepatic vein successfully. RESULTS: Endovascular punctures of the portal vein of the liver phantom were repeated 30 times under the guidance of the AR system, and the puncture needle successfully accessed the target vein during each attempt. In the experiments of live canine subjects, the punctures were successful in 2 attempts in 7 beagle dogs and in 1 attempt in the remaining 2 dogs. The puncture time of needle from hepatic vein to portal vein was 5-10 s in the phantom experiments and 10-30 s in the canine experiments. CONCLUSIONS: The feasibility of AR-based navigation facilitating accurate and successful portal vein access in preclinical models of TIPS was validated.


Assuntos
Realidade Aumentada , Procedimentos Endovasculares/instrumentação , Veias Hepáticas/cirurgia , Veia Porta/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática , Radiografia Intervencionista , Cirurgia Assistida por Computador/instrumentação , Animais , Angiografia por Tomografia Computadorizada , Cães , Estudos de Viabilidade , Veias Hepáticas/diagnóstico por imagem , Humanos , Modelos Animais , Flebografia , Veia Porta/diagnóstico por imagem , Derivação Portossistêmica Transjugular Intra-Hepática/instrumentação , Valor Preditivo dos Testes , Punções , Radiografia Intervencionista/instrumentação , Óculos Inteligentes
3.
J Vasc Interv Radiol ; 31(12): 2033-2042.e1, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33267950

RESUMO

PURPOSE: To examine predictors of midterm occlusion in portal and hepatic veins within or adjacent to the ablation zone after irreversible electroporation (IRE) of liver tumors. MATERIALS AND METHODS: This retrospective cohort analysis included 39 patients who underwent CT-guided IRE of liver tumors. Vessels within or adjacent to the ablation zone were identified on CT images acquired immediately after the procedure, and the positional relationships with the ablation zone (within/adjacent), locations (proximal/distal), and diameters (< 4 mm or ≥ 4 mm) were evaluated. Using contrast-enhanced follow-up scans, each vessel was classified as patent, stenosed, or occluded. Associations between vessel occlusion and each variable were investigated. RESULTS: Overall, 33 portal veins and 64 hepatic veins were analyzed. Follow-up scans showed occlusion in 12/33 (36.7%) portal veins and 17/64 (26.6%) hepatic veins. Vessels within the ablation zone were occluded significantly more frequently than vessels adjacent to the ablation zone (portal: 55.6% [10/18] vs 13.3% [2/15], P = .04; hepatic: 45.4% [15/33] vs 6.4% [2/31], P = .011). Vessels with a diameter < 4 mm were also occluded significantly more frequently than vessels with a diameter ≥ 4 mm (portal: 72.7% [8/11] vs 18.1% [4/22], P = .011; hepatic: 54.8% [17/31] vs 0% [0/33], P < .001). The respective positive and negative predictive values for occlusion of vessels categorized as both within and < 4 mm were 88% (7/8) and 82% (20/25) for portal veins and 79% (15/19) and 96% (43/45) for hepatic veins. CONCLUSIONS: Midterm vessel occlusion after liver IRE could be predicted with relatively high accuracy by assessing ablation location and vessel diameter.


Assuntos
Técnicas de Ablação/efeitos adversos , Eletroporação , Veias Hepáticas , Neoplasias Hepáticas/cirurgia , Veia Porta , Doenças Vasculares/etiologia , Adulto , Idoso , Constrição Patológica , Feminino , Veias Hepáticas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Veia Porta/diagnóstico por imagem , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Doenças Vasculares/diagnóstico por imagem
7.
J Clin Ultrasound ; 48(7): 416-418, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32602135

RESUMO

Liver herniation commonly associated with omphalocele occurs in only approximately 2.3% to 16% of fetuses with gastroschisis. Liver herniation in such cases is associated with considerably decreased survival rates (43% vs 97% with or without liver herniation, respectively). Rarely, abnormally positioned fetal hepatic vasculature has been reported mainly in association with congenital diaphragmatic hernia. In these rare cases, intrathoracic depiction of hepatic venous vasculature has assisted in confirming intrathoracic displacement of the fetal liver. We present a case of a large gastroschisis with complete herniation of the fetal liver in which prenatal sonography depicted an extracorporeal ductus venosus.


Assuntos
Gastrosquise/etiologia , Veias Hepáticas/diagnóstico por imagem , Hérnia Umbilical/complicações , Fígado/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Adolescente , Feminino , Gastrosquise/diagnóstico , Gastrosquise/embriologia , Hérnia Umbilical/diagnóstico , Hérnia Umbilical/embriologia , Humanos , Gravidez
8.
Vet Radiol Ultrasound ; 61(5): 519-530, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32663370

RESUMO

Congenital intrahepatic portosystemic shunts (IHPSS) in dogs are traditionally classified as right, left, or central divisional. There are few descriptive studies regarding the variation of IHPSS within these categories. This multicenter, analytical, cross-sectional study aimed to describe a large series of dogs with CT angiography (CTA) of IHPSS, hypothesizing that there would be variation to the existing classification. Ninety CTA studies were assessed for IHPSS type, insertion, and the relationship of the insertion to the primary hepatic veins. Ninety-two percent of IHPSS inserted into a primary hepatic vein (HV) or phrenic vein, 8% inserted directly into the ventral aspect of the intrahepatic caudal vena cava. The most common IHPSS type was a single right divisional (44%), including those inserting via the right lateral HV or the caudate HV. Left divisional IHPSS (33%) inserted into the left HV or left phrenic vein. Central divisional IHPSS (13%) inserted into the quadrate HV, central HV, dorsal right medial HV, or directly into the ventral aspect of the intrahepatic caudal vena cava. Multiple sites of insertion were seen in 9% of dogs. Within left, central, and right divisional types, further subclassifications can therefore commonly be defined based on the hepatic veins with which the shunting vessel communicates. Relating IHPSS morphology to the receiving primary HV could make IHPSS categorization more consistent and may influence the type and method of IHPSS attenuation recommended.


Assuntos
Angiografia por Tomografia Computadorizada/veterinária , Cães/cirurgia , Veias Hepáticas/diagnóstico por imagem , Derivação Portossistêmica Transjugular Intra-Hepática/veterinária , Veia Cava Inferior/diagnóstico por imagem , Animais , Feminino , Veias Hepáticas/cirurgia , Masculino , Derivação Portossistêmica Transjugular Intra-Hepática/estatística & dados numéricos , Veia Cava Inferior/cirurgia
11.
J Clin Ultrasound ; 48(5): 254-262, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32237150

RESUMO

PURPOSE: Acute pulmonary embolism (APE) is a life-threating cardiothoracic thromboembolic emergency in which right ventricle dysfunction (RVD) is a major concern. In the present study, we examined the hepatic veins (HVs) blood flow with pulsed-wave spectral Doppler ultrasonography to determine its relationship with the simplified pulmonary embolism severity index (sPESI) and the patient's RVD status. METHODS: We divided the 243 patients who met the inclusion criteria into two groups based on both their sPESI scores and their RVD status. Transthoracic echocardiography was performed to evaluate the RVD and the HVs within 1 hour after patient admission. The liver was evaluated using subcostal and intercostal echocardiographic windows in grayscale B-mode, and HVs were assessed using color and spectral Doppler assessment though the same echocardiographic windows. RESULT: A cut-off value of the systolic reverse flow velocity-time integral (SrVTI) = 2.2 cm carried a sensitivity and specificity of 84.29% and 74.89%, respectively, for the prediction of sPESI ≥ 1. A SrVTI cut-off value of 2.1 cm yielded a sensitivity and specificity of 83.03% and 73.91%, respectively, for the prediction of RVD. CONCLUSION: HV Doppler assessment could be a useful method for anticipating the sPESI and the presence of RVD in patients with APE. In addition, it may provide information regarding the hemodynamic impact of APE.


Assuntos
Veias Hepáticas/diagnóstico por imagem , Embolia Pulmonar/complicações , Ultrassonografia Doppler/métodos , Disfunção Ventricular Direita/complicações , Disfunção Ventricular Direita/diagnóstico , Feminino , Ventrículos do Coração/fisiopatologia , Veias Hepáticas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Embolia Pulmonar/fisiopatologia , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Disfunção Ventricular Direita/fisiopatologia
12.
J Vasc Interv Radiol ; 31(10): 1691-1696.e1, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32178944

RESUMO

PURPOSE: To characterize the effect of hepatic vessel flow using 4-dimensional (4D) flow magnetic resonance (MR) imaging and correlate their effect on microwave ablation volumes in an in vivo non-cirrhotic porcine liver model. MATERIALS AND METHODS: Microwave ablation antennas were placed under ultrasound guidance in each liver lobe of swine (n = 3 in each animal) for a total of 9 ablations. Pre- and post-ablation 4D flow MR imaging was acquired to quantify flow changes in the hepatic vasculature. Flow measurements, along with encompassed vessel size and vessel-antenna spacing, were then correlated with final ablation volume from segmented MR images. RESULTS: The linear regression model demonstrated that the preablation measurement of encompassed hepatic vein size (ß = -0.80 ± 0.25, 95% confidence interval [CI] -1.15 to -0.22; P = .02) was significantly correlated to final ablation zone volume. The addition of hepatic vein flow rate found via 4D flow MRI (ß = -0.83 ± 0.65, 95% CI -2.50 to 0.84; P = .26), and distance from antenna to hepatic vein (ß = 0.26 ± 0.26, 95% CI -0.40 to 0.92; P = .36) improved the model accuracy but not significantly so (multivariate adjusted R2 = 0.70 vs univariate (vessel size) adjusted R2 = 0.63, P = .24). CONCLUSIONS: Hepatic vein size in an encompassed ablation zone was found to be significantly correlated with final ablation zone volume. Although the univariate 4D flow MR imaging-acquired measurements alone were not found to be statistically significant, its addition to hepatic vein size improved the accuracy of the ablation volume regression model. Pre-ablation 4D flow MR imaging of the liver may assist in prospectively optimizing thermal ablation treatment.


Assuntos
Técnicas de Ablação , Veias Hepáticas/diagnóstico por imagem , Circulação Hepática , Fígado/irrigação sanguínea , Fígado/cirurgia , Imagem Cinética por Ressonância Magnética , Micro-Ondas , Imagem de Perfusão/métodos , Animais , Velocidade do Fluxo Sanguíneo , Estudos de Viabilidade , Veias Hepáticas/fisiopatologia , Modelos Animais , Valor Preditivo dos Testes , Sus scrofa
13.
World J Gastroenterol ; 26(7): 706-716, 2020 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-32116418

RESUMO

BACKGROUND: Hepatic sinusoidal obstruction syndrome (SOS) is caused by damage to hepatic sinusoidal endothelial cells that results in fibrous obliteration of intrahepatic venules and necrosis of hepatocytes. Currently the diagnosis is primarily based on nonspecific clinical features and invasive liver biopsy. Therefore, noninvasive imaging methods are required for the early diagnosis and severity assessment of hepatic SOS. AIM: To determine the effectiveness of supersonic shear wave imaging (SSI) and dual energy computed tomography (DECT) for diagnosing hepatic SOS using a rabbit model. METHODS: Among nine New Zealand white rabbits (3-4 kg, male), three in control group ingested normal saline for 20 d and six in the SOS group ingested 6-thioguanine (5 mg/kg/d) for 20 d. Liver stiffness was measured using SSI on days 0, 3, 10, and 20. On the same days, liver perfusion was evaluated from virtual monochromatic images of 55 keV and iodine map using DECT. Morphologic changes in the liver were assessed using CT. Final pathology scores were compared between the two groups. Liver stiffness and perfusion parameters were compared according to the groups, days, and pathology scores. RESULTS: Final pathology scores were significantly higher in the SOS than the control group (median 22 vs 2, P = 0.024). No gross morphologic changes were seen in livers. Liver stiffness, Hounsfield Unit values, and iodine concentrations were higher in the SOS compared to the control group on days 10 and 20 (all, P ≤ 0.007). Compared to day 0, liver stiffness and perfusion parameters were higher on day 20 in the SOS group (all, P ≤ 0.001). Correlation coefficients for liver stiffness (r = 0.635), Hounsfield Unit values (r = 0.587), and iodine concentration (r = 0.611) with final pathology scores were positive without significance (all, P > 0.05). CONCLUSION: Liver stiffness and perfusion parameters were significantly increased in the livers of a rabbit SOS model. SSI and DECT might aid in early diagnosis of hepatic SOS.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Hepatopatia Veno-Oclusiva/diagnóstico por imagem , Fígado/diagnóstico por imagem , Imagem de Perfusão/métodos , Tomografia Computadorizada por Raios X/métodos , Animais , Modelos Animais de Doenças , Células Endoteliais/patologia , Veias Hepáticas/diagnóstico por imagem , Hepatopatia Veno-Oclusiva/patologia , Hepatócitos/patologia , Fígado/irrigação sanguínea , Fígado/patologia , Masculino , Fluxo Pulsátil , Coelhos , Rigidez Vascular
16.
J Vet Intern Med ; 34(1): 45-52, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31875342

RESUMO

BACKGROUND: Spectral Doppler assessment of hepatic veins may provide information on heart function. HYPOTHESIS/OBJECTIVES: To assess the normal pattern of hepatic venous flow using spectral Doppler ultrasound examination; to correlate this information with structural and functional variables of the right ventricle (RV), and to analyze the impact of age, sex, body weight quartiles, heart rate, cardiac rhythm, and systolic arterial pressure on the results in healthy dogs. ANIMALS: Sixty-five healthy dogs. METHODS: Cross-sectional observational study. The direction and maximum velocity of each of the 4 possible components of venous flow were determined from pulsed-wave Doppler examination of the hepatic veins. In addition, structural and functional parameters (TAPSE, longitudinal strain, FAC%, S', Et /At, and E't / A't ) of the RV were evaluated. RESULTS: The same phase patterns for different waves were seen in all animals: A and V were retrograde waves, and S and D were anterograde waves. The velocity of the spectral waves increased with body weight (P < .05) and could be correlated with functional indices of the RV. A significant difference was found when comparing morphometric indices with body weight quartiles (P < .05). In addition, intra-and inter-observer assessments showed low variability. The mean duration of the examinations was 5.2 minutes. CONCLUSIONS AND CLINICAL IMPORTANCE: Hepatic spectral Doppler findings can be correlated with systolic and diastolic indices of the RV and vary with body weight.


Assuntos
Cães/anatomia & histologia , Ventrículos do Coração/diagnóstico por imagem , Veias Hepáticas/diagnóstico por imagem , Fígado/irrigação sanguínea , Ultrassonografia Doppler/veterinária , Função Ventricular/fisiologia , Envelhecimento , Animais , Tamanho Corporal , Estudos Transversais , Feminino , Masculino
17.
Curr Probl Diagn Radiol ; 49(1): 64-66, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-29674011

RESUMO

Congenital intrahepatic portosystemic venous shunts (CIPVS) are rare anomalies that can be detected before birth or in early infancy or later in life. Symptomatic shunts are treated as they carry high risk of complications like hepatic encephalopathy. Various treatment options include surgery, endovascular embolization, and percutaneous closure devices. We treated 2 infants with CIPVS successfully by endovascular embolization of the shunt using vascular plug through transjugular route. Transabdominal ultrasound guidance in addition to fluoroscopy was used at the time of vascular plug placement. We emphasize that the use of transabdominal ultrasound during endovascular occlusion enhances the safety and technical success rate.


Assuntos
Procedimentos Endovasculares/métodos , Veias Hepáticas/anormalidades , Veia Porta/anormalidades , Radiografia Intervencionista/métodos , Ultrassonografia de Intervenção/métodos , Fístula Vascular/congênito , Fístula Vascular/terapia , Fluoroscopia/métodos , Veias Hepáticas/diagnóstico por imagem , Humanos , Lactente , Recém-Nascido , Masculino , Veia Porta/diagnóstico por imagem , Resultado do Tratamento , Fístula Vascular/diagnóstico por imagem
18.
Vasc Endovascular Surg ; 54(1): 36-41, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31570064

RESUMO

OBJECTIVES: Although traumatic injuries to the superior mesenteric vein (SMV), portal vein (PV), and hepatic vein (HV) are rare, their impact is significant. Small single center reports estimate mortality rates ranging from 29% to 100%. Our aim is to elucidate the incidence and outcomes associated with each injury due to unique anatomic positioning and varied tolerance of ligation. We hypothesize that SMV injury is associated with a lower risk of mortality compared to HV and PV injury in adult trauma patients. METHODS: The Trauma Quality Improvement Program database (2010-2016) was queried for patients with injury to either the SMV, PV, or HV. A multivariable logistic regression model was used for analysis. RESULTS: From 1,403,466 patients, 966 (0.07%) had a single major hepatoportal venous injury with 460 (47.6%) involving the SMV, 281 (29.1%) involving the PV, and 225 (23.3%) involving the HV. There was no difference in the percentage of patients undergoing repair or ligation between SMV, PV, and HV injuries (P > .05). Compared to those with PV and HV injuries, patients with SMV injury had a higher rate of concurrent bowel resection (38.5% vs 12.1% vs 7.6%, P < .001) and lower mortality (33.3% vs 45.9% vs 49.3%, P < .01). After controlling for covariates, traumatic SMV injury increased the risk of mortality (odds ratio [OR] 1.59, confidence interval [CI] = 1.00-2.54, P = .05) in adult trauma patients; however, this was less than PV injury (OR = 2.77, CI = 1.56-4.93, P = .001) and HV injury (OR = 2.70, CI = 1.46-4.99, P = .002). CONCLUSION: Traumatic SMV injury had a lower rate of mortality compared to injuries of the HV and PV. SMV injury increased the risk of mortality by 60% in adult trauma patients, whereas PV and HV injuries nearly tripled the risk of mortality.


Assuntos
Veias Hepáticas/lesões , Veia Porta/lesões , Lesões do Sistema Vascular/epidemiologia , Adolescente , Adulto , Criança , Bases de Dados Factuais , Feminino , Veias Hepáticas/diagnóstico por imagem , Veias Hepáticas/cirurgia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Veia Porta/diagnóstico por imagem , Veia Porta/cirurgia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/mortalidade , Lesões do Sistema Vascular/cirurgia , Adulto Jovem
19.
Magn Reson Med Sci ; 19(2): 99-107, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31061270

RESUMO

PURPOSE: Post-contrast liver magnetic resonance imaging is typically performed with breath-hold 3D gradient echo sequences. However, breath-holding for >10 s is difficult for some patients. In this study, we compared the quality of hepatobiliary phase (HBP) imaging without breath-holding using the prototype pulse sequences stack-of-stars liver acquisition with volume acceleration (LAVA) (LAVA Star) with or without navigator echoes (LAVA Starnavi+ and LAVA Starnavi-) and Cartesian LAVA with navigator echoes (Cartesian LAVAnavi+). METHODS: Seventy-two patients were included in this single-center, retrospective, cross-sectional study. HBP imaging using the three LAVA sequences (Cartesian LAVAnavi+, LAVA Starnavi-, and LAVA Starnavi+) without breath-holding was performed for all patients using a 3T magnetic resonance system. Two independent radiologists qualitatively analyzed (overall image quality, liver edge sharpness, hepatic vein clarity, streak artifacts, and respiratory motion/pulsation artifacts) HBP images taken by the three sequences using a five-point scale. Quantitative evaluations were also performed by calculating the liver-to-spleen, -lesion, and -portal vein (PV) signal intensity ratios. The results were compared between the three sequences using the Friedman test. RESULTS: LAVA Starnavi+ showed the best image quality and hepatic vein clarity (P < 0.0001). LAVA Starnavi- showed the lowest image quality (P < 0.0001-0.0106). LAVA Starnavi+ images showed fewer streak artifacts than LAVA Starnavi- images (P < 0.0001), while Cartesian LAVAnavi+ images showed no streak artifacts. Cartesian LAVAnavi+ images showed stronger respiratory motion/pulsation artifacts than the others (P < 0.0001). LAVA Starnavi- images showed the highest liver-to-spleen ratios (P < 0.0001-0.0005). Cartesian LAVAnavi+ images showed the lowest liver-to-lesion and -PV ratios (P < 0.0001-0.0108). CONCLUSION: In terms of image quality, the combination of stack-of-stars acquisition and navigator echoes is the best for HBP imaging without breath-holding.


Assuntos
Veias Hepáticas/diagnóstico por imagem , Processamento de Imagem Assistida por Computador/métodos , Fígado/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Artefatos , Meios de Contraste , Humanos , Fígado/irrigação sanguínea , Estudos Retrospectivos
20.
Int J Med Sci ; 16(12): 1614-1620, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31839749

RESUMO

Background: To examine the incidence of cirrhosis patients with high-risk esophageal varices (EV) who show hepatic venous pressure gradient (HVPG) < 10 mmHg and to identify their hemodynamic features. Methods: This prospective study consisted of 110 cirrhosis patients with EV, all with the candidate for primary or secondary prophylaxis. Sixty-one patients had red sign, and 49 patients were bleeders. All patients underwent both Doppler ultrasound and HVPG measurement. Results: There were 18 patients (16.4%) with HVPG < 10 mmHg. The presence of venous-venous communication (VVC) was more frequent in patients with HVPG < 10 mmHg (10/18) than in those with HVPG ≥ 10 mmHg (19/92; p = 0.0021). The flow volume in the left gastric vein (LGV) and the incidence of red sign were higher in the former (251.9 ± 150.6 mL/min; 16/18) than in the latter (181 ± 100.5 mL/min, p = 0.02; 45/92; p = 0.0018). The patients with red sign had lower HVPG (13.3 ± 4.5) but advanced LGV hemodynamics (velocity 13.2 ± 3.8 cm/s; flow volume 217.5 ± 126.6 mL/min), whereas those without red sign had higher HVPG (16.2 ± 4.6, p = 0.001) but poorer LGV hemodynamics (10.9 ± 2.3, p = 0.002; 160.1 ± 83.1, p = 0.02). Conclusion: Patients with high-risk EV with HVPG < 10 mmHg showed 16.4% incidence. Although low HVPG may be underestimated by the presence of VVC, the increased LGV hemodynamics compensates for the severity of portal hypertension, which may contribute to the development of red sign.


Assuntos
Varizes Esofágicas e Gástricas/fisiopatologia , Fibrose/fisiopatologia , Veias Hepáticas/fisiopatologia , Fígado/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo/métodos , Endoscopia/métodos , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Feminino , Fibrose/complicações , Fibrose/diagnóstico por imagem , Hemodinâmica , Veias Hepáticas/diagnóstico por imagem , Humanos , Fígado/diagnóstico por imagem , Fígado/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pressão na Veia Porta/fisiologia , Estômago/irrigação sanguínea , Estômago/diagnóstico por imagem , Estômago/fisiopatologia , Ultrassonografia , Pressão Venosa
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