Portal Hypertension

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DSA in patients with portal hypertension is often performed to measure portal venous pressures and the portal-systemic pressure gradient. These measurements can not be made directly using

Mra Cirrhosis

Fig. 2a-c. 44-year-old patient with hepatic cirrhosis and repeated gastrointestinal haemorrhage. Three rotated MIP displays of the portal venous phase 3D data set depict the portal venous morphology to good advantage. The splenic vein is dilated and is draining into a convolute of gastroesophageal collaterals which can be seen to extent to the distal oesophagus. Contrast-enhanced 3D MRA provides an excellent mean for non-invasively evaluating the portal venous system. Use of Gd-BOPTA (MultiHance®, Bracco) provides optimal image quality of the portal venous system owing to the transient albumin-binding of this particular contrast agent. Gastro-oesophageal collaterals are well visualized. Lack of enhancement of the intrahepatic portal venous system suggests retrograde flow in the portal vein with portal systemic shunting to the gastro-esophageal collaterals. Based on these imaging data this patient underwent TIPS (Transjugular-Intrahepatic-Portosystemic-Shunting) in combination with embolisation of the gastro-oesophageal-collaterals

Mri Collaterals Portal Hypertension

Fig. 2a-c. 44-year-old patient with hepatic cirrhosis and repeated gastrointestinal haemorrhage. Three rotated MIP displays of the portal venous phase 3D data set depict the portal venous morphology to good advantage. The splenic vein is dilated and is draining into a convolute of gastroesophageal collaterals which can be seen to extent to the distal oesophagus. Contrast-enhanced 3D MRA provides an excellent mean for non-invasively evaluating the portal venous system. Use of Gd-BOPTA (MultiHance®, Bracco) provides optimal image quality of the portal venous system owing to the transient albumin-binding of this particular contrast agent. Gastro-oesophageal collaterals are well visualized. Lack of enhancement of the intrahepatic portal venous system suggests retrograde flow in the portal vein with portal systemic shunting to the gastro-esophageal collaterals. Based on these imaging data this patient underwent TIPS (Transjugular-Intrahepatic-Portosystemic-Shunting) in combination with embolisation of the gastro-oesophageal-collaterals

MRI. However, for patients who require a portal-systemic shunt, 3D contrast MRA can be a useful guide for shunt planning (Fig. 2). MRA accurately assesses the patency of both spontaneous (Fig. 3) and surgical shunts (Figs. 4, 5) as long as metallic clips do not obscure portal venous anatomy. In conjunction with PC-MRA-techniques, shunt volumes can be determined non-invasively. TIPS shunts are more difficult to assess due to metallic stents. Most often, a stainless steel Wall stent is used to bridge the portal and systemic venous system. Even with echo times of less than 1 ms, the lumen of this metal stent cannot be evaluated by MRA.

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