Four-dimensional flow MRI demonstrates portal flow redistribution associated with hepatic function after retrograde transvenous obliteration.

Authors

Ryota Hyodo, Yoji Ishizu, Ryota Horiguchi, Mami Iima, Yasuo Takehara, Shinya Yokoyama, Takashi Mizuno, Daniel Giese, Akihiro Manabe, Shinji Naganawa

Published in

European journal of radiology. Volume 203. Pages 113044. Jun 26, 2026. Epub Jun 26, 2026.

Abstract

To quantify portal flow redistribution after retrograde transvenous obliteration (RTO) using four-dimensional flow MRI and to evaluate its association with hepatic functional changes.
This prospective study evaluated portal hemodynamics before RTO and one week afterward using four-dimensional flow MRI. Measurements included hepatic parenchymal flow (HPF), superior mesenteric vein (SMV)- and splenic vein (SV)-derived shunt inflow, and main portal vein wall shear stress (MPV-WSS). Percentage changes in HPF and WSS were calculated. Hepatic function was assessed 2-6 months after RTO. Participants were classified by complete disappearance of SMV- or SV-derived shunt inflow (SMV-0, SV-0). Paired comparisons used the Wilcoxon signed-rank test, and correlations were assessed using Spearman's rank correlation.
Twenty-two participants (14 women; median age, 75 years [IQR, 70-81]) completed the study. RTO significantly increased MPV flow (median 8.1 to 12.9 mL/s), HPF (8.0 to 12.4 mL/s), and MPV-WSS (0.95 to 1.34 Pa) at one week (all p < 0.01). Total bilirubin, MELD, and ALBI scores improved at 2-6 months (all p < 0.05). In the overall cohort, %HPF correlated with Child-Pugh (ρ =  - 0.55, p < 0.01) and MELD (ρ =  - 0.51, p = 0.02) improvements. In subgroup analysis, %HPF was associated with MELD and ALBI improvement only in the SV-0 group. %WSS showed no significant associations with hepatic function.
Four-dimensional flow MRI quantified portal flow redistribution after RTO and identified HPF as a clinically relevant imaging marker associated with hepatic functional improvement. Complete SV-derived shunt closure showed the clearest relationship with functional recovery.

PMID:
42365739
Bibliographic data and abstract were imported from PubMed on 29 Jun 2026.

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