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Purpose Portal and mesenteric hemodynamics is greatly altered in portal hypertension patients. This study utilizes 4D flow magnetic resonance imaging (MRI) to visualize and quantify changes in abdominal hemodynamics in patients with portal hypertension undergoing meal challenge. Materials and Methods Twelve portal hypertension patients and six healthy subjects participated in the study. Baseline MRI was acquired after 5 hours of fasting. Postmeal MRI was obtained 20 minutes after subjects ingested EnSure Plus (574 mL). Imaging was performed at 3T using 4D flow MRI with an undersampled radial acquisition. Flow measurements were performed blinded to subject status (fasting/meal). Flow values for each vessel were compared before and after the meal challenge using paired Student's t-tests (P < 0.05). Results After meal challenge, significant increases in blood flow were observed in supraceliac aorta, portal vein, superior mesenteric vein, and artery in both groups (P < 0.05). In patients, hepatic artery (P = 0.001) and splenic vein (P = 0.045) flow decreased while azygos vein flow (P = 0.002) increased. Conclusion Portal venous flow regulation to adjust the increasing mesenteric venous flow after a meal challenge may be impaired in patients with cirrhosis. The ability to comprehensively quantify the hemodynamic response of the abdominal vasculature to a meal challenge using 4D flow MRI reveals the potential of this technique to noninvasively characterize portal hypertension hemodynamics. J. Magn. Reson. Imaging 2015;42:1009–1017.

Traditionally, magnetic resonance imaging (MRI) of flow using phase contrast (PC) methods is accomplished using methods that resolve single-directional flow in two spatial dimensions (2D) of an individual slice. More recently, three-dimensional (3D) spatial encoding combined with three-directional velocity-encoded phase contrast MRI (here termed 4D flow MRI) has drawn increased attention. 4D flow MRI offers the ability to measure and to visualize the temporal evolution of complex blood flow patterns within an acquired 3D volume. Various methodological improvements permit the acquisition of 4D flow MRI data encompassing individual vascular structures and entire vascular territories such as the heart, the adjacent aorta, the carotid arteries, abdominal, or peripheral vessels within reasonable scan times. To subsequently analyze the flow data by quantitative means and visualization of complex, three-directional blood flow patterns, various tools have been proposed. This review intends to introduce currently used 4D flow MRI methods, including Cartesian and radial data acquisition, approaches for accelerated data acquisition, cardiac gating, and respiration control. Based on these developments, an overview is provided over the potential this new imaging technique has in different parts of the body from the head to the peripheral arteries.

Purpose: To investigate the value of gadoxetic acid-enhanced three-dimensional T1-weighted MR cholangiography (T1w-MRC) in comparison to three-dimensional T2-weighted MR cholangiopancreaticography (T2w-MRCP) in patients with primary sclerosing cholangitis (PSC). Materials and Methods: Thirty-four MR exams in 29 patients (46.0 ± 16.1 years; 19 men, 10 women) scanned within a 14-month period were retrospectively included. Two abdominal radiologists independently evaluated image quality regarding image contrast, image quality degradation due to artifacts, and visualization quality of ducts. The order of biliary tree branches that were visualized and reader preference toward each method were recorded. Helpfulness of T1w-MRC was scored in consensus. Confirmatory endoscopic retrograde cholangiopancreaticography (ERCP) performed within 3 months of the MR examination was available in 8 patients. Results: Image quality of T1w-MRC and T2w-MRCP was graded good to excellent in all cases. There were advantages for both T1w-MRC (functional information, less degradation due to artifacts) and T2w-MRCP (higher order of visualized branches, better branch depiction). Both readers showed preference for T2w-MRCP; however, both readers found gadoxetic acid–enhanced T1w-MRC helpful in the majority of cases. Conclusion: Gadoxetic acid-enhanced T1w-MRC is complementary to, but should not replace, T2w-MRCP. T1w-MRC is a useful adjunct to T2w-MRCP for morphologic evaluation and provides additional diagnostic information. J. Magn. Reson. Imaging 2012;36:632–640. © 2012 Wiley Periodicals, Inc.

Purpose: To compare 3D magnetic resonance imaging (3D MRI) with transesophageal echocardiography (TEE) for the detection of complex aortic plaques (≥4 mm thick, ulcerated, or containing mobile thrombi). Materials and Methods: In all, 99 consecutive patients with acute cryptogenic stroke and ≥3 mm thick aortic plaques in TEE were prospectively included. 3D MRI comprised T1-weighted bright blood MRI with complete aortic coverage (spatial resolution 1 mm3). Wall thickness and occurrence of complex plaques in ascending aorta (AAo), aortic arch (AA), and descending aorta (DAo) and image quality for each segment was rated for MRI and TEE. Results: MRI detected more complex plaques than TEE (MRI vs. TEE): AAo 13 vs. 7; AA 37 vs. 11; differences were smaller in the DAo: 101 vs. 70. Image quality was higher for MRI in AAo and AA (P < 0.001) and superior for TEE in DAo (P < 0.001). MRI revealed additional complex plaques in the proximal aorta in 19 of 58 patients (32.8%) categorized as cryptogenic after complete routine diagnostics including TEE. Conclusion: Due to improved visualization of the aorta 3D MRI allows to detect more complex plaques than TEE. This renders 3D MRI particularly valuable for patients with cryptogenic stroke and for trials evaluating optimal treatment in aortic atherosclerosis. J. Magn. Reson. Imaging 2012;36:604–611. © 2012 Wiley Periodicals, Inc.

Purpose: To evaluate the signal to noise ratio (SNR) and contrast to noise ratio (CNR) performance of 0.05 mmol/kg gadoxetic acid and 0.1 mmol/kg gadobenate dimeglumine for dynamic and hepatobiliary phase imaging. In addition, flip angles (FA) that maximize relative contrast-to-noise performance for hepatobiliary phase imaging were determined. Materials and Methods: A cross-over study in 10 volunteers was performed using each agent. Imaging was performed at 3 Tesla (T) with a 32-channel phased-array coil using breathheld 3D spoiled gradient echo sequences for SNR and CNR analysis, and for FA optimization of hepatobiliary phase imaging. Results: Gadobenate dimeglumine (0.1 mmol/kg) had superior SNR performance during the dynamic phase, statistically significant for portal vein and hepatic vein in the portal venous and venous phase (for all, P < 0.05) despite twice the approved dose of gadoxetic acid (0.05 mmol/kg), while gadoxetic acid had superior SNR performance during the hepatobiliary phase. Optimal FAs for hepatobiliary phase imaging using gadoxetic acid and gadobenate dimeglumine were 25–30° and 20–30° for relative contrast liver versus muscle (surrogate for nonhepatocellular tissues), and 45° and 20° (relative contrast liver versus biliary structures), respectively. Conclusion: Gadobenate dimeglumine may be preferable for applications that require dynamic phase imaging only, while gadoxetic acid may be preferable when the hepatobiliary phase is clinically important. Hepatobiliary phase imaging with both agents benefits from flip angle optimization. J. Magn. Reson. Imaging 2011;. © 2011 Wiley-Liss, Inc.

Purpose: To assess blood flow velocities and spatial distribution of aortic Reynolds numbers in vivo using flow-sensitive magnetic resonance imaging (MRI) and probe for flow instabilities along the aorta based on an empirical model for physiological pulsatile blood flow. Materials and Methods: Thirty young healthy volunteers were examined by flow-sensitive MRI at eight imaging planes distributed along the thoracic aorta. Flow, Womersley, Strouhal, Reynolds, and critical Reynolds numbers were calculated and used to assess the presence of flow instabilities. Results: The average peak Reynolds number was higher in the ascending (≈4500) and descending aorta (≈4200) than in the aortic arch (≈3400). According to the calculated critical Reynolds numbers, flow instabilities were prominent in the ascending (14/30 volunteers) and descending aorta (22/30 volunteers) but not in the aortic arch (3/30 volunteers). A significant difference (P < 0.05) in supracritical peak Reynolds numbers was observed between genders. The supracritical Reynolds number, indicating flow instabilities, significantly correlated (P < 0.05) with body weight (r = 0.34), aortic diameter (r = 0.48), and cardiac output (r = 0.53). Conclusion: Flow-sensitive MRI was used to indirectly assess the presence of flow instabilities in vivo. The results in volunteers indicate the presence of flow instabilities in the young healthy aorta with a higher prevalence for men than women. J. Magn. Reson. Imaging 2011;33:839–846. © 2011 Wiley-Liss, Inc.

Purpose To assess the distribution and regional differences of flow and vessel wall parameters such as wall shear stress (WSS) and oscillatory shear index (OSI) in the entire thoracic aorta. Materials and Methods Thirty-one healthy volunteers (mean age = 23.7 ± 3.3 years) were examined by flow-sensitive four-dimensional (4D)-MRI at 3T. For eight retrospectively positioned 2D analysis planes distributed along the thoracic aorta, flow parameters and vectorial WSS and OSI were assessed in 12 segments along the vascular circumference. Results Mean absolute time-averaged WSS ranged between 0.25 ± 0.04 N/m2 and 0.33 ± 0.07 N/m2 and incorporated a substantial circumferential component (–0.05 ± 0.04 to 0.07 ± 0.02 N/m2). For each analysis plane, a segment with lowest absolute WSS and highest OSI was identified which differed significantly from mean values within the plane (P < 0.05). The distribution of atherogenic low WSS and high OSI closely resembled typical locations of atherosclerotic lesions at the inner aortic curvature and supraaortic branches. Conclusion The normal distribution of vectorial WSS and OSI in the entire thoracic aorta derived from flow-sensitive 4D-MRI data provides a reference constituting an important perquisite for the examination of patients with aortic disease. Marked regional differences in absolute WSS and OSI may help explaining why atherosclerotic lesions predominantly develop and progress at specific locations in the aorta. J. Magn. Reson. Imaging 2009;30:77–84. © 2009 Wiley-Liss, Inc.

Purpose To qualitatively and quantitatively evaluate the image quality in accelerated time-resolved 3D contrast-enhanced MR angiography (tr-CE-MRA) at 3T. Materials and Methods In all, 113 MRA were performed in 107 patients on a 3T MR system after written informed consent and approval by the ethics committee. Twenty consecutive thoracic (n = 87) or craniocervical (n = 26) 3D data volumes were acquired. The timeframes with maximum arterial and venous contrast were determined and a total of 663 arterial and venous segments were analyzed by two blinded observers. Diagnostic image quality was graded by applying a 0 (low) to 3 (excellent) scale. Additionally, local signal-to-noise (SNR) and contrast-to-noise ratios (relative CNR) were evaluated. Results Tr-CE-MRA was successfully performed in all patients. Good to excellent image quality (2.42 ± 0.31) was observed in all individuals with preserved discrimination of arteries (2.43 ± 0.48) and veins (2.20 ± 0.56). Minor image degradation due to artifacts (2.62 ± 0.25) and constantly high vascular signal and contrast were detected. There was a significant superiority of coronal orientation during thoracic MRA (P < 0.05). In 18 cases tr-CE-MRA provided additional information on vascular pathologies. Conclusion Large field of view tr-CE-MRA enables constantly high-quality thoracic and craniocervical angiographies. In addition, the dynamics of tr-CE-MRA can offer additional information on vascular pathologies. J. Magn. Reson. Imaging 2008;28:1116–1124. © 2008 Wiley-Liss, Inc.