Four-dimensional Flow MRI as a Marker for Risk Stratification of Gastroesophageal Varices in Patients with Liver Cirrhosis

The aim of this systematic review is to provide an overview of the use of Four-Dimensional Magnetic Resonance Imaging of vector blood flow (4D Flow MRI) in the abdominal veins. This study was composed according to the PRISMA guidelines 2009. The literature search was conducted in MEDLINE, Cochrane Library, EMBASE, and Web of Science. Quality assessment of the included studies was performed using the QUADAS-2 tool. The initial search yielded 781 studies and 21 studies were included. All studies successfully applied 4D Flow MRI in abdominal veins. Four-Dimensional Flow MRI was capable of discerning between healthy subjects and patients with cirrhosis and/or portal hypertension. The visual quality and inter-observer agreement of 4D Flow MRI were rated as excellent and good to excellent, respectively, and the studies utilized several different MRI data sampling strategies. By applying spiral sampling with compressed sensing to 4D Flow MRI, the blood flow of several abdominal veins could be imaged simultaneously in 18–25 s, without a significant loss of visual quality. Four-Dimensional Flow MRI might be a useful alternative to Doppler sonography for the diagnosis of cirrhosis and portal hypertension. Further clinical studies need to establish consensus regarding MRI sampling strategies in patients and healthy subjects.

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Optimizing Risk Stratification in Portal Vein Thrombosis after Splenectomy and its Primary Prophylaxis with Antithrombin III Concentrates and Danaparoid Sodium in Liver Cirrhosis with Portal Hypertension

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2014.07.939 ◽

2014 ◽

Vol 219 (5) ◽

pp. 865-874 ◽

Cited By ~ 29

Author(s):

Hirofumi Kawanaka ◽

Tomohiko Akahoshi ◽

Shinji Itoh ◽

Tomohiro Iguchi ◽

Norifumi Harimoto ◽

...

Keyword(s):

Liver Cirrhosis ◽

Portal Hypertension ◽

Risk Stratification ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Antithrombin Iii ◽

Primary Prophylaxis ◽

Danaparoid Sodium ◽

Vein Thrombosis

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k-t GRAPPA accelerated four-dimensional flow MRI in the aorta: Effect on scan time, image quality, and quantification of flow and wall shear stress

Magnetic Resonance in Medicine ◽

10.1002/mrm.24925 ◽

2013 ◽

Vol 72 (2) ◽

pp. 522-533 ◽

Cited By ~ 56

Author(s):

Susanne Schnell ◽

Michael Markl ◽

Pegah Entezari ◽

Riti J. Mahadewia ◽

Edouard Semaan ◽

...

Keyword(s):

Shear Stress ◽

Image Quality ◽

Wall Shear Stress ◽

Dimensional Flow ◽

Scan Time ◽

Flow Mri ◽

Wall Shear ◽

Time Image

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Liver Retraction Using n-Butyl-2-Cyanoacrylate (NBCA) Glue during Laparoscopic Splenectomy and Azygoportal Disconnection in Cirrhotic Patients

BioMed Research International ◽

10.1155/2018/3064046 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Du Kong ◽

Wei Wang ◽

Gang Du ◽

Binyao Shi ◽

Zhengchen Jiang ◽

...

Keyword(s):

Liver Cirrhosis ◽

Portal Hypertension ◽

Liver Function ◽

Blood Loss ◽

Laparoscopic Splenectomy ◽

Postoperative Bleeding ◽

Gastroesophageal Varices ◽

Liver Retraction ◽

Significant Difference ◽

Cirrhotic Patients

Background. Although liver retraction using n-butyl-2-cyanoacrylate (NBCA) glue has been applied to laparoscopic upper abdominal surgery in noncirrhotic patients, there is still no consensus on its safety and feasibility for cirrhotic patients. In this study, we aimed to investigate the safety and effectiveness of liver retraction using NBCA glue during laparoscopic splenectomy and azygoportal disconnection (LSD) for gastroesophageal varices and hypersplenism secondary to liver cirrhosis and portal hypertension. Methods. Thirty-nine gastroesophageal varices and hypersplenism secondary to liver cirrhosis and portal hypertension patients were included in our study. We performed LSD in the presence of NBCA glue (n = 22, NBCA group) and absence of NBCA glue (n = 17, n-NBCA group), respectively. The operation time, blood loss, postoperative hospitalization, and liver function were compared between the two groups. Results. There was no mortality during the operation. One patient in non-NBCA group received open surgery due to parenchyma hemorrhage. Postoperative pleural effusion occurred in 2 cases of the NBCA group and 1 of the non-NBCA group. One showed left subphrenic abscess in the non-NBCA group. No postoperative bleeding occurred after 9-30 months of follow-up. The time of operation in NBCA group was significantly shorter than those in n-NBCA group (198.86±17.86 versus 217.81±20.25min, P<0.01). Blood loss in NBCA group was significantly lower than non-NBCA group (159.09±56.98 versus 212.50±88.51 ml, P<0.05). The levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were increased on day 1 after LSD and decreased to normal level on day 7 after LSD in both groups. There was no significant difference in postoperative hospitalization and liver function between the two groups. Conclusion. Liver retraction using NBCA glue during LSD for gastroesophageal varices and hypersplenism secondary to liver cirrhosis and portal hypertension is safe, effective, and feasible.

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Vena Caval Flow Regurgitation at Four-dimensional Flow MRI: A New Sign for a Hemodynamic Phenotype of Chronic Obstructive Pulmonary Disease and Emphysema?

Radiology ◽

10.1148/radiol.2019191255 ◽

2019 ◽

Vol 292 (3) ◽

pp. 595-596

Author(s):

Yeon Hyeon Choe

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Dimensional Flow ◽

Flow Mri

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ACTIVATION OF FACTOR VII IS RELATED TO BLEEDING TENDENCY IN LIVER CIRRHOSIS

10.1055/s-0038-1644800 ◽

1987 ◽

Author(s):

V De Angelis ◽

M Zambon ◽

L Toffolo ◽

C Donada ◽

G L Molaro ◽

...

Keyword(s):

Liver Cirrhosis ◽

Major Bleeding ◽

Esophageal Varices ◽

Coagulation Cascade ◽

Factor Vii ◽

Bleeding Tendency ◽

Gastroesophageal Varices ◽

Liver Impairment ◽

Cirrhotic Patients ◽

Bleeding Episodes

Coagulation abnormalities are among the number of potential risk factors toinitiate the bleeding episodes from gastrcr-esophageal varices in liver cirrhosis. The impairment of liver clearance of activated coagulation factors, the release of thromboplastin-like activity from the necrotic liver cells and the hemodynamic changes due to expanded bollaterals may all contribute to activate the coagulation cascade.However, little is known about the mechanisms leading to this activation. Activated Factor VII (FVIIa) is known totrigger both intrinsec and extrinsec coagulation pathway. Therefore, we measured FVIIa in a group of 33 cirrhotic patients in order to see if a difference between bleeders and non-bleeders patients would correlate with Factor VII activation. The patients were divided in two groups according to the presence or the absence of major bleeding from gastroesophageal varices; haemorragic episodes were confirmed by a gastroscopic examination performed during or immediately after bleeding episodes. Factor VII coagulant assay (VII:C - one stage clotting method) and Factor VII coupled amidolytic assay (VII:CHR) were performed and a factor VII activity ratio (VIIa) was calculated as VII:C/VII:CHR. The results (mean ± S.E.) are summarized in this table:No difference in Vila distribution was seen when the patients were divided on the base of liver impairment (according to Child’s criteria) .Our study shows that FVII activation is related to bleeding from esophageal varices but not to the degree of liver impairment and strongly suggests the existence of an hypercoagulable state in liver cirrhosis, probably related to major bleeding from gastroesophageal varices in cirrhotic patients.

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Impact of Sustained Virological Response for Gastroesophageal Varices in Hepatitis-C-Virus-Related Liver Cirrhosis

Journal of Clinical Medicine ◽

10.3390/jcm9010095 ◽

2019 ◽

Vol 9 (1) ◽

pp. 95 ◽

Cited By ~ 1

Author(s):

Yukihisa Yuri ◽

Hiroki Nishikawa ◽

Hirayuki Enomoto ◽

Kazunori Yoh ◽

Yoshinori Iwata ◽

...

Keyword(s):

Liver Cirrhosis ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Sustained Virological Response ◽

Virological Response ◽

P Value ◽

Gastroesophageal Varices ◽

Direct Acting Antiviral ◽

Direct Acting

We aimed to clarify the relationship between sustained virological response (SVR) and gastroesophageal varices (GEVs) progression among hepatitis C virus (HCV)-related liver cirrhosis (LC) patients treated with interferon (IFN)-based therapies (n = 18) and direct-acting antiviral (DAA)-based therapies (n = 37), and LC patients with no SVR (n = 71) who had already developed GEVs. Factors influencing GEVs progression were also examined. During the follow-up period, GEVs progression was observed in 50 patients (39.7%). The 3-year cumulative GEVs progression rates in the DAA-SVR group, the IFN-SVR group, and the non-SVR group were 32.27%, 5.88%, and 33.76%, respectively (overall p value = 0.0108). Multivariate analysis revealed that sex (p = 0.0430), esophageal varices (EVs) F2 or more (p < 0.0001), and DAA-SVR (p = 0.0126, IFN-SVR as a reference) and non-SVR (p = 0.0012, IFN-SVR as a reference) were independent predictors for GEVs progression. The proportion of GEVs progression in patients with no or F1 EVs was significantly lower than that in patients with F2 or F3 EVs (33.9% (38/112) vs. 85.7% (12/14), p = 0.0003). In conclusion, IFN-based therapies can have a favorable impact for preventing GEVs progression in HCV-related LC patients with GEVs. Clinicians should be aware of a point of no return where SVR is no longer capable of avoiding GEVs progression.

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