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Arterial and Portal Venous Liver Perfusion Using Selective Spin Labelling MRI

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Arterial and Portal Venous Liver Perfusion Using Selective Spin Labelling MRI Arterial and portal venous liver perfusion using selective spin labelling MRI Citation for published version (APA): Schalkx, H. J., Petersen, E. T. E., Peters, N. H. G. M. N., Veldhuis, W. B., Leeuwen, van, M. S., Pluim, J. P. W., Bosch, van den, M. A. A. J., & Stralen, van, M. (2015). Arterial and portal venous liver perfusion using selective spin labelling MRI. European Radiology, 25(6), 1529-1540. https://doi.org/10.1007/s00330-014-3524-z DOI: 10.1007/s00330-014-3524-z Document status and date: Published: 01/06/2015 Document Version: Publisher’s PDF, also known as Version of Record (includes final page, issue and volume numbers) Please check the document version of this publication: • A submitted manuscript is the version of the article upon submission and before peer-review. There can be important differences between the submitted version and the official published version of record. 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If the publication is distributed under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license above, please follow below link for the End User Agreement: www.tue.nl/taverne Take down policy If you believe that this document breaches copyright please contact us at: [email protected] providing details and we will investigate your claim. Download date: 07. Oct. 2021 Eur Radiol (2015) 25:1529–1540 DOI 10.1007/s00330-014-3524-z HEPATOBILIARY-PANCREAS Arterial and portal venous liver perfusion using selective spin labelling MRI Hanke J. Schalkx & Esben T. Petersen & Nicky H. G. M. Peters & Wouter B. Veldhuis & Maarten S. van Leeuwen & Josien P. W. Pluim & Maurice A. A. J. van den Bosch & Marijn van Stralen Received: 10 July 2014 /Revised: 10 October 2014 /Accepted: 18 November 2014 /Published online: 22 March 2015 # European Society of Radiology 2015 Abstract flow-based quantification (r2=0.77). The SL results are in Purpose To investigate the feasibility of selective arterial and range with literature values. portal venous liver perfusion imaging with spin labelling (SL) Conclusion Selective spin labelling MRI of the portal venous MRI, allowing separate labelling of each blood supply. and arterial blood supply successfully quantified liver perfu- Methods The portal venous perfusion was assessed with a sion. This non-invasive technique provides specific arterial pulsed EPISTAR technique and the arterial perfusion with a and portal venous perfusion imaging and could benefit clinical pseudo-continuous sequence. To explore precision and repro- settings where contrast agents are contraindicated. ducibility, portal venous and arterial perfusion were separately Key Points quantified in 12 healthy volunteers pre- and postprandially • Perfusion imaging of the liver by Spin Labelling MRI is (before and after meal intake). In a subgroup of 6 volunteers, feasible the accuracy of the absolute portal perfusion and its relative • Selective Spin Labelling MRI assessed portal venous and postprandial change were compared with MRI flow measure- arterial liver perfusion separately ments of the portal vein. • Spin Labelling based portal venous liver perfusion showed Results The portal venous perfusion significantly increased significant postprandial increase from 63±22 ml/100g/min preprandially to 132±42 ml/100g/ • Spin Labelling based portal perfusion correlated well with min postprandially. The arterial perfusion was lower with 35± phase-contrast based portal perfusion 22 preprandially and 22±30 ml/100g/min postprandially. The • This non-invasive technique could benefit settings where pre- and postprandial portal perfusion using SL correlated contrast agents are contraindicated well with flow-based perfusion (r2=0.71). Moreover, post- prandial perfusion change correlated well between SL- and Keywords Liver . Magnetic resonance imaging . Perfusion imaging . Arterial Spin Labelling Abbreviations PVSL portal venous spin labelling ASL arterial spin labelling H. J. Schalkx (*) : E. T. Petersen : W. B. Veldhuis : M. S. van Leeuwen : M. A. A. J. van den Bosch SL spin labelling Department of Radiology, University Medical Center Utrecht, DCE-MRI dynamic contrast-enhanced magnetic HP E.01.132, Postbus 85500, 3508 GA Utrecht, The Netherlands resonance imaging e-mail: [email protected] BMI body mass index N. H. G. M. Peters SNR signal-to-noise ratio Department of Radiology, Atrium Medical Center Parkstad, SE-EPI spin-echo echo-planar imaging Heerlen, The Netherlands TI inversion time VOI volume-of-interest J. P. W. Pluim : M. van Stralen Image Sciences Institute, University Medical Center Utrecht, TR repetition time Utrecht, The Netherlands PLD post labelling delay 1530 Eur Radiol (2015) 25:1529–1540 Eur Radiol (2015) 25:1529–1540 1531 Fig. 1 Geometry and overview of the spin labelling sequences. a tomography (CT) portography in the same patients. Only Geometry of the PVSL and ASL sequences: a transverse read-out Gach et al. [10] have studied selective arterial and portal (blue) centered around entry of the portal vein into the liver; an oblique label/control slab caudal of the liver for PVSL, labelling the portal vein venous perfusion, but in just a single healthy subject. In and its feeding vessels; an oblique label/control slab transverse just above conclusion, selective arterial and portal SL-MRI perfusion the diaphragm for ASL (red), labelling the arterial blood in the imaging has been sparsely explored. descending aorta. b An overview of pulsed PVSL and pseudo- The aim of this study was to assess the feasibility of liver continuous ASL protocols with the breathing signal. Scan parameters: TR of 6500 ms; TI of 2500 ms for PVSL; labelling duration and post- perfusion imaging with selective SL-MRI in healthy volun- labelling delay of 1650 ms and 1500 ms, respectively, for ASL. Subjects teers to separately quantify arterial and portal venous perfu- were instructed to inhale and exhale after completion of each read-out and sion. Additionally, to explore the precision and reproducibility keep the expiratory breath-hold until the end of the corresponding read- of the selective SL-MRI technique, two different perfusion out. Label/control excitations, labelling delay, and read-out took place during the breath-hold. conditions were evoked by scanning pre- and postprandially (before and after eating). Finally, to probe the portal SL-MRI accuracy, MRI flow measurements in the portal vein were Introduction performed in a subgroup. Magnetic resonance imaging (MRI) of the liver plays a major role in the diagnosis and treatment monitoring of liver disease, Materials & methods where enhancement characteristics are evaluated after admin- istration of a contrast agent [1]. Quantification of arterial and Study concept portal venous perfusion has aroused interest for characterization of perfusion patterns in focal and diffuse liver disease [1, 2]. For this feasibility study, the portal venous and arterial perfu- Spin labelling MRI (SL-MRI) is a perfusion imaging tech- sion were assessed by pulsed portal venous spin labelling nique using labelled protons in blood as an endogenous con- (PVSL) and pseudo-continuous arterial spin labelling (ASL) trast for noninvasive quantification of blood flow [3]. techniques, respectively, in healthy volunteers. For evaluation Subtraction of images acquired in a labelling experiment from of the SL-MRI technique, the arterial and portal venous per- those in a control experiment allows estimation of the tissue fusion were imaged pre- and postprandially. By scanning perfusion. SL-MRI was initially introduced for brain perfu- every individual before and after ingestion of a high-calorie sion imaging [4, 5]. Its application has been extended to solid and high-sugar liquid meal, two different perfusion organs other than the brain and oncological imaging. In ab- conditions were evoked and postprandial perfusion changes dominal organs, SL-MRI is almost exclusively performed in were evaluated. A postprandial increase in the portal blood the kidneys [6–9]. Abdominal SL-MRI is especially chal- flow is expected and primarily related to meal-induced lenged by possible misalignment between the control and splanchnic vasodilation and subsequent flow increase in the label images. Furthermore, hepatic SL-MRI is challenged by superior mesenteric vein [14]. Postprandial scans were the relatively low blood flow compared to the brain and its planned around the time of expected portal venous peak flow. dual inflow. In a subgroup (N=6) the perfusion values were quantitatively However, SL-MRI has advantages of interest for liver compared to mean perfusion
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