Noninvasive Estimation of Post-TIPS Portosystemic Pressure Gradient Using 4D Flow MRI Relative Pressure Mapping and CT-Based CFD Driven by MRI-Derived Inflow: A Retrospective Validation Study.

IF 5 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Magnetic Resonance Pub Date : 2026-09-11 DOI:10.1016/j.jocmr.2026.102797

Xiaorong Chen, Xiaoxian Yang, Linhao Hu, Jianji Dai, Jiangfeng Pan, Qing Liu, Suping Wang, Meiling Hu, Dingjun Wang, Tianqi Wang, Haojia Qu, Xinyang Ge, Xiaogang Hu

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引用次数: 0

Abstract

Background: Post-transjugular intrahepatic portosystemic shunt (TIPS) portosystemic pressure gradient (PPG) is invasive and a key hemodynamic marker for post-TIPS management. Longitudinal monitoring motivates development of reliable noninvasive alternatives.

Objective: To validate the performance of non-invasively assessing post-TIPS PPG using four-dimensional flow MRI (MRI_PPG), CT (CT_PPG) (driven by MRI-derived inflow), and concordance with invasively measured PPG.

Materials and methods: This retrospective study included 31 post-TIPS patients who underwent PPG measurement and 4D flow MRI within 7 days of the invasive measurement, a subset (n=18) underwent abdominal CT. MRI_PPG was computed from 4D flow MRI velocity fields using relative pressure mapping. For CT-Based CFD Driven by MRI-Derived Inflow, portal venous phase CT was segmented to create patient-specific geometry, and 4D flow MRI-derived inflow at the main portal vein was used to define three inlet protocols: (i) time-averaged peak velocity (CT_PPG1), (ii) time-resolved flow waveform (CT_PPG2), and (iii) time-averaged mean velocity (CT_PPG3). Correlation and agreement with PPG were assessed, and classification performance for clinically relevant PPG ranges was evaluated.

Results: In the full cohort (n=31), MRI_PPG (11.23±4.74mmHg) correlated strongly with PPG (11.84±4.72mmHg) (r=0.94, P<0.01) and showed excellent agreement (ICC=0.94), with Bland-Altman bias of 0.61mmHg and limits of agreement (LoA) from -2.70 to 3.92mmHg. In the CT subset (n=18), MRI_PPG remained highly correlated (r=0.91, P<0.01) and showed good agreement (ICC=0.90; bias 0.80mmHg; LoA -3.04 to 4.63mmHg). Among CT‑based estimates, CT_PPG1 demonstrated the best performance (12.47±5.31mmHg; r=0.79, P<0.01; ICC=0.77; bias -0.42mmHg; LoA -6.84 to 6.00mmHg). Three‑range classification accuracy in the CT subset was 77.78% for MRI_PPG, compared with 66.67% for CT_PPG1, 50% for CT_PPG2, and 61.11% for CT_PPG3.

Conclusion: Both MRI_PPG and CT-PPG CFD estimates are feasible noninvasive approaches for post-TIPS hemodynamic assessment. 4D flow MRI-derived relative pressure mapping demonstrated superior performance, supporting its potential value for post-TIPS follow-up.

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利用4D流动MRI相对压力映射和基于ct的CFD在MRI衍生流入驱动下无创估计tips后门静脉系统压力梯度：一项回顾性验证研究。

背景：经颈静脉肝内门静脉分流术（TIPS）后门静脉系统压力梯度（PPG）是侵入性的，是TIPS后治疗的关键血流动力学指标。纵向监测促进了可靠的非侵入性替代方案的发展。目的：验证使用四维血流MRI （MRI_PPG）、CT (CT_PPG)（由MRI衍生的流入驱动）对tips后PPG进行无创评估的性能，以及与有创测量PPG的一致性。材料和方法：本回顾性研究包括31例tips术后患者，在有创测量后7天内接受PPG测量和4D血流MRI，其中18例患者接受腹部CT检查。MRI_PPG是利用相对压力映射从4D流动MRI速度场计算得到的。对于由mri衍生流入驱动的基于CT的CFD，门静脉相CT被分割以创建患者特定的几何形状，并使用主门静脉的4D流mri衍生流入来定义三种入口方案：(i)时间平均峰值速度（CT_PPG1），（ii）时间分辨流波形（CT_PPG2）和（iii）时间平均平均速度（CT_PPG3）。评估与PPG的相关性和一致性，并评估临床相关PPG范围的分类性能。结果：在全队列（n=31）中，MRI_PPG（11.23±4.74mmHg）与PPG（11.84±4.72mmHg）有很强的相关性（r=0.94, p）。结论：MRI_PPG和CT-PPG CFD评估都是tips后血流动力学评估的可行的无创方法。4D流动mri衍生的相对压力映射显示出优越的性能，支持其在tips后随访中的潜在价值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiovascular Magnetic Resonance 医学-核医学

CiteScore

10.90

自引率

12.50%

发文量

审稿时长

6-12 weeks

期刊介绍： Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to: New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system. New methods to enhance or accelerate image acquisition and data analysis. Results of multicenter, or larger single-center studies that provide insight into the utility of CMR. Basic biological perceptions derived by CMR methods.