Visualization of Quantitative Flow Reduction with 4D-flow Magnetic Resonance Imaging in a Patient with Pelvic Arterioven
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CASE REPORT
Visualization of Quantitative Flow Reduction with 4D-flow Magnetic Resonance Imaging in a Patient with Pelvic Arteriovenous Malformation After Transcatheter Arterial Embolization Satonori Tsuneta1 • Daisuke Abo1 • Noriko Oyama-Manabe2 • Chihoko Miyazaki3 Yuki Yoshino1 • Ryo Morita1 • Takeshi Soyama1 • Kohsuke Kudo4
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Received: 29 February 2020 / Accepted: 29 May 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Abstract A 54-year-old man was admitted to our hospital with dyspnea and heart failure. Contrast-enhanced computed tomography showed a giant pelvic arteriovenous malformation (AVM) fed by the left internal iliac artery (IIA), right IIA, and inferior mesenteric artery. (IMA). The AVM was treated with selective embolization via the left IIA. Time-resolved three-dimensional phase-contrast magnetic resonance imaging (4D-flow MRI) visualized a gradual flow reduction in the left IIA, whereas the flow in the IMA and right IIA increased relatively. After four sessions, the patient experienced symptom relief and the blood level of N-terminal prohormone brain natriuretic peptide decreased. To the best of our knowledge, we present the first reported use of 4D-flow MRI to quantitatively assess flow reduction in the case of pelvic AVM after embolization.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00270-020-02545-y) contains supplementary material, which is available to authorized users. & Noriko Oyama-Manabe [email protected] 1
Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Kita14, Nishi5, Kita-ku, Sapporo, Hokkaido 060-8648, Japan
2
Department of Radiology, Saitama Medical Center, Jichi Medical University, 1-847, Amanumacho, Omiya-ku, Saitama-shi, Saitama 330-8503, Japan
3
Department of Radiodiagnosis, Hokkaido Ohno Memorial Hospital, Miyanosawa 2-jo 1-chome 16-1, Nishi-ku, Sapporo, Hokkaido 063-0052, Japan
4
Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Kita14, Nishi7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
Keywords Magnetic resonance imaging Embolization Hemodynamics Arteriovenous malformation Cowden syndrome
Introduction Arteriovenous malformations (AVMs) are extremely challenging to treat in routine clinical practice. High-flow AVMs are heterogeneous conditions characterized by direct, low-resistance arteriovenous communications in the nidus with shunting. Computed tomography (CT) and angiography are limited in the detection of AVMs as they only assess morphological or qualitative information, and although ultrasonography measures blood flow quantitatively, it cannot be used for deep-seated locations [1]. Time-resolved three-dimensional phase-contrast magnetic resonance imaging (4D-flow MRI) is a non-invasive radiological imaging modality that enables specific flow measurements of lesions, including those in deep-seated locations [2, 3]. 4D-flo
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