A paper published by Dr. Atsushi Higaki from Kawasaki Medical University et al reported that a patient with portosystemic shunt and hepatic encephalopathy underwent open mesenteric vein ligation, resulting in improved portal flow and blood ammonia. In this case, 4D flow MRI was a valuable diagnostic and follow-up tool, enabling the visualization and quantification of physiological portal hemodynamics with features distinct from those of contrast-enhanced CT and digital subtraction angiography. This report highlights the value of 4D flow MRI in managing portosystemic shunts.
4D flow MRI is an innovative imaging method that can retrospectively assess physiological hemodynamics in a detailed, comprehensive, and simultaneous manner. It can be beneficial in the treatment planning and follow-up of patients with portosystemic shunts with complex collateral circulation.

Atsushi Higaki, Akira Yamamoto, Toshimasa Okada, Tomio Ueno, Yasuyuki Tomiyama, Kosuke Ito, and Tsutomu Tamada, "4D Flow MRI Reflects Physiological Hemodynamics for the Diagnosis and Management of Portosystemic Shunts", Magnetic Resonance in Medical Sciences, Published Online (2024) doi: 10.2463/mrms.ici.2023-0161.