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To determine the variability of blood flow measurements using 4D flow MRI in the portal and mesenteric circulations and to characterize the effects of meal ingestion, time of day, and between-day (diurnal) variations on portal and mesenteric hemodynamics.In this IRB-approved and HIPAA-compliant study, 7 healthy and 7 portal hypertension patients imaged. MRI exams were conducted at 3 T using a 32-channel body coil with large volumetric coverage and 1.25-mm isotropic true spatial resolution. Blood flow was quantified (L/min) in the hepatic and splanchnic vasculature. The first MR scan was performed after at least 8 h of fasting. Subsequently, subjects ingested 574 mL EnSure Plus® orally. A second acquisition was started 20 min after the meal ingestion. A third scan was performed before lunch and a fourth acquisition took place 20 min after lunch. A fifth scan was performed around 4 pm. Finally, subjects returned one week later for a repeat morning visit, with identical conditions as the first visit.In healthy controls significant increase in blood flow was seen in the PV, SMV, SMA, HA, and SCAo in response to breakfast but only the SCAo, SMA, SMV, and PV had a significant response to lunch. In general, patients with cirrhosis showed reduced response to meals compared to that in healthy controls. Additionally, PV flow in patients had the highest value in the afternoon.Effects of meal ingestion, time of day, and between-day variations were characterized using Radial 4D flow MRI in patients with cirrhosis and healthy controls.

Objective To investigate the relationship between metabolic syndrome (MetS) and lower urinary tract symptoms (LUTS) with functional and anatomic changes of the lower urinary tract with MRI. Materials and Methods The bladder and prostate of 95 subjects (56M, 39F) were segmented on T2-weighted pelvic MRI using Materialize Mimics 3D software. Bladder wall volume (BWV), post-void residual (PVR) and prostate volume (PV) were quantified from the 3D renderings. LUTS were quantified using validated questionnaires administered at the time of MRI. Wilcoxin rank sum, win ratio and chi-square tests were used to correlate symptom scores, BWV, PVR and PV in patients 1) without vs with MetS, 2) with mild (IPSS or UDI-6: 0-7) vs moderate-severe (IPSS: 8-35 or UDI-6: ≥8) and 3) normal vs enlarged prostates (>40cm3). Multivariate linear regression was used to determine predictors for BWV, PVR and PV. Results Men with MetS had increased BWV (66.8 vs 51.1cm3, P = .003), higher PVR (69.1 vs 50.5cc, P= .05) and increased PV (67.2 vs 40.1cm3, P= .01). Women without and with MetS had similar BWV, PVR and LUTS (P= .3-.78). There was no difference in prevalence of MetS, BWV, PVR or PV in men or women with mild vs moderate-severe LUTS (P = .26-.97). Men with enlarged prostates were more likely to have MetS (P = .003). There was no difference in BWV, PVR and LUTS for men with normal vs enlarged prostates (P= .44-.94). In men, BWV was highly correlated with MetS (P = .005) on regression analysis. Conclusion MetS leads to detrusor hypertrophy and may contribute to impaired bladder function, likely related to the effect on the prostate.

To evaluate feasibility and reproducibility of liver diffusion-weighted (DW) MRI using cardiac-motion-robust, blood-suppressed, reduced-distortion techniques.DW-MRI data were acquired at 3T in an anatomically accurate liver phantom including controlled pulsatile motion, in eight healthy volunteers and four patients with known or suspected liver metastases. Standard monopolar and motion-robust (M1-nulled, and M1-optimized) DW gradient waveforms were each acquired with single-shot echo-planar imaging (ssEPI) and multishot EPI (msEPI). In the motion phantom, apparent diffusion coefficient (ADC) was measured in the motion-affected volume. In healthy volunteers, ADC was measured in the left and right liver lobes separately to evaluate ADC reproducibility between the two lobes. Image distortions were quantified using the normalized cross-correlation coefficient, with an undistorted T2-weighted reference.In the motion phantom, ADC mean and SD in motion-affected volumes substantially increased with increasing motion for monopolar waveforms. ADC remained stable in the presence of increasing motion when using motion-robust waveforms. M1-optimized waveforms suppressed slow flow signal present with M1-nulled waveforms. In healthy volunteers, monopolar waveforms generated significantly different ADC measurements between left and right liver lobes (Synergistic effects of combined M1-optimized diffusion waveforms and msEPI acquisitions enable reproducible liver DWI with motion robustness, blood signal suppression, and reduced distortion.

Identification of critical episodes of environmental pollution, both as a outlier identification problem and as a classification problem, is a usual application of multivariate functional data analysis. This article addresses the effects of robustifying multivariate functional samples on the identification of critical pollution episodes in Medell´ın, Colombia. To do so, it compares 18 depth-based outlier identification methods and highlights the best options in terms of precision through simulation. It then applies the two methods with the best performance to robustify a real dataset of air pollution (PM2.5 concentration) in the Metropolitan Area of Medell´ın, Colombia and compares the effects of robustifying the samples on the accuracy of supervised classification through the multivariate functional DD-classifier. Our results show that 10 out of 20 methods revised perform better in at least one kind outliers. Nevertheless, no clear positive effects of robustification were identified with the real dataset.

Evaluation of the hemodynamics in the portal venous system plays an essential role in many hepatic pathologies. Changes in portal flow and vessel morphology are often indicative of disease.Routinely used imaging modalities, such as CT, ultrasound, invasive angiography, and MRI, often focus on either hemodynamics or anatomical imaging. In contrast, 4D flow MRI facilitiates a more comprehensive understanding of pathophysiological mechanisms by simultaneously and noninvasively acquiring time-resolved flow and anatomical information in a 3D imaging volume.Though promising, 4D flow MRI in the portal venous system is especially challenging due to small vessel calibers, slow flow velocities, and breathing motion. In this review article, we will discuss how to account for these challenges when planning and conducting 4D flow MRI acquisitions in the upper abdomen. We will address patient preparation, sequence acquisition, postprocessing, quality control, and analysis of 4D flow data.In the second part of this article, we will review potential clinical applications of 4D flow MRI in the portal venous system. The most promising area for clinical utilization is the diagnosis and grading of liver cirrhosis and its complications. Relevant parameters acquired by 4D flow MRI include the detection of reduced or reversed flow in the portal venous system, characterization of portosystemic collaterals, and impaired response to a meal challenge. In patients with cirrhosis, 4D flow MRI has the potential to address the major unmet need of noninvasive detection of gastroesophageal varices at high risk for bleeding. This could replace many unnecessary, purely diagnostic, and invasive esophagogastroduodenoscopy procedures, thereby improving patient compliance with follow-up. Moreover, 4D flow MRI offers unique insights and added value for surgical planning and follow-up of multiple hepatic interventions, including transjugular intrahepatic portosystemic shunts, liver transplantation, and hepatic disease in children. Lastly, we will discuss the path to clinical implementation and remaining challenges.

La identificación de datos atípicos de contaminación ambiental, tanto como un problema de identificación de atípicos como bajo los problemas de clasificación es una aplicación usual del análisis de datos funcionales multivariados. El artículo da cuenta de los efectos de la robustificación de muestras funcionales multivariadas sobre la identificación de episodios críticos de polución en Medellín, Colombia. Para hacerlo, compara 18 métodos de identificación de atípicos basados en profundidades y resalta las mejores opciones en términos de precisión a través de simulación. Después, aplica los dos métodos con mejor desempeño a la robustificación de una base de datos real de contaminación del aire en el área metropolitana de MEdellín, Colombia y compara los efectos de robustificar las muestras sobre la precisión de la clasificación supervisada. Los resultados muestran que 10 de los 20 métodos revisados se desempeñan mejor en al menos un tipo de atípicos. Sin embargo, no se evidencian resultados positivos de la robustificación en la base de datos real., Identification of critical episodes of environmental pollution, both as a outlier identification problem and as a classification problem, is a usual application of multivariate functional data analysis. This article addresses the effects of robustifying multivariate functional samples on the identification of critical pollution episodes in Medellín, Colombia. To do so, it compares 18 depth-based outlier identification methods and highlights the best options in terms of precision through simulation. It then applies the two methods with the best performance to robustify a real dataset of air pollution (PM2.5 concentration) in the Metropolitan Area of Medellín, Colombia and compares the effects of robustifying the samples on the accuracy of supervised classification through the multivariate functional DD-classifier. Our results show that 10 out of 20 methods revised perform better in at least one kind outliers. Nevertheless, no clear positive effects of robustification were identified with the real dataset.

4D flow MRI is a quantitative MRI technique that allows the comprehensive assessment of time-resolved hemodynamics and vascular anatomy over a 3-dimensional imaging volume. It effectively combines several advantages of invasive and non-invasive imaging modalities like ultrasound, angiography, and computed tomography in a single MRI acquisition and provides an unprecedented characterization of velocity fields acquired non-invasively in vivo. Functional and morphological imaging of the abdominal vasculature is especially challenging due to its complex and variable anatomy with a wide range of vessel calibers and flow velocities and the need for large volumetric coverage. Despite these challenges, 4D flow MRI is a promising diagnostic and prognostic tool as many pathologies in the abdomen are associated with changes of either hemodynamics or morphology of arteries, veins, or the portal venous system. In this review article, we will discuss technical aspects of the implementation of abdominal 4D flow MRI ranging from patient preparation and acquisition protocol over post-processing and quality control to final data analysis. In recent years, the range of applications for 4D flow in the abdomen has increased profoundly. Therefore, we will review potential clinical applications and address their clinical importance, relevant quantitative and qualitative parameters, and unmet challenges.