Current innovations in blood flow assessment: the role of 4D-flow MRI and computational fluid dynamics in hepatobiliopancreatic surgery: a systematic review

Abstract

Aim: Insufficient assessment of post-surgical organ perfusion in hepatobiliopancreatic surgery can lead to serious complications. Consequently, various technological solutions have been developed to achieve non-invasive and accurate blood flow assessment. This article aims to evaluate the current state of four-dimensional flow magnetic resonance imaging (4D-flow MRI) and computational fluid dynamics (CFD) technologies in assessing vascular blood flow within this surgical field.

Methods: A comprehensive literature search using ClinicalTrials.gov and PubMed/MEDLINE was performed; articles published between 2015 and 2025 were included. Broad search terms, including “blood flow measurement”, “4D-flow MRI”, or “computational fluid dynamics” and “abdomen” or “liver”, were utilized.

Results: Twenty-two studies were analyzed in detail. Nineteen focused on vascular conditions surrounding the liver, with 15 assessing venous flow and five evaluating the hepatic artery. Additional hemodynamic features analyzed included blood velocity, pressure, and particle distribution. The clinical applications investigated were: portal vein embolization (1), venous anastomosis (3), liver resection (2), portal hypertension (2), transarterial radioembolization (2), transjugular intrahepatic portosystemic shunt (4), and liver fibrosis (1). Notably, only CFD facilitated the simulation of prospective hemodynamic conditions (2).

Conclusion: Both 4D-flow MRI and CFD technologies facilitate the accurate study of blood flow dynamics within the supramesocolic compartment. Furthermore, CFD enables the simulation of prospective vascular conditions, establishing its potential as a preoperative planning tool. However, further research is required to fully validate the clinical utility of CFD in this surgical context.

Keywords

Computational fluid dynamics / 4D-flow magnetic resonance / blood flow measurement / hepatobiliopancreatic surgery

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