Daikenchuto increases blood flow in the superior mesenteric artery in humans: A comparison study between four-dimensional phase-contrast vastly undersampled isotropic projection reconstruction magnetic resonance imaging and Doppler ultrasound

K Suzuki ,Yoshihiro Hiramatsu,Yuhi Suzuki,Toshiya Akai,Naoki Ohishi,Oliver Wieben,Mayu Sakata,Yasuo Takehara,Hiroya Takeuchi,Masanori Kawate,Hirotoshi Kikuchi,Takafumi Kawamura,Yoshifumi Morita,Masayoshi Yamamoto,Masataka Sugiyama,Kiyotaka Kurachi,Hatsuko Nasu,Kenichi Sugiyama ,Kevin M Johnson

doi:10.1371/journal.pone.0245878

Abstract

Respiratory-gated four-dimensional phase-contrast vastly undersampled isotropic projection reconstruction (4D PC-VIPR) is magnetic resonance (MR) imaging technique that enables analysis of vascular morphology and hemodynamics in a single examination using cardiac phase resolved 3D phase-contrast magnetic resonance imaging. The present study aimed to assess the usefulness of 4D PC-VIPR for the superior mesenteric artery (SMA) flowmetry before and after flow increase was induced by the herbal medicine Daikenchuto (TJ-100) by comparing it with Doppler ultrasound (DUS) as a current standard. Twenty healthy volunteers were enrolled in this prospective single-arm study. The peak cross-sectionally averaged velocity was measured by 4D PC-VIPR, peak velocity was measured by DUS, and flow volume (FV) of SMA and aorta were measured by 4D PC-VIPR and DUS 25 min before and after the peroral administration of TJ-100. The peak cross-sectionally averaged velocity, peak velocity, and FV of SMA measured by 4D PC-VIPR and DUS significantly increased after administration of TJ-100 (4D PC-VIPR: the peak cross-sectionally averaged velocity; p = 0.004, FV; p = 0.035, DUS: the peak velocity; p = 0.003, FV; p = 0.010). Furthermore, 4D PC-VIPR can analyze multiple blood vessels simultaneously. The ratio of the SMA FV to the aorta, before and after oral administration on the 4D PC-VIPR test also increased (p = 0.015). The rate of change assessed by 4D PC-VIPR and DUS were significantly correlated (the peak cross-sectionally averaged velocity and peak velocity: r = 0.650; p = 0.005, FV: r = 0.659; p = 0.004). Retrospective 4D PC-VIPR was a useful modality for morphological and hemodynamic analysis of SMA.

Highlights

Gastrointestinal blood flow changes dynamically in response to various factors, such as diet, exercise, body temperature, medicine, and inflammation
In Doppler ultrasound (DUS), superior mesenteric artery (SMA) flowmetry was feasible in all 20 subjects. 4D PC-VIPR was successfully performed in all 20 subjects; flowmetry was not feasible in three cases, owing to the overflow of
We demonstrated that 4D PC-VIPR could assess SMA blood flow without the use of contrast agents, and the accuracy was comparable to that of conventional DUS

Summary

Introduction

Gastrointestinal blood flow changes dynamically in response to various factors, such as diet, exercise, body temperature, medicine, and inflammation. Computed tomography angiography has been used to assess the intestinal arterial morphology [1], and Doppler ultrasound (DUS) flowmeters have been used to quantify intestinal blood flow [2,3]. Contrastenhanced computed tomography is useful for consistent evaluation of the vascular network, but it cannot provide blood flow information, such as flow direction or velocity. DUS is a convenient non-invasive technique that is often preferred for measuring flow direction, volume, and velocity [4]. DUS is often hindered by problematic overlaps of the gastrointestinal gas interference. An alternative robust technique that can image and quantify the blood flow in one examination would be useful

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