Non-invasive assessment of mesenteric hemodynamics in patients with suspected chronic mesenteric ischemia using 4D flow MRI.

Abstract

Chronic mesenteric ischemia (CMI) is a rare disease with a particularly difficult diagnosis. In this study, 4D flow MRI is used to quantitatively evaluate mesenteric hemodynamics before and after a meal in patients suspected of having CMI and healthy individuals. Nineteen patients suspected of CMI and twenty control subjects were analyzed. Subjects were scanned using a radially undersampled 4D flow MR sequence (PC-VIPR). Flow rates were assessed in the supraceliac (SCAo) and infrarenal aorta, celiac artery, superior mesenteric artery (SMA), left and right renal arteries, superior mesenteric vein (SMV), splenic vein, and portal vein (PV) in a fasting state (preprandial) and 20min after a 700-kcal meal (postprandial). Patients were subcategorized into positive diagnosis (CMI+, N = 6) and negative diagnosis (CMI-, N = 13) groups based on imaging and clinical findings. Preprandial, postprandial, and percent change in flow rates were compared between subgroups using a Welch t test. In controls and CMI- patients, SCAo, SMA, SMV, and PV flow increased significantly after meal ingestion. No significant flow increases were observed in CMI+ patients. Percent changes in SMA, SMV, and PV flow were significantly greater in controls compared to CMI+ patients. Additionally, percent changes in flow in the SMV and PV were significantly greater in CMI- patients compared to CMI+ patients. 4D flow MRI with large volumetric coverage demonstrated significant differences in the redistribution of blood flow in SMA, SMV, and PV in CMI+ patients after a meal challenge. This approach may assist in the challenging diagnosis of CMI.