MRI-based pre- and postprandial flow in the mesenteric vasculature of patients with suspected chronic mesenteric ischemia
Related Experiment Video
Updated: Sep 26, 2025
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Luke G Terlouw1, Louisa J D van Dijk2, Desirée van Noord3
1Department of Gastroenterology & Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Purpose:
The physiological increase of mesenteric blood flow after a meal is impaired in patients with occlusive chronic mesenteric ischemia (CMI). This principle could be used to develop a highly desired diagnostic test assessing the sufficiency of the collateral mesenteric circulation. This study assesses the potential to identify CMI patients using two-dimensional time-resolved phase-contrast magnetic resonance imaging (2D PC-MRI) flow measurements.
Method:
This prospective cohort study included patients with suspected CMI, based on: typical history, imaging, and functional testing. Cardiac gated 2D PC-MRI flow measurements (expressed as ml/min/kg) were performed in mesenteric arteries and veins during inspiration and expiration, after six hours of fasting and 20, 30, and 40 min after a meal challenge with a high caloric drink.
Results:
Flow measurements were obtained in 19 patients: 8 CMI and 11 non-CMI. CMI patients showed a significantly smaller increase in postprandial blood flow in the superior mesenteric artery (SMA) at 30 and 40 min (30 min CMI 1.27(0.12-2.44) vs. non-CMI 7.82(6.28-10.90); 40 min CMI 0.30(-0.26-3.16) vs. non-CMI 7.94(6.32-10.90)) and a lower total arterial flow at 40 min (CMI 3.21(-0.72-5.05) vs. non-CMI 9.31(5.58-13.83)). Repeated flow measurements showed normalization of impaired postprandial venous flow after mesenteric artery stenting in one patient.
Conclusions:
The significantly lower increase in postprandial mesenteric blood flow in CMI patients confirms the promise of mesenteric blood flow measurements, before and 30-40 min after a meal, as a future diagnostic test to identify CMI patients among patients with a high clinical suspicion of CMI and mesenteric artery stenosis.
Insights
Impaired postprandial mesenteric blood flow, measured by 2D PC-MRI, can identify patients with chronic mesenteric ischemia (CMI). This technique shows promise for a new diagnostic test for CMI.
Area of Science:
- Vascular Imaging
- Gastroenterology
- Diagnostic Medicine
Background:
- Postprandial mesenteric blood flow increases physiologically.
- This increase is impaired in patients with chronic mesenteric ischemia (CMI).
- Assessing collateral mesenteric circulation is crucial for diagnosing CMI.
Purpose of the Study:
- To evaluate the potential of 2D PC-MRI flow measurements to identify CMI patients.
- To assess the diagnostic capability of measuring mesenteric blood flow changes after a meal.
Main Methods:
- Prospective cohort study of patients with suspected CMI.
- Cardiac-gated 2D PC-MRI flow measurements in mesenteric arteries and veins.
- Measurements taken after fasting and at 20, 30, and 40 minutes post-meal.
Main Results:
- 19 patients (8 CMI, 11 non-CMI) included.
- CMI patients showed significantly blunted superior mesenteric artery (SMA) flow increase post-meal.
- Total arterial flow was lower in CMI patients at 40 minutes post-meal.
Conclusions:
- Significantly lower postprandial mesenteric blood flow increase in CMI patients.
- Mesenteric blood flow measurements show promise as a future diagnostic test for CMI.
- This method can help identify CMI in patients with high clinical suspicion.
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