Predictive Value of 2D Phase Contrast Magnetic Resonance Imaging in Patients with Suspected Chronic Mesenteric...

The diagnosis of chronic mesenteric ischemia (CMI) is a clinical diagnosis of symptoms in setting of occlusive arterial disease. The study aimed to determine the predictive value of postprandial superior mesenteric vein (SMV) flow augmentation on two-dimensional phase contrast magnetic resonance imaging (2D PC-MR) as a measure of impaired perfusion in patients with suspected CMI.

A retrospective review of all adult patients undergoing evaluation for CMI with 2D PC-MR at a single tertiary university care center between January 1, 2021, and January 1, 2025, was performed. Patients required 1 symptom (postprandial pain, weight loss, food fear) and anatomic disease consistent with CMI (isolated severe SMA stenosis or occlusion, or at least moderate 2 vessel-visceral disease including the SMA). A threshold of postprandial SMV flow augmentation less than 50% was chosen to represent abnormal physiologic response. The diagnosis of CMI was determined by a vascular surgeon. Descriptive statistics and contingency analysis were applied due to the small sample size.

Thirty-three patients were included in the study. Two-dimensional (2D) PC-MR demonstrated a sensitivity of 93% and a specificity of 68%. Positive predictive value was 68% and negative predictive value was 93%. Of the 3 patients diagnosed with CMI who underwent intervention and received a postprocedure 2D PC-MR study, all demonstrated symptom resolution and normalization of postprandial SMV flow augmentation.

A threshold of postprandial SMV flow augmentation less than 50% on 2D PC-MR was sensitive in detecting patients with CMI and demonstrated a good negative predictive value, suggesting it may be used as a screening tool in the future.