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Systolically gated 3D phase contrast MRA of mesenteric arteries in suspected mesenteric ischemia
M N Wasser1, R H Geelkerken, M Kouwenhoven
1Department of Diagnostic Radiology, Leiden University Hospital, the Netherlands.
Objective:
Our goal was to assess the value of MRA for detecting stenoses in the celiac (CA) and superior mesenteric (SMA) arteries in patients suspected of having chronic mesenteric ischemia, using an optimized systolically gated 3D phase contrast technique.
Materials And Methods:
In an initial study in 24 patients who underwent conventional angiography of the abdominal vessels for different clinical indications, a 3D phase contrast MRA technique (3D-PCA) was evaluated and optimized to image the CAs and SMAs. Subsequently, a prospective study was performed to assess the value of systolically gated 3D-PCA in evaluation of the mesenteric arteries in 10 patients with signs and symptoms of chronic mesenteric ischemia. Intraarterial digital subtraction angiography and surgical findings were used as the reference standard.
Results:
In the initial study, systolic gating appeared to be essential in imaging the SMA on 3D-PCA. In 10 patients suspected of mesenteric ischemia, systolically gated 3D-PCA identified significant proximal disease in the two mesenteric vessels in 4 patients. These patients underwent sucessful reconstruction of their stenotic vessels.
Conclusion:
Cardiac-gated MRA may become a useful tool in selection of patients suspected of having mesenteric ischemia who may benefit from surgery.
Insights
Systolic-gated 3D phase contrast MRA effectively detects celiac artery (CA) and superior mesenteric artery (SMA) stenoses in patients with chronic mesenteric ischemia, aiding surgical candidate selection.
Area of Science:
- Vascular imaging
- Medical diagnostics
- Radiology
Background:
- Chronic mesenteric ischemia (CMI) is a condition caused by reduced blood flow to the intestines.
- Accurate detection of stenoses in the celiac artery (CA) and superior mesenteric artery (SMA) is crucial for diagnosing CMI.
Purpose of the Study:
- To evaluate the diagnostic value of Magnetic Resonance Angiography (MRA) for detecting CA and SMA stenoses.
- To assess the utility of an optimized systolically gated 3D phase contrast MRA technique in patients with suspected CMI.
Main Methods:
- An initial study optimized a 3D phase contrast MRA (3D-PCA) technique for imaging CA and SMA in 24 patients.
- A prospective study then assessed systolically gated 3D-PCA in 10 patients with suspected CMI, comparing results to digital subtraction angiography and surgical findings.
Main Results:
- Systolic gating was found to be essential for effective SMA imaging with 3D-PCA.
- In patients with suspected CMI, systolically gated 3D-PCA identified significant proximal stenoses in 4 out of 10 individuals.
- These 4 patients subsequently underwent successful surgical reconstruction of their stenotic mesenteric arteries.
Conclusions:
- Cardiac-gated MRA shows promise as a valuable tool for identifying patients with mesenteric ischemia who are candidates for surgical intervention.
- This imaging technique can aid in the selection process for surgical treatment of CMI.