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Terlouw LG, Moelker A, Abrahamsen J, Acosta S, Bakker OJ, Baumgartner I, Boyer L, Corcos O, van Dijk LJ, Duran M, Geelkerken RH, Illuminati G, Jackson RW, Kärkkäinen JM, Kolkman JJ, Lönn L, Mazzei MA, Nuzzo A, Pecoraro F, Raupach J, Verhagen HJ, Zech CJ, van Noord D, Bruno MJ. European guidelines on chronic mesenteric ischaemia - joint United European Gastroenterology, European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Gastrointestinal and Abdominal Radiology, Netherlands Association of Hepatogastroenterologists, Hellenic Society of Gastroenterology, Cardiovascular and Interventional Radiological Society of Europe, and Dutch Mesenteric Ischemia Study group clinical guidelines on the diagnosis and treatment of patients with chronic mesenteric ischaemia. United European Gastroenterol J 2020; 8:371-395. [PMID: 32297566 PMCID: PMC7226699 DOI: 10.1177/2050640620916681] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Chronic mesenteric ischaemia is a severe and incapacitating disease, causing
complaints of post-prandial pain, fear of eating and weight loss. Even though
chronic mesenteric ischaemia may progress to acute mesenteric ischaemia, chronic
mesenteric ischaemia remains an underappreciated and undertreated disease
entity. Probable explanations are the lack of knowledge and awareness among
physicians and the lack of a gold standard diagnostic test. The
underappreciation of this disease results in diagnostic delays, underdiagnosis
and undertreating of patients with chronic mesenteric ischaemia, potentially
resulting in fatal acute mesenteric ischaemia. This guideline provides a
comprehensive overview and repository of the current evidence and
multidisciplinary expert agreement on pertinent issues regarding diagnosis and
treatment, and provides guidance in the multidisciplinary field of chronic
mesenteric ischaemia.
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Affiliation(s)
- Luke G Terlouw
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.,Department of Radiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Adriaan Moelker
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Jan Abrahamsen
- Department of Clinical Physiology, Viborg Regional Hospital, Viborg, Denmark
| | - Stefan Acosta
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.,Department of Cardio-Thoracic and Vascular Surgery, Skane University Hospital, Malmö, Sweden
| | - Olaf J Bakker
- Department of Vascular Surgery, Sint Antonius hospital, Nieuwegein, the Netherlands.,Department of Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Iris Baumgartner
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Louis Boyer
- Department of Diagnostic and Interventional Radiology, Montpied University Hospital, Clermont-Ferrand, France
| | - Olivier Corcos
- Department of Gastroenterology, Intestinal Stroke Center, Hopital Beaujon APHP, Clichy, France
| | - Louisa Jd van Dijk
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Mansur Duran
- Department of Vascular and Endovascular Surgery, Marienhospital Gelsenkirchen, Gelsenkirchen, Germany
| | - Robert H Geelkerken
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, the Netherlands.,Multi-modality Medical Imaging (M3I) group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Giulio Illuminati
- Department of Surgical Sciences, University of Rome La Sapienza, Rome, Italy
| | - Ralph W Jackson
- Department of Interventional Radiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Jussi M Kärkkäinen
- Heart Center, Kuopio University Hospital, Kuopio, Finland.,Department of Vascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jeroen J Kolkman
- Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, the Netherlands.,Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, the Netherlands
| | - Lars Lönn
- Department of Radiology, University of Copenhagen, Copenhagen, Denmark
| | - Maria A Mazzei
- Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Alexandre Nuzzo
- Department of Gastroenterology, Hopital Beaujon APHP, Clichy, France
| | - Felice Pecoraro
- Department of Surgical Oncological and Oral Sciences, University of Palermo, Vascular Surgery Unit, AOUP 'P. Giaccone' Palermo, Palermo, Italy
| | - Jan Raupach
- Department of Radiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Hence Jm Verhagen
- Department of Vascular Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Christoph J Zech
- Radiology and Nuclear Medicine, University of Basel, Basel, Switzerland
| | - Desirée van Noord
- Department of Gastroenterology and Hepatology, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Vascular imaging of the mesenteric vasculature. Best Pract Res Clin Gastroenterol 2017; 31:3-14. [PMID: 28395786 DOI: 10.1016/j.bpg.2016.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 10/31/2016] [Accepted: 12/17/2016] [Indexed: 01/31/2023]
Abstract
Imaging of the mesenteric vasculature is crucial in diagnosing vascular disease of the gastro-intestinal tract such as acute or chronic mesenteric ischemia caused by arterial stenosis, embolism or thrombosis, mesenteric vein thrombosis and mesenteric aneurysm or dissection. The reference standard for imaging of the mesenteric vasculature is digital subtraction angiography. However, modalities as duplex ultrasonography, computed tomography angiography and magnetic resonance angiography are developing rapidly and may provide accurate imaging non-invasively. This review provides an up-to-date overview of the anatomic resolution, clinical application, emerging techniques and future perspectives of these four radiological modalities for imaging of the mesenteric vasculature.
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Hagspiel KD, Flors L, Hanley M, Norton PT. Computed tomography angiography and magnetic resonance angiography imaging of the mesenteric vasculature. Tech Vasc Interv Radiol 2014; 18:2-13. [PMID: 25814198 DOI: 10.1053/j.tvir.2014.12.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are highly accurate cross-sectional vascular imaging modalities that have almost completely replaced diagnostic catheter angiography for the evaluation of the mesenteric vasculature. CTA is the technique of choice when evaluating patients with suspected mesenteric ischemia; it permits to differentiate between occlusive and nonocclusive etiologies, to evaluate indirect signs of bowel ischemia, and in some instances, to provide alternative diagnoses. MRA has the advantage of not using ionizing radiation and iodinated contrast agents and can be appropriate in the nonacute setting. Both CTA and MRA are suitable for the assessment of patients with suspected chronic mesenteric ischemia, allowing to evaluate the degree of atherosclerotic steno-occlusive disease and the existence of collateral circulation, as well as other nonatherosclerotic vascular pathologies such as fibromuscular dysplasia and median arcuate ligament syndrome. CTA provides excellent depiction of visceral aneurysms and has an important role to plan therapy for both occlusive and aneurysmal diseases and in the follow-up of patients after open or endovascular mesenteric revascularization procedures. This article provides an introduction to the CTA and MRA imaging protocol to study the mesenteric vasculature, the imaging findings in patients presenting with acute and chronic mesenteric ischemia and visceral aneurysms, and the value of these imaging techniques for therapy planning and follow-up.
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Affiliation(s)
- Klaus D Hagspiel
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA.
| | - Lucia Flors
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA
| | - Michael Hanley
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA
| | - Patrick T Norton
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA
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Totman JJ, Marciani L, Foley S, Campbell E, Hoad CL, Macdonald IA, Spiller RC, Gowland PA. Characterization of the time course of the superior mesenteric, abdominal aorta, internal carotid and vertebral arteries blood flow response to the oral glucose challenge test using magnetic resonance imaging. Physiol Meas 2009; 30:1117-36. [PMID: 19759401 DOI: 10.1088/0967-3334/30/10/011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Blood flow to the splanchnic circulation increases postprandially which may cause a reduction in systemic and cerebral perfusion leading to postprandial syncope in the elderly who lack adequate cardiovascular reserve. We used multi-station 2D phase contrast cine magnetic resonance imaging (PC-MRI) with the aim of characterizing the time course of the haemodynamic response to an oral glucose challenge test (OGCT) in the large arteries perfusing the splanchnic, systemic and cerebral circulations (superior mesenteric artery SMA, abdominal aorta AA, internal carotid arteries, ICA and vertebral arteries VA). In this study nine fasted healthy volunteers were studied. Separate cine PC-MRI scans were acquired in the neck and in the abdomen every 88 s, these two measurements being interleaved for ten baseline scans at each station with the scanner automatically moving the subject between the two stations. After ingestion of the OGCT, a further 30 cine PC-MRI scans were acquired at each station. Using this technique we were able to characterize with frequent sampling of volumetric blood flow the time course of blood flow response to the OGCT of the SMA, AA and both VA and ICA. We found a substantial variation between individuals in the amplitude and the time to the peak of the SMA blood flow response to the OGCT which correlated positively with body mass index. MRI provides a robust, non-invasive method of studying normal physiology that could be valuable in studies of diseases such as postprandial hypotension.
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Affiliation(s)
- J J Totman
- Brain and Body Centre, University of Nottingham, Nottingham NG7 2RD, UK
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5
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Sutter R, Heilmaier C, Lutz AM, Weishaupt D, Seifert B, Willmann JK. MR angiography with parallel acquisition for assessment of the visceral arteries: comparison with conventional MR angiography and 64-detector-row computed tomography. Eur Radiol 2009; 19:2679-88. [PMID: 19526242 DOI: 10.1007/s00330-009-1473-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Revised: 04/01/2009] [Accepted: 04/24/2009] [Indexed: 12/31/2022]
Abstract
The purpose of the study was to retrospectively compare three-dimensional gadolinium-enhanced magnetic resonance angiography (conventional MRA) with MRA accelerated by a parallel acquisition technique (fast MRA) for the assessment of visceral arteries, using 64-detector-row computed tomography angiography (MDCTA) as the reference standard. Eighteen patients underwent fast MRA (imaging time 17 s), conventional MRA (29 s) and MDCTA of the abdomen and pelvis. Two independent readers assessed subjective image quality and the presence of arterial stenosis. Data were analysed on per-patient and per-segment bases. Fast MRA yielded better subjective image quality in all segments compared with conventional MRA (P = 0.012 for reader 1, P = 0.055 for reader 2) because of fewer motion-induced artefacts. Sensitivity and specificity of fast MRA for the detection of arterial stenosis were 100% for both readers. Sensitivity of conventional MRA was 89% for both readers, and specificity was 100% (reader 1) and 99% (reader 2). Differences in sensitivity between the two types of MRA were not significant for either reader. Interobserver agreement for the detection of arterial stenosis was excellent for fast (kappa = 1.00) and good for conventional MRA (kappa = 0.76). Thus, subjective image quality of visceral arteries remains good on fast MRA compared with conventional MRA, and the two techniques do not differ substantially in the grading of arterial stenosis, despite the markedly reduced acquisition time of fast MRA.
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Affiliation(s)
- Reto Sutter
- Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland
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6
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Ersoy H. The role of noninvasive vascular imaging in splanchnic and mesenteric pathology. Clin Gastroenterol Hepatol 2009; 7:270-8. [PMID: 19201388 DOI: 10.1016/j.cgh.2008.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Revised: 12/03/2008] [Accepted: 12/05/2008] [Indexed: 02/07/2023]
Abstract
Traditionally, catheter angiography (CA) has been the mainstay of diagnosis for mesenteric arterial diseases. However, CA is invasive and is associated with complications that result from the procedure itself, depending on the experience of the operators, site of vascular access, ionized radiation that could be significant when combined with interventional procedures, and administered contrast material. During the past 2 decades, technical improvements in computed tomography (CT) and magnetic resonance hardware and methods have contributed new, noninvasive tools, specifically CT angiography (CTA) and 3-dimensional gadolinium-enhanced magnetic resonance angiography (3D Gd-MRA). This article outlines the current applications, strengths, and weaknesses of CTA and 3D Gd-MRA in imaging of the mesenteric vessels.
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Affiliation(s)
- Hale Ersoy
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
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7
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Caldana RP, Bezerra ASDA, D'Ippolito G, Szejnfeld J. Estudo da circulação hepatomesentérica pela angiografia por ressonância magnética com gadolínio: comparação entre doses simples e dupla no estudo de pacientes esquistossomóticos. Radiol Bras 2006. [DOI: 10.1590/s0100-39842006000400004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Determinar a freqüência de visualização dos segmentos da circulação hepatomesentérica pela angiografia por ressonância magnética (angio-RM) com contraste e comparar o valor do método, utilizando-se duas diferentes dosagens de gadolínio (doses simples e dupla). MATERIAIS E MÉTODOS: Estudo prospectivo de 36 pacientes esquistossomóticos submetidos a angio-RM. Os exames foram realizados em equipamento de RM de 1,5 T, usando-se bobina de corpo e bomba injetora para a administração endovenosa do contraste. Foram utilizadas, de maneira randomizada, dose dupla do contraste paramagnético (0,2 mmol/kg de Gd-DTPA) em 21 pacientes e dose simples (0,1 mmol/kg) em outros 15 pacientes. Os exames foram interpretados por dois observadores em consenso, que classificaram o grau de visualização de 25 segmentos vasculares estabelecidos para análise, sem conhecimento da dose de gadolínio utilizada. RESULTADOS: Os segmentos vasculares proximais e de maior calibre foram as estruturas com melhor grau de visualização na maioria da amostra em estudo. O tronco celíaco, a artéria hepática comum, a artéria esplênica, a croça e terço médio da artéria mesentérica superior, a veia porta, a veia esplênica e a veia mesentérica superior apresentaram grau 2 de visualização em mais de 70% da amostra. Quanto à comparação das diferentes dosagens, não houve diferença significante (p < 0,05) no grau de visualização das diversas estruturas analisadas entre os grupos dose simples e dose dupla, com uma exceção isolada: na avaliação da artéria hepática direita (p = 0,008), o grupo dose simples apresentou maior freqüência de visualização grau 2, com valor significante. CONCLUSÃO: O grau de visualização dos segmentos vasculares hepatomesentéricos pela angio-RM com contraste é elevado, sendo maior nos segmentos proximais e de maior calibre. A comparação entre os grupos que utilizaram dose simples e dupla de contraste demonstrou resultados semelhantes.
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8
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Goyen M, Debatin JF. Gadopentetate dimeglumine-enhanced three-dimensional MR-angiography: dosing, safety, and efficacy. J Magn Reson Imaging 2004; 19:261-73. [PMID: 14994293 DOI: 10.1002/jmri.20005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Noninvasiveness, inherent three-dimensionality allowing reformations in any desired plane, and safe contrast agents, coupled with high diagnostic accuracy have driven the rise in popularity of contrast-enhanced MR angiography (CE-MRA) within the medical community. Reflecting its dominant market share as a paramagnetic contrast agent, gadopentetate dimeglumine (Gd-DTPA) has been used for the majority of clinically-performed MRA exams. Over the period January 1994 to February 2002, a total of 172 original studies describing the use of gadolinium-enhanced MRA in more than three human subjects were identified. Of these, 117 described the use of Gd-DTPA as the contrast agent for MRA. A total of 4046 subjects who received Gd-DTPA for MRA are described in these studies. Analysis of these data demonstrate Gd-DTPA to be a safe contrast agent for MRA when applied in a dose ranging from 0.1 to 0.3 mmol/kg of bodyweight. The documented clinical results show Gd-DTPA to be efficacious in the assessment of the arterial system. The effectiveness of Gd-DTPA-enhanced MRA extends beyond the detection, localization, and characterization of arterial disease, and encompasses choice and planning of appropriate therapy, as well as evaluation of therapeutic effectiveness.
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Affiliation(s)
- Mathias Goyen
- Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany.
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Hagspiel KD, Leung DA, Angle JF, Spinosa DJ, Pao DG, de Lange EE, Butty S, Matsumoto AH. MR angiography of the mesenteric vasculature. Radiol Clin North Am 2002; 40:867-86. [PMID: 12171189 DOI: 10.1016/s0033-8389(02)00027-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
MRA has evolved from a research tool to a robust clinical diagnostic modality. In many centers worldwide, it is the technique of choice for evaluating patients with suspected CMI, assessing operability of patients with pancreatic cancer, and investigating the portal system. Evolving indications include the assessment of liver transplant patients before and after transplant and of living related liver transplant donors. The search for the bleeding source in patients with gastrointestinal hemorrhage may be an indication in the future, once intravascular contrast agents become available.
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Affiliation(s)
- Klaus D Hagspiel
- Department of Radiology, University of Virginia Health System, Charlottesville 22908, USA.
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10
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Pereles FS, Baskaran V. Abdominal magnetic resonance angiography: principles and practical applications. Top Magn Reson Imaging 2001; 12:317-26. [PMID: 11707728 DOI: 10.1097/00002142-200110000-00002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abdominal magnetic resonance (MR) angiography has become a robust technique for evaluation of the aorta and its major branch vessels. Its safety and accuracy make MR angiography an ideal choice for screening and diagnostic angiography of the abdominal aorta and renal and visceral arteries; however, interventional procedures (i.e., angioplasty and stenting) still require conventional digital subtraction angiography. This article focuses on practical applications of abdominal MR angiography that have been made possible by recent technological advances in MR hardware and software.
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Affiliation(s)
- F S Pereles
- Department of Radiology, Northwestern University Medical School, Chicago, Illinois, USA.
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Gebel MJ, Göhde S. Diagnostic techniques in assessing vessels of the gastrointestinal tract. Best Pract Res Clin Gastroenterol 2001; 15:21-39. [PMID: 11355899 DOI: 10.1053/bega.2000.0154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Vascular disorders of the gastrointestinal tract include a variety of different underlying diseases, thus requiring different and, in many cases, more than one imaging procedure. Only a knowledge of the newest developments in vascular imaging techniques with all the possibilities and limits will ensure a time- and cost-effective, accurate and reliable diagnosis. In many acute cases and also as a screening procedure, ultrasound in combination with colour Doppler and duplex sonography, plays an important role in setting the right course for further imaging techniques, and can provide the correct diagnosis in many cases.Depending on the most prominent symptoms and the expected disease, the right choice of technique saves valuable time. Computed tomography (CT) and magnetic resonance imaging (MRI) are cross-sectional imaging techniques that not only demonstrate lesion vascularization, but also provide information about neighbouring structures and complications in an understandable and demonstrable way. The use of angiography as an invasive tool should be limited to cases where a high temporal and spatial resolution is necessary to make the diagnosis or where therapeutic interventions are also likely to be performed within the same setting. For the diagnosis of gastrointestinal vascular diseases, often no generally valid recommendation can be given, since the impact of all imaging techniques will depend on the examiner's experience, the technical equipment and on their 24-h availability in a hospital. This chapter tries to give some information about the inherent limits and indications of the different imaging techniques, as well as the newest study results concerning the most frequent vascular diseases of the gastrointestinal tract.
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Affiliation(s)
- M J Gebel
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medizinische Hochschule Hannover, Carl-Neuberg Str. 1, Hannover, 30625, Germany
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Ernst O, Asnar V, Sergent G, Lederman E, Nicol L, Paris JC, L'Herminé C. Comparing contrast-enhanced breath-hold MR angiography and conventional angiography in the evaluation of mesenteric circulation. AJR Am J Roentgenol 2000; 174:433-9. [PMID: 10658721 DOI: 10.2214/ajr.174.2.1740433] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Our aim was to compare the results of gadolinium-enhanced breath-hold MR angiography with those of conventional angiography for the study of mesenteric circulation. SUBJECTS AND METHODS MR angiography and digital subtraction angiography were prospectively performed in 33 patients referred for hepatic, pancreatic, or mesenteric disease. MR angiography was performed with four three-dimensional acquisitions at 0, 30, 60, and 90 sec after injection of 0.1 mmol/kg of gadolinium. Selective conventional angiography was used as the standard of reference. RESULTS A pure arterial angiogram (one on which veins could not be visualized) was obtained in 27 patients during the second or third acquisition. By subtracting the arterial phase from an arteriovenous phase (third or fourth acquisition) we obtained a pure venous angiogram (one on which arteries could not be visualized) in 28 patients. Agreement was good or excellent for the hepatic artery (kappa = 0.78), the superior mesenteric artery (kappa = 0.65), the splenic artery (kappa = 0.70), the portal vein (kappa = 1.0), the superior mesenteric vein (kappa = 0.88), and the splenic vein (kappa = 0.75). Agreement was poor, and vessels were better shown by conventional angiography, for the intrahepatic arteries (kappa = 0.006) and the branches of the superior mesenteric artery (kappa = 0.14). MR angiography and conventional angiography revealed 29 and 27 portosystemic collaterals, respectively. CONCLUSION Dynamic breath-hold contrast-enhanced MR angiography compared favorably with conventional angiography in preoperative assessment of the proximal mesenteric arteries and in the evaluation of portal hypertension; however, conventional angiography is still necessary to evaluate distal arteries.
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Affiliation(s)
- O Ernst
- Department of Radiology, Hôpital Huriez, Centre Hospitalier Universitaire de Lille, France
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13
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Sadick M, Diehl SJ, Lehmann KJ, Gaa J, Möckel R, Georgi M. Evaluation of breath-hold contrast-enhanced 3D magnetic resonance angiography technique for imaging visceral abdominal arteries and veins. Invest Radiol 2000; 35:111-7. [PMID: 10674455 DOI: 10.1097/00004424-200002000-00004] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the diagnostic value of breath-hold contrast-enhanced 3D magnetic resonance angiography (MRA) for assessment of the visceral abdominal arteries and veins in patients with suspected abdominal neoplasms. METHODS Twenty-one patients underwent MR imaging on a 1.5 T unit using a body phased-array coil. MRA was performed with a 3D-FLASH sequence (TR 3.8 ms, TE 1.3 ms, flip angle 25 degrees, acquisition time 20 seconds), 8 to 12 seconds after an intravenous bolus injection of Gd-DTPA. The acquisition delay between the arterial and the portal venous phase was 12 seconds. The image quality and the degree of vascular involvement were evaluated using coronal source images and maximum intensity projection reconstructions. Diagnosis was confirmed by surgery/histology. RESULTS Image quality was optimal in more than 85% of the patients (19/21 arterial phase and 17/21 portal venous phase). MRA correctly predicted vascular status in 20 of 21 patients (95%), with complete concordance between MRA results and surgical findings. In one patient with chronic pancreatitis, MRA demonstrated a false-positive finding that could not be confirmed surgically. CONCLUSIONS. Breath-hold contrast-enhanced 3D-MRA is a valuable technique for assessing visceral abdominal arteries and veins.
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Affiliation(s)
- M Sadick
- Institute of Clinical Radiology, Klinikum Mannheim, Faculty of Clinical Medicine Mannheim-University of Heidelberg, Germany
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14
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Abstract
This selective review highlights research in contrast media development and application in the field of diagnostic radiology in 1998 and 1999. The focus is on research published in Investigative Radiology, supplemented with work from other publications in the few areas not extensively covered by the journal. Studies continue to be performed, although at a low level, examining safety issues. Most preclinical investigations have focused on MR and ultrasound agents. In MR, the research effort is concentrated on the development of targeted agents; in ultrasound, work is focused on the characterization of basic contrast mechanisms. The demonstration of clinical applications is still dominated by work with MR, both in disease models and human investigations. The use of extracellular gadolinium chelates to enhance visualization of blood vessels (the field of contrast-enhanced MR angiography) is the largest single new clinical application of contrast media to emerge in several years. New clinical applications continue to be pursued with contrast media in CT, ultrasound, and x-ray angiography. As intravenously injected ultrasound contrast agents come to market, trials demonstrating clinical applications and subsequent scientific publications will increase in number.
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Affiliation(s)
- V M Runge
- Department of Diagnostic Radiology, University of Kentucky, Lexington 40536, USA
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