MR Imaging of Apparent Small-Bowel Perfusion for Diagnosing Mesenteric Ischemia: Feasibility Study

Abstract

The purpose of this study, which was approved by the institutional review board, was to assess the differentiation of individuals with from those without mesenteric ischemia. All subjects provided written informed consent. Six healthy volunteers and six patients with documented chronic mesenteric ischemia underwent magnetic resonance (MR) imaging with and without oral caloric stimulation. After intravenous administration of paramagnetic contrast material, signal intensity values of the small-bowel wall were measured up to 130 seconds after contrast material injection. Volunteers and patients, respectively, had maximum enhancement of the bowel wall between 70 and 85 seconds after contrast material administration that amounted to 269% and 267% without and 425% and 333% with caloric stimulation. MR imaging assessment of small-bowel perfusion is possible and seems feasible for differentiating individuals with from those without mesenteric ischemia.

Acute and Chronic Mesenteric Ischemia

“…Burkart and colleagues [37] documented a similar reduction in superior mesenteric and portal venous flow in patients who had CMI when compared with healthy volunteers. Finally, Lauenstein and associates [38] demonstrated decreased bowel wall enhancement following contrast administration in patients who had symptoms of mesenteric ischemia and stenosis documented angiographically. The time required to perform MRI examinations and the possible need for bowel stimulation with a meal limit the usefulness of MRI in the diagnosis of acute mesenteric ischemia, making it more appropriate for evaluating the chronic state.…”

Postprandial Evaluation of Possible Collateral Pathways in Chronic Mesenteric Ischemia with Duplex Ultrasound

“…Both Computed Tomography (CT) and magnetic resonance imaging (MR) and conventional invasive contrast arteriography may be used [8,9] including also functional testing by MR for quantification of blood flow [10]. Other non-invasive methods are under development to detect gut ischemia such as small bowel tonometry [20].…”

“…Advances in non-invasive tests include Computed Tomography Angiography (CTA) and Magnetic Resonance Angiography (MRA) where the latter also includes possibilities for quantification of blood flow [8][9][10].…”

Monitoring technologies in the neonatal intensive care unit: implications for the detection of necrotizing enterocolitis

“…Using a combined method of MRI and oral caloric stimulation, six healthy adults and six adult patients with mesenteric ischemia could be differentiated. 17 The greatest differences were identified between 35 and 75 s after the oral intake (P ¼ 0.002), suggesting the feasibility of the method for detecting mesenteric ischemia. This type of MRI may be useful for NEC evaluation, but the clinical safety of these contrast agents in premature infants remains untested.…”