A comprehensive approach using MR imaging to diagnose acute segmental mesenteric ischemia in a porcine model.
OBJECTIVE
Acute mesenteric ischemia is a lethal disease that lacks a noninvasive diagnostic test. We evaluated the abilities of contrast-enhanced MR angiography, MR oximetry, and real-time interactive MR imaging to diagnose segmental mesenteric ischemia in a porcine model.


METHODS
Segmental mesenteric ischemia was created by subselective Gelfoam embolization of the mesenteric circulation in eight pigs. Conventional digital subtraction angiography (DSA), MR oximetry, and real-time interactive MR imaging of the small bowel were performed before and after embolization. Changes in the perfusion pattern seen on DSA established the regions of true ischemia. Postembolization DSA and MR angiography were compared with this gold standard.


RESULTS
Both MR angiography and DSA had high sensitivity (91% and 100%, respectively) for detecting ischemic regions. The difference was not statistically significant (p > .2). MR angiography yielded lower specificity than DSA (80% and 90%, respectively; p < .01). After embolization, the oxygen saturation in the superior mesenteric vein (SMV) dropped significantly (p < .005). After embolization, the SMV also showed oxygen saturation significantly lower than that in the inferior vena cava (p < .005). In two of the animals, segmental hypomotility of the small bowel was observed.


CONCLUSIONS
MR oximetry is capable of detecting oxygen desaturation caused by segmental ischemia. A loss of oxygen saturation in the SMV relative to that in the inferior vena cava provides a convenient marker of mesenteric ischemia. Contrast-enhanced MR angiography has sensitivity and specificity approaching those of DSA. Both MR techniques hold promise for the detection of acute mesenteric ischemia.
Chan
F P
FP
Department of Radiology, Stanford University Medical Center, CA 94305-5105, USA.
Li
K C
KC
Heiss
S G
SG
Razavi
M K
MK
D015901:Angiography, Digital Subtraction; D000818:Animals; D001363:Awards and Prizes; D003287:Contrast Media; D005260:Female; D005290:Ferric Compounds; D007511:Ischemia / Q000175:diagnosis*; D018810:Magnetic Resonance Angiography; D008641:Mesenteric Vascular Occlusion / Q000175:diagnosis*; D010092:Oximetry; D000644:Quaternary Ammonium Compounds; D011871:Radiology; D012680:Sensitivity and Specificity; D012955:Societies, Medical; D013152:Splanchnic Circulation; D013552:Swine; D014481:United States
D003287:Contrast Media; D005290:Ferric Compounds; D000644:Quaternary Ammonium Compounds; C013531:ferric ammonium citrate