title: Accurate perioperative flow measurement of the portal vein and hepatic and renal artery: a role for preoperative MRI?
abstract: BACKGROUND
  Quantification of abdominal blood flow is essential for a variety of gastrointestinal and hepatic topics such as liver transplantation or metabolic flux measurement, but those need to be performed during surgery. It is not clear whether Duplex Doppler Ultrasound during surgery or MRI before surgery is the tool to choose.
  
  
  OBJECTIVE
  To examine whether preoperative evaluation of abdominal blood flow using MRI could prove to be a useful and reliable alternative for the perioperative sonographic approach.
  
  
  METHODS
  In this study portal and renal venous flow and hepatic arterial flow were sequentially quantified by preoperative MRI, preoperative and perioperative Duplex Doppler Ultrasound (DDUS). 55 Patients scheduled for major abdominal surgery were studied and methods and settings were compared. Additionally, average patient population values were compared.
  
  
  RESULTS
  Mean (±SD) plasmaflow measured by perioperative DDUS, preoperative DDUS and MRI, respectively was 433±200/423±162/507±96 ml/min (portal vein); 96±70/74±41/108±91 ml/min (hepatic artery); 248±139/201±118/219±69 ml/min (renal vein). No differences between the different settings of DDUS measurement were detected. Equality of mean was observed for all measurements. Bland Altman Plots showed widespread margins. Hepatic arterial flow measurements correlated with each other, but portal and renal venous flow correlations were absent.
  
  
  CONCLUSIONS
  Surgery and method (DDUS vs. MRI) do not affect mean flow values. Individual comparison is restricted due to wide range in measurements. Since MRI proves to be more reliable with respect to inter-observer variability, we recommend using mean MRI results in experimental setups.
authors: Department of Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. mar.vermeulen@vumc.nl
authors: Mechteld A R
authors: MA
authors: Vermeulen
authors: Gerdien C
authors: GC
authors: Ligthart-Melis
authors: René
authors: R
authors: Buijsman
authors: Michiel P C
authors: MP
authors: Siroen
authors: Marcel C G
authors: MC
authors: van de Poll
authors: Petra G
authors: PG
authors: Boelens
authors: Cornelis H C
authors: CH
authors: Dejong
authors: Cors
authors: C
authors: van Schaik
authors: Mark B M
authors: MB
authors: Hofman
authors: Paul A M
authors: PA
authors: van Leeuwen
mesh_terms: D001783:Blood Flow Velocity; D005260:Female; D006801:Humans; D008102:Liver Circulation; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D011169:Portal Vein / Q000473:pathology* / Q000503:physiopathology* / Q000601:surgery; D011300:Preoperative Care / Q000379:methods; D012077:Renal Artery / Q000473:pathology* / Q000503:physiopathology* / Q000601:surgery; D012079:Renal Circulation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity