title: Hemodynamic assessment of celiaco-mesenteric anastomosis in patients with pancreaticoduodenal artery aneurysm concomitant with celiac artery occlusion using flow-sensitive four-dimensional magnetic resonance imaging.
abstract: OBJECTIVE
  Many pancreaticoduodenal artery (PDA) aneurysms are associated with celiac artery (CA) stenosis. The pathogenesis of PDA aneurysm may be associated with hemodynamic changes due to CA stenosis/occlusion. The aim of this study was to assess the hemodynamic changes of celiaco-mesenteric anastomosis in patients with PDA aneurysms concomitant with CA occlusion using four-dimensional flow-sensitive magnetic resonance imaging (4D-Flow).
  
  
  METHODS
  4D-Flow was performed preoperatively on five patients. Seven age- and sex-matched individuals were used as controls. Hemodynamic parameters such as flow volume and maximum flow velocity in PDAs, gastroduodenal arteries, common hepatic arteries, and superior mesenteric arteries were compared between both groups. Wall shear stress (WSS) and oscillatory shear index (OSI) were mapped in both groups.
  
  
  RESULTS
  In the patient group, 4D-Flow identified retrograde flow of both gastroduodenal arteries and common hepatic arteries. Heterogeneous distribution patterns of both WSS and OSI were identified across the entire PDA in the patient group. OSI mapping showed multiple regions with extremely high OSI values (OSI > 0.3) in all patients. All PDA aneurysms, which were surgically resected, were atherosclerotic.
  
  
  CONCLUSIONS
  4D-Flow identified hemodynamic changes in celiaco-mesenteric arteries in patients with PDA aneurysms with concomitant CA occlusion. These hemodynamic changes may be associated with PDA aneurysm formation.
authors.affiliation: Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Mano
authors.forename: Y
authors.initials: Y
authors.lastname: Takehara
authors.forename: T
authors.initials: T
authors.lastname: Sakaguchi
authors.forename: M T
authors.initials: MT
authors.lastname: Alley
authors.forename: H
authors.initials: H
authors.lastname: Isoda
authors.forename: T
authors.initials: T
authors.lastname: Shimizu
authors.forename: T
authors.initials: T
authors.lastname: Wakayama
authors.forename: M
authors.initials: M
authors.lastname: Sugiyama
authors.forename: H
authors.initials: H
authors.lastname: Sakahara
authors.forename: H
authors.initials: H
authors.lastname: Konno
authors.forename: N
authors.initials: N
authors.lastname: Unno
mesh_terms: D000714:Anastomosis, Surgical; D000783:Aneurysm / Q000503:physiopathology* / Q000601:surgery*; D050197:Atherosclerosis / Q000503:physiopathology*; D016022:Case-Control Studies; D002445:Celiac Artery; D003287:Contrast Media; D004386:Duodenum / Q000098:blood supply*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006499:Hepatic Artery; D006801:Humans; D007091:Image Processing, Computer-Assisted; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D017538:Mesenteric Artery, Superior; D008875:Middle Aged; D010179:Pancreas / Q000098:blood supply*; D018709:Statistics, Nonparametric; D013314:Stress, Mechanical
chemical_list: D003287:Contrast Media
keywords: 4D-Flow; Arteriosclerosis; Celiac artery; Oscillatory shear index; Pancreaticoduodenal artery aneurysm; Shear stress