title: New Insights in Abdominal Pain in Paroxysmal Nocturnal Hemoglobinuria (PNH): A MRI Study.
abstract: BACKGROUND
  Abdominal pain in PNH has never been investigated by in-vivo imaging studies. With MRI, we aimed to assess mesenteric vessels flow and small bowel wall perfusion to investigate the ischemic origin of abdominal pain.
  
  
  METHODS
  Six PNH patients with (AP) and six without (NOP) abdominal pain underwent MRI. In a blinded fashion, mean flow (MF, quantity of blood moving through a vessel within a second, in mL·s-1) and stroke volume (SV, volume of blood pumped out at each heart contraction, in mL) of Superior Mesenteric Vein (SMV) and Artery (SMA), areas under the curve at 60 (AUC60) and 90 seconds (AUC90) and Ktrans were assessed by two operators.
  
  
  RESULTS
  Mean total perfusion and flow parameters were lower in AP than in NOP group. AUC60: 84.81 ± 11.75 vs. 131.73 ± 18.89 (P < 0.001); AUC90: 102.33 ± 14.16 vs. 152.58 ± 22.70 (P < 0.001); Ktrans: 0.0346 min-1 ± 0.0019 vs. 0.0521 ± 0.0015 (P = 0.093 duodenum, 0.009 jejunum/ileum). SMV: MF 4.67 ml/s ± 0.85 vs. 8.32 ± 2.14 (P = 0.002); SV 3.85 ml ± 0.76 vs. 6.55 ± 1.57 (P = 0.02). SMA: MF 6.95 ± 2.61 vs. 11.2 ± 2.32 (P = 0.07); SV 6.52 ± 2.19 vs. 8.78 ± 1.63 (P = 0.07). We found a significant correlation between MF and SV of SMV and AUC60 (MF:ρ = 0.88, P < 0.001; SV: ρ = 0.644, P = 0.024), AUC90 (MF: ρ = 0.874, P < 0.001; SV:ρ = 0.774, P = 0.003) and Ktrans (MF:ρ = 0.734, P = 0.007; SV:ρ = 0.581, P = 0.047).
  
  
  CONCLUSIONS
  Perfusion and flow MRI findings suggest that the impairment of small bowel blood supply is significantly associated with abdominal pain in PNH.
authors.affiliation: Department of Radiology and Center for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: De Cobelli
authors.affiliation: Department of Radiology and Center for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Pezzetti
authors.affiliation: Department of Radiology and Center for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Margari
authors.affiliation: Department of Radiology and Center for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Esposito
authors.affiliation: Department of Radiology and Center for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Giganti
authors.affiliation: Department of Radiology and Center for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Agostini
authors.affiliation: Department of Radiology and Center for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Del Maschio
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D000328:Adult; D019540:Area Under Curve; D004386:Duodenum / Q000098:blood supply; D005260:Female; D006457:Hemoglobinuria, Paroxysmal / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D007082:Ileum / Q000098:blood supply; D007511:Ischemia / Q000175:diagnosis; D007583:Jejunum / Q000098:blood supply; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012039:Regional Blood Flow; D013152:Splanchnic Circulation; D013318:Stroke Volume; D055815:Young Adult