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Chronic Mesenteric Ischemia

Case Study
Sundararaman, Velandai K. Philips Healthcare
Kaur, Baljit, M.D. Chandigarh, Dr. Shamer Singh Memorial Radio-Diagnostic Center (SSRD)
Khanna, Maneesh, M.D. Chandigarh, Dr. Shamer Singh Memorial Radio-Diagnostic Center (SSRD)
Kalasthry, Jagadish Chandigarh, Dr. Shamer Singh Memorial Radio-Diagnostic Center (SSRD)

Patient history:

45-year-old female complaining of pain in the abdomen after meals. Patient is known to have cardiac VSD & right renal artery occlusion with renal infarcts; on oral anti-coagulant therapy.

 

Referred for MR CE Angiography of abdomen to visualize SMA and Renal Arteries.

MR Examination:

SENSE Body coil used.

 

Survey scan was followed by B-TFE sequences in all 3 planes. Breath-hold non-contrast B-TFE of renal arteries was then performed.

 

CE-MRA was finally performed with 20 ml of contrast combined with CENTRA and SENSE Factor 2. MIP and SSD views generated using Volume View package on the Achieva console.

 

Coronal THRIVE sequence was performed immediately after CE-MRA to visualize renal parenchyma. Infarcts were found in right kidney.

 

Patient was imaged again the next morning while fasting and Q-flow of Superior Mesenteric Artery (SMA) and Superior Mesenteric Vein (SMV) was performed. Q-flow of SMA and SMV was repeated after ingestion of fatty meal by the patient. The SMA and SMV Mean Flux of normal subjects 20-30 minutes after fatty meal should increase by 361 =/- 45% and 245 =/-74% respectively. But in this patient mean flux increased by only 20% in SMA and by 28% in SMV. Patient was diagnosed with chronic mesenteric disease.

MR images and interpretation:

B-TFE COR B-TFE AXIAL B-TFE SAG
B-TFE COR
B-TFE AXIAL
B-TFE SAG
B-TFE Renal with breath-hold CE-MRA 20 ml contrast, SENSE and CENTRA SSD IMAGE
B-TFE Renal with breath-hold
CE-MRA 20 ml contrast, SENSE and CENTRA
SSD IMAGE
Breath-hold THRIVE Q-flow for SMA (fasting) Q-flow for SMV (fasting)
Breath-hold THRIVE
Q-flow for SMA (fasting)
Q-flow for SMV (fasting)
Q-flow for SMA (after fatty meal) Q-flow for SMV (after fatty meal)
Q-flow for SMA (after fatty meal)
Q-flow for SMV (after fatty meal)

References:

1. Radiology 1995; 194:801-806

2. Radiology 1994; 190:175-179



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Case Study
Achieva 1.5T
Release 1
Abdominal MRA, Body, Kidneys, Vascular
 

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