Haquin Audrey, Sigovan Monica, Si-Mohamed Salim, Mabrut Jean-Yves, Manichon Anne-Frédérique, Bakir Melisa, Rode Agnès, Boussel Loïc
1 Department of Radiology, Hôpital de la Croix-Rousse, University of Lyon, Lyon, France.
2 CREATIS, CNRS UMR 5220-INSERM U1206-University of Lyon, Lyon, France.
Br J Radiol. 2017 Apr;90(1072):20160802. doi: 10.1259/bjr.20160802. Epub 2017 Mar 3.
To evaluate the correlation between the gastroduodenal artery (GDA) haemodynamic changes and the degree of coeliac axis (CA) stenosis using phase-contrast MRI.
The study was institutional review board approved, and written informed consent was obtained from patients included prospectively. A two-dimensional phase-contrast MRI was performed in 23 patients scheduled for a potential complex supramesocolic surgery, in a plane perpendicular to the GDA, during inspiration and expiration. The peak and mean velocities (V and V), mean flow rate (Q) and flow direction at inspiration and at expiration have been correlated with the degree of CA stenosis evaluated by CT.
13 of 23 patients presented CA stenosis due to the median arcuate ligament (34-80% of stenosis), 4 of them had associated atheromatous calcifications. V, V and Q of GDA presented a significant and linear relationship with the degree of CA stenosis, at inspiration as well as at expiration (r > 0.74, p < 0.001). Velocities and flow rates presented a different pattern depending on the degree of CA stenosis: <34% (n = 10), flow direction remained physiological with low velocities and flow rates; >60% of stenosis (n = 5), a reverse flow direction with increased velocities and flow rates were observed; variable patterns between 34% and 60%.
Phase-contrast MRI permits the evaluation of haemodynamic changes in GDA induced by CA stenosis, including median arcuate ligament compression, and could be of great interest in therapeutic decision making in supramesocolic surgery, such as liver transplantation or duodenopancreatectomy, by detecting haemodynamically significant stenoses. Advances in knowledge: Physiological phase-contrast MRI detects haemodynamically significant stenoses of the CA by evaluating haemodynamic parameters in the GDA. Physiological phase-contrast MRI demonstrates that flow in the GDA can be a direct marker of the real haemodynamic impact of a CA stenosis on the hepatic vascularization and could thus participate in the pre-surgical work-up of duodenopancreatectomy or hepatic graft, whereas existing pre-operative imaging are only morphological.
使用相位对比磁共振成像（MRI）评估胃十二指肠动脉（GDA）血流动力学变化与腹腔干（CA）狭窄程度之间的相关性。
本研究经机构审查委员会批准，并前瞻性地获得了纳入患者的书面知情同意书。对23例计划进行潜在复杂结肠上区手术的患者，在吸气和呼气时于垂直于GDA的平面进行二维相位对比MRI检查。吸气和呼气时的峰值流速和平均流速（V和V）、平均血流量（Q）及血流方向与CT评估的CA狭窄程度进行相关性分析。
23例患者中有13例因正中弓状韧带导致CA狭窄（狭窄程度为34%-80%），其中4例伴有动脉粥样硬化钙化。GDA的V、V和Q在吸气和呼气时均与CA狭窄程度呈显著线性关系（r＞0.74, p＜0.001）。流速和血流量根据CA狭窄程度呈现不同模式：狭窄程度＜34%（n = 10），血流方向保持生理性，流速和血流量较低；狭窄程度＞60%（n = 5），观察到血流方向逆转，流速和血流量增加；狭窄程度在34%至60%之间呈现可变模式。
相位对比MRI能够评估CA狭窄（包括正中弓状韧带压迫）引起的GDA血流动力学变化，通过检测血流动力学上具有显著意义的狭窄，在结肠上区手术（如肝移植或胰十二指肠切除术）的治疗决策中可能具有重要价值。知识进展：生理性相位对比MRI通过评估GDA中的血流动力学参数来检测CA血流动力学上具有显著意义的狭窄。生理性相位对比MRI表明，GDA中的血流可以直接反映CA狭窄对肝血管化的实际血流动力学影响，从而可参与胰十二指肠切除术或肝移植术前评估，而现有的术前影像学检查仅为形态学检查。
