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. 2025 Feb 28;17(2):99333.
doi: 10.4329/wjr.v17.i2.99333.

Assessment of superior mesenteric vascular flow quantitation in children using four-dimensional flow magnetic resonance imaging: A feasibility study

Kantheera Leesmidt  1 , Parmede Vakil  2 , Sofia Verstraete  3 , Amanda R Liu  4 , Rachelle Durand  5 , Jesse Courtier  6
Affiliations

Assessment of superior mesenteric vascular flow quantitation in children using four-dimensional flow magnetic resonance imaging: A feasibility study

Kantheera Leesmidt et al. World J Radiol. .

Abstract

Background: Four-dimensional (4D) flow magnetic resonance imaging (MRI) is used as a noninvasive modality for assessing hemodynamic information with neurovascular and body applications. The application of 4D flow MRI for assessment of bowel disease in children has not been previously described.

Aim: To determine feasibility of superior mesenteric venous and arterial flow quantitation in pediatric patients using 4D flow MRI.

Methods: Nine pediatric patients (7-14 years old, 5 male and 4 female) with history or suspicion of bowel pathology, who underwent magnetic resonance (MR) enterography with 4D flow MR protocol from November 2022 to October 2023. Field strength/sequence: 3T MRI using 4D flow MR protocol. Flow velocity and peak speed measurements were performed by two diagnostic radiologists placing the region of interest in perpendicular plane to blood flow on each cross section of superior mesenteric artery (SMA) and superior mesenteric vein (SMV) at three predetermined levels. Bland-Altman analysis, showed good agreement of flow velocity and peak speed measurements of SMV and SMA between two readers.

Results: Mean SMV flow velocity increased from proximal to mid to distal (0.14 L/minute, 0.17 L/minute, 0.22 L/minute respectively). Mean SMA flow velocity decreased from proximal to mid to distal (0.35 L/minute, 0.27 L/minute, 0.21 L/minute respectively). Observed agreement was good for flow velocity measurements of SMV (mean bias -0.01 L/minute and 95% limits of agreement, -0.09 to 0.08 L/minute) and SMA (mean bias -0.03 L/minute and 95% limits of agreement, -0.23 to 0.17 L/minute) between two readers. Good agreement for peak speed measurements of SMV (mean bias -1.2 cm/second and 95% limits of agreement, -9.4 to 7.0 cm/second) and SMA (mean bias -3.2 cm/second and 95% limits of agreement, -31.4 to 24.9 cm/second).

Conclusion: Flow quantitation using 4D Flow is feasible to provide hemodynamic information for SMV and SMA in children.

Keywords: Bowel disease; Four-dimensional flow magnetic resonance imaging; Mesenteric vessel flow analysis; Superior mesenteric artery; Superior mesenteric vein.

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Conflict of interest statement

Conflict-of-interest statement: Jesse Courtier is founder and shareholder of Sira Medical (this is not mentioned or described in the manuscript). No other authors hold any real or potential conflicts of interest.

Figures

Figure 1
Figure 1
Flow velocity measurements of the superior mesenteric artery and superior mesenteric vein. A: Flow velocity measurements of the superior mesenteric artery. Regions of interest were placed in the perpendicular plane to the blood flow at proximal section (1), curved mid-section (2), and distal straight section before the first jejunal branching (3); B: Flow velocity measurements of the superior mesenteric vein. Regions of interest were placed in the perpendicular plane to the blood flow at the proximal section adjacent to the confluence of small venous tributaries (1), mid-section in between the proximal and distal sections (2), and distal section just below to the spleno-portal venous confluence (3); C: Tempus pixel web-based software demonstrating streamlines in the superior mesenteric artery (1) and superior mesenteric vein (2). The vectors were applied as references for the accurate perpendicular plane for flow velocity measurements. SMA: Superior mesenteric artery; SMV: Superior mesenteric vein.
See this image and copyright information in PMC

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