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MR angiography and 2-D phase-contrast imaging for evaluation of meso-rex bypass function

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Abstract

Background

The meso-Rex bypass restores blood flow to the liver in patients with extrahepatic portal vein thrombosis. Stenosis occurs in some cases, causing the reappearance of portal hypertension. Complications such as thrombocytopenia present on a spectrum and there are currently no guidelines regarding a threshold for endovascular intervention. While Doppler ultrasound (US) is common for routine evaluation, magnetic resonance (MR) angiography with two-dimensional phase-contrast MRI (2-D PC-MRI) may improve the assessment of meso-Rex bypass function.

Objectives

To determine the feasibility and utility of MR angiography with 2-D PC-MRI in evaluating children with meso-Rex bypass and to correlate meso-Rex bypass blood flow to markers of portal hypertension.

Materials and methods

MR angiography and 2-D PC-MRI in meso-Rex bypass patients were retrospectively analyzed. Minimum bypass diameter was measured on MR angiography and used to calculate cross-sectional area. Meso-Rex bypass blood flow was measured using 2-D PC-MRI and divided by ascending aortic flow to quantify bypass flow relative to systemic circulation. Platelet and white blood cell counts were recorded. Correlation was performed between minimum bypass area, blood flow and clinical data.

Results

Twenty-five children (median age: 9.5 years) with meso-Rex bypass underwent MR angiography and 2-D PC-MRI. The majority of patients were referred to imaging given clinical concern for complications. Eighteen of the 25 patients demonstrated >50% narrowing of the bypass cross-sectional area. The mean platelet count in 19 patients was 127 K/μL. There was a significant correlation between minimum cross-sectional bypass area and bypass flow (rho=0.469, P=0.018) and between bypass flow and platelet counts (r=0.525, P=0.021).

Conclusion

Two-dimensional PC-MRI can quantify meso-Rex bypass blood flow relative to total systemic flow. In a cohort of 25 children, bypass flow correlated to minimum bypass area and platelet count. Two-dimensional PC-MRI may be valuable alongside MR angiography to assess bypass integrity.

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Acknowledgements

A special thanks to 3-D analyst Brian Reilly from Ann & Robert H. Lurie Children’s Hospital of Chicago for his contribution of 3-D MR angiography reconstructions.

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Authors and Affiliations

  1. Northwestern University Feinberg School of Medicine, 420 E. Superior St., Chicago, IL, 60611, USA

    Heather A. Stefek

  2. Medical Imaging, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Heather A. Stefek, Cynthia K. Rigsby, Haben Berhane, Andrada R. Popescu & Shankar Rajeswaran

  3. Department of Radiology, Northwestern Memorial Hospital, Chicago, IL, USA

    Cynthia K. Rigsby

  4. Department of Surgery, Northwestern Memorial Hospital, Chicago, IL, USA

    Riccardo A. Superina

  5. Division of Transplant Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Riccardo A. Superina

Authors
  1. Heather A. Stefek
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  2. Cynthia K. Rigsby
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  3. Haben Berhane
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  4. Andrada R. Popescu
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  5. Shankar Rajeswaran
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  6. Riccardo A. Superina
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Correspondence to Heather A. Stefek.

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Stefek, H.A., Rigsby, C.K., Berhane, H. et al. MR angiography and 2-D phase-contrast imaging for evaluation of meso-rex bypass function. Pediatr Radiol 49, 168–174 (2019). https://doi.org/10.1007/s00247-018-4284-8

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  • DOI: https://doi.org/10.1007/s00247-018-4284-8

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