Comparing contrast-enhanced breath-hold MR angiography and conventional angiography in the evaluation of mesenteric circulation

OBJECTIVE, Our aim was to compare the results of gadolinium-enhanced breath -hold MR angiography with those of conventional angiography for the study o f mesenteric circulation. SUBJECTS AND METHODS. MR angiography and digital subtraction angiography we re prospectively performed in 33 patients referred for hepatic, pancreatic, or mesenteric disease. MR angiography was performed with four three-dimens ional acquisitions at 0, 30, 60, and 90 sec after injection of 0.1 mmol/kg of gadolinium. Selective conventional angiography was used as the standard of reference. RESULTS, A pure arterial angiogram (one on which veins could not be visuali zed) was obtained in 27 patients during the second or third acquisition. By subtracting the arterial phase from an arteriovenous phase (third or fourt h acquisition) we obtained a pure venous angiogram (one on which arteries c ould not be visualized) in 28 patients. Agreement was good or excellent for the hepatic artery (kappa = 0.78), the superior mesenteric artery (kappa = 0.65), the splenic artery (kappa = 0.70), the portal vein (kappa = 1.0), t he superior mesenteric vein (kappa = 0.88), and the splenic vein (kappa = 0 .75). Agreement was poor, and vessels were better shown by conventional ang iography, for the intrahepatic arteries (kappa = 0.006) and the branches of the superior mesenteric artery (kappa = 0.14). MR angiography and conventi onal angiography revealed 29 and 27 portosystemic collaterals, respectively . CONCLUSION. Dynamic breath-hold contrast-enhanced MR angiography compared f avorably with conventional angiography in preoperative assessment of the pr oximal mesenteric arteries and in the evaluation of portal hypertension; ho wever, conventional angiography is still necessary to evaluate distal arter ies.