Leesmidt K, Vakil P, Verstraete S, Liu AR, Durand R, Courtier J. Assessment of superior mesenteric vascular flow quantitation in children using four-dimensional flow magnetic resonance imaging: A feasibility study. World J Radiol 2025; 17(2): 99333 [PMID: 40060952 DOI: 10.4329/wjr.v17.i2.99333]
Corresponding Author of This Article
Jesse Courtier, MD, Professor, Department of Radiology and Biomedical Imaging, University of California Benioff Children's Hospital, 1975 4th Street C1758P, San Francisco, CA 94158, United States. jesse.courtier@ucsf.edu
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Radiol. Feb 28, 2025; 17(2): 99333 Published online Feb 28, 2025. 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, Parmede Vakil, Sofia Verstraete, Amanda R Liu, Rachelle Durand, Jesse Courtier
Kantheera Leesmidt, Department of Radiology, Faculty of Medicine, Naresuan University, Phitsanulok 65000, Thailand
Parmede Vakil, Department of Radiology, OHSU, Portland, OR 97239, United States
Sofia Verstraete, Department of Pediatrics, Division of Pediatric Gastroenterology, University of California, San Francisco, CA 94127, United States
Amanda R Liu, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94127, United States
Rachelle Durand, Jesse Courtier, Department of Radiology and Biomedical Imaging, University of California Benioff Children's Hospital, San Francisco, CA 94158, United States
Author contributions: Courtier J contributed to guarantor of the integrity of the entire study; Courtier J and Vakil P contributed to study concepts and design; Leesmidt K and Courtier J contributed to literature research; Verstraete S, Liu L, Durand R and Vakil P contributed to experimental studies/data analysis; Vakil P and Leesmidt K contributed to statistical analysis; All authors contributed to manuscript preparation and editing.
Institutional review board statement: Institutional review board approval for retrospective correlation of imaging with other clinical parameters was obtained, No. 18-25412.
Informed consent statement: This retrospective study was performed with institutional review board approval with informed consent requirements waived.
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.
Data sharing statement: The data that support the findings of this study are available from UCSF. Restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request at jesse.courtier@ucsf.edu and with permission of UCSF.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jesse Courtier, MD, Professor, Department of Radiology and Biomedical Imaging, University of California Benioff Children's Hospital, 1975 4th Street C1758P, San Francisco, CA 94158, United States. jesse.courtier@ucsf.edu
Received: July 19, 2024 Revised: January 7, 2025 Accepted: February 8, 2025 Published online: February 28, 2025 Processing time: 221 Days and 12.5 Hours
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.
Core Tip: In this manuscript we assess use of four-dimensional (4D) flow magnetic resonance imaging (MRI) in superior mesenteric venous and arterial flow quantitation in pediatric patients. This retrospective study included 9 pediatric patients (7-14 years old, 5 male and 4 female) with history or suspicion of bowel pathology, who underwent MRI studies with 4D flow magnetic resonance protocol. In our study of pediatric patients, 4D flow MRI is feasible to provide quantitative superior mesenteric vein and superior mesenteric artery hemodynamic flow information.
