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Contrast-enhanced MR Angiography for Evaluation of Vascular Complications of the Pancreatic Transplant¹

¹ From the Department of Radiology, MRI Learning Center, 1 Founders, Hospital of the University of Pennsylvania, Philadelphia (N.D., E.K.I., E.S.S., A.N., J.F.M.); and the Kennedy Health System, Cherry Hill, NJ (D.A.R.). Recipient of a Certificate of Merit award for an education exhibit at the 2003 RSNA Scientific Assembly. Received April 28, 2004; revision requested July 12 and received August 11; accepted August 18. All authors have no financial relationships to disclose. Address correspondence to N.D., 7239 SW Capitol Hwy, Portland, OR 97219 (e-mail: dobosn{at}att.net).

Vascular complications are a common cause of postoperative dysfunction in a pancreatic transplant. Coronal three-dimensional (3D) contrast material–enhanced magnetic resonance (MR) angiography performed with high spatial and temporal resolution is a safe and effective method of assessing these vascular complications. A study was performed of selected patients who had undergone MR imaging and MR angiography during the past 6 years for evaluation of graft dysfunction following pancreatic transplantation. Thrombosis within peripheral stump vessels involving either the arterial or venous segments was a commonly observed vascular complication. Isolated distal arterial stump thrombi are incidental findings that may not require treatment, whereas venous stump thrombi may become clinically significant in patients in whom clot propagates proximally to occlude draining pancreatic veins and are typically treated with anticoagulants or thrombectomy. Because it is difficult to predict which patients will experience clot propagation, patients with venous stump thrombi may be followed up with serial imaging regardless of treatment initiated at presentation. Although susceptibility artifacts can mimic anastomotic stenoses at MR imaging, careful attention to the multiple sequences used allows recognition of this potential pitfall. Contrast-enhanced 3D MR angiography is an accurate method of evaluating the vascular anatomy of pancreatic transplants and can help guide clinical management.

© RSNA, 2005

Abbreviations: CIA = common iliac artery, IVC = inferior vena cava, SMA = superior mesenteric artery, SMV = superior mesenteric vein, 3D = three-dimensional