Noninvasive Arterial Imaging: Computed Tomography and Magnetic Resonance Angiography

Chapter

Abstract

Mesenteric vascular disease is often challenging to diagnose because clinical presentation is often nonspecific. Cross-sectional arterial imaging with computed tomography and magnetic resonance angiography (CTA and MRA) can be used to evaluate both the mesenteric vessels and abdominal viscera in a rapid, noninvasive manner. This chapter reviews the basis of imaging with CTA and MRA and their appropriate use in diagnosing mesenteric vascular disorders. Limitations of each modality and considerations prior to choosing an imaging examination are also discussed.

Keywords

Mesenteric vascular disease Magnetic resonance angiography (MRA) Mesenteric ischemia Computed tomography angiogram (CTA) Multidetector CT (MDCT) 

References

  1. 1.
    Wadman M, Syk I, Elmståhl B, Ekberg O, Elmståhl S. Abdominal plain film findings in acute ischemic bowel disease differ with age. Acta Radiol. 2006;47(3):238–43.PubMedCrossRefGoogle Scholar
  2. 2.
    Oliva IB, Davarpanah AH, Rybicki FJ, Desjardins B, Flamm SD, Francois CJ, Dill KE. ACR appropriateness criteria® imaging of mesenteric ischemia. Abdom Imaging. 2013;38(4):714–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Taourel PG, Deneuville M, Pradel JA, Régent D, Bruel JM. Acute mesenteric ischemia: diagnosis with contrast-enhanced CT. Radiology. 1996;199(3):632–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Horton KM, Fishman EK. Multi-detector row CT of mesenteric ischemia: can it be done? Radiographics. 2001;21(6):1463–73.PubMedCrossRefGoogle Scholar
  5. 5.
    Wiesner W, Mortelé KJ, Glickman JN, Ji H, Ros PR. Pneumatosis intestinalis and portomesenteric venous gas in intestinal ischemia: correlation of CT findings with severity of ischemia and clinical outcome. Am J Roentgenol. 2001;177(6):1319–23.CrossRefGoogle Scholar
  6. 6.
    Yu CW, Lee WJ, Tsai YH, Liu KL, Chen SJ. Demonstration of extensive mesenteric venous thrombosis and intestinal infarction with multidetector row CT: value of curved planar reformations. Abdom Imaging. 2003;28(6):775–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Menke J. Diagnostic accuracy of multidetector CT in acute mesenteric ischemia: systematic review and meta-analysis. Radiology. 2010;256(1):93–101.PubMedCrossRefGoogle Scholar
  8. 8.
    Horton KM, Fishman EK. CT angiography of the mesenteric circulation. Radiol Clin North Am. 2010;48(2):331–45.PubMedCrossRefGoogle Scholar
  9. 9.
    Fleischmann D. CT angiography: injection and acquisition technique. Radiol Clin North Am. 2010;48(2):237–47.PubMedCrossRefGoogle Scholar
  10. 10.
    Horton KM, Fishman EK. Mutidetector row and 3D CT of the mesenteric vasculature: normal anatomy and pathology. In: Seminars in ultrasound, CT, and MRI (Vol. 24, No. 5). Philadelphia: WB Saunders; 2003. p. 353–63.Google Scholar
  11. 11.
    Chen JK, Johnson PT, Horton KM, Fishman EK. Unsuspected mesenteric arterial abnormality: comparison of MDCT axial sections to interactive 3D rendering. Am J Roentgenol. 2007;189(4):807–13.CrossRefGoogle Scholar
  12. 12.
    Laissy JP, Trillaud H, Douek P. MR angiography: noninvasive vascular imaging of the abdomen. Abdom Imaging. 2002;27(5):488–506.PubMedCrossRefGoogle Scholar
  13. 13.
    Shih MCP, Hagspiel KD. CTA and MRA in mesenteric ischemia: part 1, role in diagnosis and differential diagnosis. Am J Roentgenol. 2007;188(2):452–61.CrossRefGoogle Scholar
  14. 14.
    Chow LC, Chan FP, Li KCP. A comprehensive approach to MR imaging of mesenteric ischemia. Abdom Imaging. 2002;27(5):507–16.PubMedCrossRefGoogle Scholar
  15. 15.
    Heiss SG, Li KC. Magnetic resonance angiography of mesenteric arteries. Invest Radiol. 1998;33(9):670–81.PubMedCrossRefGoogle Scholar
  16. 16.
    Li KC, Whitney WS, McDonnell CH, Fredrickson JO, Pelc NJ, Dalman RL, Jeffrey RB. Chronic mesenteric ischemia: evaluation with phase-contrast cine MR imaging. Radiology. 1994;190(1):175–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Roobottom CA, Dubbins PA. Significant disease of the celiac and superior mesenteric arteries in asymptomatic patients: predictive value of Doppler sonography. Am J Roentgenol. 1993;161(5):985–8.CrossRefGoogle Scholar
  18. 18.
    Burkart DJ, Johnson CD, Reading CC, Ehman RL. MR measurements of mesenteric venous flow: prospective evaluation in healthy volunteers and patients with suspected chronic mesenteric ischemia. Radiology. 1995;194(3):801–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Li KC, Dalman RL, Ch'en IY, Pelc LR, Song CK, Moon WK, Wright GA. Chronic mesenteric ischemia: use of in vivo MR imaging measurements of blood oxygen saturation in the superior mesenteric vein for diagnosis. Radiology. 1997;204(1):71–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Barmase M, Kang M, Wig J, Kochhar R, Gupta R, Khandelwal N. Role of multidetector CT angiography in the evaluation of suspected mesenteric ischemia. Eur J Radiol. 2011;80(3):e582–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Aschoff AJ, Stuber G, Becker BW, Hoffmann MHK, Schmitz BL, Schelzig H, Jaeckle T. Evaluation of acute mesenteric ischemia: accuracy of biphasic mesenteric multi-detector CT angiography. Abdom Imaging. 2009;34(3):345–57.PubMedCrossRefGoogle Scholar
  22. 22.
    Kirkpatrick ID, Kroeker MA, Greenberg HM. Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia: initial experience. Radiology. 2003;229(1):91–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Meaney JF, Prince MR, Nostrant TT, Stanley JC. Gadolinium-enhanced MR angiography of visceral arteries in patients with suspected chronic mesenteric ischemia. J Magn Reson Imaging. 1997;7(1):171–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Gore RM, Yaghmai V, Thakrar KH, Berlin JW, Mehta UK, Newmark GM, Miller FH. Imaging in intestinal ischemic disorders. Radiol Clin North Am. 2008;46(5):845–75.PubMedCrossRefGoogle Scholar
  25. 25.
    Clavien PA, Dürig M, Harder F. Venous mesenteric infarction: a particular entity. Brit J Surg. 1988;75(3):252–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Bassiouny HS. Nonocclusive mesenteric ischemia. Surg Clin North Am. 1997;77(2):319–26.PubMedCrossRefGoogle Scholar
  27. 27.
    Mirvis SE, Shanmuganathan K, Erb R. Diffuse small-bowel ischemia in hypotensive adults after blunt trauma (shock bowel): CT findings and clinical significance. Am J Roentgenol. 1994;163(6):1375–9.CrossRefGoogle Scholar
  28. 28.
    Horton KM, Talamini MA, Fishman EK. Median arcuate ligament syndrome: evaluation with CT angiography. Radiographics. 2005;25(5):1177–82.PubMedCrossRefGoogle Scholar
  29. 29.
    Okino Y, Kiyosue H, Mori H, Komatsu E, Matsumoto S, Yamada Y, Tomonari K. Root of the small-bowel mesentery: correlative anatomy and CT features of pathologic conditions. Radiographics. 2001;21(6):1475–90.PubMedCrossRefGoogle Scholar
  30. 30.
    Suzuki S, Furui S, Kohtake H, Sakamoto T, Yamasaki M, Furukawa A, Takei R. Isolated dissection of the superior mesenteric artery. Abdom Imaging. 2004;29(2):153–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Stone WM, Abbas M, Cherry KJ, Fowl RJ, Gloviczki P. Superior mesenteric artery aneurysms: is presence an indication for intervention? J Vasc Surg. 2002;36(2):234–7.PubMedCrossRefGoogle Scholar
  32. 32.
    McDonald RJ, McDonald JS, Bida JP, Carter RE, Fleming CJ, Misra S, Kallmes DF. Intravenous contrast material-induced nephropathy: causal or coincident phenomenon? Radiology. 2013;267(1):106–18.PubMedCrossRefGoogle Scholar
  33. 33.
    McDonald JS, McDonald RJ, Comin J, Williamson EE, Katzberg RW, Murad MH, Kallmes DF. Frequency of acute kidney injury following intravenous contrast medium administration: a systematic review and meta-analysis. Radiology. 2013;267(1):119–28.PubMedCrossRefGoogle Scholar
  34. 34.
    Kumamaru KK, Hoppel BE, Mather RT, Rybicki FJ. CT angiography: current technology and clinical use. Radiol Clin North Am. 2010;48(2):213.PubMedCentralPubMedCrossRefGoogle Scholar
  35. 35.
    Bruhn RS, Distelmaier MS, Hellmann-Sokolis M, Naami A, Kuhl CK, Hohl C. Early detection of acute mesenteric ischemia using diffusion-weighted 3.0-T magnetic resonance imaging in a porcine model. Invest Radiol. 2013;48(4):231–7.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of RadiologyMayo ClinicJacksonvilleUSA
  2. 2.Department of RadiologyMayo ClinicRochesterUSA

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