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Iijima Y, Kotani T, Sakuma T, Nakayama K, Akazawa T, Kishida S, Ueno K, Kajiwara D, Ohyama S, Iwata S, Sunami T, Sakashita K, Okuwaki S, Shiga Y, Minami S, Ohtori S. Risk factors for celiac artery and superior mesenteric artery stenosis in preoperative lumbar and thoracolumbar spinal surgery patients. J Orthop Sci 2023; 28:1214-1220. [PMID: 36371339 DOI: 10.1016/j.jos.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/31/2022] [Accepted: 10/10/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Ischemic necrosis of the abdominal organs caused by compression of the celiac artery (CA) and superior mesenteric artery (SMA) by the median arcuate ligament (MAL) after correction surgery has been recognized as acute celiac artery compression syndrome (ACACS). Here, using contrast-enhanced computed tomographic (CT) images, we sought to determine the prevalence and degree of CA and SMA stenosis in spinal patients preoperatively, and the risk factors associated with the stenosis. METHODS We retrospectively examined contrast-enhanced abdominal CT of 90 patients with preoperative lumbar degenerative disease, lumbar burst fracture, or adult spinal deformity. The trunks of the CA and SMA were detected using three-dimensional reconstructed CT. To investigate their degree of stenosis, we determined the ratio of the narrowest diameter of the stenotic segment to the distal normal lumen's diameter. Patients with a degree of stenosis ≥35% were defined as being in the group with stenosis and the remainder as in the group without. To determine the risk factors for stenosis of these arteries, the relationship between the stenosis and CA and SMA calcification or the median arcuate ligament (MAL) crossing the proximal portion of the celiac axis (MAL overlap) was also investigated. RESULTS The average degree of stenosis of the CA trunk was 12.1% ± 13.9% and that for the SMA trunk was 8.5% ± 8.8%. There were 8 patients (8.9%) in the group with CA stenosis and 2 patients (2.2%) in the group with SMA stenosis. The number of patients in the group with CA stenosis was significantly greater than the number with MAL overlap or CA calcification (P < 0.05). DISCUSSION The prevalence of CA or SMA stenosis was 11.2% of preoperative patients due to undergo thoracolumbar fusion surgery. Calcifications of the CA trunk and MAL overlap are risk factors for CA stenosis.
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Affiliation(s)
- Yasushi Iijima
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan.
| | - Toshiaki Kotani
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Tsuyoshi Sakuma
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Keita Nakayama
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Tsutomu Akazawa
- Department of Orthopedic Surgery, St. Marianna University, School of Medicine, Kawasaki, Japan
| | - Shunji Kishida
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Keisuke Ueno
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Daisuke Kajiwara
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Shuhei Ohyama
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Shuhei Iwata
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Takahiro Sunami
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Kotaro Sakashita
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Shun Okuwaki
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Yasuhiro Shiga
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shohei Minami
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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Posada-Arango AM, García-Madrigal J, Echeverri-Isaza S, Alberto-Castrillón G, Martínez D, Gómez AC, Pinto JA, Pinillos L. Thrombosis in abdominal vessels associated with COVID-19 Infection: A report of three cases. Radiol Case Rep 2021; 16:3044-3050. [PMID: 34306276 PMCID: PMC8286875 DOI: 10.1016/j.radcr.2021.07.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/07/2021] [Accepted: 07/10/2021] [Indexed: 01/08/2023] Open
Abstract
Hypercoagulability related to SARS-CoV-2 infection is one of the main extrapulmonary complications of COVID-19. We present three cases of intrabdominal thrombotic complications related to the state of hypercoagulability of COVID-19 and its tomographic features. Hypercoagulability state should be taking into account in the interpretation of radiological images in all infected patients with COVID-19.
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Affiliation(s)
- Ana María Posada-Arango
- Department of Radiology, Oncosalud- AUNA, Peru Ave. Guardia Civil N 227, San Borja, Lima, Peru
| | - Joaquín García-Madrigal
- Department of Radiology, Clinic Las Americas, Medellin, Colombia.,Department of Radiology, Clinic el Rosario, Medellin, Colombia
| | - Santiago Echeverri-Isaza
- Department of Radiology, Clinical Interventionist Las Americas and Hospital Pablo Tobon Uribe, Medellin, Colombia
| | | | - David Martínez
- Department of Radiooncology, Oncosalud- AUNA, Lima, Peru
| | - Andrea C Gómez
- Basic and Translational Research Center, AUNA Ideas, Lima, Peru
| | - Joseph A Pinto
- Basic and Translational Research Center, AUNA Ideas, Lima, Peru
| | - Luis Pinillos
- Department of Radiology, Oncosalud- AUNA, Peru Ave. Guardia Civil N 227, San Borja, Lima, Peru
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N'guessan Judicael A, Kwadjau Anderson A, Abdoulaye T, Ange Patrick N, Késsé Marc Antoine B, Kouassi Paul N. Mesenteric angina successfully treated by percutaneous angioplasty. Radiol Case Rep 2021; 16:2454-2456. [PMID: 34257778 PMCID: PMC8260747 DOI: 10.1016/j.radcr.2021.05.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 05/28/2021] [Accepted: 05/28/2021] [Indexed: 11/28/2022] Open
Abstract
A female patient of 47 years was sent to our radiology department for abdominal CT. She had severe epigastric pain very marked to left hypochondrium in postprandial period for a month. The pain was increasingly progressive with critical attacks at night. That forced her into fear and food restriction with an estimated weight loss of 4kg. Drug treatments did not improve symptoms. Abdominal CT highlighted thrombosis of superior mesenteric artery of 90%. Other arterial trunks and intestines were normal. Percutaneous angiography confirmed mesenteric thrombosis. A percutaneous transluminal angioplasty (PTA) was performed with success. Antiplatelets were prescribed. A good clinical evolution was observed within one year.
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Affiliation(s)
| | | | - Touré Abdoulaye
- Department of radiology, University Hospital in Cocody, Abidjan, Côte d'Ivoire
| | - Ndja Ange Patrick
- Department of radiology, University Hospital in Cocody, Abidjan, Côte d'Ivoire
| | | | - N'zi Kouassi Paul
- Department of radiology, Cardiology Institute in Abidjan, Abidjan Côte d'Ivoire
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Maffei E, Punzo B, Cavaliere C, Bossone E, Saba L, Cademartiri F. Coronary atherosclerosis as the main endpoint of non-invasive imaging in cardiology: a narrative review. Cardiovasc Diagn Ther 2021; 10:1897-1905. [PMID: 33381433 DOI: 10.21037/cdt-20-525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The change of paradigm determined by the introduction of cardiac computed tomography (CCT) in the field of cardiovascular medicine has allowed new evidence to emerge. These evidences point towards a major role, probably the most important one in terms of prognostic impact, in the detection, characterization and quantification of atherosclerosis as the main driver and endpoint for the management of coronary artery disease (CAD). Extensive literature has been published in the last decade with large numbers and patients' populations, investigating several aspects and correlations between atherosclerotic plaque features and risk factors; also, the relationship between plaque features, both with qualitative and quantitative approaches, and cardiovascular events has been investigated. More recent studies have also pointed out the relationship between the knowledge and classification of sub-clinical atherosclerosis and the induced modification of medical therapy (both aggressiveness and compliance) that is most likely able to increase the effect of anti-atherosclerotic drugs, hence significantly improving prognosis. Non-invasive assessment of CAD by means of CCT is becoming the primary tool for management and also the most important parameter for the comprehension of natural history of CAD and how the therapies we adopt are affecting plaque burden as a whole. In this review we will address the modern concepts of CAD driven understanding and management of cardiovascular disease.
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Affiliation(s)
- Erica Maffei
- Department of Radiology, Area Vasta 1, ASUR Marche, Urbino (PU), Italy
| | - Bruna Punzo
- Department of Radiology, SDN IRCCS, Naples, Italy
| | | | - Eduardo Bossone
- Department of Cardiology, Ospedale Cardarelli, Naples, Italy
| | - Luca Saba
- Department of Radiology, University of Cagliari, Italy
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Umezawa M, Sera T, Yokota H, Takematsu M, Morita M, Yeroslavsky G, Kamimura M, Soga K. Computed tomography for in vivo deep over-1000 nm near-infrared fluorescence imaging. JOURNAL OF BIOPHOTONICS 2020; 13:e202000071. [PMID: 32388908 DOI: 10.1002/jbio.202000071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 06/11/2023]
Abstract
This study aims to develop a novel cross-sectional imaging of fluorescence in over-1000 nm near-infrared (OTN-NIR), which allows in vivo deep imaging, using computed tomography (CT) system. Cylindrical specimens of composite of OTN-NIR fluorophore, NaGdF4 co-doped with Yb3+ and Ho3+ (ex: 980 nm, em: 1150 nm), were embedded in cubic agar (10.5-12 mm) or in the peritoneal cavity of mice and placed on a rotatable stage. When the fluorescence from inside of the samples was serially captured from multiple angles, the images were disrupted by the reflection and refraction of emitted light on the sample-air interface. Immersing the sample into water filled in a rectangular bath suppressed the disruption at the interface and successfully reconstructed the position and concentration of OTN-NIR fluorophores on the cross-sectional images using a CT technique. This is promising as a novel three-dimensional imaging technique for OTN-NIR fluorescent image projections of small animals captured from multiple angles.
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Affiliation(s)
- Masakazu Umezawa
- Department of Materials Science and Technology, Faculty of Industrial Science and Technology, Tokyo University of Science, Tokyo, Japan
| | - Toshihiro Sera
- Department of Mechanical Engineering, Faculty of Engineering, Kyushu University, Fukuoka, Japan
| | - Hideo Yokota
- Image Processing Team, RIKEN Center for Advanced Photonics, Saitama, Japan
| | - Maho Takematsu
- Department of Materials Science and Technology, Faculty of Industrial Science and Technology, Tokyo University of Science, Tokyo, Japan
| | - Masahiko Morita
- Image Processing Team, RIKEN Center for Advanced Photonics, Saitama, Japan
| | - Gil Yeroslavsky
- Imaging Frontier Center, Research Institute for Science and Technology, Tokyo University of Science, Chiba, Japan
| | - Masao Kamimura
- Department of Materials Science and Technology, Faculty of Industrial Science and Technology, Tokyo University of Science, Tokyo, Japan
- Imaging Frontier Center, Research Institute for Science and Technology, Tokyo University of Science, Chiba, Japan
| | - Kohei Soga
- Department of Materials Science and Technology, Faculty of Industrial Science and Technology, Tokyo University of Science, Tokyo, Japan
- Imaging Frontier Center, Research Institute for Science and Technology, Tokyo University of Science, Chiba, Japan
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Inoue A, Ohta S, Imai Y, Murakami Y, Tomozawa Y, Sonoda A, Nitta N. Naturally shrunk visceral artery aneurysms by stenting for the superior mesenteric artery occlusion. MINIM INVASIV THER 2020; 30:245-249. [PMID: 32100596 DOI: 10.1080/13645706.2020.1732426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A 77-year-old woman who had experienced postprandial abdominal pain for four years was admitted to our institution presenting sudden and severe abdominal pain. Contrast-enhanced computed tomography (CECT) demonstrated complete short-segmented occlusion in the orifice of the superior mesenteric artery (SMA), and saccular aneurysms in the right hepatic artery and the anterior superior pancreaticoduodenal artery. She was diagnosed with abdominal angina due to occlusion of the SMA. The SMA was recanalized by stenting, and a CECT scan confirmed naturally shrunk aneurysms after eight months. The patency of the SMA was maintained at five years after endovascular treatment.
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Affiliation(s)
- Akitoshi Inoue
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Shinichi Ohta
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Yugo Imai
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Yoko Murakami
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Yuki Tomozawa
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Akinaga Sonoda
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Norihisa Nitta
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
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van Dijk LJ, van Noord D, Geelkerken RH, Harki J, Berendsen SA, de Vries AC, Moelker A, Vergouwe Y, Verhagen HJ, Kolkman JJ, Bruno MJ. Validation of a score chart to predict the risk of chronic mesenteric ischemia and development of an updated score chart. United European Gastroenterol J 2019; 7:1261-1270. [PMID: 31700639 PMCID: PMC6826523 DOI: 10.1177/2050640619856765] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 05/16/2019] [Indexed: 12/23/2022] Open
Abstract
Background and objective The objective of this article is to externally validate and update a recently published score chart for chronic mesenteric ischemia (CMI). Methods A multicenter prospective cohort analysis was conducted of 666 CMI-suspected patients referred to two Dutch specialized CMI centers. Multidisciplinary consultation resulted in expert-based consensus diagnosis after which CMI consensus patients were treated. A definitive diagnosis of CMI was established if successful treatment resulted in durable symptom relief. The absolute CMI risk was calculated and discriminative ability of the original chart was assessed by the c-statistic in the validation cohort. Thereafter the original score chart was updated based on the performance in the combined original and validation cohort with inclusion of celiac artery (CA) stenosis cause. Results In 8% of low-risk patients, 39% of intermediate-risk patients and 94% of high-risk patients of the validation cohort, CMI was diagnosed. Discriminative ability of the original model was acceptable (c-statistic 0.79). The total score of the updated chart ranged from 0 to 28 points (low risk 19% absolute CMI risk, intermediate risk 45%, and high risk 92%). The discriminative ability of the updated chart was slightly better (c-statistic 0.80). Conclusion The CMI prediction model performs and discriminates well in the validation cohort. The updated score chart has excellent discriminative ability and is useful in clinical decision making.
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Affiliation(s)
- Louisa Jd van Dijk
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.,Department of Radiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Desirée van Noord
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.,Department of Gastroenterology and Hepatology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Robert H Geelkerken
- Department of Surgery, Medisch Spectrum Twente and Multimodality Medical Imaging group, TechMed Centre, Faculty Science and Technology, University Twente, Enschede, the Netherlands
| | - Jihan Harki
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Sophie A Berendsen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Annemarie C de Vries
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Adriaan Moelker
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Yvonne Vergouwe
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Hence Jm Verhagen
- Department of Vascular Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Jeroen J Kolkman
- Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, the Netherlands.,Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, the Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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van Dijk LJD, Harki J, van Noord D, de Vries AC, Moelker A, Verhagen HJM, Kuipers EJ, Bruno MJ. Detection of mesenteric ischemia by means of endoscopic visible light spectroscopy after luminal feeding. Gastrointest Endosc 2019; 89:94-102. [PMID: 30055157 DOI: 10.1016/j.gie.2018.07.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 07/18/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Endoscopic visible light spectroscopy (VLS) enables measurement of mucosal oxygen saturation during upper GI endoscopy and is used in the diagnostic work-up of chronic mesenteric ischemia (CMI). Currently, VLS is performed when the patient has fasted. We aimed to determine whether food challenge improves the diagnostic performance of VLS measurements for the diagnosis of CMI. METHODS This was a single-center prospective study of healthy controls and consecutive patients suspected of having CMI and referred to a Dutch specialized CMI center for standardized diagnostic CMI work-up. Immediately after conventional fasting, VLS measurements were taken, luminal feeding was administered, and VLS measurements were repeated 45 minutes later. Patients were classified as CMI if a multidisciplinary expert-based consensus diagnosis of CMI was established and successful revascularization therapy resulted in symptom relief. Patients were classified as no-CMI when consensus diagnosis was not reached or when symptom relief did not occur after technically successful treatment. RESULTS We included 60 patients with suspected CMI and 16 healthy controls. Duodenal oxygen saturation was significantly higher postprandially compared with the fasting state: healthy controls: median (interquartile range) pre 54% (49%-56%), post 56% (53%-58%), P = .02), no-CMI patients (pre 55% (51%-57%), post 57% (53%-59%), P > .01); CMI patients: pre 51% (48%-53%), post 54% (50%-58%), P = .01. Mucosal oxygen saturation did not significantly increase postprandially in the duodenal bulb or antrum of the stomach. Absolute postprandial oxygen measurements and the absolute or relative difference between preprandial versus postprandial oxygen measurements did not provide additional discriminative ability for the diagnosis of CMI. CONCLUSIONS Postprandial VLS measurements have no added benefit for the diagnosis of CMI.
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Affiliation(s)
- Louisa J D van Dijk
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Radiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Jihan Harki
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Desirée van Noord
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Gastroenterology and Hepatology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Annemarie C de Vries
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Adriaan Moelker
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Hence J M Verhagen
- Department of Vascular Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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van Dijk LJ, Moons LM, van Noord D, Moelker A, Verhagen HJ, Bruno MJ, Rouwet EV. Persistent symptom relief after revascularization in patients with single-artery chronic mesenteric ischemia. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2017.12.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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10
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Fidelman N, AbuRahma AF, Cash BD, Kapoor BS, Knuttinen MG, Minocha J, Rochon PJ, Shaw CM, Ray CE, Lorenz JM. ACR Appropriateness Criteria ® Radiologic Management of Mesenteric Ischemia. J Am Coll Radiol 2018; 14:S266-S271. [PMID: 28473083 DOI: 10.1016/j.jacr.2017.02.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 01/30/2017] [Accepted: 02/02/2017] [Indexed: 12/29/2022]
Abstract
Mesenteric vascular insufficiency is a serious medical condition that may lead to bowel infarction, morbidity, and mortality that may approach 50%. Recommended therapy for acute mesenteric ischemia includes aspiration embolectomy, transcatheter thrombolysis, and angioplasty with or without stenting for the treatment of underlying arterial stenosis. Nonocclusive mesenteric ischemia may respond to transarterial infusion of vasodilators such as nitroglycerin, papaverine, glucagon, and prostaglandin E1. Recommended therapy for chronic mesenteric ischemia includes angioplasty with or without stent placement and, if an endovascular approach is not possible, surgical bypass or endarterectomy. The diagnosis of median arcuate ligament syndrome is controversial, but surgical release may be appropriate depending on the clinical situation. Venous mesenteric ischemia may respond to systemic anticoagulation alone. Transhepatic or transjugular superior mesenteric vein catheterization and thrombolytic infusion can be offered depending on the severity of symptoms, condition of the patient, and response to systemic anticoagulation. Adjunct transjugular intrahepatic portosystemic shunt creation can be considered for outflow improvement. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Nicholas Fidelman
- Principal Author, University of California San Francisco, San Francisco, California.
| | - Ali F AbuRahma
- West Virginia University, Charleston, West Virginia; Society of Vascular Surgery
| | - Brooks D Cash
- University of South Alabama, Mobile, Alabama; American Gastroenterological Association
| | | | | | - Jeet Minocha
- University of California San Diego, San Diego, California
| | - Paul J Rochon
- University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Colette M Shaw
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Charles E Ray
- Specialty Chair, University of Illinois Hospital and Health Science System, Chicago, Illinois
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11
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Kumar DS, Bhat V, Gadabanahalli K, Kalyanpur A. Spectrum of Abdominal Aortic Disease in a Tertiary Health Care Setup: MDCT Based Observational Study. J Clin Diagn Res 2017; 10:TC24-TC29. [PMID: 28050476 DOI: 10.7860/jcdr/2016/21373.8928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 09/06/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Abdominal aortic disease is an important cause of clinical disability that requires early detection by imaging methods for prompt and effective management. Understanding regional disease pattern and prevalence has a bearing on healthcare management and resource planning. Non-invasive, conclusive imaging strategy plays an important role in the detection of disease. Multi-Detector Computed Tomography (MDCT) with its technological developments provides affordable, accurate and comprehensive imaging solution. AIM To evaluate regional demography of abdominal aortic disease spectrum detected using MDCT imaging data in a tertiary hospital. MATERIALS AND METHODS A descriptive study was conducted based on MDCT imaging data of patients who were investigated with clinical diagnosis of abdominal aortic disease, from March 2008-2010, over a period of 24 months. Patients were examined with the contrast-enhanced MDCT examination. Morphological diagnosis of the aortic disease was based on changes in relative aortic caliber, luminal irregularity, presence of wall calcification, dissection or thrombus and evidence of major branch occlusion. Patients were categorized into four groups based on imaging findings. MDCT information and associated clinical parameters were examined and correlated to management of patient. Descriptive statistical data, namely mean, standard deviation and frequency of disease were evaluated. RESULTS A total of 90 out of 210 patients (43%) were detected with the abdominal aortic abnormality defined by imaging criteria. Group I, comprising of patients with atherosclerosis -including those with complications, constituted 65.5% of the patients. Group II represented patients with aneurysms (45.5%). Group III, consisting of 32.2% of the patients, contained those with dissections. The rest of the patients, including patients with aorto-arteritis, were classified as group IV. Eight patients with aneurysm and one patient with aorto-arteritis were considered for surgical treatment. Ten patients with dissection underwent endovascular procedure. Rest of the patients was managed conservatively. CONCLUSION Aortic disease was observed in 43% of investigated patients. Atherosclerosis with and without aortic aneurysm constituted the largest group. MDCT provided comprehensive information about the lesion and associated complications. In view of the wider availability and desired imaging qualities, MDCT provided optimal information for diagnosis and management of aortic pathology. Majority of our patients (90%) were treated conservatively.
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Affiliation(s)
- Dg Santosh Kumar
- Consultant Radiologist, Narayana Health, Shaw Mazumdar Medical Center , Bengaluru, Karnataka, India
| | - Venkatraman Bhat
- Director of Imaging Services, Sr. Consultant, Department of Radiology, Narayana Health, Shaw Mazumdar Medical Center , Bengaluru, Karnataka, India
| | - Karthik Gadabanahalli
- Consultant Radiologist, Department of Radiology, Narayana Health, Teleradiology Solutions , Whitefield, Bengaluru, Karnataka, India
| | - Arjun Kalyanpur
- CEO, Teleradiology Solutions, Teleradiology Solutions , Whitefield, Bengaluru, Karnataka, India
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12
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Shah AS, Schwartz LB, Moawad J, Gewertz BL. Technique profile: mesenteric reconstructions for occlusive disease. Expert Rev Cardiovasc Ther 2015; 13:1445-58. [DOI: 10.1586/14779072.2015.1094376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Hashemi J, Davoudi Y, Taghavi M, Pezeshki Rad M, Moghadam AM. Improvement of distension and mural visualization of bowel loops using neutral oral contrasts in abdominal computed tomography. World J Radiol 2014; 6:907-912. [PMID: 25550995 PMCID: PMC4278151 DOI: 10.4329/wjr.v6.i12.907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 11/10/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess and compare the image quality of 4% sorbitol and diluted iodine 2% (positive oral contrast agent) in abdomino-pelvic multi-detector computed tomography.
METHODS: Two-hundred patients, referred to the Radiology Department of a central educational hospital for multi-detector row abdominal-pelvic computed tomography, were randomly divided into two groups: the first group received 1500 mL of 4% sorbitol solution as a neutral contrast agent, while in the second group 1500 mL of meglumin solution as a positive contrast agent was administered in a one-way randomized prospective study. The results were independently reviewed by two radiologists. Luminal distension and mural thickness and mucosal enhancement were compared between the two groups. Statistical analysis of the results was performed by Statistical Package for the Social Sciences software version 16 and the Mann-Whitney test at a confidence level of 95%.
RESULTS: Use of neutral oral contrast agent significantly improved visualization of the small bowel wall thickness and mural appearance in comparison with administration of positive contrast agent (P < 0.01). In patients who received sorbitol, the small bowel showed better distention compared with those who received iodine solution as a positive contrast agent (P < 0.05).
CONCLUSION: The results of the study demonstrated that oral administration of sorbitol solution allows better luminal distention and visualization of mural features than iodine solution as a positive contrast agent.
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14
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Nonneoplastic Diseases of the Small Intestine: Clinical, Pathophysiologic, and Imaging Characteristics. AJR Am J Roentgenol 2013; 201:W382-90. [DOI: 10.2214/ajr.12.8496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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15
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Tsujikawa T, Yoden A. [Intestinal ischemic disease and NEMO]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2011; 100:78-84. [PMID: 21387638 DOI: 10.2169/naika.100.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Tomoyuki Tsujikawa
- Division of Gastroenterology, Shiga University of Medical Science, Japan
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16
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CT emergencies. Emerg Radiol 2009. [DOI: 10.1017/cbo9780511691935.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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17
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Cardiovascular and chest. Emerg Radiol 2009. [DOI: 10.1017/cbo9780511691935.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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18
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Halász S, Puskás T. The importance of multidetector computed tomography in the vascular imaging. Orv Hetil 2009; 150:1351-60. [DOI: 10.1556/oh.2009.28664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A több detektorsoros spirál-CT-berendezések és a hozzájuk tartozó speciális rekonstrukciós szoftverek bevezetése lehetővé tette az erek jó minőségű CT-vizsgálatát.
Cél és módszerek:
A szerzők ismertetik a CT-angiográfiai vizsgálatok elvét, technikáját, amelyet az elmúlt három évben közel 700 saját betegükön végzett vizsgálataik eredményeivel, tapasztalataival egészítenek ki. Bemutatják a CT-angiográfia jelentőségét, valamint annak más vascularis képalkotó eljárások helyett vagy melletti alkalmazhatóságát.
Következtetések:
A CT-angiográfia gyors, noninvazív vizsgálati módszer, amellyel – önmagában vagy más vizsgálattal kiegészítve – pontos diagnózis állítható fel.
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Affiliation(s)
- Szabolcs Halász
- 1 Vas Megyei Markusovszky Kórház Nonprofit Zrt. Radiológiai Osztály, Diagnosztikai Részleg Szombathely Szent Flórián krt. 39. 9700
| | - Tamás Puskás
- 1 Vas Megyei Markusovszky Kórház Nonprofit Zrt. Radiológiai Osztály, Diagnosztikai Részleg Szombathely Szent Flórián krt. 39. 9700
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19
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Gawenda M, Libicher M. Commentary: Imaging to Estimate the Safety of Intentional Celiac Trunk Coverage in TEVAR: Multislice CTA Cannot Replace Angiography at Present. J Endovasc Ther 2009; 16:55-8; discussion 58-9. [DOI: 10.1583/08-2549c.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Gore RM, Yaghmai V, Thakrar KH, Berlin JW, Mehta UK, Newmark GM, Miller FH. Imaging in intestinal ischemic disorders. Radiol Clin North Am 2009; 46:845-75, v. [PMID: 19103136 DOI: 10.1016/j.rcl.2008.05.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Intestinal ischemia and infarction are a heterogeneous group of diseases that have as their unifying theme hypoxia of the small bowel or colon. The incidence of bowel ischemia and infarction is on the rise for several reasons: the aging of the population, the ability of intensive care units to salvage critically ill patients, and heightened clinical awareness of these disorders. Improvements in diagnostic imaging techniques have greatly contributed to the earlier diagnosis of intestinal ischemia, which can have a positive influence on patient outcomes. In this article, role of radiology in the detection, differential diagnosis, and management of patients who have intestinal ischemia and infarction is discussed.
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Affiliation(s)
- Richard M Gore
- Department of Radiology, Evanston Northwestern Healthcare, Northwestern University Medical School, 2650 Ridge Avenue, Evanston, IL 60201, USA.
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21
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Abstract
LEARNING OBJECTIVES Learning objectives of this paper are to review and to summarize the pathogenesis of bowel ischemia and to describe its clinical, pathological, and radiological manifestations. BACKGROUND Bowel ischemia is a common disorder produced by several causes, and it shows various clinical presentations connected with an high mortality. With the increase in average life expectancy, bowel ischemia represents one of the most threatening abdominal conditions in elderly patients. In the last decade, computed tomography has tremendously altered the diagnostic approach to bowel ischemia also influencing the therapeutic approach in the current practice. IMAGING FINDINGS Computed tomographic imaging findings include bowel wall thickening, portal venous gas, intramural pneumatosis, engorgement of mesenteric veins, loss or increase of bowel wall enhancement, and infarction of other abdominal organs. CONCLUSIONS Bowel ischemia shows a broad spectrum of radiological manifestations, and regardless of the primary causes, it produces similar radiological features. Bowel ischemia may simulate cancer or inflammatory conditions; so it is a mandatory tight integration between radiological and clinical signs.
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22
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Ikeda O, Tamura Y, Nakasone Y, Yamashita Y. Celiac artery stenosis/occlusion treated by interventional radiology. Eur J Radiol 2008; 71:369-77. [PMID: 18562143 DOI: 10.1016/j.ejrad.2008.05.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Accepted: 05/06/2008] [Indexed: 12/16/2022]
Abstract
Severe stenosis/occlusion of the proximal celiac trunk due to median arcuate ligament compression (MALC), arteriosclerosis, pancreatitis, tumor invasion, and celiac axis agenesis has been reported. However, clinically significant ischemic bowel disease attributable to celiac axis stenosis/occlusion appears to be rare because the superior mesenteric artery (SMA) provides for rich collateral circulation. In patients with celiac axis stenosis/occlusion, the most important and frequently encountered collateral vessels from the SMA are the pancreaticoduodenal arcades. Patients with celiac artery stenosis/occlusion are treated by interventional radiology (IR) via dilation of the pancreaticoduodenal arcade. In patients with dilation of the pancreaticoduodenal arcade on SMA angiograms, IR through this artery may be successful. Here we provide several tips on surmounting these difficulties in IR including transcatheter arterial chemoembolization for hepatocellular carcinoma, an implantable port system for hepatic arterial infusion chemotherapy to treat metastatic liver tumors, coil embolization of pancreaticoduodenal artery aneurysms, and arterial stimulation test with venous sampling for insulinomas.
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Affiliation(s)
- Osamu Ikeda
- Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, 1-1-1, Honjo Kumamoto 860-8505, Japan.
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23
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Imaging of the Small Bowel: Challenges and Advances in Imaging Techniques. J Med Imaging Radiat Sci 2008; 39:55-63. [DOI: 10.1016/j.jmir.2008.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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24
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Abstract
Intestinal ischemia is a relatively common disorder in the elderly and, if not treated promptly, still carries a high morbidity and mortality rate. High degree of clinical suspicion is of paramount importance in diagnosis, because there is no specific laboratory test available and physical examination findings may be subtle. Once the diagnosis is made, management relies on early resuscitation, identification, and treatment of the predisposing conditions, along with careful planning of the therapeutic invasive interventions, which altogether may help reduce the mortality and morbidity associated with this condition.
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Affiliation(s)
- Nuri Ozden
- Department of Internal Medicine, Meharry Medical College, 1005 Dr. D.B. Todd, Jr. Boulevard, Nashville, TN 37208-3599, USA.
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25
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Chen JK, Johnson PT, Horton KM, Fishman EK. Unsuspected mesenteric arterial abnormality: comparison of MDCT axial sections to interactive 3D rendering. AJR Am J Roentgenol 2007; 189:807-13. [PMID: 17885049 DOI: 10.2214/ajr.07.2137] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The purpose of our study was to determine how frequently significant mesenteric arterial abnormalities that were identified by interactive 3D CT with volume rendering and maximum intensity projection were detected by axial images alone in a series of patients for whom there was no clinical suspicion of mesenteric vascular disease. Axial CT and 3D interpretations were compared for lesions involving the celiac and superior mesenteric arteries or their branches. On a per-patient basis, the axial and 3D interpretations were equivalent in 24% (10/41) of the cases. Axial CT partially agreed with 3D CT in 10% (4/41), and no mesenteric arterial lesion was reported on axial CT in 66% (27/41). The 3D CT findings were supported by other imaging, surgery, clinical findings, or management in 49% (20/41) of the cases. The mesenteric lesions identified resulted in a change in patient management in 15% (6/41) of the subjects. CONCLUSION Unsuspected mesenteric arterial abnormality may elude diagnosis when axial MDCT sections are interpreted without 3D renderings.
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Affiliation(s)
- Jennifer K Chen
- The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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26
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Horton KM, Fishman EK. Multidetector CT angiography in the diagnosis of mesenteric ischemia. Radiol Clin North Am 2007; 45:275-88. [PMID: 17502217 DOI: 10.1016/j.rcl.2007.03.010] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Multidetector CT is an ideal tool for the diagnosis of acute and chronic mesenteric ischemia. Advanced CT scanners and expertise in three-dimensional imaging are becoming increasingly widespread, opening the door to new opportunities and challenges in the evaluation of patients suspected of having mesenteric ischemia. This article reviews contrast administration and image acquisition protocols, the anatomy of the mesenteric vasculature, the etiology of acute and chronic mesenteric ischemia, and CT findings diagnostic for these conditions.
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Affiliation(s)
- Karen M Horton
- Johns Hopkins Medical Institutions, 601 N. Caroline Street/JHOC 3253, Baltimore, MD 21287, USA.
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27
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Abstract
Mesenteric ischemia is a difficult clinical diagnosis that requires a high index of clinical suspicion because the clinical and imaging features of intestinal ischemia and infarction overlap with many other intestinal disorders, and patients who have mesenteric ischemia often have coexisting diseases. Multidetector CT (MDCT) evaluation of the abdomen is the examination of choice when mesenteric ischemia is suspected because of its ability to provide two-dimensional multiplanar and three-dimensional display of the mesenteric vasculature and small intestine. This article reviews the clinical features, pathophysiology, and MDCT features of mesenteric ischemia.
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Affiliation(s)
- Angela D Levy
- Department of Radiology and Radiologic Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4799, USA.
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28
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Bilbao Jaureguízar JI, Vivas Pérez I, Cano Rafart D, Martínez de la Cuesta A. Imaging and Intervention in Gastrointestinal Hemorrhage and Ischemia. Emerg Radiol 2007. [DOI: 10.1007/978-3-540-68908-9_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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29
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30
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Ilica AT, Bilici A, Ilhan A, Kara M, Gür S. Thoracoabdominal aorta coarctation with bilateral renal artery involvement: diagnosis with multidetector CT angiography (MDCTA). Int J Cardiovasc Imaging 2006; 23:645-8. [PMID: 17033730 DOI: 10.1007/s10554-006-9135-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Accepted: 07/05/2006] [Indexed: 10/24/2022]
Abstract
Atypical coarctation of the descending thoracic and abdominal aorta is a very uncommon vascular disease. Congenital, acquired, inflammatory, and infectious etiologies have been proposed. Patients typically presents with uncontrolled secondary hypertension in the upper half of the body or hypotension in the lower extremities in the first three decades of their lives. We report the case of a 20-year-old man with severe hypertension. Diffuse coarctation of thoracoabdominal aorta associated with bilateral renal artery stenosis was demonstrated clearly by multidetector CT angiography. This is the first case of atypical aortic coarctation diagnosed by MDCTA.
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31
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Megibow AJ, Babb JS, Hecht EM, Cho JJ, Houston C, Boruch MM, Williams AB. Evaluation of bowel distention and bowel wall appearance by using neutral oral contrast agent for multi-detector row CT. Radiology 2005; 238:87-95. [PMID: 16293806 DOI: 10.1148/radiol.2381041985] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE To prospectively evaluate the performance of an orally administered 0.1% barium suspension, Volumen, as a bowel-marking agent for multi-detector row computed tomography (CT). MATERIALS AND METHODS This HIPAA-compliant study was approved by the Institutional Review Board and conformed to the institutional standards for research funded by a commercial sponsor. A total of 60 patients (33 women, 27 men; average age, 58.2 years) who were referred for multi-detector row CT of the pancreas were randomized into two groups. Prior to examination, group 1 consumed 1200 mL of Volumen over a 30-minute period and group 2 consumed 1200 mL of a solution containing three parts water and one part methylcellulose over a 30-minute period. Results were independently reviewed by two radiologists who were unaware of the contrast agent used. The degree of distention and the visualization of mural detail were qualitatively scored on a five-point scale. Differences were evaluated by using the Mann-Whitney test at a confidence level of 95%. RESULTS There was significantly better distention in the stomach (P = .013), duodenum (P = .006), jejunum (P = .029), and ileum (P = .014) [corrected] in group 1 compared with group 2. Significant distention was also evident by comparing the products of the widest cross-sectional diameters in duodenum (P = .143), jejunum (P < .001), and ileum (P < .001). Group 1 also demonstrated significantly better visualization of mural features in the duodenum (P = .003), jejunum (P = .024), and ileum (P = .01) and a trend toward better visualization of mural features in the stomach (P = .092). CONCLUSION Oral administration of Volumen provided excellent distention and excellent visualization of mural features in the gastrointestinal tract.
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Affiliation(s)
- Alec J Megibow
- Department of Radiology, New York University School of Medicine, 550 First Ave, Rm IRM 232, New York, NY 10016, USA.
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32
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Abstract
Multidetector CT angiography (MDCTA) is redefining traditional imaging strategies of the vascular structures of the abdomen. Angiographic depiction of normal and variant anatomy is becoming the standard for evaluation and has a significant impact in transplant and oncologic surgery. MDCTA is increasingly being used for assessing diseases affecting the vasculature of the abdominal organs, including the abdominal aorta for treatment planning and post therapy follow-up.
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Affiliation(s)
- Preet S Kang
- Case Western Reserve University, Cleveland, OH, USA.
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