Accuracy of the smaller superior mesenteric vein sign for the detection of acute superior mesenteric artery occlusion

Nakano, Takuma; Ito, Toshitaka; Takei, Toshinobu; Takemoto, Masaaki

doi:10.1002/ams2.313

Cited by 8 publications

(4 citation statements)

References 11 publications

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“…It has been reported that the diameters of the SMV are significantly narrowed and become smaller than the SMA in intestinal ischemic diseases such as SMA thrombosis or non-occlusive mesenteric ischemia (NOMI) [14,15]. It is called the 'smaller SMV sign'.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with indications for surgery and the presence of intestinal necrosis in patients with hepatic portal venous gas: A multicenter retrospective cohort study

Matsui¹,

Takayama²,

Kawate³

et al. 2020

Preprint

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Background The presence of hepatic portal venous gas (HPVG) has been associated with intestinal necrosis and is an indication for surgical intervention. But some cases can be treated conservatively. This study aimed to examine the factors associated with the need for surgical intervention and the development of intestinal necrosis in patients with HPVG.Methods This was a retrospective, multicenter and observational cohort study consisting of 166 patients who were diagnosed as having HPVG based on CT findings between April 2013 and March 2019. The patients were divided into two groups: surgery Required Group and Non-surgery Required Group. We reviewed medical records for clinical backgrounds, vital signs, laboratory data, CT findings, and compared the two groups using the Chi-square test and Student’s t-test with p-values < 0.05 indicating statistical significance.Results There were 72 patients in the Surgery Required Group and 94 in the Non-surgery Required Group. There were no statistically significant differences in age and sex between the two groups. Pulse rate (PR) ( p = 0.004), C-reactive protein (CRP) ( p = 0.012), lactate dehydrogenase (LDH) ( p = 0.006) and abnormality of the white blood cell count (WBC) ( p = 0.012) in the Surgery Required Group were significantly higher than those in the Non-surgery Required Group. The diameter of the superior mesenteric artery (SMA) and vein (SMV), and ratio of SMV/SMA were measured but no statistically significant difference was observed. Band-like pneumatosis ( p < 0.001) and ring like pneumatosis( p < 0.001) were observed with a significantly higher frequency in the Surgery Required Group, but no significant difference was observed in bubble-like pneumatosis. Intrahepatic HPVG was significantly more frequent in the Non-surgery Required Group than surgery Required Group ( p < 0.001), and extrahepatic HPVG ( p < 0.001) was the opposite result. There was no significant difference of HPVG distribution in lobes.Conclusions PR, CRP, LDH, abnormality of WBC, band-like pneumatosis, ring-like pneumatosis, and extrahepatic HPVG are the factors associated with an indication for surgery indication and intestinal necrosis in patients with HPVG.

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Section: Discussionmentioning

confidence: 99%

Factors associated with indications for surgery and the presence of intestinal necrosis in patients with hepatic portal venous gas: A multicenter retrospective cohort study

Matsui¹,

Takayama²,

Kawate³

et al. 2020

Preprint

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“…After contrast IV administration an abrupt interruption of luminal enhancement is seen in vessel occlusion. The SMV/SMA (SMV superior mesenteric vein) diameter ratio is measured at the level of the upper part of the kidney, a ratio ≥1 is considered normal, indicating the absence of a smaller SMV sign, while a ratio <1 has been reported indicated of acute SMA occlusion [41,42]. The sensitivity and specificity of the so-called "smaller SMV sign "have been reported at 70% and 99.2% respectively and it has been assessed in non-contrast images, advocating its utility in case of unsurpassable contraindications to the use of contrast agents [41].…”

Section: • Acute Arterial Mesenteric Ischemiamentioning

confidence: 99%

Diagnostic Role of MDCT in Acute Mesenteric Ischemia

Ronza,

Di Gennaro,

Buzzo

et al. 2024

Preprint

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Mesenteric ischemia diagnosis is challenging with an overall mortality in up to 50% of cases despite advances in treatment. The main problem that affects the outcome is the delayed diagnosis because of non-specific clinical presentation. Multi Detector CT Angiography (MDCTA) is the first line investigation for the suspected diagnosis of vascular abdominal pathologies and is the diagnostic test of choice in suspected mesenteric bowel ischemia. MDCTA can accurately detect the presence of arterial and venous thrombosis, determine the extension and the gastrointestinal tract involved, and provide detailed information determining the subtype and the stage progression of the diseases helping clinicians and surgeons for the proper management. CT can differentiate forms that are still susceptible to pharmacological or interventional treatment (NOM= non-operative management) from advanced disease with transmural necrosis in which a surgical approach is required. Knowledge of CT imaging patterns and corresponding vascular pathways is mandatory in Emergency settings to reach a prompt and accurate diagnosis. The aims of this paper are 1. to provide technical information about the optimal CTA protocol; 2. To empathize the CTA arterial and venous supply to gastrointestinal tract and relative ischemic pattern; 3. To describe vascular, bowel and extraintestinal CT findings for the diagnosis of acute mesenteric ischemia.

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“…The SMV/SMA (SMV, superior mesenteric vein) diameter ratio is measured at the level of the upper part of the kidney; a ratio ≥ 1 is considered normal, indicating the absence of a smaller SMV sign, while a ratio < 1 is indicative of acute SMA occlusion [47,48]. The sensitivity and specificity of the so-called "smaller SMV sign" for the detection of acute SMA occlusion have been reported at 70% and 99.2%, respectively, and it has been assessed in non-contrast images, advocating its utility in case of unsurpassable contraindications to the use of contrast agents [47]. Atherosclerotic steno-occlusion is usually observed in older patients with a history of systemic vasculopathy, and the risk of AMI increases when a critical stenosis involves two of the three major visceral arteries (Figure 4).…”

Section: Acute Arterial Mesenteric Ischemiamentioning

confidence: 99%

Diagnostic Role of Multi-Detector Computed Tomography in Acute Mesenteric Ischemia

Ronza,

Di Gennaro,

Buzzo

et al. 2024

Diagnostics

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Mesenteric ischemia diagnosis is challenging, with an overall mortality of up to 50% of cases despite advances in treatment. The main problem that affects the outcome is delayed diagnosis because of non-specific clinical presentation. Multi-Detector CT Angiography (MDCTA) is the first-line investigation for the suspected diagnosis of vascular abdominal pathologies and the diagnostic test of choice in suspected mesenteric bowel ischemia. MDCTA can accurately detect the presence of arterial and venous thrombosis, determine the extent and the gastrointestinal tract involved, and provide detailed information determining the subtype and the stage progression of the diseases, helping clinicians and surgeons with appropriate management. CT (Computed Tomography) can differentiate forms that are still susceptible to pharmacological or interventional treatment (NOM = non-operative management) from advanced disease with transmural necrosis in which a surgical approach is required. Knowledge of CT imaging patterns and corresponding vascular pathways is mandatory in emergency settings to reach a prompt and accurate diagnosis. The aims of this paper are 1. to provide technical information about the optimal CTA (CT Angiography) protocol; 2. to explain the CTA arterial and venous supply to the gastrointestinal tract and the relevant ischemic pattern; and 3. to describe vascular, bowel, and extraintestinal CT findings for the diagnosis of acute mesenteric ischemia.

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Accuracy of the smaller superior mesenteric vein sign for the detection of acute superior mesenteric artery occlusion

Cited by 8 publications

References 11 publications

Factors associated with indications for surgery and the presence of intestinal necrosis in patients with hepatic portal venous gas: A multicenter retrospective cohort study

Factors associated with indications for surgery and the presence of intestinal necrosis in patients with hepatic portal venous gas: A multicenter retrospective cohort study

Diagnostic Role of MDCT in Acute Mesenteric Ischemia

Diagnostic Role of Multi-Detector Computed Tomography in Acute Mesenteric Ischemia

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