Combination of Colour Duplex and Contrast Enhanced Ultrasound as an Alternative to Computed Tomography Angiography in Isolated Mesenteric Artery Dissection Surveillance

Abstract

WHAT THIS PAPER ADDS The combination of colour duplex ultrasound (CDU) and contrast enhanced ultrasound (CEUS) was found to be successful in showing the morphological characteristics of isolated mesenteric artery dissection (IMAD), and ultrasound imaging also allowed the detection and assessment of peak systolic velocity at the point of the minimum inner diameter. CDU plus CEUS was as successful as computed tomography angiography alone in the follow up for patients with IMAD, without the need for radiation exposure or iodine containing contrast use. Objectives: The aim was to investigate the effectiveness of colour duplex ultrasound (CDU) plus contrast enhanced ultrasound (CEUS) vs. computed tomography angiography (CTA) for surveillance in patients with isolated mesenteric artery dissection (IMAD). Methods: Patients who underwent CDU, CEUS, and CTA for surveillance of IMAD between January 2012 and May 2019 were included in the study. The accuracy of CDU, CEUS, and CTA for determining the morphological characteristics of IMAD was analysed. Results: A total of 42 patients undergoing 76 total imaging examinations during follow up were included. Both CTA and CDU plus CEUS demonstrated the thrombosed false lumen for 28 (36.8%) examinations and the dissecting aneurysm for 20 (26.3%) examinations (both k ¼ 1.0). The diameter of the dissecting aneurysm was 5.03 AE 1.25 mm using CDU and CEUS vs. 5.27 AE 1.23 mm on CTA (coefficient of consistency, 0.997; p < .001). The entry points were visualised by CDU and CEUS for 20 (26.3%) examinations and by CTA for 14 (18.4%) examinations (k ¼ 0.769); no re-entry points were visualised by CDU and CEUS for any examinations but re-entry points were visualised by CTA for two (2.6%) examinations. The minimum inner diameter was 2.80 AE 1.30 mm on CDU and CEUS vs. 2.52 AE 1.29 mm on CTA (coefficient of consistency, 0.999; p < .001). The peak systolic velocities were 128.2 AE 13.0 cm/s at diagnosis and 98.7 AE 4.9 cm/s after one month (p < .001). Conclusions: The combination of CDU and CEUS can be used in place of CTA for the surveillance of IMAD.

Aneurysms and dissections - What is new in the literature of 2019/2020 - a European Society of Vascular Medicine annual review

“…Similar results were reported in pts with isolated dissection of the superior mesenteric artery [66]. The authors compared a combination of colour duplex and CEUS and CTA.…”

Management of Spontaneous Isolated Mesenteric Artery Dissection: A Systematic Review

“…On the contrary, morphologic changes of the IMAD appears mainly to occur within the first year after onset of disease ( 25 ), and serial CT follow-up thereafter does not seem to be appropriate due to harmful exposure of cumulative radiation and iodine contrast to these middle-aged individuals. If imaging follow-up is considered in selected patients, the combination of color duplex ultrasound and contrast-enhanced ultrasound may be a viable and preferred alternative for surveillance ( 83 ). In asymptomatic IMAD patients, however, it is very uncertain whether imaging follow-up should be performed at all.…”

Multi-modal imaging for the diagnosis of spontaneous visceral artery dissection: A case report

“…When blood flow was slow and could not be visualized on Color Doppler ultrasound, blood flow could be determined by observing the flow or absence of microbubbles, suggesting that CEUS was more sensitive in determining blood flow in the pseudo cavity. Therefore, it was suggested that CEUS be used as an imaging modality for long-term follow-up of patients with CAD[ 10 ].…”