Value of Multi-detector CT in Detection of Isolated Spontaneous Superior Mesenteric Artery Dissection

Abstract

Objective To investigate the role of multi-detector computed tomography (CT) in the diagnosis and classification of isolated spontaneous superior mesenteric artery dissection (ISSMAD).Methods From July 2012 to December 2016, 30 consecutive patients with ISSMAD underwent CT scan at least two times. We retrospectively summarized the clinical characteristics and CT findings of them. The stenosis ratio of true lumen was compared between the patients without bowel ischemia and ones with bowel ischemia.Results There were 5 cases of type I ISSMAD, 14 cases of type Ⅱ, 1 case of type Ⅲ, 7 cases of type Ⅳ and 3 cases of type V. Intestinal ischemia occurred in 5 patients. The stenosis ratio of true lumen in the patients without bowel ischemia was lower than that with bowel ischemia (45.6% vs. 76.0%, t=-14.5, P=0.000). Five patients with intestinal ischemia underwent superior mesenteric artery stenting and others received conservative therapy. The abdominal pain was alleviated for all the patients after treatment.

Clinical implications of perivascular fat stranding surrounding spontaneous isolated superior mesenteric artery dissection on computed tomography

“…Therefore, CTA is currently the most sensitive and reliable method for diagnosing SISMAD. At our different hospitals, CTA is the diagnostic test of choice for patients suspected to have SISMAD, while CECT is the most commonly used test when SISMAD is diagnosed incidentally in China (5,6,17). However, in clinical practice, numerous patients cannot directly undergo CTA and rather undergo plain CT first.…”

“…The specific etiology of SISMAD is unclear and multiple risk factors have been suggested to be related to this arteriopathy, including connective tissue diseases, cystic medial necrosis, arterial wall dysfunction involving atherosclerosis, fibromuscular dysplasia, vasculitis, tobacco use, atherosclerosis, segmental arterial mediolysis, alcohol abuse, obesity, heavy weight lifting, history of smoking or hypertension, pregnancy and hemodynamic forces caused by the convex curvature of the SMA (1,3,6,18,(20)(21)(22)(23)(24)(25). Patients with SISMAD were predominantly males with an average age of 55 years and this may be related to male smoking and drinking behaviors (6,17). Perhaps, SISMAD can be prevented by measures such as cessation of smoking and drinking alcohol and keeping good dietary habits (6,22).…”

“…The diagnosis of SISMAD was confirmed when one of the following signs was seen in the SMA: i) Intimal flap and contrast enhancement within the false lumen; and ii) a crescent-shaped area along the wall of the SMA indicating no contrast enhancement (2,16,17). All images were jointly reviewed by two radiologists (Examiner 1 and Examiner 2, with 5 and 20 years of experience in abdominal radiology, respectively) who were blinded to the patients' history.…”

Spontaneous isolated superior mesenteric artery dissection: Systematic review and meta-analysis

“…Twentytwo 4,5,14-25,27-33 out of 30 studies (509 patients) reported bowel rest and fluid supplementation as a first approach, while strict blood pressure control using medications was performed in 296 (54.3%) patients. 4,[15][16][17][18][19][20][21][23][24][25]27,29,32,33,35 Anticoagulants were used in 20 studies 4,5, [14][15][16][18][19][20][21][22][23][24][25][26][27][29][30][31]34,35 with 451 (82.7%) patients. Data for conservative treatment with or without anticoagulants came from three studies 17,18,33 while two studies did not report the strict conservative treatment protocol.…”

Diagnostic value of color Doppler sonography for spontaneous isolated superior mesenteric artery dissection

“…With the development of medical imaging, increasing cases of SISMAD are confirmed in patients with acute abdominal pain. At present, the diagnosis of SISMAD is mainly based on computed tomography angiography (CTA) or digital subtraction angiography (DSA) (4,5). Although CTA has served as an effective diagnostic tool for SISMAD, its application in clinical practice is limited by contrast agent allergy, overdose of radiation and high cost (6).…”