CT of the mesenteric vascular anatomy.
BACKGROUND
To evaluate the appearance of the arrangement of the superior mesenteric artery (SMA) and superior mesenteric vein (SMV) on computed tomography (CT) in normal patients and in patients with abdominal masses.


METHODS
One hundred seventy-seven consecutive abdominal CT examinations of 143 adults and two children were reviewed. The relationship of the SMV to the SMA was recorded at four locations: the beginning of the mesenteric vessels and levels 3 cm, 6 cm, and 9 cm caudad to the beginning. The relationship of the SMV to the SMA was divided into four quadrants in relation to the SMA: I, ventral right or directly ventral; II, dorsal right or directly right; III, dorsal left or directly dorsal; and IV, ventral left or directly left.


RESULTS
In the beginning of the SMV-SMA complex and levels 3 cm, 6 cm, and 9 cm caudal to the beginning, the SMV was located in quadrant I in 146, 84, 69, and 43 examinations, in quadrant II in 31, 93, 71, and 27 examinations, in quadrant III in zero, zero, five, and three examinations, and in quadrant IV in zero, zero, nine, and 15 examinations, respectively. The cases with SMV inversion had neither malrotation nor adjacent tumor compression. All the cases with an adjacent tumor-induced compression of the SMV-SMA complex had a normal SMV-SMA relationship.


CONCLUSIONS
In the first 3 cm, the SMV is always to the right of the SMA. Caudal to the level of 6 cm, the SMV may be located to the left of the SMA without evidence of malrotation. A midgut nonrotation is more likely to be present when a proximal SMV inversion is coexistent with a rightward direction of the proximal jejunal vessels. A hypothetical depiction of the step-by-step change of the SMV-SMA relationship during embryologic development may explain the arrangement patterns of the mesenteric vessels in normal rotation and midgut nonrotation.
Chou
C K
CK
Department of Radiology, Chi Mei Foundation Hospital, 901, Chung Hwa Road, Tainan 71010, Taiwan, Republic of China.
Mak
C W
CW
Hou
C C
CC
Chang
J M
JM
Tzeng
W S
WS
D000008:Abdominal Neoplasms / Q000000981:diagnostic imaging; D000293:Adolescent; D002648:Child; D003287:Contrast Media; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000002:abnormalities; D007483:Iothalamic Acid / Q000031:analogs & derivatives; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging*; D008642:Mesenteric Veins / Q000000981:diagnostic imaging*; D008875:Middle Aged; D011860:Radiography, Abdominal; D014057:Tomography, X-Ray Computed
D003287:Contrast Media; D007483:Iothalamic Acid; C002587:ioxitalamic acid