title: Imaging of acute mesenteric ischemia using multidetector CT and CT angiography in a porcine model.
abstract: Acute mesenteric ischemia, a frequently lethal disease, requires prompt diagnosis and intervention for favorable clinical outcomes. This goal remains elusive due, in part, to lack of a noninvasive and accurate imaging study. Traditional angiography is the diagnostic gold standard but is invasive and costly. Computed tomography (CT) is readily available and noninvasive but has shown variable success in diagnosing this disease. The faster scanning time of multidetector row CT (M.D.CT) greatly facilitates the use of CT angiography (CTA) in the clinical setting. We sought to determine whether M.D.CT-CTA could accurately demonstrate vascular anatomy and capture the earliest stages of mesenteric ischemia in a porcine model. Pigs underwent embolization of branches of the superior mesenteric artery, then imaging by M.D.CT-CTA with three-dimensional reconstruction protocols. After scanning, diseased bowel segments were surgically resected and pathologically examined. Multidetector row CT and CT angiography reliably defined normal and occluded mesenteric vessels in the pig. It detected early changes of ischemia including poor arterial enhancement and venous dilatation, which were seen in all ischemic animals. The radiographic findings--compared with pathologic diagnoses-- predicted ischemia, with a positive predictive value of 92%. These results indicate that M.D.CT-CTA holds great promise for the early detection necessary for successful treatment of acute mesenteric ischemia.
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Rosow
authors.forename: Dushyant
authors.initials: D
authors.lastname: Sahani
authors.forename: Oliver
authors.initials: O
authors.lastname: Strobel
authors.forename: Sanjeeva
authors.initials: S
authors.lastname: Kalva
authors.forename: Mari
authors.initials: M
authors.lastname: Mino-Kenudson
authors.forename: Nagaraj S
authors.initials: NS
authors.lastname: Holalkere
authors.forename: Guido
authors.initials: G
authors.lastname: Alsfasser
authors.forename: Sanjay
authors.initials: S
authors.lastname: Saini
authors.forename: Susanna I
authors.initials: SI
authors.lastname: Lee
authors.forename: Peter R
authors.initials: PR
authors.lastname: Mueller
authors.forename: Carlos
authors.initials: C
authors.lastname: Fernández-del Castillo
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Warshaw
authors.forename: Sarah P
authors.initials: SP
authors.lastname: Thayer
mesh_terms: D000208:Acute Disease; D000792:Angiography / Q000379:methods*; D000818:Animals; D004195:Disease Models, Animal; D007511:Ischemia / Q000000981:diagnostic imaging* / Q000473:pathology; D008643:Mesentery / Q000098:blood supply* / Q000000981:diagnostic imaging*; D013552:Swine; D014057:Tomography, X-Ray Computed