Vascular contact with soft tissue: a sign of mesenteric masses at computed tomography.
OBJECTIVE
To evaluate prevalence of mesenteric vascular contact at routine computed tomography (CT) and evaluate its value for distinguishing missed mesenteric masses from adjacent bowel.


METHODS
We identified 18 abdominopelvic CT scans of 9 patients in whom mesenteric masses were missed on the prospective CT reports. We recorded the long-axis diameter of the masses, time interval to eventual detection, and presence of vascular contact (fat plane obscuration) with a mesenteric vessel greater than 1 mm in diameter. We also retrospectively identified 129 consecutive abdominopelvic CT scans of nononcology patients and recorded all locations of vascular contact between a mesenteric vessel greater than 1 mm in diameter and adjacent bowel.


RESULTS
In the 18 CT examinations where mesenteric masses were missed, the mean long-axis diameter was 2.9 cm, and time between the initial CT scan and first discovery was 12 months. Mesenteric vessels contacted the masses in 17 (94%) of 18 scans. In the 129 nononcology patients, vascular contact was rarely seen with bowel distal to the proximal jejunum (6 had vascular contact with distal jejunum, 5 with ileum, and 0 with colon). However, the third and fourth duodenal portions showed vascular contact with the superior mesenteric vessels in 36 (28%) and 12 patients (9.4%), respectively, and with the inferior mesenteric vessels in 58 patients (48%).


CONCLUSIONS
At CT, mesenteric vessels greater than 1 mm in diameter rarely contact bowel other than the duodenum and proximal jejunum; however, they often contact mesenteric masses. At CT scan review, inspection of the mesenteric vessels may facilitate mesenteric mass identification.
Yeh
Benjamin M
BM
Department of Radiology, University of California San Francisco, San Francisco, CA 94143-0628, USA. ben.yeh@radiology.ucsf.edu
Joe
Bonnie N
BN
Sirlin
Claude B
CB
Webb
Emily M
EM
Westphalen
Antonio C
AC
Qayyum
Aliya
A
Coakley
Fergus V
FV
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000008:administration & dosage; D003937:Diagnosis, Differential; D003973:Diatrizoate; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007421:Intestine, Small / Q000000981:diagnostic imaging*; D007472:Iohexol; D008297:Male; D008642:Mesenteric Veins / Q000000981:diagnostic imaging*; D008643:Mesentery / Q000000981:diagnostic imaging*; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000175:diagnosis*; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011856:Radiographic Image Enhancement / Q000379:methods; D012189:Retrospective Studies; D012983:Soft Tissue Neoplasms / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media; D003973:Diatrizoate; D007472:Iohexol