title: Three-dimensional variability of the mesentery and the superior mesenteric artery: application to virtual trauma modeling.
abstract: BACKGROUND
  Trauma is a major cause of death worldwide, mainly affecting a young male population. Blunt trauma of the abdomen can cause a trauma of the mesentery in 5 % of cases. Rapid decelerations and injuries by seat belts are the most common pathophysiological mechanisms. Three-dimensional anatomical scanning of the mesentery and gastrointestinal tract is the first essential step in modeling abdominal trauma in an attempt to understand the pathophysiology of mesenteric lesions and to improve the safety features of vehicles.
  
  
  OBJECTIVE
  To analyze the individual variability of the mesentery and the superior mesenteric artery (SMA) from medical imaging and to develop a three-dimensional customizable finite element model.
  
  
  METHODS
  In this retrospective study, one hundred abdominopelvic injected CT scans were analyzed from healthy patients. The evaluation criteria of the mesentery were its volume (total and the distribution of adipose tissue/non adipose tissue), the length of the SMA and the distance between duodenojejunal angle (DJA) and the ileocecal junction (ICJ). The variability of these measures has been studied by demographic (age and gender) and morphologic (height evaluated by the T11-L4 distance, the waist circumference and the thickness of the subcutaneous adipose tissue).
  
  
  RESULTS
  Mean mesenteric volume was 644 cm(3) (ranges from 89 to 1,869 cm(3)), and the mean length of the SMA was 224.9 mm (ranges from 138.4 to 312.3). There was a statistically significant association between waist circumference and the total volume of the mesentery, its fat component and non fat component (p < 0.001). Waist circumference was the only morphological parameter associated with the length of the superior mesenteric artery and the length of the DJA to ICJ (p < 0.001). Subcutaneous adipose tissue and female sex were statistically associated with total mesentery volume (respectively, p = 0.005 and p = 0.001). Age was an independent predictor of the increased volume of the mesentery and the length of the SMA. The height of the subject changes the length of the SMA (p = 0.001).
  
  
  CONCLUSIONS
  The assessment of the mesenteric variability highlighted three factors associated with its size and length: age, sex, and waist circumference. These parameters have to be taken into account to personalize numerical model in the area of virtual trauma.
authors.affiliation: Emergency Surgery Unit, St Roch Hospital, CHU de Nice, Université de Nice Sophia-Antipolis, 5 rue Pierre Dévoluy, CS 81319, 06006, Nice Cedex1, France, massalou.d@chu-nice.fr.
authors.forename: Damien
authors.initials: D
authors.lastname: Massalou
authors.forename: Thierry
authors.initials: T
authors.lastname: Bège
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bourgouin
authors.forename: Julien
authors.initials: J
authors.lastname: Mancini
authors.forename: Catherine
authors.initials: C
authors.lastname: Masson
authors.forename: Patrick
authors.initials: P
authors.lastname: Baqué
authors.forename: Stéphane-Victor
authors.initials: SV
authors.lastname: Berdah
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D020342:Finite Element Analysis; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging* / Q000293:injuries; D008643:Mesentery / Q000000981:diagnostic imaging* / Q000293:injuries; D008875:Middle Aged; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging
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