Comparison of CTA and DSA in the diagnosis of superior mesenteric artery dissecting aneurysm

Abstract

Objective

To compare computed tomography arteriography (CTA) and digital subtraction arteriography (DSA) in the diagnosis of superior mesenteric artery dissecting aneurysm (SMADA).

Methods

All SMADA patients who underwent CTA and DSA at one of two medical centers between May, 2007 and April, 2017 were identified. The accuracy of CTA and DSA for the depiction of morphologic characteristics of SMADA was analyzed.

Results

Fourteen patients (12 men; mean age, 55.1 ± 6.4 years) were included in this study. The mean diameter of the dissecting aneurysm was 3.78 ± 1.53 mm on CTA and 3.81 ± 1.54 mm on DSA (p = 0.96). The luminal stenosis was 0.52 ± 0.27 on CTA and 0.35 ± 0.23 on DSA (p = 0.09). The thrombosed false lumen was visualized on CTA in 79% (11/14) of patients but in no patients on DSA (p < 0.001). The entry points of the dissection were visualized on CTA in 64.3% (9/14) of patients and on DSA in 100% (14/14) of patients (p = 0.041); CTA and DSA did not visualize re-entry points in any patients. The intimal flap was visualized on CTA in 71.4% (10/14) of patients and on DSA in 78.6% (11/14) of patients (p > 0.05). Branch vessel involvement was visualized in 7.1% (1/14) of patients on CTA but in no patients on DSA (p > 0.05).

Conclusions

CTA can be used in place of DSA for the diagnosis of SMADA. Although CTA may exaggerate the degree of luminal stenosis and is weak in depicting the entry points of SMADA, this modality more accurately depicts the thrombosed false lumen and branch vessel involvement.

Keywords

Superior mesenteric artery dissection aneurysm computed tomography arteriography

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References

Alkalei

et al . Management strategy for spontaneous isolated dissection of the superior mesenteric artery based on morphologic classification. J Vasc Surg 2013; 59: 165–172.

Lee

Meiman

BH.

Dissecting anuerysm of the superior mesenteric artery. Imj Ill Med J . 1971; 139: 589–592.

Lee

Ahn

Yoon

Endovascular Stent Grafting via the Left Radial Artery for a Spontaneous Isolated Dissecting Rupture of the Superior Mesenteric Artery. Korean Circ J 2012; 42: 140–141.

Kim

Jung

Cho

et al . Clinical and radiologic course of symptomatic spontaneous isolated dissection of the superior mesenteric artery treated with conservative management. J Vasc Surg 2014; 59: 465–472.

Luan

et al . Vasodilator and endovascular therapy for isolated superior mesenteric artery dissection and literature review. J Vasc Surg 2013; 57: 1612–1620.

Jia

Zhao

Tian

et al . Initial and middle-term results of treatment for symptomatic spontaneous isolated dissection of superior mesenteric artery. Eur J Vasc Endovasc Surg 2013; 45: 502–508.

Tomita

Obara

Sekimoto

et al . Evolution of Computed Tomographic Characteristics of Spontaneous Isolated Superior Mesenteric Artery Dissection During Conservative Management. Circ J 2016; 80: 1452–1459.

Clair

Beach

JM.

Mesenteric Ischemia. N Engl J Med 2016; 374: 959–968.

Attali

Benaissa

Soize

et al . Follow-up of intracranial aneurysms treated by flow diverter: comparison of three-dimensional time-of-flight MR angiography (3D-TOF-MRA) and contrast-enhanced MR angiography (CE-MRA) sequences with digital subtraction angiography as the gold standard. J Neurointervent Surg . 2016; 8: 81–86.

10.

Sun

Ding

et al . Comparison of standard- and low-tube voltage 320-detector row volume CT angiography in detection of intracranial aneurysms with digital subtraction angiography as gold standard. Acad Radiol 2012; 19: 281–288.

11.

Subhas

Gupta

Nawalany

et al . Spontaneous isolated superior mesenteric artery dissection: a case report and literature review with management algorithm. Ann Vasc Surg 2009; 23: 788–798.

12.

Laganà

Carrafiello

Mangini

et al . Multimodal approach to endovascular treatment of visceral artery aneurysms and pseudoaneurysms. Eur J Radiol 2006; 59: 104–111.

13.

Luan

Computed tomography imaging features and classification of isolated dissection of the superior mesenteric artery. Eur J Vasc Endovasc Surg 2013; 46: 232–235.

14.

Zhou

et al . Endovascular Stent Placement for Treatment of Spontaneous Isolated Dissection of the Superior Mesenteric Artery. Ann Vasc Surg 2013; 28: 445–451.

15.

Pang

Jiang

Huang

et al . Value of endovascular stent placement for symptomatic spontaneous isolated superior mesenteric artery dissection. Eur J Radiol 2013; 82: 490–496.

16.

Dong

Chen

et al . Treatment of symptomatic isolated dissection of superior mesenteric artery. J Vasc Surg 2013; 57: 69S–76S.

17.

Zerbib

Perot

Lambert

et al . Management of isolated spontaneous dissection of superior mesenteric artery. Langenbecks Arch Surg 2010; 395: 437–443.

18.

Suzuki

Furui

Kohtake

et al . Isolated dissection of the superior mesenteric artery: CT findings in six cases. Abdom Imaging 2004; 29: 153–157.

19.

Gibbons

Roberts

DE.

Endovascular treatment of chronic arterial mesenteric ischemia: a changing perspective?

Semin Vasc Surg 2010; 23: 47–53.

20.

Zhao

Wang

Zhou

et al . Multidetector computed tomography of superior mesenteric artery: anatomy and pathologies. Can Assoc Radiol J 2014; 65: 267–274.

21.

Holalkere

Matthes

Kalva

et al . 64-Slice multidetector row CT angiography of the abdomen: comparison of low versus high concentration iodinated contrast media in a porcine model. Bjr . 2011; 84: 221–228.

22.

Wang

et al . Spectral CT demonstration of the superior mesenteric artery: comparison of monochromatic and polychromatic imaging. Acad Radiol 2014; 21: 364–368.

23.

Yamashita

Sakuramoto

Mieno

et al . Preoperative dual-phase 3D CT angiography assessment of the right hepatic artery before gastrectomy. Surg Today 2014; 44: 1912–1919.