Imaging
Mesenteric Ischemia
- Preliminary Diagnosis: Mesenteric Ischemia
-
I. What imaging technique is first-line for this diagnosis
- II. Describe the advantages and disadvantages of this technique for diagnosis of mesenteric ischemia.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of mesenteric ischemia.
- VI. What are the contraindications for the alternative imaging techniques?
Preliminary Diagnosis: Mesenteric Ischemia
I. What imaging technique is first-line for this diagnosis
CT of the abdomen and pelvis with CTA protocol
II. Describe the advantages and disadvantages of this technique for diagnosis of mesenteric ischemia.
Advantages
Relatively fast and efficient imaging modality
Offers exquisite visualization of the anatomical structures including the vascular, soft tissue, lymphatic, and osseous structures
Highly sensitive and specific in diagnosing and detecting the quantity and location of stenosis and luminal irregularity within the mesenteric arteries
May help guide treatment
Vascular calcifications are well detailed on CT imaging.
Disadvantages
Exposes patients to ionizing radiation
III. What are the contraindications for the first-line imaging technique?
May be contraindicated in pregnant patients
IV. What alternative imaging techniques are available?
MR of the abdomen and pelvis with MRA protocol
Ultrasound
Catheter angiography
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of mesenteric ischemia.
MR of the abdomen and pelvis with MRA protocol
Advantages
Does not expose patients to ionizing radiation
Able to identify and detail the underlying soft tissues
Useful for excluding other causes of abdominal pain
Offers great visualization and sensitivity in evaluating for abdominal and pelvic collateral arterial circulation
Disadvantages
Offers less exquisite visualization of the vascular structures
Less adept in detailing location and quantity of vascular occlusion or luminal irregularity compared with CT imaging
May be susceptible to weighted artifact and motion artifact degradation of image quality
Ultrasound
Advantages
Highly portable
Relatively inexpensive imaging modality
Does not expose patients to ionizing radiation
Disadvantages
Highly operator dependent
Less sensitive and specific in detecting and characterizing vascular lesions
Less sensitive and specific in detecting vascular calcifications
Catheter angiography
Advantages
Gold standard for diagnosing and treating mesenteric ischemia (occlusive and nonocclusive)
Disadvantages
Exposes patients to large amounts of ionizing radiation
Associated with greater morbidity and mortality because ofthe invasiveness of the procedure
VI. What are the contraindications for the alternative imaging techniques?
MR of the abdomen and pelvis with MRA protocol
Contraindicated in patients with non–MR-compatible hardware
Ultrasound
No specific contraindications exist.
Catheter Angiography
Contraindicated in patients with a severe hypocoagulable status
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