Mesenteric Ischemia

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