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Isolated superior mesenteric artery dissection: CTA features and clinical relevance.

Abstract

PURPOSE

To determine the detailed computed tomography angiography (CTA) features of isolated superior mesenteric artery dissection (ISMAD), aiming to improve the current understanding of ISMAD.

MATERIALS AND METHODS

We retrospectively analyzed 57 patients with confirmed diagnoses of ISMAD with CTA from June 2011 to June 2018 in our hospital. The superior mesenteric artery (SMA) angle, entry site of dissection, and features of both false and true lumen were analyzed individually.

RESULTS

In general, middle-aged men with atherosclerosis (42.1%), hypertension (35.3%), or long-term smoking (33.3%) were the main populations. 80.7% of patients can be discharged successfully after conservative treatment. 87% of patients had a right (or almost right) SMA angle, and the entry site of dissection in 90% of patients occurred in the curved segment of the SMA. As a polymorphic disease, we can use the coded CTA features to delineate individual cases, including cases beyond the presenting classification systems. The diameter of the true lumen is the only different CTA feature between the conservative treatment group and the interventional treatment group (p = 0.000). The re-entry site (p = 0.501), thrombosis in the false lumen (p = 0.135), the distance between the entry site of dissection and SMA root (p = 0.133), and SMA branch involvement (p = 0.322) had no difference between the 2 groups.

CONCLUSIONS

Based on CTA analysis, the bending area, especially in the SMA with right or nearly right SMA angle, is the most vulnerable anatomical region for the occurrence of ISMAD. The diameter of true lumen is the determined CTA feature for the decision of treatment. CTA should be recommended as a standardized diagnostic and classification tool for ISMAD.

Authors+Show Affiliations

Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Department of Gerontology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Department of Gerontology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Department of Gerontology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. yangjun_tjh@163.com. Department of Gerontology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. yangjun_tjh@163.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31401677

Citation

Dou, Lei, et al. "Isolated Superior Mesenteric Artery Dissection: CTA Features and Clinical Relevance." Abdominal Radiology (New York), 2019.
Dou L, Tang H, Zheng P, et al. Isolated superior mesenteric artery dissection: CTA features and clinical relevance. Abdom Radiol (NY). 2019.
Dou, L., Tang, H., Zheng, P., Wang, C., Li, D., & Yang, J. (2019). Isolated superior mesenteric artery dissection: CTA features and clinical relevance. Abdominal Radiology (New York), doi:10.1007/s00261-019-02171-4.
Dou L, et al. Isolated Superior Mesenteric Artery Dissection: CTA Features and Clinical Relevance. Abdom Radiol (NY). 2019 Aug 10; PubMed PMID: 31401677.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Isolated superior mesenteric artery dissection: CTA features and clinical relevance. AU - Dou,Lei, AU - Tang,Hao, AU - Zheng,Ping, AU - Wang,Chao, AU - Li,Dongjian, AU - Yang,Jun, Y1 - 2019/08/10/ PY - 2019/8/12/entrez PY - 2019/8/12/pubmed PY - 2019/8/12/medline KW - Artery dissection KW - Clinical KW - Computed tomography angiography KW - Superior mesenteric artery JF - Abdominal radiology (New York) JO - Abdom Radiol (NY) N2 - PURPOSE: To determine the detailed computed tomography angiography (CTA) features of isolated superior mesenteric artery dissection (ISMAD), aiming to improve the current understanding of ISMAD. MATERIALS AND METHODS: We retrospectively analyzed 57 patients with confirmed diagnoses of ISMAD with CTA from June 2011 to June 2018 in our hospital. The superior mesenteric artery (SMA) angle, entry site of dissection, and features of both false and true lumen were analyzed individually. RESULTS: In general, middle-aged men with atherosclerosis (42.1%), hypertension (35.3%), or long-term smoking (33.3%) were the main populations. 80.7% of patients can be discharged successfully after conservative treatment. 87% of patients had a right (or almost right) SMA angle, and the entry site of dissection in 90% of patients occurred in the curved segment of the SMA. As a polymorphic disease, we can use the coded CTA features to delineate individual cases, including cases beyond the presenting classification systems. The diameter of the true lumen is the only different CTA feature between the conservative treatment group and the interventional treatment group (p = 0.000). The re-entry site (p = 0.501), thrombosis in the false lumen (p = 0.135), the distance between the entry site of dissection and SMA root (p = 0.133), and SMA branch involvement (p = 0.322) had no difference between the 2 groups. CONCLUSIONS: Based on CTA analysis, the bending area, especially in the SMA with right or nearly right SMA angle, is the most vulnerable anatomical region for the occurrence of ISMAD. The diameter of true lumen is the determined CTA feature for the decision of treatment. CTA should be recommended as a standardized diagnostic and classification tool for ISMAD. SN - 2366-0058 UR - https://www.unboundmedicine.com/medline/citation/31401677/Isolated_superior_mesenteric_artery_dissection:_CTA_features_and_clinical_relevance_ L2 - https://dx.doi.org/10.1007/s00261-019-02171-4 DB - PRIME DP - Unbound Medicine ER -