Korean Journal of Radiology

  • 제14권1호
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  • Pages.38-44
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  • 2013
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  • 1229-6929(pISSN)
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  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지
DOI QR코드

DOI QR Code

Mesenteric Vascular Occlusion: Comparison of Ancillary CT Findings between Arterial and Venous Occlusions and Independent CT Findings Suggesting Life-Threatening Events

  • Wong, Yon-Cheong (Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University) ;
  • Wu, Cheng-Hsien (Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University) ;
  • Wang, Li-Jen (Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University) ;
  • Chen, Huan-Wu (Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University) ;
  • Lin, Being-Chuan (Division of Trauma and Emergency, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University) ;
  • Huang, Chen-Chih (Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University)
  • 발행 : 2013.02.01
⟨ 이전 논문 다음 논문 ⟩

초록

Objective: To compare the ancillary CT findings between superior mesenteric artery thromboembolism (SMAT) and superior mesenteric vein thrombosis (SMVT), and to determine the independent CT findings of life-threatening mesenteric occlusion. Materials and Methods: Our study was approved by the institution review board. We included 43 patients (21 SMAT and 22 SMVT between 1999 and 2008) of their median age of 60.0 years, and retrospectively analyzed their CT scans. Medical records were reviewed for demographics, management, surgical pathology diagnosis, and outcome. We compared CT findings between SMAT and SMVT groups. Multivariate analysis was conducted to determine the independent CT findings of life-threatening mesenteric occlusion. Results: Of 43 patients, 24 had life-threatening mesenteric occlusion. Death related to mesenteric occlusion was 32.6%. A thick bowel wall (p < 0.001), mesenteric edema (p < 0.001), and ascites (p = 0.009) were more frequently associated with SMVT, whereas diminished bowel enhancement (p = 0.003) and paralytic ileus (p = 0.039) were more frequent in SMAT. Diminished bowel enhancement (OR = 20; p = 0.007) and paralytic ileus (OR = 16; p = 0.033) were independent findings suggesting life-threatening mesenteric occlusion. Conclusion: The ancillary CT findings occur with different frequencies in SMAT and SMVT. However, the independent findings indicating life-threatening mesenteric occlusion are diminished bowel wall enhancement and paralytic ileus.

키워드

참고문헌

  1. Schoots, IG, Koffeman, GI, Legemate, DA, Levi, M, van Gulik, TM,Systematic review of survival after acute mesenteric ischaemia according to disease aetiology, Br J Surg, 91, 1, 17-27(2004) https://doi.org/10.1002/bjs.4459
  2. Yasuhara, H,Acute mesenteric ischemia: the challenge of gastroenterology, Surg Today, 35, 2, 185-195(2005) https://doi.org/10.1007/s00595-004-2924-0
  3. Martinez, JP, Hogan, GJ,Mesenteric ischemia, Emerg Med Clin North Am, 22, 3, 909-928(2004) https://doi.org/10.1016/j.emc.2004.05.002
  4. Bakal, CW, Sprayregen, S, Wolf, EL,Radiology in intestinal ischemia. Angiographic diagnosis and management, Surg Clin North Am, 72, 4, 125-141(1992) https://doi.org/10.1016/S0039-6109(16)45631-8
  5. Klein, HM, Lensing, R, Klosterhalfen, B, Töns, C, Günther, RW,Diagnostic imaging of mesenteric infarction, Radiology, 197, 5, 79-82(1995) https://doi.org/10.1148/radiology.197.1.7568858
  6. Kim, JH, Ha, HK, Sohn, MJ, Shin, BS, Lee, YS, Chung, SY,Usefulness of MR imaging for diseases of the small intestine: comparison with CT, Korean J Radiol, 1, 6, 43-50(2000) https://doi.org/10.3348/kjr.2000.1.1.43
  7. Leschka, S, Alkadhi, H, Wildermuth, S, Marincek, B,Multi-detector computed tomography of acute abdomen, Eur Radiol, 15, 7, 2435-2447(2005) https://doi.org/10.1007/s00330-005-2897-4
  8. Federle, MP,CT of the acute (emergency) abdomen, Eur Radiol, 15, 8, D100-D104(2005) https://doi.org/10.1007/s10406-005-0123-8
  9. Horton, KM, Fishman, EK,Multi-detector row CT of mesenteric ischemia: can it be done?, Radiographics, 21, 9, 1463-1473(2001) https://doi.org/10.1148/radiographics.21.6.g01nv091463
  10. Rosow, DE, Sahani, D, Strobel, O, Kalva, S, Mino-Kenudson, M, Holalkere, NS,Imaging of acute mesenteric ischemia using multidetector CT and CT angiography in a porcine model, J Gastrointest Surg, 9, 10, 1262-1274(2005) https://doi.org/10.1016/j.gassur.2005.07.034
  11. Kirkpatrick, ID, Kroeker, MA, Greenberg, HM,Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia: initial experience, Radiology, 229, 11, 91-98(2003) https://doi.org/10.1148/radiol.2291020991
  12. Wiesner, W, Khurana, B, Ji, H, Ros, PR,CT of acute bowel ischemia, Radiology, 226, 12, 635-650(2003) https://doi.org/10.1148/radiol.2263011540
  13. Segatto, E, Mortelé, KJ, Ji, H, Wiesner, W, Ros, PR,Acute small bowel ischemia: CT imaging findings, Semin Ultrasound CT MR, 24, 13, 364-376(2003) https://doi.org/10.1016/S0887-2171(03)00074-X
  14. Romano, S, Romano, L, Grassi, R,Multidetector row computed tomography findings from ischemia to infarction of the large bowel, Eur J Radiol, 61, 14, 433-441(2007) https://doi.org/10.1016/j.ejrad.2006.11.002
  15. Tang, ZH, Qiang, JW, Feng, XY, Li, RK, Sun, RX, Ye, XG,Acute mesenteric ischemia induced by ligation of porcine superior mesenteric vein: multidetector CT evaluations, Acad Radiol, 17, 15, 1146-1152(2010) https://doi.org/10.1016/j.acra.2010.04.014
  16. Rha, SE, Ha, HK, Lee, SH, Kim, JH, Kim, JK, Kim, JH,CT and MR imaging findings of bowel ischemia from various primary causes, Radiographics, 20, 16, 29-42(2000) https://doi.org/10.1148/radiographics.20.1.g00ja0629
  17. Moschetta, M, Stabile Ianora, AA, Pedote, P, Scardapane, A, Angelelli, G,Prognostic value of multidetector computed tomography in bowel infarction, Radiol Med, 114, 17, 780-791(2009) https://doi.org/10.1007/s11547-009-0422-6
  18. Chang, RW, Chang, JB, Longo, WE,Update in management of mesenteric ischemia, World J Gastroenterol, 12, 18, 3243-3247(2006) https://doi.org/10.3748/wjg.v12.i20.3243
  19. Gore, RM, Yaghmai, V, Thakrar, KH, Berlin, JW, Mehta, UK, Newmark, GM,Imaging in intestinal ischemic disorders, Radiol Clin North Am, 46, 19, 845-875(2008) https://doi.org/10.1016/j.rcl.2008.05.004
  20. Romano, S, Niola, R, Maglione, F, Romano, L,Small bowel vascular disorders from arterial etiology and impaired venous drainage, Radiol Clin North Am, 46, 20, 891-908(2008) https://doi.org/10.1016/j.rcl.2008.07.003
  21. Romano, S, Lassandro, F, Scaglione, M, Romano, L, Rotondo, A, Grassi, R,Ischemia and infarction of the small bowel and colon: spectrum of imaging findings, Abdom Imaging, 31, 21, 277-292(2006) https://doi.org/10.1007/s00261-005-0376-7
  22. Chou, CK, Wu, RH, Mak, CW, Lin, MP,Clinical significance of poor CT enhancement of the thickened small-bowel wall in patients with acute abdominal pain, AJR Am J Roentgenol, 186, 22, 491-498(2006) https://doi.org/10.2214/AJR.04.1362
  23. Cenedese, A, Monneuse, O, Gruner, L, Tissot, E, Mennesson, N, Barth, X,Initial management of extensive mesenteric venous thrombosis: retrospective study of nine cases, World J Surg, 33, 23, 2203-2208(2009) https://doi.org/10.1007/s00268-009-0168-2
  24. Kurimoto, Y, Morishita, K, Fukada, J, Kawaharada, N, Komatsu, K, Yama, N,A simple but useful method of screening for mesenteric ischemia secondary to acute aortic dissection, Surgery, 136, 24, 42-46(2004) https://doi.org/10.1016/j.surg.2003.12.019

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