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