Split-bolus CTA for mesenteric ischemia with a single scan opacifying arterial and mesenteric venous systems.

Abstract:

OBJECTIVE:To evaluate the diagnostic accuracy of split-bolus single-scan computed tomography angiography (CTA) protocol for evaluation of acute mesenteric ischemia and alternate diagnoses. MATERIALS AND METHODS:In this IRB-approved, HIPAA-compliant retrospective study, consecutive patients from 21 October 2016 to 6 May 2018 evaluated for mesenteric ischemia with split-bolus CTA (a single scan in concurrent arterial and portal venous phase) in a single tertiary academic institution were included. Intravenous contrast was administered on weight-based basis. Quantitative and qualitative assessments of superior mesenteric artery (SMA) and superior mesenteric vein (SMV) attenuation and patency were performed by two independent reviewers. CT imaging findings were correlated with clinical reference outcomes. RESULTS:One hundred fifty-four patients (age 66.3 ± 14.1 years, BMI 27.3 ± 6, 86 (56%) female) were included. CTA studies were performed with a volumetric CT dose index of 15.9 ± 5.5 mSv and dose length product of 1042.9 ± 389.4 mGy cm. Average intravenous contrast volume administered was 164.3 ± 12.1 cc. SMA attenuation was 263.6 ± 92.4HU, SMV was 190 ± 50.2HU. Qualitative assessment of SMA and SMV showed good opacification in all patients. 17/154 (11%) patients were diagnosed on CT with mesenteric ischemia; in 6/154 (4%), CTA studies were indeterminate; in 131/154 (85%), CTA confidently ruled out mesenteric ischemia. Alternate diagnoses were made in 38/154 (25%) patients. Using composite clinical outcomes as a reference standard, sensitivity of split-bolus CTA protocol for diagnosis of mesenteric ischemia is 100% (95% CI 79-100%), and specificity is 99% (95% CI 96-100%). CONCLUSIONS:Split-bolus CTA has high sensitivity and specificity for diagnosis of acute mesenteric ischemia. KEY POINTS:• Split-bolus CTA protocol for mesenteric ischemia has great diagnostic accuracy with lower radiation exposure and fewer images to interpret compared with standard multiphasic CTA.

journal_name

Eur Radiol

journal_title

European radiology

authors

Nakhaei M,Mojtahedi A,Brook OR

doi

10.1007/s00330-020-06769-x

subject

Has Abstract

pub_date

2020-07-01 00:00:00

pages

3987-3995

issue

7

eissn

0938-7994

issn

1432-1084

pii

10.1007/s00330-020-06769-x

journal_volume

30

pub_type

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