Imaging
Mesenteric Thrombosis
- Preliminary Diagnosis: Mesenteric Thrombosis
-
I. What imaging technique is first-line for this diagnosis?
- II. Describe the advantages and disadvantages of this technique for diagnosis of mesenteric thrombosis.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of mesenteric thrombosis.
- VI. What are the contraindications for the alternative imaging techniques?
Preliminary Diagnosis: Mesenteric Thrombosis
I. What imaging technique is first-line for this diagnosis?
CT of abdomen and pelvis utilizing CTA protocol
II. Describe the advantages and disadvantages of this technique for diagnosis of mesenteric thrombosis.
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 amount and location of stenosis 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 IV contrast
Ultrasound
Catheter angiography
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of mesenteric thrombosis.
MR of the abdomen and pelvis MRA protocol
Advantages
Does not expose patients to ionizing radiation.
Able to well 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
Expensive
Time consuming
Requires significant patient cooperation to minimize motion artifact
Offers less exquisite visualization of the vascular structures and is less adept in detailing location and quantity of vascular occlusion compared with CT imaging
Ultrasound
Advantages
Highly portable and 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 identifying vascular calcifications compared with CT imaging
Catheter angiography
Advantages
Gold standard for diagnosing and treating mesenteric thrombosis
Disadvantages
Exposes patients to large amounts of ionizing radiation
Associated with greater morbidity and mortality because of the invasiveness of the procedure
VI. What are the contraindications for the alternative imaging techniques?
MR of the abdomen and pelvis MRA protocol
Contraindicated in patients with non–MR-compatible hardware
Ultrasound
No specific contraindications exist.
Catheter Angiography
Contraindicated in patients in a severe hypocoagulable state
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