Clinical implications of perivascular fat stranding surrounding spontaneous isolated superior mesenteric artery dissection on computed tomography

Tan,Zhengwu; Jin,Qianna; Fan,Wenliang; Han,Ping; Li,Xin

doi:10.3892/etm.2020.9466

Clinical implications of perivascular fat stranding surrounding spontaneous isolated superior mesenteric artery dissection on computed tomography

Authors:
- Zhengwu Tan
- Qianna Jin
- Wenliang Fan
- Ping Han
- Xin Li
View Affiliations

Affiliations: Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
Published online on: November 11, 2020 https://doi.org/10.3892/etm.2020.9466
Article Number: 34

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Patients with spontaneous isolated superior mesenteric artery (SMA) dissection (SISMAD) usually present with acute or chronic abdominal pain and are admitted to the emergency or digestive diseases department to undergo auxiliary examinations, typically abdominal plain CT or contrast‑enhanced CT (CECT). Plain CT is the most crucial examination in emergency radiology. An enlarged SMA diameter and perivascular fat stranding (PFS) on plain CT, though non‑specific, may be the only indications for SISMAD. These results may be easily overlooked and the diagnosis of SISMAD may be missed. However, PFS around the SMA on CT may be the only indicator of the possible presence of SISMAD, particularly during the early stage when there are no massive changes in the vascular wall. The present study aimed to determine whether PFS surrounding the SMA on CT may help with the diagnosis of SISMAD by indicating the requirement for further examination. The data of 161 consecutive patients with SMA dissection who underwent abdominal CECT or underwent SMA CT angiography (CTA) after abdominal plain CT between February 2015 and February 2018 were retrospectively reviewed. SMA diameter, classification, PFS, complications, comorbidities and treatments were analyzed. The results demonstrated that SISMAD with PFS was significantly associated with admission type (emergency), clinical manifestations (abdominal pain), diagnostic modality and dissection subtype. On plain CT, PFS surrounding the SMA may be a marker for SISMAD, particularly in the emergency setting, and indicates the requirement for CTA examination.

View Figures

View References

1	D'Ambrosio N, Friedman B, Siegel D, Katz D, Newatia A and Hines J: Spontaneous isolated dissection of the celiac artery: CT findings in adults. AJR Am J Roentgenol. 188:W506–W511. 2007.PubMed/NCBI View Article : Google Scholar
2	Satokawa H, Takase S, Seto Y, Yokoyama H, Gotoh M, Kogure M, Midorikawa H, Saito T and Maehara K: Management strategy of isolated spontaneous dissection of the superior mesenteric artery. Ann Vasc Dis. 7:232–238. 2014.PubMed/NCBI View Article : Google Scholar
3	Yoo J, Lee JB, Park HJ, Lee ES, Park SB, Kim YS and Choi BI: Classification of spontaneous isolated superior mesenteric artery dissection: Correlation with multi detector CT features and clinical presentation. Abdom Radiol (NY). 43:3157–3165. 2018.PubMed/NCBI View Article : Google Scholar
4	Bauersfeld SR: Dissecting aneurysm of the aorta; a presentation of 15 cases and a review of the recent literature. Ann Intern Med. 26:873–889. 1947.PubMed/NCBI View Article : Google Scholar
5	Ghodasara N, Liddell R, Fishman EK and Johnson PT: High-value multidetector CT angiography of the superior mesenteric artery: What emergency medicine physicians and interventional radiologists need to know. Radiographics. 39:559–577. 2019.PubMed/NCBI View Article : Google Scholar
6	Luan JY, Guan X, Li X, Wang CM, Li TR, Zhang L and Han JT: Isolated superior mesenteric artery dissection in China. J Vasc Surg. 63:530–536. 2016.PubMed/NCBI View Article : Google Scholar
7	Kim HK, Jung HK, Cho J, Lee JM and Huh S: Clinical and radiologic course of symptomatic spontaneous isolated dissection of the superior mesenteric artery treated with conservative management. J Vasc Surg. 59:465–472. 2014.PubMed/NCBI View Article : Google Scholar
8	Park WJ and Seo JW: Follow-up with computed tomography after spontaneous isolated dissection of the splanchnic artery. Clin Imaging. 52:1–7. 2018.PubMed/NCBI View Article : Google Scholar
9	Sakamoto I, Ogawa Y, Sueyoshi E, Fukui K, Murakami T and Uetani M: Imaging appearances and management of isolated spontaneous dissection of the superior mesenteric artery. Eur J Radiol. 64:103–110. 2007.PubMed/NCBI View Article : Google Scholar
10	Zerbib P, Perot C, Lambert M, Seblini M, Pruvot FR and Chambon JP: Management of isolated spontaneous dissection of superior mesenteric artery. Langenbecks Arch Surg. 395:437–443. 2010.PubMed/NCBI View Article : Google Scholar
11	Schwartz SA, Taljanovic MS, Smyth S, O'Brien MJ and Rogers LF: CT findings of rupture, impending rupture, and contained rupture of abdominal aortic aneurysms. AJR Am J Roentgenol. 188:W57–W62. 2007.PubMed/NCBI View Article : Google Scholar
12	Luan JY and Li X: Computed tomography imaging features and classification of isolated dissection of the superior mesenteric artery. Eur J Vasc Endovasc Surg. 46:232–235. 2013.PubMed/NCBI View Article : Google Scholar
13	Suzuki S, Furui S, Kohtake H, Sakamoto T, Yamasaki M, Furukawa A, Murata K and Takei R: Isolated dissection of the superior mesenteric artery: CT findings in six cases. Abdom Imaging. 29:153–157. 2004.PubMed/NCBI View Article : Google Scholar
14	Hedgire S, Baliyan V, Zucker EJ, Bittner DO, Staziaki PV, Takx RAP, Scholtz JE, Meyersohn N, Hoffmann U and Ghoshhajra B: Perivascular epicardial fat stranding at coronary CT angiography: A marker of acute plaque rupture and spontaneous coronary artery dissection. Radiology. 287:808–815. 2018.PubMed/NCBI View Article : Google Scholar
15	Thornton E, Mendiratta-Lala M, Siewert B and Eisenberg RL: Patterns of fat stranding. AJR Am J Roentgenol. 197:W1–W14. 2011.PubMed/NCBI View Article : Google Scholar
16	Li DL, He YY, Alkalei AM, Chen XD, Jin W, Li M, Zhang HK and Liang TB: Management strategy for spontaneous isolated dissection of the superior mesenteric artery based on morphologic classification. J Vasc Surg. 59:165–172. 2014.PubMed/NCBI View Article : Google Scholar
17	Li T, Zhao S, Li J, Huang Z, Luo C and Yang L: Value of multi-detector CT in detection of isolated spontaneous superior mesenteric artery dissection. Chin Med Sci J. 32:28–33. 2017.PubMed/NCBI View Article : Google Scholar
18	Yun WS, Kim YW, Park KB, Cho SK, Do YS, Lee KB, Kim DI and Kim DK: Clinical and angiographic follow-up of spontaneous isolated superior mesenteric artery dissection. Eur J Vasc Endovasc Surg. 37:572–577. 2009.PubMed/NCBI View Article : Google Scholar
19	Jia Z, Tu J and Jiang G: The classification and management strategy of spontaneous isolated superior mesenteric artery dissection. Korean Circ J. 47:425–431. 2017.PubMed/NCBI View Article : Google Scholar
20	Li S, Gu X, Jiang G and Tian F: Comment on ‘The value of a new image classification system for planning treatment and prognosis of spontaneous isolated superior mesenteric artery dissection’. Vascular. 23(558)2015.PubMed/NCBI View Article : Google Scholar
21	Kimura Y, Kato T, Nagao K, Izumi T, Haruna T, Ueyama K, Inada T and Inoko M: Outcomes and radiographic findings of isolated spontaneous superior mesenteric artery dissection. Eur J Vasc Endovasc Surg. 53:276–281. 2017.PubMed/NCBI View Article : Google Scholar
22	Tomita K, Obara H, Sekimoto Y, Matsubara K, Watada S, Fujimura N, Shibutani S, Nagasaki K, Hayashi S, Harada H, et al: Evolution of computed tomographic characteristics of spontaneous isolated superior mesenteric artery dissection during conservative management. Circ J. 80:1452–1459. 2016.PubMed/NCBI View Article : Google Scholar
23	Nath A, Yewale S and Kousha M: Spontaneous isolated superior mesenteric artery dissection. Case Rep Gastroenterol. 10:775–780. 2016.PubMed/NCBI View Article : Google Scholar
24	El-Zein RS, Sobecki J, Greenberg R, Keleher M and Palma RA: A spontaneous isolated superior mesenteric artery dissection associated with cocaine abuse: A pathomechanistic association. Case Rep Vasc Med. 2020(2514687)2020.PubMed/NCBI View Article : Google Scholar
25	Park YJ, Park CW, Park KB, Roh YN, Kim DI and Kim YW: Inference from clinical and fluid dynamic studies about underlying cause of spontaneous isolated superior mesenteric artery dissection. J Vasc Surg. 53:80–86. 2011.PubMed/NCBI View Article : Google Scholar
26	Mindelzun RE, Jeffrey RB Jr, Lane MJ and Silverman PM: The misty mesentery on CT: Differential diagnosis. AJR Am J Roentgenol. 167:61–65. 1996.PubMed/NCBI View Article : Google Scholar
27	Filippone A, Cianci R, Di Fabio F and Storto ML: Misty mesentery: A pictorial review of multidetector-row CT findings. Radiol Med. 116:351–365. 2011.PubMed/NCBI View Article : Google Scholar
28	Okino Y, Kiyosue H, Mori H, Komatsu E, Matsumoto S, Yamada Y, Suzuki K and Tomonari K: Root of the small-bowel mesentery: Correlative anatomy and CT features of pathologic conditions. Radiographics. 21:1475–1490. 2001.PubMed/NCBI View Article : Google Scholar
29	Antonopoulos AS, Sanna F, Sabharwal N, Thomas S, Oikonomou EK, Herdman L, Margaritis M, Shirodaria C, Kampoli AM, Akoumianakis I, et al: Detecting human coronary inflammation by imaging perivascular fat. Sci Transl Med. 9(eaal2658)2017.PubMed/NCBI View Article : Google Scholar
30	Furukawa H and Moriyama N: Spontaneous dissection of the superior mesenteric artery diagnosed on multidetector helical CT. J Comput Assist Tomogr. 26:143–144. 2002.PubMed/NCBI View Article : Google Scholar
31	Takaoka M, Suzuki H, Shioda S, Sekikawa K, Saito Y, Nagai R and Sata M: Endovascular injury induces rapid phenotypic changes in perivascular adipose. Arterioscler Thromb Vasc Biol. 30:1576–1582. 2010.PubMed/NCBI View Article : Google Scholar
32	Thanvi B, Munshi SK, Dawson SL and Robinson TG: Carotid and vertebral artery dissection syndromes. Postgrad Med J. 81:383–388. 2005.PubMed/NCBI View Article : Google Scholar
33	Park KW, Park JS, Hwang SC, Im SB, Shin WH and Kim BT: Vertebral artery dissection: Natural history, clinical features and therapeutic considerations. J Korean Neurosurg Soc. 44:109–115. 2008.PubMed/NCBI View Article : Google Scholar
34	Vela D, Buja LM, Madjid M, Burke A, Naghavi M, Willerson JT, Casscells SW and Litovsky S: The role of periadventitial fat in atherosclerosis. Arch Pathol Lab Med. 131:481–487. 2007.PubMed/NCBI View Article : Google Scholar
35	Xiong J, Wu Z, Guo W, Liu X, Wang L, Zhang H, Jia X and Ma X: The value of a new image classification system for planning treatment and prognosis of spontaneous isolated superior mesenteric artery dissection. Vascular. 23:504–512. 2015.PubMed/NCBI View Article : Google Scholar