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Multidetector Computed Tomography of Superior Mesenteric Artery: Anatomy and Pathologies  Yan E. Zhao, MD, Zhen Jane Wang, MD, Chang Sheng Zhou, BS, Fei.

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Presentation on theme: "Multidetector Computed Tomography of Superior Mesenteric Artery: Anatomy and Pathologies  Yan E. Zhao, MD, Zhen Jane Wang, MD, Chang Sheng Zhou, BS, Fei."— Presentation transcript:

1 Multidetector Computed Tomography of Superior Mesenteric Artery: Anatomy and Pathologies 
Yan E. Zhao, MD, Zhen Jane Wang, MD, Chang Sheng Zhou, BS, Fei Peng Zhu, MD, Long Jiang Zhang, MD, Guang Ming Lu, MD  Canadian Association of Radiologists Journal  Volume 65, Issue 3, Pages (August 2014) DOI: /j.carj Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

2 Figure 1 Normal anatomy and variants of the superior mesentery artery. (A) Coronal volume rendering reformatted image, demonstrating the origin and branches of the superior mesenteric artery. (B) Sagittal volume rendering reformatted image, demonstrating the celiacomesenteric trunk (the common trunk of celiac axis and superior mesenteric artery). (C) Oblique volume rendering reformatted image, demonstrating a replaced right hepatic artery (white arrow). This figure is available in colour online at Canadian Association of Radiologists Journal  , DOI: ( /j.carj ) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

3 Figure 2 A 78-year-old woman with atherosclerotic stenosis of the superior mesentery artery. (A) Axial computed tomographic image and (B) curved planar reformatted image, demonstrating the mixed plaque in the proximal segment of the superior mesentery artery, which results in severe stenosis of the lumen. (C) Volume rendering reformatted image, demonstrating artifact in the reconstruction rather than calcification (white arrow). This figure is available in colour online at Canadian Association of Radiologists Journal  , DOI: ( /j.carj ) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

4 Figure 3 A 51-year-old man with occlusion of the superior mesentery artery (SMA). (A) Sagittal maximum intensity projection reformatted image, demonstrating the occlusion of the proximal SMA (black arrow). (B) The volume rendering computed tomography image, and (C) digital subtraction arteriography image, showing an arc of Riolan (white arrow), which provides communication between the inferior mesenteric artery and SMA distributions secondary to proximal occlusion. This figure is available in colour online at Canadian Association of Radiologists Journal  , DOI: ( /j.carj ) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

5 Figure 4 A 75-year-old woman with atrial fibrillation. (A) Axial contrast-enhanced computed tomography image and (B) curved planar reformatted images, showing filling defect in the superior mesentery artery, which indicates the acute thrombus (white arrow in A and in B). Canadian Association of Radiologists Journal  , DOI: ( /j.carj ) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

6 Figure 5 A 68-year-old man with acute embolism of the superior mesenteric artery (SMA). (A) Coronal oblique maximum intensity projection image, demonstrating acute occlusion of the middle colic artery (white arrow) and acute thrombus in the lumen of the distal SMA. (B) Selective superior mesenteric angiography, demonstrating the computed tomography angiographic findings. (C) The filling defects in the SMA disappeared after anticoagulation therapy (black arrow). Canadian Association of Radiologists Journal  , DOI: ( /j.carj ) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

7 Figure 6 A 54-year-old man with acute thrombus. (A) A curved planar image and (B) sagittal volume rendering reformatted images, showing the thrombosis of the superior mesenteric artery (SMA) (white arrow in A and in B). One month after anticoagulation treatment, (C) curved planar reformatted image, demonstrating the disappearance of the filling defect (curved arrow) in the SMA in (A), and the slightly thickened wall of the SMA can be shown, which indicates near resolution of thrombosis compared with (A). (D) An oblique volume rendering image, demonstrating enlarged SMA (curved arrow) compared with (B). This figure is available in colour online at Canadian Association of Radiologists Journal  , DOI: ( /j.carj ) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

8 Figure 7 A 41-year-old woman with Takayasu arteritis. (A) Volume rendering reformatted images, demonstrating severe stenosis of the proximal superior mesenteric artery (white arrow) and the abdominal aorta. (B) Maximum intensity projection image, which indicates the severe stenosis of bilateral proximal renal arteries. This figure is available in colour online at Canadian Association of Radiologists Journal  , DOI: ( /j.carj ) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

9 Figure 8 A 26-year-old woman with nutcracker syndrome had macroscopic hematuria for 6 years. (A) An axial computed tomographic image, demonstrating the stenosis of the left renal vein (black arrowhead) compressed by the abdominal aorta (white arrow) and the superior mesenteric artery (SMA) (curved arrow). (B) Sagittal volume rendering and (C) maximum intensity projection reformatted images, showing the small angle between the SMA and the aorta. This figure is available in colour online at Canadian Association of Radiologists Journal  , DOI: ( /j.carj ) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

10 Figure 9 An 18-year-old man with superior mesenteric artery (SMA) syndrome. (A) Axial computed tomographic image, demonstrating the stenosis of the duodenum and short aorta-SMA distance at the level of the duodenum. (B) Sagittal maximum intensity projection image, demonstrating the small angle between the SMA and the aorta (black arrow). (C) An upper gastrointestinal barium examination, demonstrating the dilated proximal duodenum and cutoff at the third part of the duodenum (white arrow). Canadian Association of Radiologists Journal  , DOI: ( /j.carj ) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

11 Figure 10 A 46-year-old man with multiple visceral aneurysms. (A) Axial contrast-enhanced computed tomographic image and (B) volume rendering reformatted images, showing the saccular enlargement of the superior mesenteric artery (white arrow in A and in B) and the celiac artery (black arrow in B). This figure is available in colour online at Canadian Association of Radiologists Journal  , DOI: ( /j.carj ) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

12 Figure 11 Drawings that illustrate imaging classification of spontaneous dissection of the superior mesenteric artery. (A) Type I, patent false lumen with both entry and reentry; (B) type II, “cul-de-sac” shaped false lumen without reentry; (C) type III, thrombosed false lumen with ulcer; (D) Type IV, completely thrombosed false lumen without ulcer. This figure is available in colour online at Canadian Association of Radiologists Journal  , DOI: ( /j.carj ) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

13 Figure 12 A 61-year-old man with type II of superior mesenteric artery dissection. (A) Axial contrast-enhanced computed tomographic image, demonstrating low-density intimal flap (black arrow), which divides the superior mesenteric artery into true and false lumen. (B) Curved planar reformatted and (C) volume rendering formatted images, showing the isolated dissection of the superior mesenteric artery without reentry in the false lumen. This figure is available in colour online at Canadian Association of Radiologists Journal  , DOI: ( /j.carj ) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

14 Figure 13 A 42-year-old man with type III of superior mesenteric artery dissection. (A) Curved planar reformatted image and (B) volume rendering reformatted image, showing the thrombosed false lumen with an ulcer (white arrow in A and in B) like projection protruding from the true lumen into the thrombosed false lumen. (C) Axial contrast-enhanced image, demonstrating the crescent-shaped thrombus of the superior mesenteric artery (black arrow). This figure is available in colour online at Canadian Association of Radiologists Journal  , DOI: ( /j.carj ) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

15 Figure 14 A 49-year-old man with superior mesenteric artery dissection who received stent implantation. (A, B) Curved planar reformatted images and (C) volume rendering reformatted image, showing the patent stent (thick arrows, A-C) in the superior mesentery artery and focal dissection (thin arrow, B) in the distal ostium of the stent. This figure is available in colour online at Canadian Association of Radiologists Journal  , DOI: ( /j.carj ) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

16 Figure 15 A 48-year-old man with pancreatic cancer. (A) An axial contrast-enhanced image and (B) sagittal planar image, showing the encasement of the superior mesentery artery by the tumour (white arrow). (C) Sagittal volume rendering reformatted image, displaying the stenosis of the proximal superior mesenteric artery (white arrow). This figure is available in colour online at Canadian Association of Radiologists Journal  , DOI: ( /j.carj ) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

17 Figure 16 A 21-year-old woman with a gastrointestinal stromal tumour of the ileum. (A) Axial contrast-enhanced computed tomographic image, demonstrating a heterogeneously enhanced mass in the pelvis. (B) A maximum intensity projection and (C) volume rendering reformatted images, showing that the superior mesenteric artery supplies blood to the mass (white arrow in B and in C). This figure is available in colour online at Canadian Association of Radiologists Journal  , DOI: ( /j.carj ) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions


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