Mesenteric artery calcium scoring: a potential screening method for chronic mesenteric ischemia

Published on Jun 1, 2021in European Radiology4.101
· DOI :10.1007/S00330-020-07530-0
Luke G. Terlouw2
Estimated H-index: 2
(EUR: Erasmus University Rotterdam),
Désirée van Noord9
Estimated H-index: 9
+ 2 AuthorsAdriaan Moelker27
Estimated H-index: 27
(EUR: Erasmus University Rotterdam)
Sources
Abstract
A practical screening tool for chronic mesenteric ischemia (CMI) could facilitate early recognition and reduce undertreatment and diagnostic delay. This study explored the ability to discriminate CMI from non-CMI patients with a mesenteric artery calcium score (MACS). This retrospective study included CTAs of consecutive patients with suspected CMI in a tertiary referral center between April 2016 and October 2019. A custom-built software module, using the Agatston definition, was developed and used to calculate the MACS for the celiac artery (CA), superior mesenteric artery (SMA), and inferior mesenteric artery. Scoring was performed by two blinded observers. Interobserver agreement was determined using 39 CTAs scored independently by both observers. CMI was defined as sustained symptom improvement after treatment. Non-CMI patients were patients not diagnosed with CMI after a diagnostic workup and patients not responding to treatment. The MACS was obtained in 184 patients, 49 CMI and 135 non-CMI. Interobserver agreement was excellent (intraclass correlation coefficient 0.910). The MACS of all mesenteric arteries was significantly higher in CMI patients than in non-CMI patients. ROC analysis of the combined MACS of CA + SMA showed an acceptable AUC (0.767), high sensitivity (87.8%), and high NPV (92.1%), when using a ≥ 29.7 CA + SMA MACS cutoff. Comparison of two CTAs, obtained in the same patient at different points in time with different scan and reconstruction parameters, was performed in 29 patients and revealed significant differences in MACSs. MACS seems a promising screening method for CMI, but correction for scan and reconstruction parameters is warranted. • A mesenteric artery calcium score obtained in celiac artery and superior mesenteric artery has a high negative predictive value for chronic mesenteric ischemia and could serve as a screening tool. • Interobserver agreement of the mesenteric artery calcium score is excellent. • Scan and reconstruction parameters influence the mesenteric artery calcium score and warrant the development of a method to correct for these parameters.
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Newest
INTRODUCTION: This study aimed to determine the incidence of chronic mesenteric ischemia (CMI) and to examine the influence of the etiological cause, location, and severity of a mesenteric artery stenosis on the probability of having CMI. METHODS: A prospective database, containing the details of all patients with suspected CMI referred to a renowned CMI expert center, was used. Patients residing within the expert centers’ well-defined region, between January 2014 and October 2019, were included...
3 CitationsSource
#1Luke G. Terlouw (EUR: Erasmus University Rotterdam)H-Index: 2
#2Adriaan Moelker (EUR: Erasmus University Rotterdam)H-Index: 27
Last. Marco J. Bruno (EUR: Erasmus University Rotterdam)H-Index: 67
view all 24 authors...
Chronic mesenteric ischaemia is a severe and incapacitating disease, causing complaints of post-prandial pain, fear of eating and weight loss. Even though chronic mesenteric ischaemia may progress ...
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#1Ronald Booij (EUR: Erasmus University Rotterdam)H-Index: 7
#2Niels R. van der Werf (UU: Utrecht University)H-Index: 5
Last. Marcel van Straten (EUR: Erasmus University Rotterdam)H-Index: 12
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To assess the dose reduction potential of a calcium-aware reconstruction technique, which aims at tube voltage-independent computed tomography (CT) numbers for calcium. A cardiothoracic phantom, mimicking three different patient sizes, was scanned with two calcium inserts (named D100 and CCI), containing calcifications varying in size and density. Tube voltage was varied both manually (range 70–150 and Sn100 kVp) and automatically. Tube current was automatically adapted to maintain reference ima...
6 CitationsSource
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1,161 CitationsSource
#1Louisa J.D. van Dijk (EUR: Erasmus University Rotterdam)H-Index: 4
#2Désirée van Noord (EUR: Erasmus University Rotterdam)H-Index: 9
Last. Marco J. Bruno (EUR: Erasmus University Rotterdam)H-Index: 23
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Background and objectiveThe objective of this article is to externally validate and update a recently published score chart for chronic mesenteric ischemia (CMI).MethodsA multicenter prospective co...
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#1Louisa J.D. van Dijk (EUR: Erasmus University Rotterdam)H-Index: 4
#2Désirée van Noord (EUR: Erasmus University Rotterdam)H-Index: 9
Last. Marco J. Bruno (EUR: Erasmus University Rotterdam)H-Index: 23
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This This Dutch Mesenteric Ischemia Study group consists of: Ron Balm, Academic Medical Center, Amsterdam Gert Jan de Borst, University Medical Center Utrecht, Utrecht Juliette T Blauw, Medisch Spe...
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#1Fares Alahdab (Mayo Clinic)H-Index: 46
#2Remy Arwani (Ain Shams University)H-Index: 1
Last. M. Hassan Murad (Mayo Clinic)H-Index: 88
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Abstract Background Despite the enthusiasm for endovascular revascularization for chronic mesenteric ischemia (CMI), it is not clear if early benefits offset long-term patency rates. This systematic review aimed to provide an up-to-date comprehensive evidence synthesis evaluating the two approaches. Methods We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through July 15, 2016, for studies that compared the endovascu...
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#1Cesare Mantini (University of Chieti-Pescara)H-Index: 6
#2Erica MaffeiH-Index: 52
Last. Filippo CademartiriH-Index: 77
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Abstract Objective To investigate the influence of different CT reconstruction parameters on coronary artery calcium scoring (CACS) values and reclassification of predicted cardiovascular (CV) risk. Methods CACS was evaluated in 113 patients undergoing ECG-gated 64-slice CT. Reference CACS protocol included standard kernel filter (B35f) with slice thickness/increment of 3/1.5 mm, and field-of-view (FOV) of 150–180 mm. Influence of different image reconstruction algorithms (reconstructed slice th...
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#1Jihan Harki (EUR: Erasmus University Rotterdam)H-Index: 4
#2Yvonne VergouweH-Index: 34
Last. Eric T.T.L. TjwaH-Index: 13
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BACKGROUND: No golden diagnostic standard is available to diagnose chronic gastrointestinal ischemia (CGI). GOALS: We aimed to establish an accurate prediction model for CGI, based on clinical symptoms and radiologic evaluation of the amount of stenosis in the celiac artery (CA) and superior mesenteric artery (SMA) by means of computed tomography-angiography or magnetic resonance (MR)-angiography. STUDY: We prospectively included 436 consecutive patients with clinical suspicion of CGI in a terti...
9 CitationsSource
#1Mohamad Adam BujangH-Index: 12
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115 Citations
Cited By1
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#1Luke G. Terlouw (EUR: Erasmus University Rotterdam)H-Index: 2
Last. Marco J. Bruno (EUR: Erasmus University Rotterdam)H-Index: 67
view all 6 authors...
BACKGROUND The mesenteric artery calcium score (MACS) identifies patients with possible chronic mesenteric ischaemia (CMI) using standard computed tomography (CT) imaging. The MACS does not necessitate a dedicated computed tomography angiography (CTA) which is required for evaluation of mesenteric artery patency. This study aimed to test the use of a symptom and MACS based score chart to facilitate the selection of patients with a low probability of CMI, in whom further diagnostic workup can be ...
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