Author/Editor		Popovič, Peter
Title		Racionalna slikovna diagnostika mezenterične ishemije
Translated title		Rational imaging in mesenteric ischaemia
Type		članek
Source		Gastroenterolog
Vol. and No.		Letnik 9, št. 21
Publication year		2005
Volume		str. 47-55
Language		slo
Abstract		Plain abdominal radiography, ultrasound (US), computerized tomography (CT) and magnetic resonance (MR) are non-invasive imaging techniques used in the diagnosis of patients with acute and chronic mesenteric ischaemia. Plain abdominal radiography is the first diagnostic tool employed in patients presenting with acute abdomen which may also be due to mesenteric iscbaemia. The examination can rule out other causes of acute abdomen, such as organ perforation, ileus and other pathologies, and, in addition, it detects changes that emphasize suspicion of mesenteric ischaemia. US shows clearly the presence of free fluid in the portal system and intestinal wall, which is compatible with extensive necrosis of the intestinal mucosa. Doppler US can demonstrate narrowing or occlusion of the arterial trunks, but cannot exclude involvement of peripheral mesenteric vessels. The examination is frequently technically hindered by the presence of gas in distended intestinal loops. CT angiography can provide more accurate information about signs and causes of mesenteric ischaemia; its specificity and sensitivity rates being 94% and 96%, respectively. Signs of mesenteric ischaemia include focal or segmental thickening of the bowel mucosa (submucosal oedema) - which may become evident after the injection of contrast agent. the presence of intraperitoneal Fluid or of gas in the bowel mucosa and in the portal system. Mesenteric ischaemia is due to narrowing or occlusion of mesenteric arteries and veins. The diagnostic value of CT angiography has considerably improved by the advent of multislice CT scanning, which affords fast visualization of the bowel and vessels, and makes the creation of multiplanar reconstructions and 3-dimensional representation possible. Despite all technical advances made in the field, accurate visualization of peripheral branches of the mesenteric arteries is not yet possible. (Abstract truncated at 2000 characters)
Summary		Nativno rentgensko slikanje, ultrazvočna (UZ) preiskava, računalniška tomografija (CT) in magnetnoresonančno slikanje (MRl) trebuha so neinvazivne slikovne preiskave za ugotavljanje akutne in kronične mczenterične ishemije. Nativni rentgenogram trebuha je običajno prva preiskava pri bolniku z akutnim abdomnom, katerega vzrok je lahko tudi mezenterična ishemija. Z njim lahko izhljučimo druge vzroke akutncga abdomna, kot sta perforacija organa in ileus, in obcncm prikažemo spremembe, ki poudarijo sum na mezenterično ishemijo. UZ preiskava dobro prikaže prosto tekočino in plin v portalnem sistemu in v steni črevesja, kar zanesljivo pomeni obsežno nekrozo mukoze oziroma stene črevesja. Dopplerska sonogralija lahko prikaže zožitvc ali zapore na deblih mezenteričnih arterij, ne more pa prikazati ali izključiti sprememb na perifernih vejah. Preiskava jc pogosto tehnično omejena zaradi plina v razširjenih črevesnih vijugah. Z računalniškotomografsko angiografijo (CTA) lahko natančneje ugotovimo znake in vzroke za mezenterično ishemijo, specifičnost in občutljivost metode je 94- oz. 96-odstotna. Znaki mezenterične ishemije so fokalna ali segmentna zadebelitev črevesne stene, hipodenzna stena črevesja (submukozni edem), ki se po aplikaciji kontrastnega sredstva obarva ali pa ne, prosta tekočina intraperitonealno in plin v steni črevesja ter v portalnem sistemu. Vzroki zanjo so zapore in zožitvc mezenteričnih arterij in ven. Povednost CTA se je bistveno izboljšala z uvedbo večrezinskega CT (MSCT), ki omogoča hitro preiskavo črevesja in ožilja z možnostmi matiplanarne rekonstrukcije (MPR) in tridimenzionalega prikaza. Kjub vsem tehničnim možnostim pa ne moremo dovolj natančno prikazati perifernih vej mezenteričnih arterij. MRI je daljše od CTA in ga večinoma delamo pri bolnikih z sumom na kronično mezenterično ishemijo. Z digitalno suhtrakcijsko angiografijo (DSA) najbolj zanesljivo prikažemo spremembe na mezenteričnem ožilju. (Izvleček skrajšan na 2000 znakov)
Descriptors		MESENTERIC VASCULAR OCCLUSION TOMOGRAPHY, X-RAY COMPUTED AORTOGRAPHY