How do CTA and MRA compare for diagnosing mesenteric ischemia?

Bottom Line: When mesenteric ischemia is suspected, both CT angiography and MR angiography are suitable for the workup depending on circumstances.

American College of Radiology (ACR) Appropriateness Criteria for imaging of mesenteric ischemia.  2012.  IN:  DynaMed Acute Mesenteric Ischemia article, Guidelines section.

CTA has higher spatial resolution and faster acquisition times than MRA, allowing greater accuracy in assessment of the peripheral visceral branches and the inferior mesenteric artery. CTA also allows investigation of other causes of abdominal pain.  CTA exposes the patient to higher radiation levels than MRA.
A small diagnostic cohort study of 31 patients (age 16-73) with suspected acute mesenteric ischemia (AMI)  had multidetector CTA.  Reference standard was “surgical, clinical, or histopathologic findings.  RESULTS:    16 patients had AMI; sensitivity=100%; specificity=100%.

MRA eliminates exposure to radiation and iodinated contrast agents, making it the technique of choice for children and patients with azotemia.  It has a high sensitivity for severe stenosis or occlusions located in the celiac axis and the superior mesenteric artery, but is less sensitive in detecting  embolism, nonocclusive mesenteric ischemia, and mesenteric ischemia in the inferior mesenteric artery (as MRA only depicts 25% of the inferior mesenteric artery.)

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