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Multi–Detector Row CT of Mesenteric Ischemia: Can It Be Done?¹

¹ From the Department of Radiology, Johns Hopkins Medical Institutions, 601 N Caroline St, Rm 3251, Baltimore, MD 21287. Recipient of a Certificate of Merit award for an education exhibit at the 2000 RSNA scientific assembly. Received March 15, 2001; revision requested April 19 and final revision received June 27; accepted July 2. Address correspondence to E.K.F. (e-mail: efishman@jhmi.edu).

	Abstract

Top Abstract Introduction CT Technique Three-dimensional Reformatting... Multi-Detector Row CT Findings... Conclusions References

 
Mesenteric ischemia is a complicated disorder whose prevalence in the United States is increasing as the population ages. It is often difficult to diagnose, both clinically and radiologically. In the past, computed tomography (CT) has allowed only limited success in the early detection of ischemia. However, with the introduction of multi–detector row CT and three-dimensional (3D) imaging, it is now possible to perform a detailed CT examination of the small bowel and mesenteric vessels. Multi–detector row CT allows routine studies to be performed much faster than with single-detector CT scanners and makes available new applications, especially in the field of CT angiography. Its increased speed and narrower collimation, coupled with the use of water as an oral contrast agent, improve visualization of the bowel wall and mesenteric vasculature. Multi–detector row CT with 3D reformatting may improve the ability to make an early diagnosis and identify the cause of disease in patients with suspected acute or chronic mesenteric ischemia. In many cases, this examination has eliminated the need for additional imaging studies such as Doppler ultrasonography or angiography. Further investigation will be needed to determine the scope of the utility of multi–detector row CT in this clinical setting.

Index Terms: Computed tomography (CT), utilization • Intestines, CT, 74.1211 • Intestines, ischemia, 95.761 • Mesentery, CT, 792.1211 • Mesentery, ischemia, 95.761

	Introduction

Top Abstract Introduction CT Technique Three-dimensional Reformatting... Multi-Detector Row CT Findings... Conclusions References

 
Mesenteric ischemia is a complicated disorder that occurs when blood flow (arterial or venous) to the intestines is compromised. The prevalence of mesenteric ischemia is increasing in the United States as the population ages. The disease can be classified as either acute or chronic. It is estimated that nearly 1% of patients presenting with acute abdomen have ischemic intestinal disease (1–3). Despite heightened awareness of and sensitivity for the disease, its morbidity and mortality have remained high over the past 30 years, with mortality rates in patients with acute mesenteric ischemia exceeding 60% (4,5). This is due in part to the lack of an accurate diagnostic imaging tool. Although angiography is considered the standard of reference for the diagnosis of mesenteric ischemia, it is an invasive, time-consuming, and costly procedure. Angiography may also cause morbidity in those in whom intestinal ischemia is most commonly seen (ie, elderly patients with atherosclerotic disease).

Since its introduction in the late 1970s, computed tomography (CT) has been used with variable success in the evaluation of small bowel ischemia. CT has traditionally been used for two reasons in patients with suspected ischemia. First, it can help detect ischemic changes in the affected small bowel loops and mesentery. These changes include bowel wall thickening and edema, submucosal hemorrhage, increased or decreased enhancement of the bowel wall, mesenteric stranding or fluid, and pneumatosis. Second, CT can sometimes help determine the cause of the ischemia by allowing evaluation of the mesenteric vasculature for atherosclerosis, thrombus, occlusion, compression or invasion by tumor, and trauma.

Early reports of CT accuracy in the detection of mesenteric ischemia with first- and second-generation scanners were not encouraging (6,7). The introduction of spiral CT definitely improved the capacity of CT to demonstrate the mesenteric vessels and bowel wall by allowing narrow collimation and faster scanning coupled with bolus timing achieved with intravenous administration of contrast material (8,9). Despite these improvements, however, spiral CT was still not sensitive for the early detection of reversible small bowel ischemia, and, in most cases of high clinical suspicion, angiography was necessary. In a study by Taourel et al (8), the CT sensitivity and specificity for diagnosing mesenteric ischemia were only 64% and 92%, respectively.

Multi–detector row CT is the latest advancement in CT technology and is now more readily available. Multi–detector row CT combines multiple rows of detectors and faster gantry rotation with narrow collimation (10). Thus, it offers advantages over classic spiral CT for imaging the mesenteric vasculature and small bowel.

In this article, we review multi–detector row CT technique in patients with suspected mesenteric ischemia. We also discuss and illustrate various three-dimensional (3D) image reformatting techniques (shaded surface display, maximum intensity projection, volume rendering) and CT findings in both acute and chronic mesenteric ischemia.

	CT Technique

Top Abstract Introduction CT Technique Three-dimensional Reformatting... Multi-Detector Row CT Findings... Conclusions References

 
Our protocol for the evaluation of patients with suspected mesenteric ischemia is shown in the Table. It includes the administration of 500–750 mL of water as oral contrast material. In the past, CT of the small bowel has traditionally been performed with high-attenuation contrast agents for opacification of the gastrointestinal tract and has relied on structural changes in the appearance of the bowel (eg, wall thickening, pneumatosis) for diagnosis. However, a low-attenuation oral contrast agent (eg, water, methylcellulose, air) offers two major advantages in the evaluation of patients with suspected mesenteric ischemia.

View larger version (139K): [in this window] [in a new window] [Download PPT slide]   Figure 1.   Drawings illustrate the value of using water as an oral contrast agent instead of high-attenuation contrast agents when evaluating small bowel disease and enhancement. Drawings A ("unenhanced CT scan") and B ("contrast material-enhanced CT scan") illustrate the results of using a high-attenuation contrast agent, whereas drawings C (unenhanced CT scan) and D (contrast-enhanced CT scan) illustrate the results of using a low-attenuation contrast agent (eg, water). Intraluminal water clearly allows better visualization of the enhancing bowel wall.

View larger version (160K): [in this window] [in a new window] [Download PPT slide]   Figure 2a.   Coronal volume-rendered 3D multi-detector row CT scans (b obtained anterior to a) demonstrate the normal small bowel. Water was used as an oral contrast agent, allowing visualization of the enhancing small bowel wall and intestinal folds.

View larger version (162K): [in this window] [in a new window] [Download PPT slide]   Figure 2b.   Coronal volume-rendered 3D multi-detector row CT scans (b obtained anterior to a) demonstrate the normal small bowel. Water was used as an oral contrast agent, allowing visualization of the enhancing small bowel wall and intestinal folds.

In patients with suspected mesenteric ischemia, it is crucial to visualize the mesenteric vessels and conduct a thorough examination of the intestines. Multi–detector row CT offers distinct advantages over traditional spiral CT in imaging the mesenteric vasculature. First, multi–detector row CT scanners are faster than single-detector spiral CT scanners. Depending on the manufacturer and model of the scanner and the parameters selected, a multi–detector row scanner can be up to eight times faster than a single-section spiral scanner operating at 1 second per section. This virtually eliminates motion and respiratory artifact. Also, faster scanning allows more accurate timing of bolus administration of contrast material so that data can be obtained during both the arterial and venous phases. This faster scanning combined with rapid intravenous administration of contrast material (3–5 mL/sec) allows visualization of the more distal branches of the mesenteric vessels, which is especially important in patients with embolic disease (Fig 3). Second, modern multi–detector row CT scanners allow thinner collimation than single-detector spiral scanners. A section thickness of 0.5–1 mm is possible, thus reducing volume averaging of small vessel branches. This thinner collimation, coupled with overlapping reformatted images, allows creation of superior 3D volume sets and improves visualization of distal branches of the mesenteric arteries and veins.

View larger version (155K): [in this window] [in a new window] [Download PPT slide]   Figure 3a.   (a) Sagittal volume-rendered 3D multi-detector row CT scan demonstrates the normal celiac axis (straight arrow) and superior mesenteric artery (SMA) (curved arrow). (b) Coronal volume-rendered 3D multi-detector row CT scan shows the normal branching pattern of the SMA (arrow). (c) Coronal oblique volume-rendered 3D multi-detector row CT scan shows the normal branching pattern of the inferior mesenteric artery (arrows). (d) Coronal volume-rendered 3D multi-detector row CT scan demonstrates the normal mesenteric veins.

View larger version (190K): [in this window] [in a new window] [Download PPT slide]   Figure 3b.   (a) Sagittal volume-rendered 3D multi-detector row CT scan demonstrates the normal celiac axis (straight arrow) and superior mesenteric artery (SMA) (curved arrow). (b) Coronal volume-rendered 3D multi-detector row CT scan shows the normal branching pattern of the SMA (arrow). (c) Coronal oblique volume-rendered 3D multi-detector row CT scan shows the normal branching pattern of the inferior mesenteric artery (arrows). (d) Coronal volume-rendered 3D multi-detector row CT scan demonstrates the normal mesenteric veins.

View larger version (135K): [in this window] [in a new window] [Download PPT slide]   Figure 3c.   (a) Sagittal volume-rendered 3D multi-detector row CT scan demonstrates the normal celiac axis (straight arrow) and superior mesenteric artery (SMA) (curved arrow). (b) Coronal volume-rendered 3D multi-detector row CT scan shows the normal branching pattern of the SMA (arrow). (c) Coronal oblique volume-rendered 3D multi-detector row CT scan shows the normal branching pattern of the inferior mesenteric artery (arrows). (d) Coronal volume-rendered 3D multi-detector row CT scan demonstrates the normal mesenteric veins.

View larger version (169K): [in this window] [in a new window] [Download PPT slide]   Figure 3d.   (a) Sagittal volume-rendered 3D multi-detector row CT scan demonstrates the normal celiac axis (straight arrow) and superior mesenteric artery (SMA) (curved arrow). (b) Coronal volume-rendered 3D multi-detector row CT scan shows the normal branching pattern of the SMA (arrow). (c) Coronal oblique volume-rendered 3D multi-detector row CT scan shows the normal branching pattern of the inferior mesenteric artery (arrows). (d) Coronal volume-rendered 3D multi-detector row CT scan demonstrates the normal mesenteric veins.

	Three-dimensional Reformatting Techniques

Top Abstract Introduction CT Technique Three-dimensional Reformatting... Multi-Detector Row CT Findings... Conclusions References

Shaded Surface Display
With SSD, specific attenuation thresholds are set. Voxels within the thresholds are displayed, whereas voxels outside the thresholds are excluded. Thus, only portions of the data set are being used. SSD is simple to use and can be performed on inexpensive computer platforms; however, it is not adequate for visualization of the bowel wall. Because only the surface is displayed, there is considerable artifact, noise, and loss of mural detail. In a study by Hopper et al (14) of mucosal detail at virtual reality CT, volume rendering was found to be superior to SSD.

Maximum Intensity Projection
MIP is a simple algorithm that displays the brightest voxel along computer-generated rays in a specified orientation (15). MIP can be a valuable tool for visualizing distal branches of vessels; however, spatial relationships are lost.

Volume Rendering
Volume rendering is the most advanced and computer-intensive rendering algorithm available (16). Unlike SSD, it incorporates all of the relevant data into the resulting image. For example, parameters can be applied to the volume set to affect the appearance of the small intestine so that related anatomy and disease are optimally demonstrated. These parameters include window width and level, attenuation, and brightness and can be adjusted interactively by the user. The display parameters can also be manipulated to optimize visualization of the enhancing bowel wall. In addition, the setting can be adjusted to simulate an image from a traditional small bowel study or enteroclysis (Fig 4). Volume rendering is also a powerful tool when performing CT angiography of the mesenteric vessels. In a recent study of CT angiography of the peripancreatic vessels, volume rendering was found to be superior to both SSD and MIP (17). The major advantage of volume rendering is its capacity to accurately display the vessels as well as adjacent structures. In addition, unlike with MIP, spatial relationships are preserved with volume rendering. The quality of CT angiograms obtained with volume rendering is comparable to that of conventional angiograms, but at a fraction of the cost and in far less time (Fig 3). When viewing 3D data sets obtained in patients with suspected mesenteric ischemia, we use volume rendering and, occasionally, MIP. Our 3D software is Siemens Virtuoso.

View larger version (168K): [in this window] [in a new window] [Download PPT slide]   Figure 4a.   Coronal volume-rendered 3D multi-detector row CT scans obtained with different rendering parameters after rectal insufflation of approximately 1 L of air show reflux of the air back into the small bowel. The appearance of the distended bowel is the same as at enteroclysis (a) and at a barium small bowel study (b).

View larger version (121K): [in this window] [in a new window] [Download PPT slide]   Figure 4b.   Coronal volume-rendered 3D multi-detector row CT scans obtained with different rendering parameters after rectal insufflation of approximately 1 L of air show reflux of the air back into the small bowel. The appearance of the distended bowel is the same as at enteroclysis (a) and at a barium small bowel study (b).

	Multi–Detector Row CT Findings in Mesenteric Ischemia

Top Abstract Introduction CT Technique Three-dimensional Reformatting... Multi-Detector Row CT Findings... Conclusions References

Acute Ischemia
Acute mesenteric ischemia can result in changes in affected bowel loops. The most common CT finding is circumferential thickening of the bowel wall (Fig 5). The bowel wall may demonstrate low attenuation, thereby reflecting submucosal edema and inflammation. Alternatively, the bowel wall may demonstrate high attenuation due to submucosal hemorrhage, which often accompanies ischemia (8,18,19). It can appear homogeneous or may have a "halo" appearance. After the intravenous administration of contrast material, affected loops may demonstrate decreased enhancement compared with normal loops due to compromised blood flow. In some patients, the affected loops may demonstrate increased enhancement due to hyperemia (19). Delayed and persistent enhancement of the affected loops has also been described (8). In cases of infarction, pneumatosis may be present, signifying irreversible disease (Figs 5, 6). At this stage, urgent surgical resection is necessary, before perforation and sepsis occur. In addition to bowel wall thickening, ischemic small bowel may demonstrate luminal dilatation and mesenteric stranding (Fig 7). In patients with acute mesenteric ischemia, the portion of the intestine affected depends on the cause of the ischemia and the availability of collateral vessels. If a major artery or vein is compromised (eg, SMA, superior mesenteric vein), the entire mesenteric small bowel (ie, the jejunum and ileum) may be involved as well as the right and transverse colon. On the other hand, patients with atrial fibrillation may develop emboli that affect only a small segment of the small intestine.

View larger version (171K): [in this window] [in a new window] [Download PPT slide]   Figure 5a.   Acute mesenteric ischemia in a 59-year-old man who was admitted to the hospital with atrial fibrillation and acute abdominal pain. (a) Coronal 3D multi-detector row CT scan demonstrates segmental thickening of a small bowel loop in the left side of the abdomen (straight arrow). This loop is narrowed compared with the remainder of the small bowel, which is minimally dilated. The small mesenteric vessels feeding the loop are distended (curved arrows). (b) Coronal 3D multi-detector row CT scan obtained 4 days later demonstrates pneumatosis of the small bowel loop (arrow), a finding that is compatible with infarction. Note that the dilated mesenteric vessels are no longer visible.

View larger version (154K): [in this window] [in a new window] [Download PPT slide]   Figure 5b.   Acute mesenteric ischemia in a 59-year-old man who was admitted to the hospital with atrial fibrillation and acute abdominal pain. (a) Coronal 3D multi-detector row CT scan demonstrates segmental thickening of a small bowel loop in the left side of the abdomen (straight arrow). This loop is narrowed compared with the remainder of the small bowel, which is minimally dilated. The small mesenteric vessels feeding the loop are distended (curved arrows). (b) Coronal 3D multi-detector row CT scan obtained 4 days later demonstrates pneumatosis of the small bowel loop (arrow), a finding that is compatible with infarction. Note that the dilated mesenteric vessels are no longer visible.

View larger version (150K): [in this window] [in a new window] [Download PPT slide]   Figure 6a.   Acute mesenteric ischemia in a 57-year-old man with long-standing atherosclerotic heart disease who presented with acute abdominal pain and watery diarrhea. (a) Axial contrast-enhanced volume-rendered multi-detector row CT scan demonstrates pneumatosis of several small bowel loops in the right side of the abdomen (arrows). (b) Lateral volume-rendered 3D multi-detector row CT scan demonstrates calcified plaque at the origins of the celiac axis (straight arrow) and SMA (curved arrow) as well as moderate calcified plaque in the aorta. (c) On axial oblique 3D multi-detector row CT scans (right image obtained inferior to left image), the SMA (curved arrow) has a smaller caliber than the celiac axis (straight arrow). Surgery revealed infarction of the distal small bowel with associated ischemic changes in the right colon. Severe stenosis was noted at the origin of the SMA with minimal stenosis at the celiac origin. Endarterectomy of the SMA was performed along with a bypass graft procedure.

View larger version (171K): [in this window] [in a new window] [Download PPT slide]   Figure 6b.   Acute mesenteric ischemia in a 57-year-old man with long-standing atherosclerotic heart disease who presented with acute abdominal pain and watery diarrhea. (a) Axial contrast-enhanced volume-rendered multi-detector row CT scan demonstrates pneumatosis of several small bowel loops in the right side of the abdomen (arrows). (b) Lateral volume-rendered 3D multi-detector row CT scan demonstrates calcified plaque at the origins of the celiac axis (straight arrow) and SMA (curved arrow) as well as moderate calcified plaque in the aorta. (c) On axial oblique 3D multi-detector row CT scans (right image obtained inferior to left image), the SMA (curved arrow) has a smaller caliber than the celiac axis (straight arrow). Surgery revealed infarction of the distal small bowel with associated ischemic changes in the right colon. Severe stenosis was noted at the origin of the SMA with minimal stenosis at the celiac origin. Endarterectomy of the SMA was performed along with a bypass graft procedure.

View larger version (171K): [in this window] [in a new window] [Download PPT slide]   Figure 6c.   Acute mesenteric ischemia in a 57-year-old man with long-standing atherosclerotic heart disease who presented with acute abdominal pain and watery diarrhea. (a) Axial contrast-enhanced volume-rendered multi-detector row CT scan demonstrates pneumatosis of several small bowel loops in the right side of the abdomen (arrows). (b) Lateral volume-rendered 3D multi-detector row CT scan demonstrates calcified plaque at the origins of the celiac axis (straight arrow) and SMA (curved arrow) as well as moderate calcified plaque in the aorta. (c) On axial oblique 3D multi-detector row CT scans (right image obtained inferior to left image), the SMA (curved arrow) has a smaller caliber than the celiac axis (straight arrow). Surgery revealed infarction of the distal small bowel with associated ischemic changes in the right colon. Severe stenosis was noted at the origin of the SMA with minimal stenosis at the celiac origin. Endarterectomy of the SMA was performed along with a bypass graft procedure.

View larger version (155K): [in this window] [in a new window] [Download PPT slide]   Figure 7a.   Acute mesenteric ischemia in a patient with severe abdominal pain. Axial (a) and coronal (b) 3D multi-detector row CT scans demonstrate a mesenteric mass (arrows in a, straight arrows in b) encasing the mesenteric vessels. Focal calcification is seen within the mass (curved arrow in b). The small bowel loops are thickened, and ascites and mesenteric stranding are also noted. Biopsy revealed sclerosing mesenteritis.

View larger version (162K): [in this window] [in a new window] [Download PPT slide]   Figure 7b.   Acute mesenteric ischemia in a patient with severe abdominal pain. Axial (a) and coronal (b) 3D multi-detector row CT scans demonstrate a mesenteric mass (arrows in a, straight arrows in b) encasing the mesenteric vessels. Focal calcification is seen within the mass (curved arrow in b). The small bowel loops are thickened, and ascites and mesenteric stranding are also noted. Biopsy revealed sclerosing mesenteritis.

Ischemia can occur when either the superior mesenteric vein or SMA is acutely compromised. This could be due to thrombosis or severe narrowing of a mesenteric artery or vein (Figs 6, 8, 9). The mesenteric vessels can also be encased and occluded by adjacent tumors such as pancreatic cancer. In addition, low-flow states can cause diffuse ischemia of the intestines. In these patients, the mesenteric arteries may appear narrowed with limited opacification of branches due to hypovolemia and spasm.

View larger version (146K): [in this window] [in a new window] [Download PPT slide]   Figure 8a.   Acute mesenteric ischemia in a 56-year-old woman with severe abdominal pain. The patient had undergone Whipple surgery for pancreatic cancer 5 days earlier. (a) Axial multi-detector row CT scan demonstrates thrombosis of the superior mesenteric vein (arrow). (b) Axial CT scan obtained inferior to a demonstrates thickened small bowel loops with a halo appearance, findings that are compatible with ischemia.

View larger version (121K): [in this window] [in a new window] [Download PPT slide]   Figure 8b.   Acute mesenteric ischemia in a 56-year-old woman with severe abdominal pain. The patient had undergone Whipple surgery for pancreatic cancer 5 days earlier. (a) Axial multi-detector row CT scan demonstrates thrombosis of the superior mesenteric vein (arrow). (b) Axial CT scan obtained inferior to a demonstrates thickened small bowel loops with a halo appearance, findings that are compatible with ischemia.

View larger version (142K): [in this window] [in a new window] [Download PPT slide]   Figure 9a.   Acute mesenteric ischemia in a 76-year-old woman with severe abdominal pain. The patient had undergone successful laparoscopic cholecystectomy 2 days earlier. (a) Multi-detector row CT scan demonstrates focal narrowing of the SMA approximately 2 cm from its origin (arrow). This finding was most likely caused by atherosclerotic plaque. (b) On a CT angiogram, the branches of the SMA appear small and narrowed (arrows), possibly due to vasospasm. The bowel wall (not shown) appeared normal with no evidence of thickening. The CT angiographic findings were confirmed at conventional angiography. The patient was treated conservatively, and the symptoms resolved within a week. The patient was discharged in good condition.

View larger version (157K): [in this window] [in a new window] [Download PPT slide]   Figure 9b.   Acute mesenteric ischemia in a 76-year-old woman with severe abdominal pain. The patient had undergone successful laparoscopic cholecystectomy 2 days earlier. (a) Multi-detector row CT scan demonstrates focal narrowing of the SMA approximately 2 cm from its origin (arrow). This finding was most likely caused by atherosclerotic plaque. (b) On a CT angiogram, the branches of the SMA appear small and narrowed (arrows), possibly due to vasospasm. The bowel wall (not shown) appeared normal with no evidence of thickening. The CT angiographic findings were confirmed at conventional angiography. The patient was treated conservatively, and the symptoms resolved within a week. The patient was discharged in good condition.

CT can help detect calcified plaque in the aorta and mesenteric arteries as well as the presence of collateral vessels in patients with chronic mesenteric ischemia (Fig 10). However, calcified atherosclerotic plaque at the origin of the mesenteric arteries is relatively common in older individuals, most of whom do not have symptoms of ischemia. Unlike in patients with acute mesenteric ischemia, the small intestine usually appears normal in patients with chronic mesenteric ischemia, unless an acute thrombus is also present. In patients with chronic mesenteric ischemia, mesenteric collateral vessels may form to preserve adequate blood flow to the intestines. These can also be identified at multi–detector row CT with 3D reformatting (Fig 11).

View larger version (148K): [in this window] [in a new window] [Download PPT slide]   Figure 10.   Chronic mesenteric ischemia in a 68-year-old woman with the classic symptoms of the disease. Multi-detector row CT scan demonstrates atherosclerotic plaque and minimal narrowing at the origins of the celiac axis (straight arrow) and SMA (curved arrow), which otherwise appear normal. The small bowel and colon (not shown) demonstrated normal enhancement with no evidence of thickening. Because of the CT findings and clinical symptoms, the patient underwent aortomesenteric bypass surgery. Although the CT findings may be subtle, they may also be hemodynamically significant, especially in situations that put stress on the mesenteric circulation (eg, after meals).

View larger version (185K): [in this window] [in a new window] [Download PPT slide]   Figure 11a.   Chronic mesenteric ischemia. (a) Sagittal volume-rendered 3D multi-detector row CT scan demonstrates occlusion at the origins of the celiac axis (straight arrow) and SMA (curved arrow). (b) Coronal volume-rendered 3D multi-detector row CT scan demonstrates an enlarged inferior mesenteric artery filling the celiac axis and SMA in a retrograde fashion through collateral vessels (arrows).

View larger version (150K): [in this window] [in a new window] [Download PPT slide]   Figure 11b.   Chronic mesenteric ischemia. (a) Sagittal volume-rendered 3D multi-detector row CT scan demonstrates occlusion at the origins of the celiac axis (straight arrow) and SMA (curved arrow). (b) Coronal volume-rendered 3D multi-detector row CT scan demonstrates an enlarged inferior mesenteric artery filling the celiac axis and SMA in a retrograde fashion through collateral vessels (arrows).

	Conclusions

Top Abstract Introduction CT Technique Three-dimensional Reformatting... Multi-Detector Row CT Findings... Conclusions References

	Footnotes

 
Abbreviations: MIP = maximum intensity projection, SMA = superior mesenteric artery, SSD = shaded surface display, 3D = three-dimensional

	References

Top Abstract Introduction CT Technique Three-dimensional Reformatting... Multi-Detector Row CT Findings... Conclusions References

 

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