The ratio of superior mesenteric artery diameter to superior mesenteric vein diameter based on non-enhanced computed tomography in the early diagnosis of spontaneous isolated superior mesenteric artery dissection

doi:10.5847/wjem.j.1920-8642.2022.045

Abstract

Abstract:

BACKGROUND: Spontaneous isolated superior mesenteric artery (SMA) dissection (SISMAD) is a rare cause of abdominal pain. The aim of the study is to investigate the role of a new parameter, the ratio of the SMA diameter to the superior mesenteric vein (SMV) diameter (SMA/SMV) based on non-enhanced computed tomography (CT), in the early diagnosis of SISMAD.

METHODS: In a registry study from December 2013 to June 2021, 97 abdominal pain SISMAD patients (SISMAD group) admitted to our hospital were enrolled. Meanwhile, the matched sex and age abdominal pain non-SISMAD patients at 1:2 were collected in reverse chronological order as the control group. Student's t-test, Wilcoxon rank-sum test, and Chi-square test were used to compare differences between the SISMAD and control groups. MedCalc was used to generate receiver operating characteristic (ROC) curve.

RESULTS: A total of 291 abdominal pain patients, including 97 SISMAD patients and 194 non-SISMAD patients, were included in the current study. The maximum SMA diameter, perivascular exudation, and SMA/SMV based on non-enhanced CT were significant between the two groups (all P<0.05). ROC curves showed that for the maximum SMA diameter, the area under the curve (AUC), cut-off, sensitivity, and specificity were 0.926, 9.80, 93.8%, and 79.4%, respectively. For SMA/SMV, its AUC, cut-off, sensitivity, and specificity were 0.956, 0.83, 88.7%, and 92.3%, respectively. The diagnostic efficiency of SMA/SMV was better than that of the maximum SMA diameter (P<0.05). The combined parameters of SMA/SMV and maximum SMA diameter had the best diagnostic efficiency (AUC=0.970).

CONCLUSION: SMA/SMV may be a potential marker for SISMAD.

Key words: Abdominal pain, Spontaneous isolated superior mesenteric artery dissection, Computed tomography, Receiver operating characteristic curve

Yuan-li Lei, Wen-xing Song, Yi Lin, Hui-ping Li, He-ping Lyu, Jiao-zhen Chen, Zhang-ping Li, Jia-na Yin, Ji-ke Xue, Shou-quan Chen. The ratio of superior mesenteric artery diameter to superior mesenteric vein diameter based on non-enhanced computed tomography in the early diagnosis of spontaneous isolated superior mesenteric artery dissection[J]. World Journal of Emergency Medicine, 2022, 13(3): 202-207.

Figures/Tables 3

Table 1.

Table 2.

Figure 1.

References 23

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Variables	Total patients (n=291)	SISMAD group (n=97)	Control group (n=194)	t/χ²/Z	P-value
Age, years	52.03±7.39	52.03±7.42	52.03±7.40	0.000	1.000
Male	261 (89.7)	97 (89.7)	174 (89.7)	0.000	1.000
Hypertension	78 (26.8)	37 (38.1)	41 (21.1)	9.537	0.002
Diabetes mellitus	22 (7.6)	0 (0)	22 (14.7)	11.900	0.001
Liver-relative disease	45 (15.5)	13 (28.9)	32 (16.5)	0.473	0.492
Malignancy	47 (16.2)	5 (5.2)	42 (21.6)	12.992	<0.001
Digestive system malignancy	37 (12.7)	1 (1.0)	36 (18.6)	17.897	<0.001
Heart disease	9 (3.1)	0 (0)	9 (4.6)	3.225	0.073
Arrhythmia	9 (3.1)	4 (4.1)	5 (2.6)	0.129	0.719
Duration of abdominal pain, d	1.0 (0.4-3.0)	1.0 (0.3-3.0)	0.5 (1.0-3.0)	-1.176	0.239

Variables	Total patients (n=291)	SISMAD group (n=97)	Control group (n=194)	t/χ²/Z	P-value
Diameter of SMA root, mm	9.43±1.41	10.25±1.56	9.02±1.13	6.897	<0.001
Diameter of SMA trunk, mm	8.70 (7.72-10.28)	11.18 (10.15-12.13)	8.00 (7.40-8.70)	-13.217	<0.001
SMV diameter, mm	11.65±1.68	11.36±1.44	11.80±1.78	-2.128	0.034
SMA/SMV	0.75 (0.65-0.90)	1.00 (0.89-1.10)	0.69 (0.61-0.75)	-12.671	<0.001
Maximum SMA diameter, mm	9.60 (8.70-10.89)	11.37 (10.39-12.38)	9.07 (8.33-9.69)	-11.854	<0.001
Location of maximum SMA diameter (SMA trunk)	84 (28.9)	72 (74.2)	12 (6.2)	145.801	<0.001
Perivascular exudation	114 (39.2)	59 (60.8)	55 (48.2)	28.620	<0.001

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