Non-Contrast Magnetic Resonance Imaging of Isolated Superior Mesenteric Artery Dissection

A 52-year-old man with hypertension was referred for persistent epigastric pain of 3 weeks’ duration. Contrast-enhanced computed tomography (CT) was initially performed to examine the etiology of symptoms, but had to be discontinued due to an allergic reaction to the contrast medium. Non-contrast magnetic resonance imaging (MRI) (Figure A,D,G) showed isolated superior mesenteric artery dissection (ISMAD) with vascular signal intensity on the blood-suppressed T1-weighted image (T1WI) suggestive of false lumen thrombosis.¹ Antihypertensive therapy was continued conservatively because there were no intestinal ischemic signs and no significant flow-limiting stenosis associated with the dissection (peak systolic velocity at the ISMAD site was 1.2 m/s on ultrasonography). At re-examination 5 weeks later (Figure B,E,H), no progression of dissection was observed on MRI, and 46 weeks later (Figure C,F,I), the high signal intensity on the blood-suppressed T1WI had disappeared, suggesting dissection healing.

Figure.

Non-contrast magnetic resonance imaging of isolated superior mesenteric artery (SMA) dissection at admission, 5 and 46 weeks. Axial images from T2-weighted imaging (T2WI; A–C) and blood-suppressed T1-weighted imaging (T1WI; D–F); and maximum intensity projection (MIP) coronal images on T1WI (G–I). Arrows and arrowheads indicate the main trunk of the SMA and dissected lesions, respectively. a, anterior; lt, left; p, posterior; rt, right.

Non-contrast MRI, especially the blood-suppressed T1WI, can provide valuable information on the nature of a dissected artery and support the diagnosis and follow-up when unable to perform contrast-enhanced CT.

Disclosures

K.K. is a member of Circulation Reports’ Editorial Team.

IRB Information

The present study was approved by Koga General Hospital. Reference number: 22-18.

Reference

• 1.   Baliga RR, Nienaber CA, Bossone E, Oh JK, Isselbacher EM, Sechtem U, et al. The role of imaging in aortic dissection and related syndromes. JACC Cardiovasc Imaging 2014; 7: 406–424.