Abstract
Purpos
Acute mesenteric ischaemia (AMI) is a life-threatening vascular emergency with a high mortality rate. Early diagnosis is the key to reducing its mortality rate and improving the quality of life. Although computed tomography (CT) is still the gold standard for acute intestinal disorders, over the last few years, magnetic resonance imaging (MRI) has become a useful alternative tool. An animal model of AMI was developed in order to study the effectiveness of MRI in early detection of this condition and to observe lesion evolution.
Methods
Thirty Sprague Dawley rats were randomly divided into two groups (n=15): in the first group, after laparotomy, the animals underwent ligation of the superior mesenteric artery (SMA), followed by macroscopic monitoring and histological evaluation; in the second, ischaemia was induced by squeezing a loop around the SMA 3 days before evaluation with 7-T micro-MRI.
Results
Macroscopically, a refl ex spastic ileus followed by refl ex hypotonic ileus and colour changes in some of the loops were detected. MRI evidenced luminal dilatation with air-fluid levels, free intraperitoneal fluid and bowelwall oedema. Histological analysis confirmed ischaemia and earlier damage involving the central portion of the ileum.
Conclusions
This model shows the correct sequence of events during arterial AMI and demonstrates that MRI can be recommended for early diagnosis of these lesions.
Riassunto
Obiettivo
L’ischemia mesenterica acuta (IMA) rappresenta un’emergenza vascolare ad elevata mortalità. La diagnosi precoce è imprescindibile per migliorare sopravvivenza e qualità di vita dei pazienti. Sebbene attualmente la tomografia computerizzata (TC) rimane la metodica di scelta nelle patologie intestinali acute, negli ultimi anni la risonanza magnetica (RM) si è proposta come valida alternativa. Per valutare l’efficacia della RM nella diagnosi precoce di IMA ed investigare l’evoluzione delle lesioni è stato utilizzato un modello animale di ischemia mesenterica.
Materiali e metodi
Trenta ratti Sprague-Dawley sono stati divisi casualmente in 2 gruppi (n=15): nel primo, dopo legatura dell’arteria mesenterica superiore (AMS) in laparotomia, le lesioni sono state monitorate macroscopicamente e istopatologicamente; nel secondo, grazie ad un cappio posizionato all’emergenza dell’AMS tre giorni prima, è stata indotta l’ischemia e valutata con micro-RM a 7 T.
Risultati
Macroscopicamente si è osservato un ileo rifl esso spastico, transitato poi in ipotono, ed il viraggio cromatico di alcune anse. La RM ha documentato la dilatazione luminale con livelli idro-aerei, liquido libero intraperitoneale ed edema parietale. L’analisi istopatologica ha confermato l’ischemia con danno più precoce a carico dell’ileo centrale.
Conclusioni
Il modello documenta la corretta sequenza degli eventi dell’ischemia mesenterica arteriosa acuta (IMAA) e dimostra che la RM può essere proposta per la sua diagnosi precoce.
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Berritto, D., Somma, F., Landi, N. et al. Seven-Tesla micro-MRI in early detection of acute arterial ischaemia: evolution of findings in an in vivo rat model. Radiol med 116, 829–841 (2011). https://doi.org/10.1007/s11547-011-0676-7
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DOI: https://doi.org/10.1007/s11547-011-0676-7