Split-bolus single scan CTA for evaluation of mesenteric ischemia

Purpose: To evaluate split-bolus single scan CTA protocol for evaluation of acute mesenteric ischemia. Materials and methods: In this HIPAA-compliant IRB-approved study, consecutive patients evaluated for mesenteric ischemia between 11/2015 and 10/2016 were included. Patients scanned prior to 4/2016 were scanned with multiphasic CTA protocol and after with split-bolus single scan CTA. Objective and subjective evaluation was performed by three board-certified readers. Findings were correlated to composite clinical reference outcome. Results: Eighty patients were included: 40 with split-bolus and 40 with multiphasic CTA protocol with similar age (60.3 +/- 16.2 years vs. 64.7 +/- 17.0 years, p = 0.19) and BMI (28.0 +/- 6.7 vs. 27.0 +/- 8.7, p = 0.56). SMA attenuation was higher in multiphasic protocol compared to split-bolus protocol (336.5 +/- 97.5 HU vs. 258.0 +/- 67.3 HU, p < 0.001) with similar SMV attenuation (multiphasic 213.7 +/- 58.4 HU vs. split-bolus 194.2 +/- 52.2 HU, p = 0.14). Optimal phase of bowel, liver, and spleen enhancement was seen in similar high proportion (94-99%) in both protocols. There were 8/40 (20%) positive cases of mesenteric ischemia in each group. There was no difference in the diagnostic confidence of the readers for evaluation of the mesenteric vessels and bowel ischemia. There were no missed cases of mesenteric ischemia in either group. Mean effective dose was 42% lower in the split-bolus group, p < 0.001. There was a higher number of axial images to review in multiphasic protocol compared to split-bolus protocol (437.9 +/- 48.7 vs. 263.5 +/- 31.2, p < 0.001). Conclusions: The split-bolus protocol for evaluation of mesenteric ischemia is clinically feasible with confident and accurate diagnostic ability, while reducing number of images and decreasing radiation exposure to the patient.