Comparison of CTA and DSA in the diagnosis of superior mesenteric artery dissecting aneurysm

Objective To compare computed tomography arteriography (CTA) and digital subtraction arteriography (DSA) in the diagnosis of superior mesenteric artery dissecting aneurysm (SMADA). Methods All SMADA patients who underwent CTA and DSA at one of two medical centers between May, 2007 and April, 2017 were identified. The accuracy of CTA and DSA for the depiction of morphologic characteristics of SMADA was analyzed. Results Fourteen patients (12 men; mean age, 55.16.4 years) were included in this study. The mean diameter of the dissecting aneurysm was 3.78 +/- 1.53 mm on CTA and 3.81 +/- 1.54 mm on DSA (p = 0.96). The luminal stenosis was 0.52 +/- 0.27 on CTA and 0.35 +/- 0.23 on DSA (p = 0.09). The thrombosed false lumen was visualized on CTA in 79% (11/14) of patients but in no patients on DSA (p < 0.001). The entry points of the dissection were visualized on CTA in 64.3% (9/14) of patients and on DSA in 100% (14/14) of patients (p = 0.041); CTA and DSA did not visualize re-entry points in any patients. The intimal flap was visualized on CTA in 71.4% (10/14) of patients and on DSA in 78.6% (11/14) of patients (p>0.05). Branch vessel involvement was visualized in 7.1% (1/14) of patients on CTA but in no patients on DSA (p>0.05). Conclusions CTA can be used in place of DSA for the diagnosis of SMADA. Although CTA may exaggerate the degree of luminal stenosis and is weak in depicting the entry points of SMADA, this modality more accurately depicts the thrombosed false lumen and branch vessel involvement.