Becker Lena S, Stahl Klaus, Meine Timo C, von Falck Christian, Meyer Bernhard C, Dewald Cornelia L A, Rittgerodt Nina, Busch Markus, David Sascha, Wacker Frank, Hinrichs Jan B
Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
Abdom Radiol (NY). 2020 Oct;45(10):3342-3351. doi: 10.1007/s00261-020-02457-y.
To evaluate the feasibility of 2D-perfusion angiography (2D-PA) for the analysis of intra-procedural treatment response after intra-arterial prostaglandin E1 therapy in patients with non-occlusive mesenteric ischemia (NOMI).
Overall, 20 procedures in 18 NOMI patients were included in this retrospective case-control study. To evaluate intra-procedural splanchnic circulation changes, post-processing of digital subtraction angiography (DSA) series was performed. Regions of interest (ROIs) were placed in the superior mesenteric artery (SMA; reference), the portal vein (PV; ROI), as well as the aorta next to the origin of the SMA (ROI). Peak density (PD), time to peak (TTP), and area under the curve (AUC) were assessed, and parametric ratios 'target ROI/reference ROI' were computed and compared within treatment and control group. Additionally, a NOMI score was assessed pre- and post-treatment compared to 2D-PA.
Vasodilator therapy leads to a significant decrease of the 2D-PA-derived values PD (p = 0.04) and AUC (p = 0.03). These findings correlated with changes of the simplified NOMI score, both for overall (4 to 1, p < 0.0001) and for each category. Prostaglandin application caused a significant increase of the AUC (p = 0.04) and TTP was accelerated without reaching statistical significance (p = 0.13). When compared to a control group, all 2D-PA values in the NOMI group (pre- and post-intervention) differed significantly (p < 0.05) with longer TTP and lower AUC and PD .
2D-PA offers an objective approach to analyze immediate flow and perfusion changes following vasodilatory therapies of NOMI patients and may be a valuable tool for assessing treatment response.
评估二维灌注血管造影（2D-PA）用于分析非闭塞性肠系膜缺血（NOMI）患者动脉内前列腺素E1治疗后术中治疗反应的可行性。
本回顾性病例对照研究共纳入18例NOMI患者的20次手术。为评估术中内脏循环变化，对数字减影血管造影（DSA）系列进行了后处理。在肠系膜上动脉（SMA；参考）、门静脉（PV；感兴趣区）以及SMA起源处旁边的主动脉（感兴趣区）放置感兴趣区（ROI）。评估峰值密度（PD）、达峰时间（TTP）和曲线下面积（AUC），并计算参数比值“目标感兴趣区/参考感兴趣区”，在治疗组和对照组内进行比较。此外，在治疗前后与2D-PA相比评估NOMI评分。
血管扩张剂治疗导致2D-PA得出的PD值（p = 0.04）和AUC值（p = 0.03）显著降低。这些发现与简化NOMI评分的变化相关，无论是总体评分（从4降至1，p < 0.0001）还是各分类评分。应用前列腺素导致AUC显著增加（p = 0.04），TTP加快但未达到统计学显著性（p = 0.13）。与对照组相比，NOMI组（干预前后）的所有2D-PA值均有显著差异（p < 0.05），TTP更长，AUC和PD更低。
2D-PA为分析NOMI患者血管扩张治疗后的即时血流和灌注变化提供了一种客观方法，可能是评估治疗反应的有价值工具。
