Case-Control Study of 3D Morphology in Isolated Mesenteric Artery Dissection

Abstract

Introduction: Isolated mesenteric artery dissection (IMAD) is uncommon and has not been investigated in detail. This study aimed to accurately identify the morphological differences of IMAD patients with control individuals using a detailed 3D volumetric analysis.

Methods: In this retrospective case-control study, cases were patients with acute symptomatic IMAD treated in a French intestinal stroke center between January 2016 and November 2019. Case-control matching was (1:3) by age, gender, and body mass index (BMI). The semi-automatic morphological analysis of the mesenteric artery included volumetric measurements of the true and false lumen size, the centerline curvature and the 3D aortomesenteric angles.

Results: Seventeen IMAD cases (mean age 56 ± 4 years, 94% men) were matched with 51 controls. The mean overall lumen (OL) volume was higher in IMAD patients as compared to controls (+ 64%, p < 0.001). In the same way, the mean OL cross-sectional area and diameters were higher in IMAD patients: + 77% for OL area (< 0.001) and + 34% for OL diameters (< 0.001). Meanwhile, no significant difference was found in terms of true lumen (TL) volume (p = 0.16) or cross-sectional area (p = 0.30) between IMAD patients and controls, whereas the mean TL diameter was lower in the IMAD group (p < 0.05). Patients with acute mesenteric ischemia had a lower [TL/OL volume] ratio (45% vs. 59%, p < 0.05) and longer dissections (63 mm vs. 48 mm, p < 0.01). The 3D aortomesenteric angle was significantly higher in IMAD patients at both 2 cm (p < 0.01) and 4 cm (p < 0.05) from the ostium.

Conclusion: Using an original 3D semi-automated analysis, this study shows that IMAD induces significant morphological changes compared to control individuals: a larger aortomesenteric 3D angle, an increased overall volume and area. IMAD patients with acute mesenteric ischemia presented with a more severe morphological profile.

Keywords: 3D morphology; Aortomesenteric angle; Mesenteric artery dissection.