Multimodality Diagnosis of Mesenteric Ischemia.

Area of Science:

• Vascular Surgery
• Diagnostic Imaging
• Gastroenterology

Background:

• Early diagnosis of mesenteric ischemia is challenging due to non-specific symptoms and lack of definitive laboratory markers before tissue necrosis.
• Computed tomography (CT) is standard but has limitations including radiation exposure, renal damage risk, potentially misleading findings, and limited availability in critical timeframes.
• Current diagnostic methods for mesenteric ischemia lack the speed and accessibility needed for timely intervention, often delaying treatment until irreversible damage occurs.

Purpose of the Study:

• To explore the utility of ultrasonography and near-infrared (NIR) light-based techniques for overcoming the limitations of conventional diagnostic imaging in mesenteric ischemia.
• To present clinical findings and assess the accuracy of these novel methods in real-time diagnosis and management of mesenteric ischemia.

Main Methods:

• Utilized ultrasonography, including transesophageal echocardiography, for real-time assessment of intestinal morphology, kinetics, and mesenteric vessel perfusion without radiation.
• Employed near-infrared imaging with indocyanine green to visualize vessel and tissue perfusion during laparotomy in aortic aneurysm cases.
• Applied near-infrared spectroscopy (NIRS) for non-invasive, digital quantification of oxygen debt in intestinal tissue, aiming for early ischemia detection.

Main Results:

• Ultrasonography provided real-time, non-invasive evaluation of mesenteric perfusion, crucial for patients in the operating room or remote locations.
• Near-infrared imaging successfully visualized perfusion in aortic dissection and aneurysm cases, aiding intraoperative assessment.
• Near-infrared spectroscopy demonstrated potential for early mesenteric ischemia detection by quantifying tissue oxygen debt digitally, without requiring laparotomy.

Conclusions:

• Ultrasonography and near-infrared techniques offer promising alternatives to CT for early and accurate diagnosis of mesenteric ischemia.
• These advanced imaging modalities can provide critical real-time perfusion data, improving patient outcomes by enabling timely interventions.
• Near-infrared spectroscopy shows particular promise for non-invasive, early detection of mesenteric ischemia, addressing a significant unmet clinical need.