Evaluation of Atherosclerotic Changes in the Superior Mesenteric Artery Using MDCT

Atherosclerosis is a systemic vascular disease that can affect visceral arteries, including the superior mesenteric artery (SMA), potentially leading to mesenteric ischemia with high morbidity and mortality rates. Despite its clinical importance, SMA involvement remains under-reported. This study aimed to evaluate the prevalence, morphological characteristics, anatomical distribution, and associated risk factors of SMA atherosclerotic plaques using multidetector computed tomography (MDCT).

This retrospective study was conducted using data collected from a University Hospital in Turkey. This study focused on patients referred to the Department of Radiology and examined imaging data obtained between January 2008 and December 2010. Information was gathered by examining MDCT scans, patient reports, laboratory findings, and medical records of 15,000 patients admitted to our University Hospital over a designated period. The anatomical distribution of the aneurysms within the SMA (proximal, middle, distal, or diffuse) was recorded. The presence of concomitant atherosclerosis in other visceral arteries and cardiovascular risk factors, including hypertension (HT), diabetes mellitus (DM), coronary artery disease (CAD), and abnormal lipid profiles, was evaluated. Statistical analysis was performed using SPSS (Version 10.0), and associations were assessed using Pearson's chi-square test, with a significance level set at p < 0.05.

The prevalence of SMA atherosclerosis was 0.86% in the studied population. Clinical data were available for 102 patients in this study. HT, DM, and CAD were present in 73.5%, 49%, and 44.1% of the patients, respectively. Calcified plaques were the most common type (55.8%), followed by mixed (28.7%) and soft plaques (15.5%).Plaques were predominantly located in the proximal (29.4%) and proximal-middle (22.4%) segments of the SMA, followed by the middle (14.7%), middle-distal (14.7%), distal (4.6%), and diffuse segments (13.9%). All patients demonstrated concomitant abdominal aortic atherosclerosis. Atherosclerotic involvement of other visceral arteries was frequently observed in this study. The renal arteries were the most commonly affected, with bilateral involvement in 49.2% of the patients and unilateral calcified plaques in 23.4% of the patients. Celiac trunk atherosclerosis was detected in 41.8% of patients, splenic artery involvement in 12.4%, and inferior mesenteric artery (IMA) involvement in 27.1%, making it the least affected artery. Lipid profile analysis revealed elevated total cholesterol levels in 38% of the patients and low HDL levels in 25% of the patients although no significant correlation was found between lipid levels and plaque characteristics or distribution.

Contrast-enhanced MDCT is a reliable, noninvasive imaging modality for detecting and characterizing SMA atherosclerosis, allowing for an accurate assessment of plaque morphology, distribution, and associated vascular involvement. Although relatively uncommon, SMA atherosclerosis is strongly associated with systemic atherosclerotic disease and major cardiovascular risk factors. Routine evaluation of mesenteric vessels during abdominal CT examinations may facilitate early diagnosis and improve clinical outcomes by enabling timely management of patients at risk for mesenteric ischemia.