Non-invasive diagnosis of acute mesenteric ischaemia using PET

Abstract

Purpose: Acute mesenteric ischaemia (AMI) is a lethal disease with an increasing incidence. Despite the availability of effective treatment, AMI remains a vascular emergency with over 60% mortality rate mainly due to late diagnosis. The difficulty in diagnosing this fatal condition stems from non-specific clinical and laboratory findings and lack of appropriate imaging study. Our aim was to test a non-invasive method of identifying AMI using PET.

Methods: The study was conducted in normal pigs (n = 14), sham-operated pigs (n = 4) and pigs undergoing ischaemia and reperfusion of intestine (n = 6). Liver blood flow was imaged by H(2) (15)O PET and liver blood content by C(15)O PET. Both scans were performed during intestinal ischaemia and during reperfusion.

Results: AMI was identified by PET imaging of hepatic perfusion and blood pool. The H(2) (15)O PET scan during AMI detected a 40% decrease in total liver perfusion, which was caused by a 45% reduction of portal blood flow and no alteration in arterial blood flow. Compromised hepatic perfusion during AMI was accompanied by a 75% decrease in hepatic blood pool recognized by the C(15)O PET scan. The striking reduction of liver blood flow and blood content persisted during reperfusion of intestine.

Conclusion: Our results demonstrate that AMI can be readily recognized by PET imaging of liver blood flow and blood content. Moreover, PET can be used in detection of perfusion abnormalities after revascularization. This non-invasive imaging tool could represent a novel approach to diagnose AMI.