CT angiography of the splanchnic vessels

Last revised by Travis Fahrenhorst-Jones on 01 Jul 2021

Multislice CT angiography of the splanchnic vessels is a powerful minimally invasive technique for the evaluation of the splanchnic vascular system.

CT angiography is indicated in the evaluation of the following conditions related to the splanchnic vessels 8:

  • aneurysm
  • thrombosis
  • stenosis
  • dissection
  • vasculitis 
  • bowel ischemia

The actual procedure will vary depending on institutional protocol/guidelines but below is a typical description 2, 4:

  • patient receives 500-800 mL of negative oral contrast (=water) to opacify the stomach and small bowels
  • patient in supine position with arms up behind his head
  • peripheral venous access (18-20G) in an antecubital vein
  • a volume of 100–120 mL of iodinated contrast medium is administered at a rate of 4-5 mL/sec
  • because both the mesenteric arterial and venous systems must be adequately evaluated, arterial and venous phases are obtained
    • arterial phase (obtained 25-30 seconds after contrast agent injection), images are obtained from above the level of the celiac axis to the level of the common iliac arteries
    • portal venous phase (obtained 60–70 seconds after contrast agent injection), images in this phase are obtained from above the level of the diaphragm to below the level of the symphysis pubis

CT angiograms are assessed for evidence of arterial stenosis or occlusion e.g.

  • vessel occlusion is defined as complete obstruction of the lumen
  • hemodynamically-significant vessel stenosis is defined as a reduction in lumen diameter >50%
  • hemodynamically-insignificant stenosis is defined as a reduction in lumen diameter <50% 1

Axial CT images should be evaluated for secondary signs of ischemia e.g. bowel wall thickening, focal lack of bowel wall enhancement, bowel dilatation, mesenteric fat stranding, ascites, pneumatosis intestinalis, free superior mesenteric or portal venous gas, intraperitoneal gas, solid organ infarction.

General CT contraindications include:

Mesenteric CT angiography has several advantages over conventional angiography as:

The term 'splanchnic' is derived from the Greek word σπλαγχνον (splanchnon) meaning 'the innards' 6,7.

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Cases and figures

  • Case 1: CT angiography of splanchnic arteries
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