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CT findings in idiopathic myointimal hyperplasia of mesenteric veins (IMHMV) and comparison to other colitides

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Abstract

Purpose

The purpose of this study is to determine computed tomography (CT) findings that aid in differentiating idiopathic myointimal hyperplasia of mesenteric veins (IMHMV) from other colitides.

Methods

Retrospective review of histiologic proven cases of IMHMV (n = 12) with contrast enhanced CT (n = 11) and/or computed tomography angiography (CTA) (n = 9) exams. Control groups comprised of CT of infectious colitis (n = 13), CT of inflammatory bowel disease (IBD) (n = 12), and CTA of other colitides (n = 13). CT exams reviewed by 2 blinded gastrointestinal radiologists for maximum bowel wall thickness, enhancement pattern, decreased bowel wall enhancement, submucosal attenuation value, presence and location of IMV occlusion, peripheral mesenteric venous occlusion, dilated pericolonic veins, subjective IMA dilation, maximum IMA diameter, maximum peripheral IMA branch diameter, ascites, and mesenteric edema. Presence of early filling veins was an additional finding evaluated on CTA exams.

Results

Statistically significant CT findings of IMHMV compared to control groups included greater maximum bowel wall thickness, decreased bowel enhancement, IMV occlusion, and peripheral mesenteric venous occlusion (p < 0.05). Dilated pericolonic veins were seen more frequently in IMHMV compared to the infectious colitis group (64% versus 15%, p = 0.02). Additional statistically significant finding on CTA included early filling veins in IMHMV compared to the CTA control group (100% versus 46%, p = 0.008).

Conclusion

IMHMV is a rare chronic non-thrombotic ischemia predominantly involving the rectosigmoid colon. CT features that may aid in differentiating IMHMV from other causes of left-sided colitis include marked bowel wall thickening with decreased enhancement, IMV and peripheral mesenteric venous occlusion or tapering, and early filling of dilated veins on CTA.

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Corrie R. Bach, Shannon P. Sheedy, Jay P. Heiken & Jeff L. Fidler

  2. Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA

    Rondell P. Graham, Roger K. Moreira & Thomas C. Smyrk

  3. Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    Seth R. Sweetser

Authors
  1. Corrie R. Bach
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  2. Shannon P. Sheedy
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  3. Jay P. Heiken
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  4. Rondell P. Graham
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  5. Roger K. Moreira
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  6. Thomas C. Smyrk
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  7. Seth R. Sweetser
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  8. Jeff L. Fidler
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Contributions

All authors contributed to the study conception and design, data collection and analysis. The first draft of the manuscript was written by CRB and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Corrie R. Bach.

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The authors declare they have no conflict of interest.

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This research study was conducted retrospectively from data obtained for clinical purposes following Institutional Review Board approval.

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Bach, C.R., Sheedy, S.P., Heiken, J.P. et al. CT findings in idiopathic myointimal hyperplasia of mesenteric veins (IMHMV) and comparison to other colitides. Abdom Radiol 49, 375–383 (2024). https://doi.org/10.1007/s00261-023-04129-z

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  • DOI: https://doi.org/10.1007/s00261-023-04129-z

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