Biphasic CT with Mesenteric CT Angiography in the Evaluation of Acute Mesenteric Ischemia: Initial Experience

TL;DR: In this article, a case of a patient, without any specific known risk factor, with small intestinal ischemia secondary to superior mesenteric vein thrombosis (SMVT) was reported.

Abstract: presentation of the available'data, the limited number 01 images clearly comparing 99Tc" Sn phytate and 99Tc" ASC. assays carried out only on 9'Tc" Sn phytate nodes and a number of other issues which have been skirted, 1 presently have little conviction that non-uptake by a lymph node of 99Tc" Sn phytate, an unsuitable agent. constitutes tumour specificity of the agent. The data so far on radiolabelled liposomes are likewise supported more by the investigators' enthusiasm than by extended clinical investigations to which we all look forward. Peyton et al. are comparing their limited experience in axillary lymphoscintigraphy with substantial clinical experience in internal mammary lymphoscintigraphy ( 1 I , 12). As shown by Matsuo, ihese two lymphatic regions differ significantly in view of non-specific changes which may more consistently affect the axillary lymphatics. They have disregarded anatomic considerations and have not established reproducibility of their technique in consistently demonstrating the same lymphatic pathways subsequent to the injection of the same anatomic region. The variability of visualization of normal axillary lymphatics following a single peri-areolar injection of radiocolloid is not surprising in an anatomic area so richly endowed with lymphatic structures: hence normal nodes with no demonstrable radiocolloid were encountered by Peyton et al. The consistency of demonstration of parasternal lymphatics, the anatomic validity of the image and reproducibility of this image following injection into the subcostal site have been reported in 140 studies (13) and have been verified in 1500 or more repeat studies. It would have been laudable if the authors had utilized their resources and facilities to augment our understanding of lymphatic anatomy and the pathophysiology of lymphatic neoplasm which, as scientists and physicians, should be our objective. Instead, in condemning the technique on the basis of limited experience and a very cursory review of the literature. they have confidently arrived at 'a diametrically opposite conclusion to other recently published studies'. Since my publication of 1977 (1 I), reviewed and misquoted by Peyton et al., 9 publications by me alone have appeared in the literature; countless others have added to the collective body of evidence exploring the implications of this technique and supporting its value. In a study of 13 dogs with mammary carcinoma we have demonstrated a high degree of correlation between lymphoscintigraphy and histopathology, yielding a sensitivity of 1.0 and a specificity of 0.9 for ''Tc'" ASC lymphoscintigraphy (14). The observations reported by Peyton et al. confirm a recognized fact and do not detract from the value of a technique which currently has no substitute in the management of patients with oncologic disease. The validity of their conclusions, however. is to be challenged.