Clin Colon Rectal Surg 2022; 35(04): 328-337
DOI: 10.1055/s-0042-1744481
Review Article

Radiology of the Mesentery

Patrick W. O'Regan
1   Department of Radiology, University Hospital Limerick, St. Nessan's Road, Dooradoyle, Limerick, Ireland
,
Jennifer M. Ní Mhuircheartaigh
1   Department of Radiology, University Hospital Limerick, St. Nessan's Road, Dooradoyle, Limerick, Ireland
2   School of Medicine, University of Limerick, Limerick, Ireland
,
Timothy G. Scanlon
1   Department of Radiology, University Hospital Limerick, St. Nessan's Road, Dooradoyle, Limerick, Ireland
2   School of Medicine, University of Limerick, Limerick, Ireland
,
Martin J. Shelly
1   Department of Radiology, University Hospital Limerick, St. Nessan's Road, Dooradoyle, Limerick, Ireland
2   School of Medicine, University of Limerick, Limerick, Ireland
› Institutsangaben

Abstract

The recent description and re-classification of the mesentery as an organ prompted renewed interest in its role in physiological and pathological processes. With an improved understanding of its anatomy, accurately and reliably assessing the mesentery with non-invasive radiological investigation becomes more feasible.

Multi-detector computed tomography is the main radiological modality employed to assess the mesentery due to its speed, widespread availability, and diagnostic accuracy.

Pathologies affecting the mesentery can be classified as primary or secondary mesenteropathies. Primary mesenteropathies originate in the mesentery and subsequently progress to involve other organ systems (e.g., mesenteric ischemia or mesenteric volvulus). Secondary mesenteropathies describe disease processes that originate elsewhere and progress to involve the mesentery with varying degrees of severity (e.g., lymphoma).

The implementation of standardized radiological imaging protocols, nomenclature, and reporting format with regard to the mesentery will be essential in improving the assessment of mesenteric anatomy and various mesenteropathies.

In this article, we describe and illustrate the current state of art in respect of the radiological assessment of the mesentery.

Abbreviations

CTcomputed tomography


USultrasound


MRImagnetic resonance imaging


PETpositron emission tomography


MRAmagnetic resonance angiography




Publikationsverlauf

Artikel online veröffentlicht:
14. August 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
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  • References

  • 1 Coffey JC, O'Leary DP. The mesentery: structure, function, and role in disease. Lancet Gastroenterol Hepatol 2016; 1 (03) 238-247
  • 2 Byrnes KG, Walsh D, Dockery P, McDermott K, Coffey JC. Anatomy of the mesentery: Current understanding and mechanisms of attachment. Semin Cell Dev Biol 2019; 92: 12-17
  • 3 Byrnes KG, Walsh D, Lewton-Brain P, McDermott K, Coffey JC. Anatomy of the mesentery: Historical development and recent advances. Semin Cell Dev Biol 2019; 92: 4-11
  • 4 Gray H. Anatomy, Descriptive and Surgical. John W. Parker and Son; 1858
  • 5 Treves F. Lectures on the anatomy of the intestinal canal and peritoneum in man. BMJ 1885; 1 (1264): 580-583
  • 6 Culligan K, Coffey JC, Kiran RP, Kalady M, Lavery IC, Remzi FH. The mesocolon: a prospective observational study. Colorectal Dis 2012; 14 (04) 421-428 , discussion 428–430. Doi: 10.1111/j.1463-1318.2012.02935.x
  • 7 Culligan K, Walsh S, Dunne C. et al. The mesocolon: a histological and electron microscopic characterization of the mesenteric attachment of the colon prior to and after surgical mobilization. Ann Surg 2014; 260 (06) 1048-1056
  • 8 Coffey JC, Culligan K, Walsh LG. et al. An appraisal of the computed axial tomographic appearance of the human mesentery based on mesenteric contiguity from the duodenojejunal flexure to the mesorectal level. Eur Radiol 2016; 26 (03) 714-721
  • 9 Spitzer V, Ackerman MJ, Scherzinger AL, Whitlock D. The visible human male: a technical report. J Am Med Inform Assoc 1996; 3 (02) 118-130
  • 10 Coffey JC, Sehgal R, Culligan K. et al. Terminology and nomenclature in colonic surgery: universal application of a rule-based approach derived from updates on mesenteric anatomy. Tech Coloproctol 2014; 18 (09) 789-794
  • 11 Osiro SB, Cunningham D, Shoja MM, Tubbs RS, Gielecki J, Loukas M. The twisted colon: a review of sigmoid volvulus. Am Surg 2012; 78 (03) 271-279
  • 12 Coffey JC, O'Leary DP, Kiernan MG, Faul P. The mesentery in Crohn's disease: friend or foe?. Curr Opin Gastroenterol 2016; 32 (04) 267-273
  • 13 Coffey JC, Dillon M, Sehgal R. et al. Mesenteric-based surgery exploits gastrointestinal, peritoneal, mesenteric and fascial continuity from duodenojejunal flexure to the anorectal junction–a review. Dig Surg 2015; 32 (04) 291-300
  • 14 Tracy RP. Is visceral adiposity the “enemy within”?. Arterioscler Thromb Vasc Biol 2001; 21 (06) 881-883
  • 15 Desreumaux P, Ernst O, Geboes K. et al. Inflammatory alterations in mesenteric adipose tissue in Crohn's disease. Gastroenterology 1999; 117 (01) 73-81
  • 16 Dighe S, Purkayastha S, Swift I. et al. Diagnostic precision of CT in local staging of colon cancers: a meta-analysis. Clin Radiol 2010; 65 (09) 708-719
  • 17 Koo BC, Chinogureyi A, Shaw AS. Imaging acute pancreatitis. Br J Radiol 2010; 83 (986) 104-112
  • 18 Dodds WJ, Darweesh RM, Lawson TL. et al. The retroperitoneal spaces revisited. AJR Am J Roentgenol 1986; 147 (06) 1155-1161
  • 19 Stecco C, Sfriso MM, Porzionato A. et al. Microscopic anatomy of the visceral fasciae. J Anat 2017; 231 (01) 121-128
  • 20 Esteban JM, Maldonado L, Sanchiz V, Minguez M, Benages A. Activity of Crohn's disease assessed by colour Doppler ultrasound analysis of the affected loops. Eur Radiol 2001; 11 (08) 1423-1428
  • 21 Akisik FM, Sandrasegaran K, Aisen AM, Lin C, Lall C. Abdominal MR imaging at 3.0 T. Radiographics 2007; 27 (05) 1433-1444 , discussion 1462–1464. Doi: 10.1148/rg.275075023
  • 22 Satoh Y, Ichikawa T, Motosugi U. et al. Diagnosis of peritoneal dissemination: comparison of 18F-FDG PET/CT, diffusion-weighted MRI, and contrast-enhanced MDCT. AJR Am J Roentgenol 2011; 196 (02) 447-453
  • 23 Herbert GS, Steele SR. Acute and chronic mesenteric ischemia. Surg Clin North Am 2007; 87 (05) 1115-1134, ix
  • 24 Bradbury AW, Brittenden J, McBride K, Ruckley CV. Mesenteric ischaemia: a multidisciplinary approach. Br J Surg 1995; 82 (11) 1446-1459
  • 25 Patel T, Kuladhipati I, Shah S. Successful percutaneous endovascular management of acute post-traumatic superior mesenteric artery dissection using a transradial approach. J Invasive Cardiol 2010; 22 (04) E61-E64
  • 26 Oliva IB, Davarpanah AH, Rybicki FJ. et al. ACR Appropriateness Criteria ® imaging of mesenteric ischemia. Abdom Imaging 2013; 38 (04) 714-719
  • 27 Shih MC, Angle JF, Leung DA. et al. CTA and MRA in mesenteric ischemia: part 2, Normal findings and complications after surgical and endovascular treatment. AJR Am J Roentgenol 2007; 188 (02) 462-471
  • 28 Shih MC, Hagspiel KD. CTA and MRA in mesenteric ischemia: part 1, Role in diagnosis and differential diagnosis. AJR Am J Roentgenol 2007; 188 (02) 452-461
  • 29 Meaney JF. Non-invasive evaluation of the visceral arteries with magnetic resonance angiography. Eur Radiol 1999; 9 (07) 1267-1276
  • 30 Meaney JF, Prince MR, Nostrant TT, Stanley JC. Gadolinium-enhanced MR angiography of visceral arteries in patients with suspected chronic mesenteric ischemia. J Magn Reson Imaging 1997; 7 (01) 171-176
  • 31 Kiss J, Naum A, Kudomi N. et al. Non-invasive diagnosis of acute mesenteric ischaemia using PET. Eur J Nucl Med Mol Imaging 2009; 36 (08) 1338-1345
  • 32 Zissin R, Rathaus V, Oscadchy A, Kots E, Gayer G, Shapiro-Feinberg M. Intestinal malrotation as an incidental finding on CT in adults. Abdom Imaging 1999; 24 (06) 550-555
  • 33 Pickhardt PJ, Bhalla S. Intestinal malrotation in adolescents and adults: spectrum of clinical and imaging features. Am J Roentgenol 2002; 179 (06) 1429-1435
  • 34 Lawler LP, McCarthy DM, Fishman EK, Hruban R. Sclerosing mesenteritis: depiction by multidetector CT and three-dimensional volume rendering. Am J Roentgenol 2002; 178 (01) 97-99
  • 35 Sabaté JM, Torrubia S, Maideu J, Franquet T, Monill JM, Pérez C. Sclerosing mesenteritis: imaging findings in 17 patients. Am J Roentgenol 1999; 172 (03) 625-629
  • 36 Pérez-Fontán FJ, Soler R, Sanchez J, Iglesias P, Sanjurjo P, Ruiz J. Retractile mesenteritis involving the colon: barium enema, sonographic, and CT findings. Am J Roentgenol 1986; 147 (05) 937-940
  • 37 Katz ME, Heiken JP, Glazer HS, Lee JK. Intraabdominal panniculitis: clinical, radiographic, and CT features. Am J Roentgenol 1985; 145 (02) 293-296
  • 38 Durst AL, Yarom R, Luttwak EM. Malignant fibromatous peritoneal mesothelioma associated with liposclerotic mesenteritis. Am J Gastroenterol 1971; 55 (05) 477-481
  • 39 Zhang P, Dyer RB. The “fat ring” sign of sclerosing mesenteritis. Abdom Radiol (NY) 2018; 43 (07) 1839-1840
  • 40 Johnson LA, Longacre TA, Wharton Jr KA, Jeffrey RB. Multiple mesenteric lymphatic cysts: an unusual feature of mesenteric panniculitis (sclerosing mesenteritis). J Comput Assist Tomogr 1997; 21 (01) 103-105
  • 41 Mata JM, Inaraja L, Martin J, Olazabal A, Castilla MT. CT features of mesenteric panniculitis. J Comput Assist Tomogr 1987; 11 (06) 1021-1023
  • 42 Seo BK, Ha HK, Kim AY. et al. Segmental misty mesentery: analysis of CT features and primary causes. Radiology 2003; 226 (01) 86-94
  • 43 Mindelzun RE, Jeffrey Jr RB, Lane MJ, Silverman PM. The misty mesentery on CT: differential diagnosis. Am J Roentgenol 1996; 167 (01) 61-65
  • 44 Gray H. Gray's Anatomy, The Anatomical Basis of Clinical Practice. 42nd ed. Elsevier; 2020: 1606
  • 45 Hassan R, Alexander R. Nonpleural mesotheliomas: mesothelioma of the peritoneum, tunica vaginalis, and pericardium. Hematol Oncol Clin North Am 2005; 19 (06) 1067-1087, vi
  • 46 Busch JM, Kruskal JB, Wu B. Armed Forces Institute of Pathology. Best cases from the AFIP. Malignant peritoneal mesothelioma. Radiographics 2002; 22 (06) 1511-1515
  • 47 Pickhardt PJ, Bhalla S. Primary neoplasms of peritoneal and sub-peritoneal origin: CT findings. Radiographics 2005; 25 (04) 983-995
  • 48 Park JY, Kim KW, Kwon HJ. et al. Peritoneal mesotheliomas: clinicopathologic features, CT findings, and differential diagnosis. Am J Roentgenol 2008; 191 (03) 814-825
  • 49 Weiss SW, Tavassoli FA. Multicystic mesothelioma. An analysis of pathologic findings and biologic behavior in 37 cases. Am J Surg Pathol 1988; 12 (10) 737-746
  • 50 González-Moreno S, Yan H, Alcorn KW, Sugarbaker PH. Malignant transformation of “benign” cystic mesothelioma of the peritoneum. J Surg Oncol 2002; 79 (04) 243-251
  • 51 Carr SR, Dinsmore RC, Wilkinson NW. Idiopathic spontaneous intraperitoneal hemorrhage: a clinical update on abdominal apoplexy in the year 2001. Am Surg 2001; 67 (04) 374-376
  • 52 Parker SG, Thompson JN. Spontaneous mesenteric haematoma; diagnosis and management. BMJ Case Rep 2012; 2012: bcr2012006624
  • 53 Guglielmo FF, Anupindi SA, Fletcher JG. et al. Small bowel Crohn disease at CT and MR enterography: imaging atlas and glossary of terms. Radiographics 2020; 40 (02) 354-375
  • 54 Meyers MA, McGuire PV. Spiral CT demonstration of hypervascularity in Crohn disease: “vascular jejunization of the ileum” or the “comb sign”. Abdom Imaging 1995; 20 (04) 327-332
  • 55 Koh DM, Miao Y, Chinn RJ. et al. MR imaging evaluation of the activity of Crohn's disease. AJR Am J Roentgenol 2001; 177 (06) 1325-1332
  • 56 Bettenworth D, Bokemeyer A, Baker M. et al; Stenosis Therapy and Anti-Fibrotic Research (STAR) Consortium.. Assessment of Crohn's disease-associated small bowel strictures and fibrosis on cross-sectional imaging: a systematic review. Gut 2019; 68 (06) 1115-1126
  • 57 Seshul MB, Coulam CM. Pseudomyxoma peritonei: computed tomography and sonography. AJR Am J Roentgenol 1981; 136 (04) 803-806
  • 58 Kim Y, Cho O, Song S, Lee H, Rhim H, Koh B. Peritoneal lymphomatosis: CT findings. Abdom Imaging 1998; 23 (01) 87-90
  • 59 Karaosmanoglu D, Karcaaltincaba M, Oguz B, Akata D, Ozmen M, Akhan O. CT findings of lymphoma with peritoneal, omental and mesenteric involvement: peritoneal lymphomatosis. Eur J Radiol 2009; 71 (02) 313-317
  • 60 Yoo E, Kim JH, Kim MJ. et al. Greater and lesser omenta: normal anatomy and pathologic processes. Radiographics 2007; 27 (03) 707-720
  • 61 Pai RK, Longacre TA. Pseudomyxoma peritonei syndrome: classification of appendiceal mucinous tumours. Cancer Treat Res 2007; 134: 71-107
  • 62 Sulkin TV, O'Neill H, Amin AI, Moran B. CT in pseudomyxoma peritonei: a review of 17 cases. Clin Radiol 2002; 57 (07) 608-613
  • 63 Sinan T, Sheikh M, Ramadan S, Sahwney S, Behbehani A. CT features in abdominal tuberculosis: 20 years experience. BMC Med Imaging 2002; 2 (01) 3
  • 64 Epstein BM, Mann JH. CT of abdominal tuberculosis. AJR Am J Roentgenol 1982; 139 (05) 861-866
  • 65 Pereira JM, Madureira AJ, Vieira A, Ramos I. Abdominal tuberculosis: imaging features. Eur J Radiol 2005; 55 (02) 173-180