Skip to main content

Advertisement

Log in

Evaluation of acute mesenteric ischemia: accuracy of biphasic mesenteric multi-detector CT angiography

  • Published:
Abdominal Imaging Aims and scope Submit manuscript

Abstract

The purpose of this study was to explore the accuracy of multi-detector row helical CT (MDCT), using a biphasic mesenteric angiography protocol for evaluation of acute mesenteric ischemia (AMI). In total, 79 consecutive patients with clinical signs of AMI underwent contrast enhanced 16- or 40-channel MDCT. MDCT findings were correlated with surgery, endoscopy and clinical outcome. Sensitivity, specificity, and positive and negative predictive values were calculated using the patients in which AMI had been excluded as a control group. In 28 patients the final diagnosis was AMI. In 27 patients (96.4%) MDCT correctly diagnosed AMI (specificity of 97.9%). A sensitivity of 93%, specificity of 100%, and positive and negative predictive values of 100% and 94%, respectively were achieved for the CT findings of visceral artery occlusion, intestinal pneumatosis, portomesenteric venous gas or bowel wall thickening in combination with either portomesenteric thrombosis or solid organ infarction. Our findings suggest that mesenteric MDCT angiography is an accurate tool for fast diagnostic work-up of patients with suspected AMI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. Lock G (2001) Acute intestinal ischaemia. Best Pract Res Clin Gastroenterol 15:83–98

    Article  PubMed  CAS  Google Scholar 

  2. Oldenburg WA, Lau LL, Rodenberg TJ, et al. (2004) Acute mesenteric ischemia: a clinical review. Arch Intern Med 164:1054–1062

    Article  PubMed  Google Scholar 

  3. Inderbitzi R, Wagner HE, Seiler C, et al. (1992) Acute mesenteric ischaemia. Eur J Surg 158:123–126

    PubMed  CAS  Google Scholar 

  4. Safioleas MC, Moulakakis KG, Papavassiliou VG, et al. (2006) Acute mesenteric ischaemia, a highly lethal disease with a devastating outcome. Vasa 35:106–111

    Article  PubMed  CAS  Google Scholar 

  5. Cohn SM, Moller BA, Zieg PM, et al. (1998) Angiography for preoperative evaluation in patients with lower gastrointestinal bleeding: are the benefits worth the risks? Arch Surg 133:50–55

    Article  PubMed  CAS  Google Scholar 

  6. Taourel PG, Deneuville M, Pradel JA, et al. (1996) Acute mesenteric ischemia: diagnosis with contrast-enhanced CT. Radiology 199:632–636

    PubMed  CAS  Google Scholar 

  7. Kirkpatrick ID, Kroeker MA, Greenberg HM (2003) Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia: initial experience. Radiology 229:91–98

    Article  PubMed  Google Scholar 

  8. Horton KM, Fishman EK (2001) Multi-detector row CT of mesenteric ischemia: can it be done? Radiographics 21:1463–1473

    PubMed  CAS  Google Scholar 

  9. Wiesner W, Mortele KJ, Glickman JN, et al. (2001) Pneumatosis intestinalis and portomesenteric venous gas in intestinal ischemia: correlation of CT findings with severity of ischemia and clinical outcome. AJR Am J Roentgenol 177:1319–1323

    PubMed  CAS  Google Scholar 

  10. Yu CW, Lee WJ, Tsai YH, et al. (2003) Demonstration of extensive mesenteric venous thrombosis and intestinal infarction with multidetector row CT: value of curved planar reformations. Abdom Imaging 28:775–777

    Article  PubMed  CAS  Google Scholar 

  11. Romano S, Lassadro F, Scaglione M, et al. (2006) Ischemia and infarction of the small bowel and colon: spectrum of imaging findings. Abdom Imaging 31:277–292

    Article  PubMed  CAS  Google Scholar 

  12. Wildermuth S, Leschka S, Alkadhi H, et al. (2005) Multislice CT in the pre- and postinterventional evaluation of mesenteric perfusion. Eur Radiol 15:1203–1210

    Article  PubMed  Google Scholar 

  13. Shih MC, Hagspiel KD (2007) CTA and MRA in mesenteric ischemia: part 1, Role in diagnosis and differential diagnosis. AJR Am J Roentgenol 188:452–461

    Article  PubMed  Google Scholar 

  14. Rosow DE, Sahani D, Strobel O, et al. (2005) Imaging of acute mesenteric ischemia using multidetector CT and CT angiography in a porcine model. J Gastrointest Surg 9:1262–1274

    Article  PubMed  Google Scholar 

  15. Sebastia C, Quiroga S, Espin E, et al. (2000) Portomesenteric vein gas: pathologic mechanisms, CT findings, and prognosis. Radiographics 20:1213–1224

    PubMed  CAS  Google Scholar 

  16. Zielke A, Hasse C, Nies C, et al. (1998) Hepatic-portal venous gas in acute colonic diverticulitis. Surg Endosc 12:278–280

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A. J. Aschoff.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Aschoff, A.J., Stuber, G., Becker, B.W. et al. Evaluation of acute mesenteric ischemia: accuracy of biphasic mesenteric multi-detector CT angiography. Abdom Imaging 34, 345–357 (2009). https://doi.org/10.1007/s00261-008-9392-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-008-9392-8

Keywords

Navigation