Acute mesenteric ischemia: diagnosis with contrast-enhanced CT.

Taourel, Patrice; Deneuville, M; Pradel, J; Régent, D; Bruel, Jean‐Michel

doi:10.1148/radiology.199.3.8637978

Cited by 272 publications

(165 citation statements)

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“…While traditional CT imaging has improved the diagnosis of many abdominal diseases, it has been shown to have a sensitivity of only 64% for the diagnosis of mesenteric ischemia. 14 Because of the ability of M.D.CT-CTA to visually represent arterial anatomy and perfusion, it may represent a great improvement over single-detector CT in imaging this disease.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study reported that spiral CT demonstrated a sensitivity and specificity of 64% and 92%, respectively, for diagnosing mesenteric ischemia. 14 Multidetector CT, combining multiple rows of detectors and faster gantry rotation with narrow collimation, increases scanning speed and virtually eliminates motion and respiratory artifact. These factors allow for improved visualization of the small-bowel wall and distal branches of the mesenteric vessels.…”

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confidence: 99%

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Imaging of Acute Mesenteric Ischemia Using Multidetector CT and CT Angiography in a Porcine Model

Rosow

Sahani

Strobel

et al. 2005

Journal of Gastrointestinal Surgery

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Acute mesenteric ischemia, a frequently lethal disease, requires prompt diagnosis and intervention for favorable clinical outcomes. This goal remains elusive due, in part, to lack of a noninvasive and accurate imaging study. Traditional angiography is the diagnostic gold standard but is invasive and costly. Computed tomography (CT) is readily available and noninvasive but has shown variable success in diagnosing this disease. The faster scanning time of multidetector row CT (M.D.CT) greatly facilitates the use of CT angiography (CTA) in the clinical setting. We sought to determine whether M.D.CT-CTA could accurately demonstrate vascular anatomy and capture the earliest stages of mesenteric ischemia in a porcine model. Pigs underwent embolization of branches of the superior mesenteric artery, then imaging by M.D.CT-CTA with three-dimensional reconstruction protocols. After scanning, diseased bowel segments were surgically resected and pathologically examined. Multidetector row CT and CT angiography reliably defined normal and occluded mesenteric vessels in the pig. It detected early changes of ischemia including poor arterial enhancement and venous dilatation, which were seen in all ischemic animals. The radiographic findings-compared with pathologic diagnoses-predicted ischemia, with a positive predictive value of 92%. These results indicate that M.D.CT-CTA holds great promise for the early detection necessary for successful treatment of acute mesenteric ischemia. KeywordsMesenteric ischemia; computed tomography; angiography; animal model Acute mesenteric ischemia, the process of insufficient blood supply to the bowel, carries consequences ranging from a transient, totally reversible insult to a lethal event. The prevalence of mesenteric ischemia is increasing in the United States as the population ages. It is estimated that nearly 1% of patients presenting with acute abdominal pain have ischemic intestinal disease, 1-3 and it may be responsible for 0.1% of all hospital The lethality of the disease is well documented, with some series reporting mortality rates exceeding 60%. [4][5][6][7] A critical factor for survival of acute mesenteric ischemia is early diagnosis and intervention. In cases of superior mesenteric artery (SMA) embolism in which surgery is performed once the bowel is infarcted, the mortality rate nearly doubles from 35% to 68%. 8 The mean duration of ischemia preceding surgery for noninfarcted bowel is 13 hours, compared with 21 hours for those with infarction. 9 Thus, the window of opportunity for intervention is narrow and prompt diagnosis is crucial for patient survival. Nevertheless, this goal remains elusive, due in part to the lack of an accurate diagnostic imaging tool. NIH Public AccessAlthough angiography is considered the standard of reference for the diagnosis of mesenteric ischemia, it is not widely used because it is invasive, time-consuming, and costly. Computed tomography has been historically used with variable success for evaluating small bowel ischemia. It can help dete...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Imaging of Acute Mesenteric Ischemia Using Multidetector CT and CT Angiography in a Porcine Model

Rosow

Sahani

Strobel

et al. 2005

Journal of Gastrointestinal Surgery

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“…Radiographs can demonstrate thumbprinting due to bowel wall edema or intramural hemorrhage; in more advanced stages, pneumatosis or portal venous gas, the latter being a poor prognostic sign, can be present. CT may show ascites, dilated bowel, mural thickening, or abnormal wall enhancement as well as abnormalities in the mesentery including edema and vessel engorgement (34). However, the features of ischemic bowel are not specific for SLE and vary depending on the duration of the ischemia.…”

Section: Bowelmentioning

confidence: 99%

Imaging Findings in Systemic Lupus Erythematosus

Lalani¹,

Kanne²,

Hatfield³

et al. 2004

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103

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“…Imaging studies reveal thrombosis in the mesenteric veins, establishing a definitive diagnosis of mesenteric venous thrombosis. Computed Tomography with contrast is the initial test of choice and is diagnostic in up to 90% of cases [12]. If this fails to make a diagnosis, and there is high clinical suspicion of thrombosis, CT angiography with delayed imaging or Magnetic resonance angiography may be done.…”

Section: Discussionmentioning

confidence: 99%

Acute Superior Mesenteric Vein Thrombosis in a Patient with Primary Antiphospholipid Syndrome: A Case Report and Brief Review of the Literature

Egwuonwu¹

2015

J Gastrointest Dig Syst

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Acute mesenteric ischemia: diagnosis with contrast-enhanced CT.

Abstract: Dynamic, contrast-enhanced CT is a valuable tool in the diagnosis of and determination of prognosis in acute mesenteric ischemia.

Cited by 272 publications

References 0 publications

Imaging of Acute Mesenteric Ischemia Using Multidetector CT and CT Angiography in a Porcine Model

Imaging of Acute Mesenteric Ischemia Using Multidetector CT and CT Angiography in a Porcine Model

Imaging Findings in Systemic Lupus Erythematosus

Acute Superior Mesenteric Vein Thrombosis in a Patient with Primary Antiphospholipid Syndrome: A Case Report and Brief Review of the Literature

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