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

Kirkpatrick, Iain D.C.; Kroeker, M A; Greenberg, Howard M.

doi:10.1148/radiol.2291020991

Cited by 327 publications

(226 citation statements)

References 17 publications

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“…Early reports of the role of CT scan in mesenteric ischaemia revealed a low sensitivity rate of 64 % [12]. However, the development of MDCT has greatly improved the Bleeding complications (due to anticoagulation) 6 Relaparotomy 4 Others (ascites, disorientation) 5 *Some patients had more than one complication sensitivity so that it is now greater than 90 % [13,14]. A CT scan of the abdomen is now the imaging study of choice for mesenteric ischaemia, because it is rapid, non-invasive, and widely available in most hospitals and provides specific information on the location of the occluded vessel and the presence of bowel ischaemia [15] by showing bowel wall thickening, mucosal enhancement, intramural air, dilatation, portal venous gas and pneumatosis [16][17][18].…”

Section: Discussionmentioning

confidence: 99%

“…A CT scan of the abdomen is now the imaging study of choice for mesenteric ischaemia, because it is rapid, non-invasive, and widely available in most hospitals and provides specific information on the location of the occluded vessel and the presence of bowel ischaemia [15] by showing bowel wall thickening, mucosal enhancement, intramural air, dilatation, portal venous gas and pneumatosis [16][17][18]. Kirkpatrick and colleagues [13] suggested that CT angiography findings of portal venous gas, pneumatosis, or a combination of bowel wall thickening with venous thrombosis, solid organ infarction, or focal lack of enhancement of bowel wall to be criteria for the diagnosis of mesenteric ischaemia; with sensitivity and specificity rates of 96 % and 94 %, respectively. The presence of pneumatosis on CT does not necessarily indicate that transmural infarction has occurred-this is more likely in patients who have both pneumatosis and portomesenteric venous gas [19].…”

Section: Discussionmentioning

confidence: 99%

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Acute Mesenteric Ischaemia—An Indian Perspective

et al. 2014

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In Western countries, acute mesenteric ischaemia is commonly due to arterial occlusion and occurs in patients who are usually in their seventh decade. A venous cause for intestinal gangrene has been reported in only about 10 %. We examined whether this was so in India and compared the clinical features of patients with mesenteric arterial and venous ischaemia and relate these to their ultimate prognosis. We studied retrospectively, the records of all patients admitted or referred to the department with a diagnosis of acute mesenteric ischaemia between January 1997 and October 2012, noting their demographic details and mode of presentation, the results of preoperative imaging and blood investigations, the extent of bowel ischaemia, and the length of bowel that was resected at operation and their outcome. There were 117 patients, 85 males and 32 females whose median age was 53 years. Mesenteric venous thrombosis was seen in 56 patients (48 %) and mesenteric arterial occlusion in 61 (52 %). Forty six patients died (39 %); 15 with venous occlusion (27 %) and 31 with arterial occlusion (51 %). Compared to patients with arterial occlusion, the patients with venous obstruction were younger, had a longer duration of symptoms, were less frequently hypotensive at presentation, had higher platelet counts, had a shorter length of bowel resected, had fewer colonic resections and had a lower mortality. Other predictors of mortality on multivariate analysis were a longer duration of symptoms, lower serum albumin and higher creatinine levels at presentation and a shorter length of residual bowel. In India, acute mesenteric ischaemia in tertiary care centres is due to venous thrombosis in almost half of the patients who are at least a decade younger than those in the West. Significant predictors of mortality include low serum albumin and raised creatinine levels, a shorter residual bowel length and an arterial cause for mesenteric ischaemia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acute Mesenteric Ischaemia—An Indian Perspective

et al. 2014

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“…As DSA allows only catheter based angiography and is thus limited to vascular diagnoses, all tested noninvasive modalities may provide additional information regarding tissue and organs surrounding the mesenteric arteries and thus expand the diagnostic field [6-8, [14][15][16][17]. Especially in patients with acute mesenteric ischemia, CTA is considered the first-line imaging method [16][17][18][19][20][21][22]. With the high prevalence of mesenteric artery stenosis of up to 70 % [2], an accurate assessment of a potential mesenteric artery stenosis is essential concerning the diagnosis of acute mesenteric ischemia.…”

Section: Image Qualitymentioning

confidence: 99%

Comparison of Noninvasive Imaging Modalities for Stenosis Grading in Mesenteric Arteries

Schaefer

Pfarr

Trentmann

et al. 2013

Fortschr Röntgenstr

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Bildqualität wurde beurteilt mit 1-unzureichend, 2-schlecht, 3-mäßig, 4-gut oder 5-exzellent. Stenosen wurden eingeteilt in die Grade 1 (< 25 %), 2 (25 -< 50 %), 3 (50 -< 75 %) oder 4 (> 75 %). Mittels zweiseitigen Chi-Quadrat-Tests wurde die Korrelation in der Stenosegradbeurteilung zwischen den Modalitäten bestimmt. Mittels gewichtetem Cohen's-kappa wurde das Korrelationsmaß berechnet. Für nicht-relevante versus relevante Stenosen (Schwellenwert 50 %) wurden Sensitivität, Spezifität, PPV, NPV und Genauigkeit ermittelt. Ergebnisse: Die durchschnittliche Bildqualität für DSA/Duplex-Sonografie/CTA/MRA lag bei 3,8 ± 0,7/3,1 ± 1,0/4,4 ± 0,7/3,8 ± 0,9. Alle nicht-invasiven Modalitäten erreichten eine signifikante Korrelation in der Stenosegradbeurteilung für TC und AMS im Vergleich mit der DSA mit jeweils p < 0,001. Der gewichtete Cohen's-kappa betrug für Duplex-Sonografie/CTA/MRA für TC 0,94/ 0,93/0,74 und für AMS 0,64/ 0,91/ 0,56. Die höchste Sensitivität/Spezifität/NPV/PPV/Genauigkeit erreichte die CTA mit 100 %/95 %/85 %/ 100 %/96 % für den TC und mit na/98 %/na/100 %/ 98 % für die AMS. Schlussfolgerung: Bei bester Bildqualität erreichte die CTA das höchste Maß an Korrelation in der Stenosegradbeurteilung und bot die größte diagnostische Genauigkeit. Abstract !Objective: To prospectively analyze duplex sonography, CTA, and MRA with respect to stenosis grading of the celiac trunk (TC) and the superior mesenteric artery (SMA), with DSA as the reference. Materials and Methods: 52 subjects were enrolled (mean age: 71). The image quality was graded: 1-insufficient, 2-bad, 3-moderate, 4-good or 5-excellent. Stenosis was graded: 1 (< 25 %), 2 (25 -< 50 %), 3 (50 -75 %) or 4 (75 %). Two-sided chi-square tests were used to check for correlation of stenosis grading between modalities. The weighted Cohen's kappa was calculated to assess the strength of correlation. With a threshold of 50 % for non-relevant stenosis vs. relevant stenosis, the sensitivity, specificity, PPV, NPV, and accuracy were calculated. Results: The mean image quality was 3.8 ± 0.7, 3.1 ± 1.0, 4.4 ± 0.7, and 3.8 ± 0.9 for DSA, duplex sonography, CTA, and MRA, respectively. For both TC and SMA, stenosis grading reached a significant level of correlation between each noninvasive modality with DSA (p < 0.001, each). The weighted Cohen's kappa for duplex sonography/ CTA/MRA was 0.94/0.93/0.74, respectively, for the TC and 0.64/0.91/0.56, respectively, for the SMA. Highest sensitivity/specificity/NPV/PPV/ accuracy were found for CTA with 100 %/95 %/ 85 %/100 %/96 % for the TC and with na/98 %/na/ 100 %/98 %, respectively, for the SMA. Conclusion: CTA provided the best image quality, reached the highest level of agreement and significance in correlation in stenosis grading, and offered the best diagnostic accuracy.This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

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“…Common causes of acute mesenteric ischaemia are embolic arterial occlusion, usually of cardiac origin, non-occlusive ischaemia, and, less frequently, superior mesenteric vein thrombosis, vasculitis, or dissection of the superior mesenteric artery [56]. In previous studies, CT has been shown to be very useful for the diagnosis of bowel ischaemia [56,57]. Typical CT findings of bowel ischaemia-although non-specific-include bowel dilatation and wall thickening, abnormal bowel wall enhancement, intestinal pneumatosis, and ascites [58].…”

Section: Ischaemic Bowel Diseasementioning

confidence: 99%

Multidetector computed tomography of acute abdomen

et al. 2006

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Acute abdominal pain is one of the most common causes for referrals to the emergency department. The sudden onset of severe abdominal pain characterising the "acute abdomen" requires rapid and accurate identification of a potentially lifethreatening abdominal pathology to provide a timely referral to the appropriate physician. While the physical examination and laboratory investigations are often non-specific, computed tomography (CT) has evolved as the first-line imaging modality in patients with an acute abdomen. Because the new multi-detector CT (MDCT) scanner generations provide increased speed, greater volume coverage and thinner slices, the acceptance of CT for abdominal imaging has increased rapidly. The goal of this article is to discuss the role of MDCT in the diagnostic work-up of acute abdominal pain.

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

Abstract: Biphasic CT with mesenteric CT angiography is effective in the diagnosis of AMI.

Cited by 327 publications

References 17 publications

Acute Mesenteric Ischaemia—An Indian Perspective

Acute Mesenteric Ischaemia—An Indian Perspective

Comparison of Noninvasive Imaging Modalities for Stenosis Grading in Mesenteric Arteries

Multidetector computed tomography of acute abdomen

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