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

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.

Risk Factors Effecting Mortality in Acute Mesenteric Ischemia and Mortality Rates: A Single Center Experience

“…9 Computed tomography (CT) angiography has high sensitivity and specificity. 10 Although mesenteric vessels can be visualized with magnetic resonance (MRI) angiography, its evaluation of the mesenteric arteries is primarily limited to the proximal celiac and superior mesenteric artery (SMA).…”

Predictors of mortality in acute mesenteric vascular ischemia with bowel gangrene

“…13 Though CT angiography has very good; sensitivity to detect mesenteric ischemia invasive angiography is the gold standard for detecting early ischemia. 5 It also has important therapeutic roll of revascularisation by embolectomy or catheter guided thrombolytic agent, anticoagulants or papaverin administration to prevent or limit the extent of gangrene. But in practice there are limitations to use these techniques as they are not available easily and many patients may not be suitable for them.…”

“…High index of suspicion and aggressive investigation policy including contrast enhanced CT scan which has high sensitivity and specificity, is the key to achieve early diagnosis and execute prompt surgical treatment to limit morbidity and mortality in these patients. 5,6 In spite of all attempts towards early diagnosis and treatment mortality in patients with acute mesenteric vascular ischemia leading to intestinal gangrene remains high. 4,7,8 This high mortality rate prompted us to undertake this study to identify prognostic indicators of mortality in these patients to provide guidance for deciding management strategies.…”

Accuracy of the smaller superior mesenteric vein sign for the detection of acute superior mesenteric artery occlusion

“…There are various clinical findings in patients with this disease; therefore, diagnosis can be extremely difficult. For the diagnosis of acute SMA occlusion, imaging techniques, such as ultrasonography, computed tomographic angiography (CTA), and magnetic resonance angiography, are useful 1, 3, 4. However, each of these methods has limitations.…”