Usefulness of multidetector-row CT (MDCT) for the diagnosis of non-occlusive mesenteric ischemia (NOMI): Assessment of morphology and diameter of the superior mesenteric artery (SMA) on multi-planar reconstructed (MPR) images

Woodhams, Reiko; Nishimaki, Hiroshi; Fujii, Kaoru; Kakita, Satoko; Hayakawa, Kazushige

doi:10.1016/j.ejrad.2009.05.012

Cited by 87 publications

(64 citation statements)

References 12 publications

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“…In particular, in the early phase of NOMI, CT appearances regarding the abnormal arterial findings are superimposable to angiography, revealing the narrowing of many branches of the SMA, spasm of the intestinal marginal artery, and poor contrast enhancement of veins in the muscular layer as a feature of vasospam, associated with NOMI. In our patient population, the mean value of the SMA diameter was 4.6 +/− 1.4 mm (range 2.2-7.4 mm), whereas it was 3.4 +/− 1.1 mm, in the study of Woodhams R. 3,6) In both studies, a significant difference with controls was found and the average SMA diameter was consistent within the errors. In addition, in line with our experience too, the great advantage of MDCT, in comparison to angiography, is the possibility to also evaluate mesenteric, bowel and peritoneal findings and not only the appearance of the vessels.…”

mentioning

confidence: 51%

Non-Obstructive Mesenteric Ischemia after Cardiovascular Surgery: Not So Uncommon

Mazzei

Guerrini

Squitieri

et al. 2014

ATCS

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mentioning

confidence: 51%

Non-Obstructive Mesenteric Ischemia after Cardiovascular Surgery: Not So Uncommon

Mazzei

Guerrini

Squitieri

et al. 2014

ATCS

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Section: Discussionmentioning

confidence: 99%

“…The clinicopathologic diagnostic criteria for NOMI include the absence of occlusion of the mesenteric artery or vein in the area of bowel necrosis and the presence of ischemic and necrotic spots and segments distributed over a wide area in a non-consecutive manner (6). The histopathological findings include hemorrhagic and necrotic changes without fibrin plugs (6). Since abdominal CT and AAA revealed diffuse ischemia of the SMA and IMA without arterial occlusion and colonoscopy showed diffuse ischemia with necrosis of the colonic mucosa in this case, the diagnosis of NOMI in our patient was obvious.…”

Section: Discussionmentioning

confidence: 99%

Non-occlusive Mesenteric Ischemia after Splenic Metastasectomy for Small-Cell Lung Cancer

et al. 2015

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A 68-year-old man presented with severe abdominal pain. Seven months earlier, he had received systemic chemotherapy for small-cell lung cancer with solitary metastasis to the spleen, followed by splenectomy. Abdominal computed tomography and abdominal arterial angiography showed diffuse ischemia of the mesenteric artery without apparent occlusion. The patient also suffered from septicemia caused by Enterococcus faecium. Therefore, a diagnosis of non-occlusive mesenteric ischemia (NOMI) induced by septicemia was supposed. Although treatment with antibiotics and papaverine hydrochloride was administered and the necrotic tissue in the intestinal tract was resected, the patient died.Physicians should be aware that patients undergoing splenectomy are likely to be affected by septicemia, which may subsequently induce NOMI.

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“…13,14 The main goal of current therapy for NOMI is reduction of spasm and improved perfusion of the mesenteric artery using vasodilators, and the role of surgery should be limited to the excision of irreversibly necrotized intestine. In cases of this type, the purpose of imaging in the diagnosis of NOMI is essential: firstly, for the earliest possible identification of this critical condition, to plan the most appropriate treatment that is based on a different approach from those of the occlusive forms of AMI, 3,6 then to identify effective reperfusion. In fact, in NOMI, the primary injury as a result of ischaemia could be repaired by reperfusion, meaning the re-establishment of normal mesenteric Annotations are as in Table 3.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 Only a few articles have explored the effectiveness of MDCT for NOMI diagnosis, with a very limited cohort of patients. [3][4][5]10 However, these studies explored the only vessel features [morphology and diameter of the superior mesenteric artery (SMA)], whereas MDCT not only analyses mesenteric vessels but other features, for example, abnormalities in the bowel wall, mesentery and peritoneal cavity. CT imaging of AMI changes is widely dependent upon the cause and the underlying physiopathology, on the severity of bowel ischaemia (i.e., superficial mucosal or transmural bowel wall necrosis), duration and severity of the ischaemic event (i.e., only small bowel, small and large bowel), the state of collateral circulation and any potential reperfusion occurrences that are more common in NOMI than in AMI of an occlusive type.…”

Section: Introductionmentioning

confidence: 99%

Reperfusion in non-occlusive mesenteric ischaemia (NOMI): effectiveness of CT in an emergency setting

Mazzei

Guerrini

Squitieri

et al. 2016

BJR

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Objective: To investigate the CT features of reperfusion (presence/absence) in non-occlusive mesenteric ischaemia (NOMI) and their prognostic value in an emergency setting. Methods: A revision was undertaken of imaging from 20 patients (16 males/4 females) with a dismissal summary of NOMI. All patients had previously undergone a minimum of one multidetector CT examination, and consequently underwent surgery (n 5 8), autopsy (n 5 2), angiography (n 5 1) or endoscopy (n 5 9). An evaluation of the CT scans was conducted to determine vessels, mesentery, bowel and peritoneal cavity features. The superior mesenteric artery (SMA) average diameter of NOMI cases were compared with 30 controlled cases. Kappa, KolmogorovSmirnov (K-S) and Fisher's exact tests were used for statistical analysis. Results: A mean SMA diameter significantly smaller than that of the controlled cases was found for patients with NOMI (K-S test: D 5 0.75, p 5 3.7 3 10-08). Fisher's exact tests showed a strong connection between the presence of reperfusion and mesenteric fat stranding (p 5 0.026), bowel wall thickening (p 5 3.2 3 10-05) and a high attenuation of the bowel wall on unenhanced CT images (p 5 2.8 3 10-04). A reduction in mortality was significantly linked to the combination of normal mesenteric vessels and wall thickening (p 5 0.034). Conclusion: Analysis of not only vessels findings but also mesentery and bowel CT features will support the identification of NOMI with or without a reperfusion event in an emergency setting. A strong correlation between some CT features and lower mortality exists. Advances in knowledge: CT features of NOMI with or without reperfusion are demonstrated. Correctly assessing the presence of reperfusion in NOMI, may allow better management of these conditions in the emergency setting. INTRODUCTIONNon-occlusive mesenteric ischaemia (NOMI) is an abdominal emergency that accounts for 20-30% of all intestinal ischaemic events.1 Bowel ischaemia and infarction in NOMI are present as a result of reduced mesenteric blood supply without vascular occlusion, because of a mesenteric arterial vasoconstriction on reflex to hypotension owing to various forms of shock, septicaemia, dehydration, heart or major abdominal surgery followed by hypotension and overuse of vasoconstrictive agents.

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Usefulness of multidetector-row CT (MDCT) for the diagnosis of non-occlusive mesenteric ischemia (NOMI): Assessment of morphology and diameter of the superior mesenteric artery (SMA) on multi-planar reconstructed (MPR) images

Cited by 87 publications

References 12 publications

Non-Obstructive Mesenteric Ischemia after Cardiovascular Surgery: Not So Uncommon

Non-Obstructive Mesenteric Ischemia after Cardiovascular Surgery: Not So Uncommon

Non-occlusive Mesenteric Ischemia after Splenic Metastasectomy for Small-Cell Lung Cancer

Reperfusion in non-occlusive mesenteric ischaemia (NOMI): effectiveness of CT in an emergency setting

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