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CT for Diagnosis of Acute Mesenteric Ischemia

Biphasic computed tomography may be a promising and accurate alternative to catheter angiography for evaluation of mesenteric ischemia.

Acute mesenteric ischemia (AMI) is uncommon but potentially lethal, and gastroenterologists must maintain a high index of suspicion for this diagnosis. Because of its serious consequences and its uncommon and sometimes atypical occurrence, AMI accounts for a disproportionate percentage of malpractice actions against gastroenterologists. The gold standard for diagnosis is catheter angiography. These authors prospectively evaluated 62 patients with suspected AMI using biphasic computed tomography (CT), including CT angiography.

Patients were scanned with a 4-row multidetector scanner during both the arterial and venous phases of contrast injection. Using many CT criteria, the original radiologists identified AMI with a diagnostic sensitivity of 100% and a specificity of 89%; the final diagnoses, verified by surgery or clinical criteria, were AMI in 26 patients and other diagnoses in 36. CT allowed definitive alternative diagnoses in 21 patients (58%) without AMI.

The CT studies then were analyzed retrospectively to determine which CT criteria optimized AMI diagnoses: Any one of pneumatosis intestinalis, venous gas, superior mesenteric artery (SMA) occlusion, celiac and inferior mesenteric artery occlusion with distal SMA disease, or arterial embolism or, alternatively, bowel-wall thickening plus focal lack of bowel-wall enhancement, solid organ infarction, or venous thrombosis was 96% sensitive and 94% specific for AMI.

Comment: Because CT scanning is available more widely and is easier to arrange than catheter angiography is, these prospective data suggest a promising and accurate alternative to catheter angiography. Although CT will provide less information about mesenteric blood flow and will not allow immediate catheter therapy, accurate diagnosis of acute mesenteric insufficiency, ability to diagnose other acute intraabdominal conditions, and widespread, rapid availability (given the widespread use of multidetector CT scanners) is advantageous.

— Douglas K. Rex, MD

Published in Journal Watch Gastroenterology November 12, 2003

Citation(s):

Kirkpatrick IDC et al. Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia: Initial experience. Radiology 2003 Oct; 229:91-8.

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