Mesenteric ischemia CT: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
 
(3 intermediate revisions by 2 users not shown)
Line 14: Line 14:
* CTA shows the following findings consistent with mesenteric ischemia, which are as follows:<ref name="pmid18690454">{{cite journal| author=Ofer A, Abadi S, Nitecki S, Karram T, Kogan I, Leiderman M et al.| title=Multidetector CT angiography in the evaluation of acute mesenteric ischemia. | journal=Eur Radiol | year= 2009 | volume= 19 | issue= 1 | pages= 24-30 | pmid=18690454 | doi=10.1007/s00330-008-1124-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18690454  }} </ref><ref name="pmid18425546">{{cite journal| author=Aschoff AJ, Stuber G, Becker BW, Hoffmann MH, Schmitz BL, Schelzig H et al.| title=Evaluation of acute mesenteric ischemia: accuracy of biphasic mesenteric multi-detector CT angiography. | journal=Abdom Imaging | year= 2009 | volume= 34 | issue= 3 | pages= 345-57 | pmid=18425546 | doi=10.1007/s00261-008-9392-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18425546  }} </ref><ref name="pmid20186630">{{cite journal| author=Qiang JW, Li RK, Feng XY, Liao ZH, He C, Feng Q et al.| title=[Multidetector-row CT evaluation of acute bowel ischemia induced by embolization of superior mesenteric artery in experimental porcine models]. | journal=Zhonghua Wei Chang Wai Ke Za Zhi | year= 2010 | volume= 13 | issue= 2 | pages= 151-5 | pmid=20186630 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20186630  }} </ref><ref name="pmid21993179">{{cite journal| author=Barmase M, Kang M, Wig J, Kochhar R, Gupta R, Khandelwal N| title=Role of multidetector CT angiography in the evaluation of suspected mesenteric ischemia. | journal=Eur J Radiol | year= 2011 | volume= 80 | issue= 3 | pages= e582-7 | pmid=21993179 | doi=10.1016/j.ejrad.2011.09.015 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21993179  }} </ref><ref name="pmid16332482">{{cite journal| author=Rosow DE, Sahani D, Strobel O, Kalva S, Mino-Kenudson M, Holalkere NS et al.| title=Imaging of acute mesenteric ischemia using multidetector CT and CT angiography in a porcine model. | journal=J Gastrointest Surg | year= 2005 | volume= 9 | issue= 9 | pages= 1262-74; discussion 1274-5 | pmid=16332482 | doi=10.1016/j.gassur.2005.07.034 | pmc=3807105 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16332482  }} </ref>
* CTA shows the following findings consistent with mesenteric ischemia, which are as follows:<ref name="pmid18690454">{{cite journal| author=Ofer A, Abadi S, Nitecki S, Karram T, Kogan I, Leiderman M et al.| title=Multidetector CT angiography in the evaluation of acute mesenteric ischemia. | journal=Eur Radiol | year= 2009 | volume= 19 | issue= 1 | pages= 24-30 | pmid=18690454 | doi=10.1007/s00330-008-1124-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18690454  }} </ref><ref name="pmid18425546">{{cite journal| author=Aschoff AJ, Stuber G, Becker BW, Hoffmann MH, Schmitz BL, Schelzig H et al.| title=Evaluation of acute mesenteric ischemia: accuracy of biphasic mesenteric multi-detector CT angiography. | journal=Abdom Imaging | year= 2009 | volume= 34 | issue= 3 | pages= 345-57 | pmid=18425546 | doi=10.1007/s00261-008-9392-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18425546  }} </ref><ref name="pmid20186630">{{cite journal| author=Qiang JW, Li RK, Feng XY, Liao ZH, He C, Feng Q et al.| title=[Multidetector-row CT evaluation of acute bowel ischemia induced by embolization of superior mesenteric artery in experimental porcine models]. | journal=Zhonghua Wei Chang Wai Ke Za Zhi | year= 2010 | volume= 13 | issue= 2 | pages= 151-5 | pmid=20186630 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20186630  }} </ref><ref name="pmid21993179">{{cite journal| author=Barmase M, Kang M, Wig J, Kochhar R, Gupta R, Khandelwal N| title=Role of multidetector CT angiography in the evaluation of suspected mesenteric ischemia. | journal=Eur J Radiol | year= 2011 | volume= 80 | issue= 3 | pages= e582-7 | pmid=21993179 | doi=10.1016/j.ejrad.2011.09.015 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21993179  }} </ref><ref name="pmid16332482">{{cite journal| author=Rosow DE, Sahani D, Strobel O, Kalva S, Mino-Kenudson M, Holalkere NS et al.| title=Imaging of acute mesenteric ischemia using multidetector CT and CT angiography in a porcine model. | journal=J Gastrointest Surg | year= 2005 | volume= 9 | issue= 9 | pages= 1262-74; discussion 1274-5 | pmid=16332482 | doi=10.1016/j.gassur.2005.07.034 | pmc=3807105 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16332482  }} </ref>
'''Early radiological features:'''
'''Early radiological features:'''
** Bowel dilation  
** [[Intestine|Bowel]] dilation  
** Focal or segmental bowel wall thickening  
** Focal or segmental [[Intestine|bowel]] wall thickening  
** Mesenteric stranding  
** [[Mesentery|Mesenteric]] stranding  
'''Late radiological features:'''
'''Late radiological features:'''
** Intestinal pneumatosis (presence of air within the bowel wall)  
** [[Intestine|Intestinal]] [[Pneumatosis intestinalis|pneumatosis]] (presence of air within the bowel wall)  
** Portal venous gas  
** [[Portal venous gas]]
* Following radiological features are seen on CTA in mesenteric ischemia of different etiologies:<ref name="JangMin2010">{{cite journal|last1=Jang|first1=Kyung Mi|last2=Min|first2=Kwangseon|last3=Kim|first3=Min Jeong|last4=Koh|first4=Sung Hye|last5=Jeon|first5=Eui Yong|last6=Kim|first6=In-Gyu|last7=Choi|first7=Dongil|title=Diagnostic Performance of CT in the Detection of Intestinal Ischemia Associated With Small-Bowel Obstruction Using Maximal Attenuation of Region of Interest|journal=American Journal of Roentgenology|volume=194|issue=4|year=2010|pages=957–963|issn=0361-803X|doi=10.2214/AJR.09.2702}}</ref><ref name="pmid12659341">{{cite journal| author=Kim AY, Ha HK| title=Evaluation of suspected mesenteric ischemia: efficacy of radiologic studies. | journal=Radiol Clin North Am | year= 2003 | volume= 41 | issue= 2 | pages= 327-42 | pmid=12659341 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12659341  }} </ref>
* Following radiological features are seen on [[CT angiography|CTA]] in mesenteric ischemia of different etiologies:<ref name="JangMin2010">{{cite journal|last1=Jang|first1=Kyung Mi|last2=Min|first2=Kwangseon|last3=Kim|first3=Min Jeong|last4=Koh|first4=Sung Hye|last5=Jeon|first5=Eui Yong|last6=Kim|first6=In-Gyu|last7=Choi|first7=Dongil|title=Diagnostic Performance of CT in the Detection of Intestinal Ischemia Associated With Small-Bowel Obstruction Using Maximal Attenuation of Region of Interest|journal=American Journal of Roentgenology|volume=194|issue=4|year=2010|pages=957–963|issn=0361-803X|doi=10.2214/AJR.09.2702}}</ref><ref name="pmid12659341">{{cite journal| author=Kim AY, Ha HK| title=Evaluation of suspected mesenteric ischemia: efficacy of radiologic studies. | journal=Radiol Clin North Am | year= 2003 | volume= 41 | issue= 2 | pages= 327-42 | pmid=12659341 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12659341  }} </ref>


{| class="wikitable"
{| class="wikitable"
Line 56: Line 56:


[[File:Portal-venous-gas-2.jpg|thumb|center|☃☃adiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/19680">rID: 19680</a>]]
[[File:Portal-venous-gas-2.jpg|thumb|center|☃☃adiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/19680">rID: 19680</a>]]
**
'''Patient #1: CT images of patient with ischemic bowel demonstrates pneumatosis and portal venous gas'''
<gallery>
Image:
Bowel-infarction-CT-01.jpg
Image:
Bowel-infarction-CT-02.jpg
Image:
Bowel-infarction-CT-03.jpg
</gallery>
'''Patient #2: CT images demonstrate mesenteric ischemia with marked atherosclerosis of arteries'''
<gallery>
Image:
Ischemicbowel.PNG|By James Heilman, MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=18076957
Mesenteric ischemia 101.jpg
Image:
Mesenteric ischemia 102.jpg
Image:
Mesenteric ischemia 103.jpg
Image:
Mesenteric ischemia 104.jpg
Image:
Mesenteric ischemia 105.jpg
Image:
Mesenteric ischemia 106.jpg
</gallery>


==References==
==References==


{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 23:21, 20 January 2018

Mesenteric ischemia Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Mesenteric ischemia from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Guidelines for Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

CT

MRA

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Mesenteric ischemia CT On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Mesenteric ischemia CT

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Mesenteric ischemia CT

CDC on Mesenteric ischemia CT

Mesenteric ischemia CT in the news

Blogs on Mesenteric ischemia CT

Directions to Hospitals Treating Mesenteric ischemia

Risk calculators and risk factors for Mesenteric ischemia CT

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Feham Tariq, MD [2]

Overview

Computerised axial tomographic angiography should be performed as soon as possible in order to diagnose mesenteric ischemia becasue of its ability to define the arterial anatomy and demonstrate the site of occlusion.

CT

  • Computerised axial tomographic angiography (CTA) without intravenous contrast should be the first investigation done for the diagnosis of mesenteric ischemia regardless of the etiology.[1][2]
  • Intravenous contrast is avoided for the following reasons:[3][4][5][6][7][8][9]
    • It can obscure the vessels
    • Delays the diagnosis
    • Hides the bowel wall enhancement
  • CTA shows the following findings consistent with mesenteric ischemia, which are as follows:[10][11][12][13][14]

Early radiological features:

Late radiological features:

Radiological feature Mesenteric arterial occlusion Mesenteric venous thrombosis Non occlusive mesenteric ischemia
Bowel wall Thinning ("paper thin wall") Thickening No change in the bowel wall
Attenuation of bowel wall on unenhanced CT Not characteristic Low with edema, high with hemorrhage Not characteristic
Bowel dilation Not apparent Moderate to prominent Not apparent
Mesenteric vessels Filling defect in the artery or absence of flow Venous filling defect Areas of focal narrowing in major branches with a string-of-beads appearance, reduced or absent flow in the smaller vessels, and an absent submucosal "blush."
Mesentery Normal until bowel infarction has occurred Hazy with ascites Normal until bowel infarction has occurred
Mesenteric ischemia
Source: Wikimedia commons [16]
☃☃adiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/19680">rID: 19680</a>

References

  1. ↑ Sreenarasimhaiah J (2005). "Chronic mesenteric ischemia". Best Pract Res Clin Gastroenterol. 19 (2): 283–95. doi:10.1016/j.bpg.2004.11.002. PMID 15833694.
  2. ↑ Yikilmaz, Ali; Karahan, Okkes Ibrahim; Senol, Serkan; Tuna, Ibrahim Sacit; Akyildiz, Hizir Yakup (2011). "Value of multislice computed tomography in the diagnosis of acute mesenteric ischemia". European Journal of Radiology. 80 (2): 297–302. doi:10.1016/j.ejrad.2010.07.016. ISSN 0720-048X.
  3. ↑ Li KC (1997). "Magnetic resonance angiography of the visceral arteries: techniques and current applications". Endoscopy. 29 (6): 496–503. doi:10.1055/s-2007-1004254. PMID 9342567.
  4. ↑ Laissy JP, Trillaud H, Douek P (2002). "MR angiography: noninvasive vascular imaging of the abdomen". Abdom Imaging. 27 (5): 488–506. doi:10.1007/s00261-001-0063-2. PMID 12172987.
  5. ↑ Fleischmann D (2003). "Multiple detector-row CT angiography of the renal and mesenteric vessels". Eur J Radiol. 45 Suppl 1: S79–87. PMID 12598031.
  6. ↑ Bradbury MS, Kavanagh PV, Chen MY, Weber TM, Bechtold RE (2002). "Noninvasive assessment of portomesenteric venous thrombosis: current concepts and imaging strategies". J Comput Assist Tomogr. 26 (3): 392–404. PMID 12016369.
  7. ↑ Horton KM, Fishman EK (2003). "The current status of multidetector row CT and three-dimensional imaging of the small bowel". Radiol Clin North Am. 41 (2): 199–212. PMID 12659334.
  8. ↑ 8.0 8.1 Kim AY, Ha HK (2003). "Evaluation of suspected mesenteric ischemia: efficacy of radiologic studies". Radiol Clin North Am. 41 (2): 327–42. PMID 12659341.
  9. ↑ Mitsuyoshi A, Obama K, Shinkura N, Ito T, Zaima M (2007). "Survival in nonocclusive mesenteric ischemia: early diagnosis by multidetector row computed tomography and early treatment with continuous intravenous high-dose prostaglandin E(1)". Ann Surg. 246 (2): 229–35. doi:10.1097/01.sla.0000263157.59422.76. PMC 1933563. PMID 17667501.
  10. ↑ Ofer A, Abadi S, Nitecki S, Karram T, Kogan I, Leiderman M; et al. (2009). "Multidetector CT angiography in the evaluation of acute mesenteric ischemia". Eur Radiol. 19 (1): 24–30. doi:10.1007/s00330-008-1124-5. PMID 18690454.
  11. ↑ Aschoff AJ, Stuber G, Becker BW, Hoffmann MH, Schmitz BL, Schelzig H; et al. (2009). "Evaluation of acute mesenteric ischemia: accuracy of biphasic mesenteric multi-detector CT angiography". Abdom Imaging. 34 (3): 345–57. doi:10.1007/s00261-008-9392-8. PMID 18425546.
  12. ↑ Qiang JW, Li RK, Feng XY, Liao ZH, He C, Feng Q; et al. (2010). "[Multidetector-row CT evaluation of acute bowel ischemia induced by embolization of superior mesenteric artery in experimental porcine models]". Zhonghua Wei Chang Wai Ke Za Zhi. 13 (2): 151–5. PMID 20186630.
  13. ↑ Barmase M, Kang M, Wig J, Kochhar R, Gupta R, Khandelwal N (2011). "Role of multidetector CT angiography in the evaluation of suspected mesenteric ischemia". Eur J Radiol. 80 (3): e582–7. doi:10.1016/j.ejrad.2011.09.015. PMID 21993179.
  14. ↑ Rosow DE, Sahani D, Strobel O, Kalva S, Mino-Kenudson M, Holalkere NS; et al. (2005). "Imaging of acute mesenteric ischemia using multidetector CT and CT angiography in a porcine model". J Gastrointest Surg. 9 (9): 1262–74, discussion 1274-5. doi:10.1016/j.gassur.2005.07.034. PMC 3807105. PMID 16332482.
  15. ↑ Jang, Kyung Mi; Min, Kwangseon; Kim, Min Jeong; Koh, Sung Hye; Jeon, Eui Yong; Kim, In-Gyu; Choi, Dongil (2010). "Diagnostic Performance of CT in the Detection of Intestinal Ischemia Associated With Small-Bowel Obstruction Using Maximal Attenuation of Region of Interest". American Journal of Roentgenology. 194 (4): 957–963. doi:10.2214/AJR.09.2702. ISSN 0361-803X.
  16. ↑ "File:Ischemicbowel.PNG - Wikimedia Commons". External link in |title= (help)
Retrieved from "https://www.wikidoc.org/index.php?title=Mesenteric_ischemia_CT&oldid=1431524"