Mesenteric ischemia CT: Difference between revisions

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** Delays the diagnosis
** Delays the diagnosis
** Hides the bowel wall enhancement  
** Hides the bowel wall enhancement  
* 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>
* 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  
** Bowel dilation  

Revision as of 14:06, 15 January 2018

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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:

    • Bowel dilation
    • Focal or segmental bowel wall thickening
    • Mesenteric stranding

Late radiological features:

    • Intestinal pneumatosis
    • Portal venous gas
  • Following radiological features are seen on CTA in mesenteric ischemia of different etiologies:
Mesenteric ischemia
Source: Wikimedia commons [15]
☃☃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

Patient #2: CT images demonstrate mesenteric ischemia with marked atherosclerosis of arteries

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. ↑ 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. ↑ "File:Ischemicbowel.PNG - Wikimedia Commons". External link in |title= (help)
Retrieved from "https://www.wikidoc.org/index.php?title=Mesenteric_ischemia_CT&oldid=1430011"