Mesenteric ischemia CT: Difference between revisions

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==CT==
==CT==
* Computerised axial tomographic [[Angiogram|angiography]] without intravenous contrast should be the first investigation done for the diagnosis of [[Mesenteric ischemia|mesenteric]] ischemia regardless of the etiology.<ref name="pmid15833694">{{cite journal| author=Sreenarasimhaiah J| title=Chronic mesenteric ischemia. | journal=Best Pract Res Clin Gastroenterol | year= 2005 | volume= 19 | issue= 2 | pages= 283-95 | pmid=15833694 | doi=10.1016/j.bpg.2004.11.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15833694  }} </ref><ref name="YikilmazKarahan2011">{{cite journal|last1=Yikilmaz|first1=Ali|last2=Karahan|first2=Okkes Ibrahim|last3=Senol|first3=Serkan|last4=Tuna|first4=Ibrahim Sacit|last5=Akyildiz|first5=Hizir Yakup|title=Value of multislice computed tomography in the diagnosis of acute mesenteric ischemia|journal=European Journal of Radiology|volume=80|issue=2|year=2011|pages=297–302|issn=0720048X|doi=10.1016/j.ejrad.2010.07.016}}</ref>
* Computerised axial tomographic [[Angiogram|angiography]] (CTA) without intravenous contrast should be the first investigation done for the diagnosis of [[Mesenteric ischemia|mesenteric]] ischemia regardless of the etiology.<ref name="pmid15833694">{{cite journal| author=Sreenarasimhaiah J| title=Chronic mesenteric ischemia. | journal=Best Pract Res Clin Gastroenterol | year= 2005 | volume= 19 | issue= 2 | pages= 283-95 | pmid=15833694 | doi=10.1016/j.bpg.2004.11.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15833694  }} </ref><ref name="YikilmazKarahan2011">{{cite journal|last1=Yikilmaz|first1=Ali|last2=Karahan|first2=Okkes Ibrahim|last3=Senol|first3=Serkan|last4=Tuna|first4=Ibrahim Sacit|last5=Akyildiz|first5=Hizir Yakup|title=Value of multislice computed tomography in the diagnosis of acute mesenteric ischemia|journal=European Journal of Radiology|volume=80|issue=2|year=2011|pages=297–302|issn=0720048X|doi=10.1016/j.ejrad.2010.07.016}}</ref>
* Intravenous contrast is avoided for the following reasons:<ref name="pmid9342567">{{cite journal| author=Li KC| title=Magnetic resonance angiography of the visceral arteries: techniques and current applications. | journal=Endoscopy | year= 1997 | volume= 29 | issue= 6 | pages= 496-503 | pmid=9342567 | doi=10.1055/s-2007-1004254 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9342567  }} </ref><ref name="pmid12172987">{{cite journal| author=Laissy JP, Trillaud H, Douek P| title=MR angiography: noninvasive vascular imaging of the abdomen. | journal=Abdom Imaging | year= 2002 | volume= 27 | issue= 5 | pages= 488-506 | pmid=12172987 | doi=10.1007/s00261-001-0063-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12172987  }} </ref><ref name="pmid12598031">{{cite journal| author=Fleischmann D| title=Multiple detector-row CT angiography of the renal and mesenteric vessels. | journal=Eur J Radiol | year= 2003 | volume= 45 Suppl 1 | issue=  | pages= S79-87 | pmid=12598031 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12598031  }} </ref><ref name="pmid12016369">{{cite journal| author=Bradbury MS, Kavanagh PV, Chen MY, Weber TM, Bechtold RE| title=Noninvasive assessment of portomesenteric venous thrombosis: current concepts and imaging strategies. | journal=J Comput Assist Tomogr | year= 2002 | volume= 26 | issue= 3 | pages= 392-404 | pmid=12016369 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12016369  }} </ref><ref name="pmid12659334">{{cite journal| author=Horton KM, Fishman EK| title=The current status of multidetector row CT and three-dimensional imaging of the small bowel. | journal=Radiol Clin North Am | year= 2003 | volume= 41 | issue= 2 | pages= 199-212 | pmid=12659334 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12659334  }} </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><ref name="pmid17667501">{{cite journal| author=Mitsuyoshi A, Obama K, Shinkura N, Ito T, Zaima M| title=Survival in nonocclusive mesenteric ischemia: early diagnosis by multidetector row computed tomography and early treatment with continuous intravenous high-dose prostaglandin E(1). | journal=Ann Surg | year= 2007 | volume= 246 | issue= 2 | pages= 229-35 | pmid=17667501 | doi=10.1097/01.sla.0000263157.59422.76 | pmc=1933563 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17667501  }} </ref>
* Intravenous contrast is avoided for the following reasons:<ref name="pmid9342567">{{cite journal| author=Li KC| title=Magnetic resonance angiography of the visceral arteries: techniques and current applications. | journal=Endoscopy | year= 1997 | volume= 29 | issue= 6 | pages= 496-503 | pmid=9342567 | doi=10.1055/s-2007-1004254 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9342567  }} </ref><ref name="pmid12172987">{{cite journal| author=Laissy JP, Trillaud H, Douek P| title=MR angiography: noninvasive vascular imaging of the abdomen. | journal=Abdom Imaging | year= 2002 | volume= 27 | issue= 5 | pages= 488-506 | pmid=12172987 | doi=10.1007/s00261-001-0063-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12172987  }} </ref><ref name="pmid12598031">{{cite journal| author=Fleischmann D| title=Multiple detector-row CT angiography of the renal and mesenteric vessels. | journal=Eur J Radiol | year= 2003 | volume= 45 Suppl 1 | issue=  | pages= S79-87 | pmid=12598031 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12598031  }} </ref><ref name="pmid12016369">{{cite journal| author=Bradbury MS, Kavanagh PV, Chen MY, Weber TM, Bechtold RE| title=Noninvasive assessment of portomesenteric venous thrombosis: current concepts and imaging strategies. | journal=J Comput Assist Tomogr | year= 2002 | volume= 26 | issue= 3 | pages= 392-404 | pmid=12016369 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12016369  }} </ref><ref name="pmid12659334">{{cite journal| author=Horton KM, Fishman EK| title=The current status of multidetector row CT and three-dimensional imaging of the small bowel. | journal=Radiol Clin North Am | year= 2003 | volume= 41 | issue= 2 | pages= 199-212 | pmid=12659334 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12659334  }} </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><ref name="pmid17667501">{{cite journal| author=Mitsuyoshi A, Obama K, Shinkura N, Ito T, Zaima M| title=Survival in nonocclusive mesenteric ischemia: early diagnosis by multidetector row computed tomography and early treatment with continuous intravenous high-dose prostaglandin E(1). | journal=Ann Surg | year= 2007 | volume= 246 | issue= 2 | pages= 229-35 | pmid=17667501 | doi=10.1097/01.sla.0000263157.59422.76 | pmc=1933563 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17667501  }} </ref>
** It can obscure the vessels
** It can obscure the vessels
** Delay the diagnosis
** Delays the diagnosis
** Hides the bowel wall enhancement  
** Hides the bowel wall enhancement  
* CTA shows the following findings consistent with acute ischemia, which are as follows:
** Bowel dilation
** Focal or segmental bowel wall thickening
** Mesenteric stranding
** Intestinal pneumatosis
** Portal venous gas


* Following radiological features are seen more prominently on CT imaging of [[Mesenteric ischemia|mesenteric]] [[ischemia]].<ref name="pmid12944600">{{cite journal| author=Kirkpatrick ID, Kroeker MA, Greenberg HM| title=Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia: initial experience. | journal=Radiology | year= 2003 | volume= 229 | issue= 1 | pages= 91-8 | pmid=12944600 | doi=10.1148/radiol.2291020991 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12944600  }} </ref>
* Following radiological features are seen more prominently on CT imaging of [[Mesenteric ischemia|mesenteric]] [[ischemia]].<ref name="pmid12944600">{{cite journal| author=Kirkpatrick ID, Kroeker MA, Greenberg HM| title=Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia: initial experience. | journal=Radiology | year= 2003 | volume= 229 | issue= 1 | pages= 91-8 | pmid=12944600 | doi=10.1148/radiol.2291020991 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12944600  }} </ref>

Revision as of 13:50, 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 acute ischemia, which are as follows:
    • Bowel dilation
    • Focal or segmental bowel wall thickening
    • Mesenteric stranding
    • Intestinal pneumatosis
    • Portal venous gas
Red arrow shows pneumatosis intestinalis and purple arrow shows calcified vessel Source: Radiopedia.org - Case courtesy of Dr Ahmed Samir Mehany, Radiopaedia.org, rID: 55794


Yellow arrow shows multiple small bowel loops and proximal large bowel show wall edema or thickening and hypo-enhancement, Mild mesenteric congestion, No free fluid or uncontained gas, Central filling defect is seen at the superior mesenteric artery post middle colic artery branch : Radiopedia.org - Case contributed by Dr. Abdallah Khateeb
Mesenteric ischemia
Source: Wikimedia commons [11]
Case courtesy of Hugo Neves (RT), <a href="https://radiopaedia.org/">Radiopaedia.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. ↑ Kirkpatrick ID, Kroeker MA, Greenberg HM (2003). "Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia: initial experience". Radiology. 229 (1): 91–8. doi:10.1148/radiol.2291020991. PMID 12944600.
  11. ↑ "File:Ischemicbowel.PNG - Wikimedia Commons". External link in |title= (help)
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