CT Manifestations of Bowel Ischemia

Chou, Chung Kuao

doi:10.2214/ajr.178.1.1780087

Cited by 70 publications

(38 citation statements)

References 6 publications

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“…8, 9). If the compression of the artery is tight enough from the beginning of the obstruction, the wall might be thin and totally unenhanced [66]. The bowel segment proximal to an obstruction can become ischemic due to severe bowel distention.…”

Section: Bowel Obstructionmentioning

confidence: 99%

Nontraumatic abdominal emergencies: acute abdominal pain: diagnostic strategies

Marinček

2002

Eur Radiol

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Common causes of acute abdominal pain include appendicitis, cholecystitis, bowel obstruction, urinary colic, perforated peptic ulcer, pancreatitis, diverticulitis, and nonspecific, nonsurgical abdominal pain. The topographic classification of acute abdominal pain (pain in one of the four abdominal quadrants, diffuse abdominal pain, flank or epigastric pain) facilitates the choice of the imaging technique. The initial radiological evaluation often consists of plain abdominal radiography, despite significant diagnostic limitations. The traditional indications for plain films--bowel obstruction, pneumoperitoneum, and the search of ureteral calculi--are questioned by helical computed tomography (CT). Although ultrasonography (US) is in many centers the modality of choice for imaging the gallbladder and the pelvis in children and women of reproductive age, CT is considered to be one of the most valued tools for triaging patients with acute abdominal pain. CT is particularly beneficial in patients with marked obesity, unclear US findings, bowel obstruction, and multiple lesions. The introduction of multidetector row CT (MDCT) has further enhanced the utility of CT in imaging patients with acute abdominal pain.

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Section: Bowel Obstructionmentioning

confidence: 99%

Nontraumatic abdominal emergencies: acute abdominal pain: diagnostic strategies

Marinček

2002

Eur Radiol

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“…Changes that have been reported include bowel wall thickening and edema, submucosal hemorrhage, increased or decreased enhancement of the bowel wall, mesenteric stranding or fluid, and pneumatosis intestinalis. [10][11][12][13] However, these morphologic descriptions are not adequate for the early detection of reversible bowel ischemia. A recent study reported that spiral CT demonstrated a sensitivity and specificity of 64% and 92%, respectively, for diagnosing mesenteric ischemia.…”

mentioning

confidence: 99%

Imaging of Acute Mesenteric Ischemia Using Multidetector CT and CT Angiography in a Porcine Model

Rosow

Sahani

Strobel

et al. 2005

Journal of Gastrointestinal Surgery

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Acute mesenteric ischemia, a frequently lethal disease, requires prompt diagnosis and intervention for favorable clinical outcomes. This goal remains elusive due, in part, to lack of a noninvasive and accurate imaging study. Traditional angiography is the diagnostic gold standard but is invasive and costly. Computed tomography (CT) is readily available and noninvasive but has shown variable success in diagnosing this disease. The faster scanning time of multidetector row CT (M.D.CT) greatly facilitates the use of CT angiography (CTA) in the clinical setting. We sought to determine whether M.D.CT-CTA could accurately demonstrate vascular anatomy and capture the earliest stages of mesenteric ischemia in a porcine model. Pigs underwent embolization of branches of the superior mesenteric artery, then imaging by M.D.CT-CTA with three-dimensional reconstruction protocols. After scanning, diseased bowel segments were surgically resected and pathologically examined. Multidetector row CT and CT angiography reliably defined normal and occluded mesenteric vessels in the pig. It detected early changes of ischemia including poor arterial enhancement and venous dilatation, which were seen in all ischemic animals. The radiographic findings-compared with pathologic diagnoses-predicted ischemia, with a positive predictive value of 92%. These results indicate that M.D.CT-CTA holds great promise for the early detection necessary for successful treatment of acute mesenteric ischemia. KeywordsMesenteric ischemia; computed tomography; angiography; animal model Acute mesenteric ischemia, the process of insufficient blood supply to the bowel, carries consequences ranging from a transient, totally reversible insult to a lethal event. The prevalence of mesenteric ischemia is increasing in the United States as the population ages. It is estimated that nearly 1% of patients presenting with acute abdominal pain have ischemic intestinal disease, 1-3 and it may be responsible for 0.1% of all hospital The lethality of the disease is well documented, with some series reporting mortality rates exceeding 60%. [4][5][6][7] A critical factor for survival of acute mesenteric ischemia is early diagnosis and intervention. In cases of superior mesenteric artery (SMA) embolism in which surgery is performed once the bowel is infarcted, the mortality rate nearly doubles from 35% to 68%. 8 The mean duration of ischemia preceding surgery for noninfarcted bowel is 13 hours, compared with 21 hours for those with infarction. 9 Thus, the window of opportunity for intervention is narrow and prompt diagnosis is crucial for patient survival. Nevertheless, this goal remains elusive, due in part to the lack of an accurate diagnostic imaging tool. NIH Public AccessAlthough angiography is considered the standard of reference for the diagnosis of mesenteric ischemia, it is not widely used because it is invasive, time-consuming, and costly. Computed tomography has been historically used with variable success for evaluating small bowel ischemia. It can help dete...

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“…Unfortunately, abdominal CT occasionally does not help EPs differentiate SIIH from AMI due to similar CT findings (4)(5)(6). It is critical for EPs to make the right decision because the optimal treatments are quite different, conservative medical treatment for SIIH (1,7,8) and emergent surgical intervention for AMI (9)(10)(11).…”

Section: Discussionmentioning

confidence: 99%

“…Abdominal computed tomography (CT) can help EPs to differentiate patients with acute abdominal pain due to its characteristics of rapid, first-line, imaging modality with high accuracy. However, abdominal CT occasionally is not useful to help EPs differentiate SIIH from acute mesenteric ischemia (AMI) due to similar findings, such as homogenous bowel wall thickening or the presence of a target sign on intravenous contrast-enhanced studies (4)(5)(6). Ap- (1,3,7,8) and emergent surgical intervention for AMI (9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Spontaneous Intramural Intestinal Hemorrhage versus Acute Mesenteric Ischemia by CT Evaluation

et al. 2016

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Objective The purpose of our study was to differentiate the imaging findings of patients with spontaneous intramural intestinal hemorrhage (SIIH) from those with acute mesenteric ischemia (AMI) after abdominal computed tomography (CT) survey in the emergency department. Methods We retrospectively included 83 patients diagnosed with SIIH or AMI after abdominal CT. Results The mean ages of 30 SIIH patients and 53 AMI patients were 74.4±14.6 years and 75.8±11.2 years, respectively. Patients with SIIH had significantly thicker maximal intestinal wall thickening (14.8±3.9 vs. 10.9 ±4.1, p<0.001), a lower rate of ileum involvement (26.7% vs. 77.4%, p<0.001) and a higher rate of ascites (96.7% vs. 64.2%, p<0.001) compared with patients with AMI. Neither pneumatosis intestinalis (p< 0.001) nor portomesenteric gas (p<0.01) were detected in SIIH patients but were observed in AMI patients. A receiver-operating characteristic (ROC) curve analysis showed that the optimal cut-off value for maximal intestinal wall thickening between groups was 10.4 mm and the area under the ROC curve between groups was 0.752 (p<0.0001). A multiple logistic regression analysis showed that the independent predictors of SIIH were non-involvement of the ileum (odds ratio, OR, 6.998; p=0.001), maximal intestinal wall thickening ! 10.4 mm (OR, 5.748; p=0.040) and ascites (OR, 13.348; p=0.023). The area under the ROC curve for the model was 0.854 (p<0.001). Conclusion The independent predictors of SIIH from AMI after abdominal CT in acute abdominal patients include non-involvement of the ileum, intestinal wall thickening ! 10.4 mm, and ascites.

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CT Manifestations of Bowel Ischemia

Cited by 70 publications

References 6 publications

Nontraumatic abdominal emergencies: acute abdominal pain: diagnostic strategies

Nontraumatic abdominal emergencies: acute abdominal pain: diagnostic strategies

Imaging of Acute Mesenteric Ischemia Using Multidetector CT and CT Angiography in a Porcine Model

Spontaneous Intramural Intestinal Hemorrhage versus Acute Mesenteric Ischemia by CT Evaluation

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