Early risk stratification of patients with suspected chronic mesenteric ischaemia using a symptom and mesenteric artery calcium score based score chart

Abstract

Background The mesenteric artery calcium score (MACS) identifies patients with possible chronic mesenteric ischaemia (CMI) using standard computed tomography (CT) imaging. The MACS does not necessitate a dedicated computed tomography angiography (CTA) which is required for evaluation of mesenteric artery patency. This study aimed to test the use of a symptom and MACS based score chart to facilitate the selection of patients with a low probability of CMI, in whom further diagnostic workup can be omitted, and to validate the CTA‐based score chart proposed by van Dijk et al. which guides treatment decisions in patients with suspected CMI. Methods This retrospective study included consecutive patients with suspected CMI. The Agatston definition was used to calculate the MACS. Multivariable logistic regression analysis was used to create a MACS score chart, which was applied in all patients to determine its discriminative ability. The score chart by van Dijk et al. was validated in this independent external patient series. Results Hundred‐ninety‐two patients were included, of whom 49 had CMI. The MACS score chart composed of the variables weight loss, postprandial abdominal pain, history of cardiovascular disease, and MACS, showed an excellent discriminative ability (area under the curve [AUC] 0.87). CMI risks were 2.1% in the low‐risk group (0–4 points) and 39.1% in the increased risk group (5–10 points); sensitivity (97.8%) and negative predictive value (NPV; 97.9%) were high. The CTA‐based score chart by van Dijk et al. showed an excellent discriminative ability (AUC 0.89). Conclusion The MACS score chart shows promise for early risk stratification of patients with suspected CMI based on a near‐perfect NPV. It is complementary to the CTA‐based score chart by van Dijk et al., which showed excellent external validity and is well suited to guide subsequent (invasive) treatment decisions in patients with suspected CMI.

Development of a Novel Scoring Model to Estimate the Severity Grade of Mesenteric Artery Stenosis

“…Other predictors for this scoring model included gender, weight loss, and cardiovascular disease. The results of this score are validated by other studies [9,20]. In contrast to the present study, none of the existing studies reported on the extension of stenosis of the visceral artery as a possible a predictor of CMI and outcome.…”

“…While the diagnosis of CMI is based on clinical findings and radiologic manifestations [8,9], the CSI-score is entirely independent of the clinical findings and is a pure morphological classification of the radiologic findings. However, we found a strong association between this score and clinical manifestations, treatment options, and outcomes.…”

“…Many studies have reported the classification of visceral arterial stenosis according to the number of stenotic vessels (one, two, or three), the stenotic vessels (CA, SMA, or IMA), or the degree of stenosis [9,[11][12][13]. Additionally, several recent studies have compared endovascular treatment with open surgical repair in patients with CMI [14][15][16][17][18][19].…”

A diagnostic workup and laparoscopic approach for median arcuate ligament syndrome

“…1). 19,20 As a first line of investigations, we recommend upper abdominal US along with colonoscopy and gastroscopy to exclude more common pathologies such as cholelithiasis, gastritis or pancreatitis (Fig. 1).…”