Mesenteric ischemia CT

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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

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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

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* 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 (presence of air within the bowel wall)
* Portal venous gas
* Following radiological features are seen on CTA in mesenteric ischemia of different etiologies:[15][8]

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

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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.CS1 maint: Multiple names: authors list (link)
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.CS1 maint: Multiple names: authors list (link)
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.CS1 maint: Multiple names: authors list (link)
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.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
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.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
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.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
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.CS1 maint: Multiple names: authors list (link)
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.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
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)