Akira Furukawa MD, Presenter: Nothing to Disclose

Naoaki Kono MD, Abstract Co-Author: Nothing to Disclose

Masato Fujita MD, PhD, Abstract Co-Author: Nothing to Disclose

Katsumi Hayakawa MD, Abstract Co-Author: Nothing to Disclose

Kiyoshi Murata MD, PhD, Abstract Co-Author: Nothing to Disclose

Tsutomu Sakamoto MD, Abstract Co-Author: Nothing to Disclose

Michio Yamasaki MD, Abstract Co-Author: Nothing to Disclose

Yasuo Onaka MD, Abstract Co-Author: Nothing to Disclose

Keiji Shimoyama, Abstract Co-Author: Nothing to Disclose

Shuzo Kanasaki MD,PHD, Abstract Co-Author: Nothing to Disclose

Kiyosumi Maeda MD, Abstract Co-Author: Nothing to Disclose

Toyohiko Tanaka MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

To evaluate the accuracy of dynamic contrast enhanced CT in the diagnosis of acute arterial mesenteric ischemia and its potential of assessing patients’ prognosis.

Among patients with acute arterial mesenteric ischemia diagnosed by angiography, surgery or autopsy, contrast enhanced CT had been performed in 31 patients who formed the study group. CT scanning was performed with a bolus injection of intravenous contrast (100 – 150 ml) at a rate of 2 – 4 ml/sec with a delay time of 40 – 60 seconds to obtain contiguous images of 5 – 10 mm slice thickness. CT images were specifically analyzed for: embolus in the superior mesenteric artery (SMA) or in its branches, bowel-wall thickness, degree of enhancement, luminal dilatation, amount of luminal fluid, length of involvement, mesenteric edema or fluid, vascular engorgement, ascites, and the diameter of SMA compared to SMV at the proximal portion (often SMA > SMV in this condition from our experiences). Prevalence of each finding was calculated. Prevalence of each finding was also calculated in patients who died and survived, and they were compared.

Every patient had at least one positive CT finding. The most prevalent CT finding of acute arterial mesenteric ischemia was emboli in SMA or in its branches (28/31), followed by decrease or lack of bowel enhancement (24/31), luminal dilatation (17/31), thinning of bowel-wall (15/31) and finding of enlarged SMA (15/31). Mesenteric edema or fluid and vascular engorgement were seldom observed. Mortality rate of acute arterial mesenteric ischemia in this study was 48.4% (15/31). Statistically significant poor prognostic CT findings for survival were thinning of bowel wall (P < 0.001), involvement of longer segment (P < 0.01), and lack of bowel-wall enhancement (P < 0.05). Nine patients were survived with trans-catheter thrombolysis therapy without surgery. Mesenteric edema was significantly less-prominent and ascites was less frequently seen in this group compared to the others.

Dynamic contrast enhanced CT with bolus injection is quite valuable in the diagnosis of acute arterial mesenteric ischemia and in the assessment of patients’ prognosis.

Furukawa, A, Kono, N, Fujita, M, Hayakawa, K, Murata, K, Sakamoto, T, Yamasaki, M, Onaka, Y, Shimoyama, K, Kanasaki, S, Maeda, K, Tanaka, T, et al, , Acute Arterial Mesenteric Ischemia: Diagnosis with Contrast-enhanced CT.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4412221.html