Tina Jaeckle MD, Presenter: Nothing to Disclose

Bjoern W Becker, Abstract Co-Author: Nothing to Disclose

Bernd Schmitz MD, Abstract Co-Author: Nothing to Disclose

Gregor Stuber MD, Abstract Co-Author: Nothing to Disclose

Hans-Juergen Brambs MD, Abstract Co-Author: Nothing to Disclose

To explore the value of multi-detector row CT (MDCT) using a biphasic mesenteric angiography protocol for evaluation of mesenteric ischemia (AMI).

16 Patients (7 females, 9 males; age 31-86 years, mean age 70.2 years) with clinical signs of AMI such as elevated lactate levels or unexplained metabolic acidosis underwent diagnostic imaging with 40- or 16-channel MDCT. Arterial and venous mesenteric CT angiography were performed after administration of an intravenous contrast agent (CM) using bolus timing. CM was administered at a rate of 4 ml/sec by power injector at a dose of 1.2 ml/kg body weight followed by a saline chaser. Axial images (1 or 2 mm slice thickness) were obtained. CT angiograms were reconstructed with multiplanar (MPR) and maximum intensity projection (MIP). All scans were evaluated retrospectively by four independent experienced radiologists for CT evidence of ischemia. MDCT signs of ischemia were calculated retrospectively and correlated with surgical or clinical outcome.

In 11 out of 16 patients (68.8%) AMI was confirmed by surgery. 5/16 patients (31.2%) were treated conservatively with either i.v. anticoagulation or catecholamines. In one patient, signs of venous mesenteric ischemia were followed-up with clinical findings and ultrasound examinations. 4/16 (25.0%) patients died while in the hospital. All patients with CT findings of pneumatosis intestinalis (37.5%), mesenteric artery occlusion/emboly (56.3%), superior mesenteric/portal venous thrombosis (25.0%) and/or mesenteric venous gas (31.5%) underwent bowel resection due to mesenteric ischemic changes. These CT findings were detected by all four radiologists (100% specifity). 14 (87.5%) of the 16 patients with mesenteric ischemia had CT signs of bowel wall thickening whereas 13 (81.3%) showed bowel dilatation. All patients with pneumatosis intestinalis showed transmural infarction during surgery.

Biphasic mesenteric CT angiography using MDCT is an accurate tool for fast diagnostic workup of patients with mesenteric ischemia.

MDCT can be used as the criterion standard for detection and localization of mesenteric ischemic changes.

Jaeckle, T, Becker, B, Schmitz, B, Stuber, G, Brambs, H, Evaluation of Mesenteric Ischemia: Mesenteric CT Angiography Using Biphasic Multi-detector Row Helical CT.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4440643.html