Okkes Ibrahim Karahan MD, Presenter: Nothing to Disclose

Ali Yikilmaz MD, Abstract Co-Author: Nothing to Disclose

Serkan Senol MD, Abstract Co-Author: Nothing to Disclose

Yakup Hizir Akyildiz MD, Abstract Co-Author: Nothing to Disclose

To define the value of multislice computed tomography (CT) in the diagnosis of acute mesenteric ischemia (AMI).

Two hundred patients (age range: 20-92 years) who were referred to the emergency CT department with a clinical suspicion of AMI were included in the study. CT examinations were performed with a multislice (16) CT scanner and the protocol included pre-contrast, arterial and venous phase acquisition after intravenous injection of 100 ml non-ionic contrast material. Images were evaluated by using multiplanar reconstruction, maximum intensity projection and volume-rendering techniques at the CT work-station.

Ninety-four patients (%47) underwent surgery for AMI or for other causes of acute abdominal pain. One hundred-six patients (%53) were followed conservatively according to clinical, radiologic and laboratory findings. Of the 94 patients who underwent surgery, 49 (%25) were found to have AMI. CT diagnosed all of these 49 patients with AMI preoperatively. In the other 45 patients who underwent surgery, CT findings were negative for AMI. None of the patients, who were followed conservatively, were eventually diagnosed as having AMI except 1 patient. This patient was debile and could not undergo surgery although the clinical and radiologic findings were consistent with AMI and died after 3 days. The sensitivity and specificity values of CT for the detection of AMI were calculated to be 100% for each.

Multislice CT was found to have 100% sensitivity and specificity for diagnosing AMI.In the differential diagnosis between AMI and cardiac failure which mostly mimics AMI, presence of bowel dilation was valuable. AMI patients with embolic arterial occlusion had higher frequencies of focal loss of enhancement in the bowel wall and organ infarction on CT in comparison with other etiologies. Although IMA is a small artery, AMI due to isolated IMA embolus has not been observed. The demonstration of collaterals on CT angiography is not adequate for the diagnosis of AMI; therefore other CT findings should be taken into consideration as well.  Pneumatosis intestinalis has 99% specificity; gas in the SMV and portal vein, stenosis in the SMA have 100% specificity for AMI.  

Multislice CT should be the first-line examination for AMI for the positive identification of AMI as well as its exclusion.  

Karahan, O, Yikilmaz, A, Senol, S, Akyildiz, Y, Value of Multislice Computed Tomography in the Diagnosis of Acute Mesenteric Ischemia.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8000184.html