Francesca Iacobellis MD, Presenter: Nothing to Disclose

Daniela Berritto MD, Abstract Co-Author: Nothing to Disclose

Maria Paola Belfiore, Abstract Co-Author: Nothing to Disclose

Giuliano Gagliardi, Abstract Co-Author: Nothing to Disclose

Mariano Scaglione MD, Abstract Co-Author: Nothing to Disclose

Maria Antonietta Mazzei MD, Abstract Co-Author: Nothing to Disclose

Roberto Grassi MD, Abstract Co-Author: Nothing to Disclose

To define the CT findings of ischemic colitis (IC), according to the different etiologies and timing of the disease.

A computerized search of all medical records was used to retrospectively identify 130 patients who were admitted with the suspected diagnosis of IC over a five-year period. From these, 52 patients with IC proven by endoscopy with biopsies or surgical pathology were considered for the enrollment in the present study. Among 52 patients, 32 subjects (17 men and 15 women; median age 74, range 51-94 years) that underwent at least one CT examination, constituted the object of the analysis.Their medical history and CT examinations were retrospectively reviewed

Among the 32 CT examinations performed in the acute phase in 62.5% no defects or occlusion of the superior mesenteric artery (SMA) or inferior mesenteric artery (IMA) was found whereas in 37.5% IMA occlusion was detected. In acute phase in 100% of patients the presence of pericolic fluid was found, undergoing progressive resorption from acute to sub-acute phase if an effective reperfusion occured;the bowel wall thickening was observed in 28.1% patients in acute phase and in 86.4% patients evaluated in sub acute phase. The unthickened colonic wall was found in all conditions where ischemia is not followed by effective reperfusion, 71.9% of cases, and it was never found in chronic phase, when the colon appears irregularly thickened.

The results of this study showed that particular attention should be paid in the diagnosis of non-occlusive mesenteric ischemia (NOMI) before reperfusion representing the more difficult form of IC to detect at imaging, diagnostic difficulties may also be encountered in sub acute forms where the colon wall thickening could be misdiagnosed as normal wall with collapsed lumen, and in chronic forms where the irregular thickening of large bowel could be misdiagnosed if the patient’s clinical history is unknown.CT has a crucial role, it allows to define the morpho-functional alterations associated with the IC distinguishing among acute, sub acute and chronic phases and allows to estimate the timing of the ischemic damage.

The definition of the CT findings of ischemic colitis in relationship with the etiology and the timing of the disease has a crucial role to ensure a correct diagnosis and an appropriate treatment.

Iacobellis, F, Berritto, D, Belfiore, M, Gagliardi, G, Scaglione, M, Mazzei, M, Grassi, R, Ischemic Colitis: Is There a Relationship between the CT Findings, the Different Etiologies and the Timing of the Disease? A Clinical Study.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13017803.html