Cinthia Cruz MD, Presenter: Nothing to Disclose

Hani H. Abujudeh MD, MBA, Abstract Co-Author: Research Grant, Bracco Group Consultant, RCG HealthCare Consulting Author, Oxford University Press

Rosalynn Nazarian MD, Abstract Co-Author: Nothing to Disclose

James H. Thrall MD, Abstract Co-Author: Board Member, Mobile Aspects, Inc Board Member, WorldCare International, Inc

Determine the most frequent findings on IV contrast CT examinations of pathologically proven cases of ischemic colitis and define the most frequent sites of colonic involvement.

IRB compliant retrospective review of CT examinations done with intravenous contrast of pathologically proven cases of ischemic colitis, from 2007 to 2010 in our institution. Patients with a history of recent abdominal surgery or trauma, and those without a concurrent IV contrast enhanced CT at time of diagnosis were excluded.102 scans were analyzed for the presence of the following criteria involving the colon: abnormal wall enhancement, bowel wall thickening, dilatation, mesenteric fat stranding, venous engorgement, presence of fluid or ascites, pneumatosis-portomesenteric gas, infarcts of other organs and vasculature occlusion. Affected segments of the colon were noted.  

Colonic wall thickening and mesenteric fat stranding were the most frequently seen findings, each was present in 90 of 102 cases(88%). Altered wall enhancement was detected in 84 of 102 cases (82%), increased enhancement was the most common pattern.Venous engorgement, was seen in 52 of 102 patients(51%). 36 of 102 cases (35%) in our series showed pericolonic fluid or ascites, in 27 of 36 cases (75%) fluid was present in small or trace amounts.Only 20 of 102 (20%) patients were found to have colonic dilatation.Pneumatosis was observed in 10 of 102 (9.8%) exams, with the presence of portomesenteric gas in 2 of those 10 cases (20%). Mesenteric arterial occlusion was observed in only 1 case of 102 (0.9%). No Infarcts of other organs were observed. Segmental distribution of ischemia was described in 96/102 (92%) cases whereas the involvement of the entire colon was seen only in 6/102 (5.9%) of the scans. Descending colon and sigmoid were the most frequently involved segments at 64 of 102 (62.7%) and 58 of 102 (56.9%) cases, and with fewer cases: transverse 23 of 102 (22.5%) and caecum 21 of 102 (21%).  

The most frequent IV contrast CT findings in patients diagnosed with ischemic colitis are: Bowel wall thickening, fat stranding, abnormal wall enhancement and venous engorgement. The descending and sigmoid colon are the most frequently involved segments in ischemic colitis, and with lower incidences transverse and caecum.

IV contrast CT is critical to demonstrate the findings in the early onset of ischemic colitis and its possible causes.  

Cruz, C, Abujudeh, H, Nazarian, R, Thrall, J, Frequency of IV Contrast CT Findings and Most Frequent Sites of Involvement in Pathologically Proven Cases of Ischemic Colitis.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14014565.html