Emergency Radiology

, Volume 18, Issue 2, pp 145–156

Multidetector CT imaging in mesenteric ischemia—pearls and pitfalls

  • Ashish Wasnik
  • Ravi K. Kaza
  • Mahmoud M. Al-Hawary
  • Peter S. Liu
  • Joel F. Platt
Review Article


Mesenteric ischemia is a complex and devastating disease which still remains a diagnostic challenge to the clinicians due to non-specific clinical and laboratory findings. Several imaging features have been described with multidetector computed tomography which allows the diagnosis of mesenteric ischemia with high sensitivity and specificity. However, there are imaging features which overlap with other pathologies including benign inflammation and infection. Knowledge of imaging findings in mesenteric ischemia and its potential mimics is important in early and definitive diagnosis.


Mesenteric ischemia Bowel ischemia Bowel infarction Multidetector computed tomography 


  1. 1.
    Martinez JP, Hogan GJ (2004) Mesenteric ischemia. Emerg Med Clin North Am 22:909–928PubMedCrossRefGoogle Scholar
  2. 2.
    Gore RM, Thakrar KH, Mehta UK, Berlin J, Yaghmai V, Newmark GM (2008) Imaging in intestinal ischemic disorders. Clin Gastroenterol Hepatol 6:849–858PubMedCrossRefGoogle Scholar
  3. 3.
    Wiesner W, Khurana B, Ji H, Ros PR (2003) CT of acute bowel ischemia. Radiology 226:635–650PubMedCrossRefGoogle Scholar
  4. 4.
    Horton KM, Fishman EK (2007) Multidetector CT angiography in the diagnosis of mesenteric ischemia. Radiol Clin North Am 45:275–288PubMedCrossRefGoogle Scholar
  5. 5.
    Furukawa A, Kanasaki S, Kono N et al (2009) CT diagnosis of acute mesenteric ischemia from various causes. AJR Am J Roentgenol 192:408–416PubMedCrossRefGoogle Scholar
  6. 6.
    Menke J (2010) Diagnostic accuracy of multidetector CT in acute mesenteric ischemia: systematic review and meta-analysis. Radiology 256:93–101PubMedCrossRefGoogle Scholar
  7. 7.
    Kirkpatrick ID, Kroeker MA, Greenberg HM (2003) Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia: initial experience. Radiology 229:91–98PubMedCrossRefGoogle Scholar
  8. 8.
    Ha HK, Rha SE, Kim AY, Auh YH (2000) CT and MR diagnoses of intestinal ischemia. Semin Ultrasound CT MR 21:40–55PubMedCrossRefGoogle Scholar
  9. 9.
    Horton KM, Fishman EK (2010) CT angiography of the mesenteric circulation. Radiol Clin North Am 48:331–345, viiiGoogle Scholar
  10. 10.
    Gore RM, Yaghmai V, Thakrar KH et al (2008) Imaging in intestinal ischemic disorders. Radiol Clin North Am 46:845–875, vPubMedCrossRefGoogle Scholar
  11. 11.
    Levy AD (2007) Mesenteric ischemia. Radiol Clin North Am 45:593–599, xPubMedCrossRefGoogle Scholar
  12. 12.
    Brandt LJ, Feuerstadt P (2010) Intestinal ischemia. In: Feldmann M, Friedman LS, Brandt LJ (eds) Sleisenger and Fordtran’s gastrointestinal and liver disease. Saunders, Philadelphia, PA, pp 2027–2049Google Scholar
  13. 13.
    Ofer A, Abadi S, Nitecki S et al (2009) Multidetector CT angiography in the evaluation of acute mesenteric ischemia. Eur Radiol 19:24–30PubMedCrossRefGoogle Scholar
  14. 14.
    Meyer T, Klein P, Schweiger H, Lang W (1998) How can the prognosis of acute mesenteric artery ischemia be improved? Results of a retrospective analysis. Zentralbl Chir 123:230–234PubMedGoogle Scholar
  15. 15.
    Lange H, Jackel R (1994) Usefulness of plasma lactate concentration in the diagnosis of acute abdominal disease. Eur J Surg 160:381–384PubMedGoogle Scholar
  16. 16.
    Lange H, Toivola A (1997) Warning signals in acute abdominal disorders. Lactate is the best marker of mesenteric ischemia. Lakartidningen 94:1893–1896PubMedGoogle Scholar
  17. 17.
    Baixauli J, Kiran RP, Delaney CP (2003) Investigation and management of ischemic colitis. Cleve Clin J Med 70:920–921, 925–926, 928–930 passimPubMedCrossRefGoogle Scholar
  18. 18.
    Stoney RJ, Cunningham CG (1993) Acute mesenteric ischemia. Surgery 114:489–490PubMedGoogle Scholar
  19. 19.
    McKinsey JF, Gewertz BL (1997) Acute mesenteric ischemia. Surg Clin North Am 77:307–318PubMedCrossRefGoogle Scholar
  20. 20.
    Brandt L, Boley S, Goldberg L, Mitsudo S, Berman A (1981) Colitis in the elderly. A reappraisal. Am J Gastroenterol 76:239–245PubMedGoogle Scholar
  21. 21.
    Inderbitzi R, Wagner HE, Seiler C, Stirnemann P, Gertsch P (1992) Acute mesenteric ischaemia. Eur J Surg 158:123–126PubMedGoogle Scholar
  22. 22.
    Levine JS, Jacobson ED (1995) Intestinal ischemic disorders. Dig Dis 13:3–24PubMedCrossRefGoogle Scholar
  23. 23.
    Ruotolo RA, Evans SR (1999) Mesenteric ischemia in the elderly. Clin Geriatr Med 15:527–557PubMedGoogle Scholar
  24. 24.
    Bastidas JRP, Bulkley GB (1995) Mesenteric vascular insufficiency. In: Yamada T (ed) Textbook of gastroenterology. Lippincott, Philadelphia, PA, pp 2490–2523Google Scholar
  25. 25.
    Vicente DC, Kazmers A (1999) Acute mesenteric ischemia. Curr Opin Cardiol 14:453–458PubMedCrossRefGoogle Scholar
  26. 26.
    Jrvinen O, Laurikka J, Salenius JP, Tarkka M (1994) Acute intestinal ischaemia. A review of 214 cases. Ann Chir Gynaecol 83:22–25PubMedGoogle Scholar
  27. 27.
    Clavien PA, Durig M, Harder F (1988) Venous mesenteric infarction: a particular entity. Br J Surg 75:252–255PubMedCrossRefGoogle Scholar
  28. 28.
    Newman TS, Magnuson TH, Ahrendt SA, Smith-Meek MA, Bender JS (1998) The changing face of mesenteric infarction. Am Surg 64:611–616PubMedGoogle Scholar
  29. 29.
    Sudhakar CB, Al-Hakeem M, MacArthur JD, Sumpio BE (1997) Mesenteric ischemia secondary to cocaine abuse: case reports and literature review. Am J Gastroenterol 92:1053–1054PubMedGoogle Scholar
  30. 30.
    Taourel P, Aufort S, Merigeaud S, Doyon FC, Hoquet MD, Delabrousse E (2008) Imaging of ischemic colitis. Radiol Clin North Am 46:909–924, viPubMedCrossRefGoogle Scholar
  31. 31.
    Klein HM, Lensing R, Klosterhalfen B, Tons C, Gunther RW (1995) Diagnostic imaging of mesenteric infarction. Radiology 197:79–82PubMedGoogle Scholar
  32. 32.
    Chou CK (2002) CT manifestations of bowel ischemia. AJR Am J Roentgenol 178:87–91PubMedGoogle Scholar
  33. 33.
    Bartnicke BJ, Balfe DM (1994) CT appearance of intestinal ischemia and intramural hemorrhage. Radiol Clin North Am 32:845–860PubMedGoogle Scholar
  34. 34.
    Desai RK, Tagliabue JR, Wegryn SA, Einstein DM (1991) CT evaluation of wall thickening in the alimentary tract. Radiographics 11:771–783, discussion 784PubMedGoogle Scholar
  35. 35.
    Teefey SA, Roarke MC, Brink JA et al (1996) Bowel wall thickening: differentiation of inflammation from ischemia with color Doppler and duplex US. Radiology 198:547–551PubMedGoogle Scholar
  36. 36.
    Macari M, Balthazar EJ (2001) CT of bowel wall thickening: significance and pitfalls of interpretation. AJR Am J Roentgenol 176:1105–1116PubMedGoogle Scholar
  37. 37.
    Horton KM, Corl FM, Fishman EK (2000) CT evaluation of the colon: inflammatory disease. Radiographics 20:399–418PubMedGoogle Scholar
  38. 38.
    Horton KM, Corl FM, Fishman EK (1999) CT of nonneoplastic diseases of the small bowel: spectrum of disease. J Comput Assist Tomogr 23:417–428PubMedCrossRefGoogle Scholar
  39. 39.
    Chou CK, Wu RH, Mak CW, Lin MP (2006) Clinical significance of poor CT enhancement of the thickened small-bowel wall in patients with acute abdominal pain. AJR Am J Roentgenol 186:491–498PubMedCrossRefGoogle Scholar
  40. 40.
    Balthazar EJ, Yen BC, Gordon RB (1999) Ischemic colitis: CT evaluation of 54 cases. Radiology 211:381–388PubMedGoogle Scholar
  41. 41.
    Macari M, Chandarana H, Balthazar E, Babb J (2003) Intestinal ischemia versus intramural hemorrhage: CT evaluation. AJR Am J Roentgenol 180:177–184PubMedGoogle Scholar
  42. 42.
    Umphrey H, Canon CL, Lockhart ME (2008) Differential diagnosis of small bowel ischemia. Radiol Clin North Am 46:943–952, vi–viiPubMedCrossRefGoogle Scholar
  43. 43.
    Horton KM, Fishman EK (2001) Multi-detector row CT of mesenteric ischemia: can it be done? Radiographics 21:1463–1473PubMedGoogle Scholar
  44. 44.
    Mirvis SE, Shanmuganathan K, Erb R (1994) Diffuse small-bowel ischemia in hypotensive adults after blunt trauma (shock bowel): CT findings and clinical significance. AJR Am J Roentgenol 163:1375–1379PubMedGoogle Scholar
  45. 45.
    Alpern MB, Glazer GM, Francis IR (1988) Ischemic or infarcted bowel: CT findings. Radiology 166:149–152PubMedGoogle Scholar
  46. 46.
    Segatto E, Mortele KJ, Ji H, Wiesner W, Ros PR (2003) Acute small bowel ischemia: CT imaging findings. Semin Ultrasound CT MR 24:364–376PubMedCrossRefGoogle Scholar
  47. 47.
    Moschetta M, Stabile Ianora AA, Pedote P, Scardapane A, Angelelli G (2009) Prognostic value of multidetector computed tomography in bowel infarction. Radiol Med 114:780–791PubMedCrossRefGoogle Scholar
  48. 48.
    Feczko PJ, Mezwa DG, Farah MC, White BD (1992) Clinical significance of pneumatosis of the bowel wall. Radiographics 12:1069–1078PubMedGoogle Scholar
  49. 49.
    Sebastia C, Quiroga S, Espin E, Boye R, Alvarez-Castells A, Armengol M (2000) Portomesenteric vein gas: pathologic mechanisms, CT findings, and prognosis. Radiographics 20:1213–1224, discussion 1224–1216PubMedGoogle Scholar
  50. 50.
    Wiesner W, Mortele KJ, Glickman JN, Ji H, Ros PR (2001) Pneumatosis intestinalis and portomesenteric venous gas in intestinal ischemia: correlation of CT findings with severity of ischemia and clinical outcome. AJR Am J Roentgenol 177:1319–1323PubMedGoogle Scholar
  51. 51.
    Longo WE, Ballantyne GH, Gusberg RJ (1992) Ischemic colitis: patterns and prognosis. Dis Colon Rectum 35:726–730PubMedCrossRefGoogle Scholar
  52. 52.
    Zalcman M, Sy M, Donckier V, Closset J, Gansbeke DV (2000) Helical CT signs in the diagnosis of intestinal ischemia in small-bowel obstruction. AJR Am J Roentgenol 175:1601–1607PubMedGoogle Scholar

Copyright information

© Am Soc Emergency Radiol 2010

Authors and Affiliations

  • Ashish Wasnik
    • 1
  • Ravi K. Kaza
    • 1
  • Mahmoud M. Al-Hawary
    • 1
  • Peter S. Liu
    • 1
  • Joel F. Platt
    • 1
  1. 1.Division of Abdominal Imaging, Department of RadiologyUniversity of Michigan Health SystemAnn ArborUSA

Personalised recommendations