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CT angiography in the setting of suspected acute mesenteric ischemia: prevalence of ischemic and alternative diagnoses

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Abstract

Purpose

The purpose of the study was to determine the prevalence of ischemic and alternative diagnoses and the diagnostic accuracy of CT angiography (CTA) in the setting of suspected acute mesenteric ischemia (AMI).

Material and methods

We included 959 patients undergoing CTA for the evaluation of suspected AMI. The final clinical diagnosis was used to determine the prevalence of ischemic and alternative diagnoses and to calculate the diagnostic accuracy of CTA. Prevalence of diagnoses by age, sex, and admission status was compared using Cochran–Armitage and χ 2 tests.

Results

Prevalence was 18.8% (180/959) for AMI and 61.2% (587/959) for specific alternative diagnoses. In the remaining 20.0% (192/959), no clear clinical diagnosis was established. The most frequent alternative diagnoses were small-bowel obstruction (10.4%; 61/587), infectious colitis (8.7%; 51/587), pneumonia (6.5%; 38/587), cholecystitis (6.1%; 36/587), and diverticulitis (5.6%; 33/587). Prevalence of specific alternative diagnoses varied significantly according to both age (p < .013) and admissions status (p < 0.001). CTA had a sensitivity and specificity for diagnosing AMI of 89.4%/99.5% and for alternative diagnoses of 86.7%/96.9%, respectively.

Conclusion

In the setting of suspected AMI, the prevalence of ischemic and alternative diagnoses varies significantly by age, sex, and admission status. CTA provides for rapid and non-invasive assessment of ischemic and alternative diagnoses with high diagnostic accuracy.

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Abbreviations

AMI:

Acute mesenteric ischemia

CTA:

Computed tomography angiography

IV contrast:

Intravenous contrast

ED:

Emergency department

HIS:

Hospital information system

kV:

Kilovoltage

mAs:

Milliamper-second

PPV:

Positive predictive value

NPV:

Negative predictive value

SBO:

Small-bowel obstruction

UTI:

Urinary tract infection

DLC:

Decompensated liver cirrhosis

IBD:

Inflammatory bowel disease

CRC:

Colorectal carcinoma

GDU:

Gastroduodenal ulcer

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Authors and Affiliations

  1. Department of Radiology, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Frank Oliver Henes, Andrzej Herzyk, Thorsten Derlin, Gerhard Adam & Peter Bannas

  2. Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA

    Perry J. Pickhardt, Scott J. Lee, Utaroh Motosugi, Meghan G. Lubner & Peter Bannas

  3. Department of Medical Biometry and Epidemiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Gerhard Schön

Authors
  1. Frank Oliver Henes
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  2. Perry J. Pickhardt
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  3. Andrzej Herzyk
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  4. Scott J. Lee
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  5. Utaroh Motosugi
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Corresponding author

Correspondence to Frank Oliver Henes.

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Funding

No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Henes, F.O., Pickhardt, P.J., Herzyk, A. et al. CT angiography in the setting of suspected acute mesenteric ischemia: prevalence of ischemic and alternative diagnoses. Abdom Radiol 42, 1152–1161 (2017). https://doi.org/10.1007/s00261-016-0988-0

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