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Triphasic CT in the diagnosis of acute mesenteric ischaemia

European Radiology volume 23, pages 1891–1900 (2013)Cite this article

Abstract

Objective

To evaluate the yield of each phase in a triphasic CT protocol used to diagnose acute mesenteric ischaemia (AMI).

Methods

Retrospective analysis of patients who underwent CT to exclude AMI was conducted. From 218 patients, 80 were randomly selected for analysis: 39 with proven AMI; 41 controls. Three readers evaluated the studies; two readers were provided with only portions of the examination to determine the yield of unenhanced CT (NECT) and CT angiography (CTA). The diagnostic accuracy of CT findings was calculated and compared between readers.

Results

The sensitivity and specificity of submucosal haemorrhage were 10 % and 98 %. Interobserver variability was poor (κ = 0.17). All true-positive cases had other CT findings of AMI (n = 4). There was no difference in the assessment of bowel enhancement between readers (P < 0.05). There was no difference between readers (P < 0.05) and interobserver variability was moderate to good when diagnosing arterial abnormalities without CTA. Sample size was small and errors occurred when using only the portal venous phase for this purpose.

Conclusion

NECT is not required for diagnosis of AMI. Splanchnic arterial abnormalities can be diagnosed without CTA although errors occur when using only the portal venous phase for this purpose.

Key points

• Triphasic CT is the current gold standard for diagnosing acute mesenteric ischaemia.

• Multiphase CT multiplies the radiation dose when compared to single phase CT.

• Each phase in a multiphase CT examination should be independently validated.

• Unenhanced CT is not required for diagnosis of acute mesenteric ischaemia.

• CT angiography should be performed for diagnosis of acute mesenteric ischaemia.

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Abbreviations

AMI:

Acute mesenteric ischaemia

NECT:

Unenhanced or non-enhanced CT

CTA:

CT angiography

PVP:

Portal venous phase

SMA:

Superior mesenteric artery

IMA:

Inferior mesenteric artery

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Authors and Affiliations

  1. The Ottawa Hospital, The University of Ottawa, 1053 Carling Avenue, Ottawa, Ontario, Canada, K1Y 4E9

    Nicola Schieda

  2. Department of Radiology, Civic Campus C1, The Ottawa Hospital, The University of Ottawa, 1053 Carling Avenue, Ottawa, Ontario, Canada, K1Y 4E9

    Najla Fasih & Wael Shabana

Authors
  1. Nicola Schieda
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  2. Najla Fasih
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  3. Wael Shabana
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Correspondence to Nicola Schieda.

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Schieda, N., Fasih, N. & Shabana, W. Triphasic CT in the diagnosis of acute mesenteric ischaemia. Eur Radiol 23, 1891–1900 (2013). https://doi.org/10.1007/s00330-013-2797-y

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  • DOI: https://doi.org/10.1007/s00330-013-2797-y

Keywords

  • Computed tomography
  • Mesenteric ischaemia
  • Submucosal haemorrhage
  • Bowel enhancement
  • Radiation dose