To evaluate the yield of each phase in a triphasic CT protocol used to diagnose acute mesenteric ischaemia (AMI).
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.
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.
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.
• 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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Acute mesenteric ischaemia
Unenhanced or non-enhanced CT
Portal venous phase
Superior mesenteric artery
Inferior mesenteric artery
Burns BJ, Brandt LJ (2003) Intestinal ischemia. Gastroenterol Clin N Am 32:1127–1143
Oldenburg W, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD (2004) Acute mesenteric ischemia, a clinical review. Arch Intern Med 164:1054–1061
Herbert GS, Steele SR (2007) Acute and chronic mesenteric ischemia. Surg Clin N Am 87:1115–1134
Gore RM, Yaghmai V, Thakrar KH, Berlin JW, Mehta UK, Newmark GM, Miller FH (2008) Imaging in intestinal ischemic disorders. Radiol Clin N Am 46:845–875
Wiesner W, Khurana B, Ji H, Ros PR (2003) CT of acute bowel ischemia. Radiology 226:635–650
Horton KM, Fishman EK (2001) Multi-detector row CT of mesenteric ischemia: can it be done? Radiographics 21:1463–1473
Kirkpatrick ID, Kroeker MA, Greenberg HM (2003) Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia: initial experience. Radiology 229:91–98
Wiesner W, Hauser A, Steinbrich W (2004) Accuracy of multidetector row computed tomography in a non-selected study population. Eur Radiol 14:2347–2356
Aschoff AJ, Stuber G, Becker BW, Hoffmann HK, Schmitz BL, Schelzig H, Jaeckle T (2009) Evaluation of acute mesenteric ischemia: accuracy of biphasic mesenteric multi-detector CT angiography. Abdom Imaging 10:345–357
Taourel PG, Deneuville M, Pradel JA, Regent D, Bruel JM (1996) Acute mesenteric ischemia: diagnosis with contrast-enhanced CT. Radiology 199:632–636
Macari M, Chandarana H, Balthazar E, Babb J (2003) Intestinal ischemia versus intramural haemorrhage: CT evaluation. AJR Am J Roentgenol 180:177–184
Bartnicke BJ, Balfe DM (1994) CT appearance of intestinal ischemia and intramural haemorrhage. Radiol Clin N Am 5:845–860
Balthazar EJ, Hulnick D, Megibow AJ, Opulencia JF (1987) Computed tomography of intramural haemorrhage and bowel ischemia. J Comput Assist Tomogr 2:67–71
Guite KM, Hinshaw JL, Ranallo FN et al (2011) Ionizing radiation in abdominal CT: unindicated multiphase scans are an important source of medically unnecessary exposure. JACR 8:756–761
Brenner DJ, Hall EJ (2007) Computed tomography—an increasing source of radiation exposure. N Engl J Med 357:2277–2284
Ofer A, Abadi S, Nitecki S, Karram T, Kogan I, Leiderman M, Shmulevsky P, Israelit S, Engel A (2009) Multidetector CT angiography in the evaluation of acute mesenteric ischemia. Eur Radiol 19:24–30
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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
- Computed tomography
- Mesenteric ischaemia
- Submucosal haemorrhage
- Bowel enhancement
- Radiation dose