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Triphasic CT in the diagnosis of acute mesenteric ischaemia



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.

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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Acute mesenteric ischaemia


Unenhanced or non-enhanced CT


CT angiography


Portal venous phase


Superior mesenteric artery


Inferior mesenteric artery


  1. Burns BJ, Brandt LJ (2003) Intestinal ischemia. Gastroenterol Clin N Am 32:1127–1143

    Article  Google Scholar 

  2. Oldenburg W, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD (2004) Acute mesenteric ischemia, a clinical review. Arch Intern Med 164:1054–1061

    Article  PubMed  Google Scholar 

  3. Herbert GS, Steele SR (2007) Acute and chronic mesenteric ischemia. Surg Clin N Am 87:1115–1134

    Article  PubMed  Google Scholar 

  4. 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

    Article  PubMed  Google Scholar 

  5. Wiesner W, Khurana B, Ji H, Ros PR (2003) CT of acute bowel ischemia. Radiology 226:635–650

    Article  PubMed  Google Scholar 

  6. Horton KM, Fishman EK (2001) Multi-detector row CT of mesenteric ischemia: can it be done? Radiographics 21:1463–1473

    PubMed  CAS  Google Scholar 

  7. Kirkpatrick ID, Kroeker MA, Greenberg HM (2003) Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia: initial experience. Radiology 229:91–98

    Article  PubMed  Google Scholar 

  8. Wiesner W, Hauser A, Steinbrich W (2004) Accuracy of multidetector row computed tomography in a non-selected study population. Eur Radiol 14:2347–2356

    Article  PubMed  Google Scholar 

  9. 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

    Article  Google Scholar 

  10. Taourel PG, Deneuville M, Pradel JA, Regent D, Bruel JM (1996) Acute mesenteric ischemia: diagnosis with contrast-enhanced CT. Radiology 199:632–636

    PubMed  CAS  Google Scholar 

  11. Macari M, Chandarana H, Balthazar E, Babb J (2003) Intestinal ischemia versus intramural haemorrhage: CT evaluation. AJR Am J Roentgenol 180:177–184

    Article  PubMed  Google Scholar 

  12. Bartnicke BJ, Balfe DM (1994) CT appearance of intestinal ischemia and intramural haemorrhage. Radiol Clin N Am 5:845–860

    Google Scholar 

  13. Balthazar EJ, Hulnick D, Megibow AJ, Opulencia JF (1987) Computed tomography of intramural haemorrhage and bowel ischemia. J Comput Assist Tomogr 2:67–71

    Article  Google Scholar 

  14. 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

    PubMed  Google Scholar 

  15. Brenner DJ, Hall EJ (2007) Computed tomography—an increasing source of radiation exposure. N Engl J Med 357:2277–2284

    Article  PubMed  CAS  Google Scholar 

  16. 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

    Article  PubMed  Google Scholar 

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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).

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