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Interpretation of Abdominal CT Findings in Patients Who Develop Acute on Chronic Mesenteric Ischemia

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

We studied whether ischemia-specific computed tomography (CT) findings are consistently detectable in patients who develop acute on chronic mesenteric ischemia (AOCMI), whereas absent in chronic mesenteric ischemia (CMI).

Methods

Consecutive patients with symptomatic angiography-verified atherosclerotic obstruction of the superior mesenteric artery (SMA) were categorized as AOCMI (n = 27) or CMI (n = 20). Three experienced radiologists blindly evaluated the contrast-enhanced CTs for vascular and intestinal findings. Kappa statistics was used to test interobserver agreement.

Results

Two observers had substantial agreement (k = 0.66) that two thirds of AOCMI patients showed ischemia-specific CT findings (decreased bowel wall enhancement, pneumatosis, or thrombotic SMA clot); the third observer agreed only fairly regarding pneumatosis and thrombosis (k = 0.3–0.4). All observers had substantial agreement (k = 0.65–0.71) that most patients with AOCMI had unspecific intestinal findings such as mesenteric fat stranding in up to 96 %, bowel lumen dilatation in 93 %, and bowel wall thickening in 70 %, while only few patients with CMI had such findings (due to chronic ischemic colitis) (P < 0.001).

Conclusion

One third of AOCMI patients presented without any ischemia-specific CT signs. However, any intestinal abnormality in CT together with SMA obstruction should raise suspicion of intestinal ischemia. Furthermore, clinicians need to be aware of the interobserver variability in the CT interpretation.

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Authors and Affiliations

  1. Heart Center, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland

    Jussi M. Kärkkäinen

  2. Department of Gastrointestinal Surgery, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland

    Jussi M. Kärkkäinen & Hannu Paajanen

  3. Department of Clinical Radiology, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland

    Petri Saari, Hannu-Pekka Kettunen, Tiina T. Lehtimäki, Ritva Vanninen & Hannu Manninen

  4. University of Eastern Finland, Kuopio, Finland

    Tiina T. Lehtimäki, Ritva Vanninen, Hannu Paajanen & Hannu Manninen

Authors
  1. Jussi M. Kärkkäinen
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  2. Petri Saari
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  3. Hannu-Pekka Kettunen
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  4. Tiina T. Lehtimäki
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  5. Ritva Vanninen
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  6. Hannu Paajanen
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  7. Hannu Manninen
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Corresponding author

Correspondence to Jussi M. Kärkkäinen.

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Disclosure

Dr. Kärkkäinen has received a grant from State Research Funding of Kuopio University Hospital with no potential conflict of interest regarding the current study. Dr. Lehtimäki has received grants from Instru Foundation and State Research Funding of Kuopio University Hospital with no potential conflict of interest regarding the current study. The other authors declare no conflict of interest.

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Kärkkäinen, J.M., Saari, P., Kettunen, HP. et al. Interpretation of Abdominal CT Findings in Patients Who Develop Acute on Chronic Mesenteric Ischemia. J Gastrointest Surg 20, 791–802 (2016). https://doi.org/10.1007/s11605-015-3013-y

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  • DOI: https://doi.org/10.1007/s11605-015-3013-y

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