Skip to main content
SpringerLink
Log in

Imaging of Bowel Ischemia

  • Dual Energy CT (S Nicolaou and M Patlas, Section Editors)
  • Published:
Current Radiology Reports Aims and scope Submit manuscript

Abstract

Acute bowel ischemia is a broad category of disease that includes acute mesenteric ischemia and acute colonic ischemia. These two entities differ in their pathogenesis but result in hypoxic injury that presents with nonspecific clinical findings and a wide range of imaging appearances. Multi-row detector computed tomography (CT) and computed tomography angiography (CTA) have supplanted conventional angiography as the test of choice for acute mesenteric ischemia. Routine portal venous CT is typically adequate for colonic ischemia as it is most commonly nonocclusive in etiology. Dual-energy computed tomography is a more recent advancement that can potentially offer improved conspicuity of differential bowel wall enhancement compared to conventional CT. Magnetic resonance angiography may be used as a secondary option to CTA in acute mesenteric ischemia in stable patients for whom iodinated contrast and ionizing radiation are a primary concern.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Acosta S. Epidemiology of mesenteric vascular disease: clinical implications. Semin Vasc Surg. 2010;23(1):4–8.

    Article  PubMed  Google Scholar 

  2. Ahmed R, Malas M. Mesenteric vascular insufficiency. In: Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J, editors. Harrison’s principles of internal medicine. 19th ed. New York: McGraw-Hill Eductaion; 2015.

    Google Scholar 

  3. Wiesner W, Khurana B, Ji H, Ros PR. CT of acute bowel ischemia. Radiology. 2003;226(3):635–50.

    Article  PubMed  Google Scholar 

  4. Shetty AS, Mellnick VM, Raptis C, Loch R, Owen J, Bhalla S. Limited utility of MRA for acute bowel ischemia after portal venous phase CT. Abdom Imaging. 2015;40(8):3020–8.

    Article  PubMed  Google Scholar 

  5. Brandt LJ, Feuerstadt P, Longstreth GF, Boley SJ, American College of Gastroenterology. ACG clinical guideline: epidemiology, risk factors, patterns of presentation, diagnosis, and management of colon ischemia (CI). Am J Gastroenterol. 2015;110(1):18–44.

    Article  PubMed  Google Scholar 

  6. • Cruz C, Abujudeh HH, Nazarian RM, Thrall JH. Ischemic colitis: spectrum of CT findings, sites of involvement and severity. Emerg Radiol. 2015;22(4):357–65. Ischemic colitis is typically nonocclusive, has a variety of imaging presentations, and can affect any segment of the colon.

  7. Longstreth GF, Yao JF. Epidemiology, clinical features, high-risk factors, and outcome of acute large bowel ischemia. Clin Gastroenterol Hepatol. 2009;7(10):1075–80.

    Article  PubMed  Google Scholar 

  8. Feuerstadt P, Brandt LJ. Update on colon ischemia: recent insights and advances. Curr Gastroenterol Rep. 2015;17(12):45.

    Article  PubMed  Google Scholar 

  9. Menke J. Diagnostic accuracy of multidetector CT in acute mesenteric ischemia: systematic review and meta-analysis. Radiology. 2010;256(1):93–101.

    Article  PubMed  Google Scholar 

  10. Wyers MC. Acute mesenteric ischemia: diagnostic approach and surgical treatment. Semin Vasc Surg. 2009;23(1):9–20.

    Article  Google Scholar 

  11. Kassahun WT, Schulz T, Richter O, Hauss J. Unchanged hight mortality rates from acute occlusive intestinal ischemia: six year review. Langenbecks Arch Surg. 2008;393:163–71.

    Article  PubMed  Google Scholar 

  12. Higgins PDR, Davis KJ, Laine L. Systematic review: the epidemiology of ischaemic colitis. Aliment Pharmacol Ther. 2004;19:729–38.

    Article  CAS  PubMed  Google Scholar 

  13. Brandt LJ, Feuerstadt P. Intestinal Ischemia. In: Feldman M, Friedman LS, Brandt LJ, editors. Sleisenger and Fordtran’s gastrointestinal and liver disease. 10th ed. Philadelphia: Saunders Elsevier; 2016.

    Google Scholar 

  14. Kärkkäinen JM, Saari P, Kettunen HP, et al. Interpretation of abdominal CT findings in patients who develop acute on chronic mesenteric ischemia. J Gastrointest Surg. 2016;20(4):791–802. doi:10.1007/s11605-015-3013-y.

    Article  PubMed  Google Scholar 

  15. Acosta S, Nilsson T. Current status on plasma biomarkers for acute mesenteric ischemia. J Thromb Thrombolysis. 2012;33(4):355–61.

    Article  CAS  PubMed  Google Scholar 

  16. Mosele M, Cardin F, Inelmen EM, et al. Ischemic colitis in the elderly: predictors of the disease and prognostic factors to negative outcome. Scand J Gastroenterol. 2010;45(4):428–33.

    Article  PubMed  Google Scholar 

  17. Demir IE, Ceyhan GO, Friess H. Beyond lactate: is there a role for serum lactate measurement in diagnosing acute mesenteric ischemia? Dig Surg. 2012;29(3):226–35.

    Article  CAS  PubMed  Google Scholar 

  18. Oliva IB, Davarpanah AH, Rybicki FJ, et al. (2013) ACR Appropriateness Criteria® Imaging of Mesenteric Ischemia. https://acsearch.acr.org/docs/70909/Narrative/. American College of Radiology. Accessed 21 Jan 2016.

  19. Kirkpatrick ID, Kroeker MA, Greenberg HM. Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia: initial experience. Radiology. 2003;229(1):91–8.

    Article  PubMed  Google Scholar 

  20. Wiesner W, Hauser A, Steinbrich W. Accuracy of multidetecor row computed tomography for the diagnosis of acute bowel ischemia in a non-selected study population. Eur Radiol. 2004;14(12):2347–56.

    Article  PubMed  Google Scholar 

  21. Aschoff AJ, Stuber G, Becker BW, et al. Evaluation of acute mesenteric ischemia: accuracy of biphasic mesenteric multi-detector CT angiography. Abdom Imaging. 2009;34(3):345–57.

    Article  CAS  PubMed  Google Scholar 

  22. Geffroy Y, Boulay-Coletta I, Jullès MC, Nakache S, Taourel P, Zins M. Increased unenhanced bowel-wall attenuation at multidetector CT is highly specific of ischemia complicating small-bowel obstruction. Radiology. 2014;270(1):159–67.

    Article  PubMed  Google Scholar 

  23. Schieda N, Fasih N, Shabana W. Triphasic CT in the diagnosis of acute mesenteric ischaemia. Eur Radiol. 2013;23(7):1891–900.

    Article  PubMed  Google Scholar 

  24. Horton KM, Fishman EK. Multidetector CT angiography in the diagnosis of mesenteric ischemia. Radiol Clin N Am. 2007;45(2):275–88.

    Article  PubMed  Google Scholar 

  25. Millet I, Taourel P, Ruyer A, Molinari N. Value of CT findings to predict surgical ischemia in small bowel obstruction: a systematic review and meta-analysis. Eur Radiol. 2015;25(6):1823–35.

    Article  PubMed  Google Scholar 

  26. Nakashima K, Ishimaru H, Fujimoto T, et al. Diagnostic performance of CT findings for bowel ischemia and necrosis in closed-loop small-bowel obstruction. Abdom Imaging. 2015;40(5):1097–103.

    Article  PubMed  Google Scholar 

  27. Balthazar EJ, George W. Holmes lecture. CT of small-bowel obstruction. Am J Roentgenol. 1994;162(2):255–61.

    Article  CAS  Google Scholar 

  28. Taourel PG, Deneuville M, Pradel JA, Régent D, Bruel JM. Acute mesenteric ischemia: diagnosis with contrast-enhanced CT. Radiology. 1996;199(3):632–6.

    Article  CAS  PubMed  Google Scholar 

  29. Ho LM, Paulson EK, Thompson WM. Pneumatosis intestinalis in the adult: benign to life-threatening causes. Am J Roentgenol. 2007;188:1604–13.

    Article  Google Scholar 

  30. Morris MS, Gee AC, Cho D, et al. Management and outcome of pneumatosis intestinalis. Am J Surg. 2008;195:679–83.

    Article  PubMed  Google Scholar 

  31. Lee HS, Cho YW, Kim KJ, Lee JS, Lee SS, Yang SK. A simple score for predicting mortality in patients with pneumatosis intestinalis. Eur J Radiol. 2014;84(4):639–45.

    Article  Google Scholar 

  32. • Bani Hani M, Kamangar F, Goldberg S, et al. Pneumatosis and portal venous gas: do CT findings reassure? J Surg Res. 2013;185(2):581–6. Patient age, physical exam, and laboratory values are the best predictors of whether pneumatosis and portal venous gas seen on CT represent bowel necrosis or have arisen from an alternative, less ominous condition.

  33. Hussain A, Mahmood H, El-Hasani S. Portal vein gas in emergency surgery. World J Emerg Surg. 2008;3:21–5.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Johnson TR. Dual-energy CT: general principles. Am J Roentgenol. 2012;199(5 Suppl):S3–8.

    Article  Google Scholar 

  35. Otrakji A, Digumarthy SR, Gullo RL, Flores EJ, Shepard JO, Kalra MK. Dual-energy CT: spectrum of thoracic abnormalities. Radiographics. 2016;36(1):38–52.

    Article  PubMed  Google Scholar 

  36. • Potretzke TA, Brace CL, Lubner MG, Sampson LA, Willey BJ, Lee FT Jr. Early small-bowel ischemia: dual-energy CT improves conspicuity compared with conventional CT in a swine model. Radiology. 2015;275(1):119–26. Dual energy CT may improve conspicuity of ischemic bowel compared to standard CT.

  37. Laissy JP, Trillaud H, Douek P. MR angiography: noninvasive vascular imaging of the abdomen. Abdom Imaging. 2002;27(5):488–506.

    Article  CAS  PubMed  Google Scholar 

  38. Carlos RC, Stanley JC, Stafford-Johnson D, Prince MR. Interobserver variability in the evaluation of chronic mesenteric ischemia with gadolinium-enhanced MR angiography. Acad Radiol. 2001;8(9):879–87.

    Article  CAS  PubMed  Google Scholar 

  39. Schaefer PJ, Pfarr J, Trentmann J, et al. Comparison of noninvasive imaging modalities for stenosis grading in mesenteric arteries. Rofo. 2013;185(7):628–34.

    Article  CAS  PubMed  Google Scholar 

  40. Meaney JF, Prince MR, Nostrant TT, Stanley JC. Gadolinium-enhanced MR angiography of visceral arteries in patients with suspected chronic mesenteric ischemia. J Magn Reson Imaging. 1997;7(1):171–6.

    Article  CAS  PubMed  Google Scholar 

  41. Edelman RR, Sheehan JJ, Dunkle E, Schindler N, Carr J, Koktzoglou I. Quiescent-interval single-shot unenhanced magnetic resonance angiography of peripheral vascular disease: technical considerations and clinical feasibility. Magn Reson Med. 2010;63(4):951–8.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Broder JS, Hamedani AG, Liu SW, Emerman CL. Emergency department contrast practices for abdominal/pelvic computed tomography-anational survey and comparison with e American college of radiology appropriateness criteria(®). J Emerg Med. 2013;44(2):423–33.

    Article  PubMed  Google Scholar 

  43. Hill BC, Johnson SC, Owens ED, Gerber JL, Senagore AJ. CT scan for suspected acute abdominal process: impact of combinations of IV, oral, and rectal contrast. World J Surg. 2010;34(4):699–703.

    Article  PubMed  Google Scholar 

  44. Plastaras L, Vuitton L, Badet N, Koch S, Di Martino V, Delabrousse E. Acute colitis: differential diagnosis using multidetector CT. Clin Radiol. 2015;70(3):262–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, Campus Box 8131, Saint Louis, MO, 63110, USA

    Andrew B. Wallace, Constantine A. Raptis & Vincent M. Mellnick

Authors
  1. Andrew B. Wallace
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Constantine A. Raptis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vincent M. Mellnick
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vincent M. Mellnick.

Ethics declarations

Conflict of Interest

Andrew B. Wallace, Constantine A. Raptis, and Vincent M. Mellnick each declare no potential conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Dual Energy CT.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wallace, A.B., Raptis, C.A. & Mellnick, V.M. Imaging of Bowel Ischemia. Curr Radiol Rep 4, 29 (2016). https://doi.org/10.1007/s40134-016-0158-8

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s40134-016-0158-8

Keywords

Search

Navigation