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What Is the Most Sensitive and Specific Imaging Study for the Detection of Acute Mesenteric Ischemia? Is MDCT the Gold Standard?

  • Courtney H. McKee
  • Sarah Ronan-BentleEmail author
Chapter

Abstract

Angiography has traditionally been considered the gold standard test for diagnosis of acute mesenteric ischemia (AMI). Angiography is not only diagnostic but allows for immediate therapeutic interventions to achieve revascularization. However, computed tomography angiography (CTA) has now replaced angiography as the first-line diagnostic test for AMI. CTA is accurate and has excellent sensitivity and specificity, approaching 100%. It is fast and nearly universally available. Multiple studies and expert guidelines cite CTA as the test of choice for the diagnosis of AMI in the emergency department. Magnetic resonance angiography (MRA) does have a role, but the delay in diagnosis and lack of universal availability make it a less favorable diagnostic tool when compared to CTA.

Keywords

Acute mesenteric ischemia Angiography Computed tomography angiography Magnetic resonance angiography Bowel ischemia Pneumatosis intestinalis 

References

  1. 1.
    Bradbury AW, Brittenden J, McBride K, Ruckley CV. Mesenteric ischaemia: a multidisciplinary approach. Br J Surg. 1995;82(11):1446–59.CrossRefGoogle Scholar
  2. 2.
    Kassahun W, Schulz T, Richter O, Hauss J. Unchanged high mortality rates from acute occlusive intestinal ischemia: six year review. Langenbeck's Arch Surg. 2008;393(2):163–71.CrossRefGoogle Scholar
  3. 3.
    Lock G. Acute intestinal ischaemia. Best Pract Res Clin Gastroenterol. 2001;15(1):83–98.CrossRefGoogle Scholar
  4. 4.
    Cangemi JR. Intestinal ischemia in the elderly. Gastroenterol Clin N Am. 2009;38(3):527–40.CrossRefGoogle Scholar
  5. 5.
    Acosta S, Wadman M, Syk I, Elmståhl S, Ekberg O. Epidemiology and prognostic factors in acute superior mesenteric artery occlusion. J Gastrointest Surg. 2010;14(4):628–35.CrossRefGoogle Scholar
  6. 6.
    Wyers MC. Acute mesenteric ischemia: diagnostic approach and surgical treatment. Semin Vasc Surg. 2010;23(1):9–20.CrossRefGoogle Scholar
  7. 7.
    Oliva I, Davarpanah A, Rybicki F, Desjardins B, Flamm S, Francois C, et al. ACR appropriateness criteria® imaging of mesenteric ischemia. Abdom Imaging. 2013;38(4):714–9.CrossRefGoogle Scholar
  8. 8.
    Aschoff A, Stuber G, Becker B, Hoffmann M, Schmitz B, Schelzig H, et al. Evaluation of acute mesenteric ischemia: accuracy of biphasic mesenteric multi-detector CT angiography. Abdom Imaging. 2009;34(3):345–57.CrossRefGoogle Scholar
  9. 9.
    Hagspiel K, Flors L, Hanley M, Norton P. Computed tomography angiography and magnetic resonance angiography imaging of the mesenteric vasculature. Tech Vasc Interv Radiol. 2015;18(1):2–13.CrossRefGoogle Scholar
  10. 10.
    Menke J. Diagnostic accuracy of multidetector CT in acute mesenteric ischemia: systematic review and meta-analysis. Radiology. 2010;256(1):93–101.CrossRefGoogle Scholar
  11. 11.
    Kirkpatrick I, Kroeker M, Greenberg H. Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia: initial experience. Radiology. 2003;229(1):91–8.CrossRefGoogle Scholar
  12. 12.
    Bala M, Kashuk J, Moore E, Kluger Y, Biffl W, Gomes C, et al. Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. World J Emerg Surg. 2017;12(38).  https://doi.org/10.1186/s13017-017-0150-5
  13. 13.
    Gaa J, Laub G, Edelman RR, Georgi M. First clinical results of ultrafast, contrast-enhanced 2-phase 3D-angiography of the abdomen. Röfo. 1998;169(2):135–9.PubMedGoogle Scholar
  14. 14.
    Gilfeather M, Holland GA, Siegelman ES, et al. Gadolinium-enhanced ultrafast three-dimensional spoiled gradient-echo MR imaging of the abdominal aorta and visceral and iliac vessels. Radiographics. 1997;17(2):423–32.CrossRefGoogle Scholar
  15. 15.
    Holland GA, Dougherty L, Carpenter JP, et al. Breath-hold ultrafast three-dimensional gadolinium-enhanced MR angiography of the aorta and the renal and other visceral abdominal arteries. AJR Am J Roentgenol. 1996;166(4):971–81.CrossRefGoogle Scholar
  16. 16.
    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.CrossRefGoogle Scholar
  17. 17.
    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.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.University of Cincinnati College of Medicine, Department of Emergency MedicineCincinnatiUSA

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