Impact of MDCT with intravenous contrast on the survival in patients with acute superior mesenteric artery occlusion
Abstract
Acute thromboembolic occlusion in the superior mesenteric artery (SMA) is a condition with high mortality and morbidity. Multi-detector computerised tomography with intravenous contrast enhancement (MDCTiv) may improve diagnostic accuracy and survival. Patients with acute SMA occlusion were identified between 2004 and 2008 at Malmö University Hospital, Sweden. Medical records were analysed. Each MDCTiv was re-evaluated. A total of 67 patients were identified with SMA occlusion, of which 36 were examined with MDCTiv and ten with plain MDCT without intravenous contrast. In all, 24 (67%) of the 36 patients were correctly diagnosed by MDCTiv at first evaluation. Clinical suspicion of intestinal ischemia followed by a distinct inquiry for intestinal ischemia was associated with trend for a higher rate of correct radiological diagnosis, 18 of 23 (78%), at first evaluation (0.06) but without affecting in-hospital survival (p = 0.27). At re-evaluation, SMA occlusion was found in all cases with MDCTiv, whereas intestinal findings were present in half. In-hospital mortality rate was 42% for patients who underwent MDCTiv, which was significantly lower compared to 90% for the ten patients examined with plain MDCT (p = 0.007) and 71% for patients not examined with MDCTiv or plain MDCT (p = 0.031). Patients that underwent plain MDCT had higher levels of creatinine compared to those examined with MDCTiv (p = 0.005). Patients who underwent intestinal revascularisation, endovascular or open, had higher survival rate (p = 0.001). Examination with MDCTiv in patients with acute SMA occlusion was associated with survival benefit. Hence, MDCTiv seems to be the method of choice in the workup phase. Radiologists should routinely describe the mesenteric vessels in patients with acute abdomen even when the diagnosis is not asked for. Patients with high creatinine levels are at risk to be examined without intravenous contrast, and survival in these patients is poor.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
If no clinical suspicion of AMI is raised in the information provided to the radiologist, the condition is highly likely to be underdiagnosed.
“If no clinical suspicion of AMI is raised in the information provided to the radiologist, the condition is highly likely to be underdiagnosed. 134,139”
Synchronous emboli to other visceral, limb, or cerebral arteries is a common finding in acute embolic SMA occlusion.
“Synchronous emboli to other visceral, limb, or cerebral arteries is a common finding. 139”
Lower sensitivity of CT scans has been observed in real-life clinical settings when the CT-scan protocol does not include both arterial and venous phases.
“Furthermore, lower sensitivity of CT scans has been observed in real-life clinical settings when the CT-scan protocol does not include both arterial and venous phases [14, 33, 34].”
From Improving clinical suspicion of acute mesenteric ischemia among patients with acute abdomen: A cross-sectional study from an intestinal stroke center (2023) · cites this paper as [34]
Cites
Acute Mesenteric Ischemia: A Clinical Review
Oldenburg, W. A., Lau, L. L., Rodenberg, T. J., Edmonds, H. J., & Burger, C. D. (2004) · Archives of Internal Medicine · doi:10.1001/archinte.164.10.1054 · Cited by 714 · see citing works
Systematic review of survival after acute mesenteric ischaemia according to disease aetiology
Schoots, I. G., Koffeman, G. I., Legemate, D. A., Levi, M., & van Gulik, T. M. (2004) · Journal of British Surgery · doi:10.1002/bjs.4459 · Cited by 502 · see citing works
Mesenteric ischaemia: A multidisciplinary approach
Bradbury, A. W., Brittenden, J., McBride, K., & Ruckley, C. V. (1995) · Journal of British Surgery · doi:10.1002/bjs.1800821105 · Cited by 239 · see citing works
Aschoff, A. J., Stuber, G., Becker, B. W., Hoffmann, M. H. K., Schmitz, B. L., Schelzig, H., & Jaeckle, T. (2009) · Abdominal Imaging · doi:10.1007/s00261-008-9392-8 · Cited by 223 · see citing works
Acosta, S., Ögren, M., Sternby, N.-H., Bergqvist, D., & Björck, M. (2005) · Annals of Surgery · doi:10.1097/01.sla.0000154269.52294.57 · Cited by 162 · see citing works
Self-citationRoobottom, C. A., & Dubbins, P. A. (1993) · American Journal of Roentgenology · doi:10.2214/ajr.161.5.8273642 · Cited by 161 · see citing works
Failure to improve outcome in acute mesenteric ischaemia: seven-year review
Mamode, I. P. (1999) · The European Journal of Surgery · doi:10.1080/110241599750007054 · Cited by 154 · see citing works
Superior Mesenteric Artery Embolism: Eighty-Two Cases
Batellier, J., & Kiény, R. (1990) · Annals of Vascular Surgery · doi:10.1007/bf02001363 · Cited by 127 · see citing works
Acosta, S., Ögren, M., Sternby, N.-H., Bergqvist, D., & Björck, M. (2004) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2003.11.003 · Cited by 126 · see citing works
Self-citationEndovascular Therapeutic Approaches for Acute Superior Mesenteric Artery Occlusion
Acosta, S., Sonesson, B., & Resch, T. A. (2009) · CardioVascular and Interventional Radiology · doi:10.1007/s00270-009-9559-x · Cited by 106 · see citing works
Self-citationSurvival after Operations for Ischaemic Bowel Disease
Wadman, M. (2000) · The European Journal of Surgery · doi:10.1080/110241500447263 · Cited by 78 · see citing works
Self-citation(1994) · PubMed · Cited by 58 · see citing works
Mesenteric Ischemia: Still a Deadly Puzzle for the Medical Community
Stamatakos, M., Stefanaki, C., Mastrokalos, D. S., Arampatzi, H., Safioleas, P., Chatziconstantinou, C., Xiromeritis, C., & Safioleas, M. C. (2008) · The Tohoku Journal of Experimental Medicine · doi:10.1620/tjem.216.197 · Cited by 44 · see citing works
Zangos, S., Steenburg, S. D., Phillips, K., et al. (2006) · Academic Radiology · doi:10.1016/j.acra.2006.09.050 · Cited by 39 · see citing works
Debus, E. S., Diener, H., & Larena-Avellaneda, A. A. (2009) · Der Chirurg · doi:10.1007/s00104-009-1699-7 · Cited by 39 · see citing works
[Prognostic factors in mesenteric infarct].
Jp, R., Runkel, N. S. F., Berger, G., et al. (1997) · PubMed · Cited by 28 · see citing works
[Diagnosis and prognosis of mesenterial infarct].
Jonas, J., & Böttger, T. (1994) · PubMed · Cited by 17 · see citing works
Wadman, M., Syk, I., & Elmståhl, S. (2004) · Aging Clinical and Experimental Research · doi:10.1007/bf03327384 · Cited by 4 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Editor's Choice – Management of the Diseases of Mesenteric Arteries and Veins
Björck, M., Koelemay, M., Acosta, S., Bastos Goncalves, F., Kölbel, T., Kolkman, J. J., Lees, T., Lefevre, J. H., Menyhei, G., Oderich, G., et al. (2017) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2017.01.010 · Cited by 658 · see citing works
Self-citationACR appropriateness criteria® imaging of mesenteric ischemia
Oliva, I. B., Davarpanah, A. H., Rybicki, F. J., Desjardins, B., Flamm, S. D., Francois, C. J., Gerhard-Herman, M. D., Kalva, S. P., Ashraf Mansour, M., Mohler, E. R., et al. (2013) · Abdominal Imaging · doi:10.1007/s00261-012-9975-2 · Cited by 200 · see citing works
Acute mesenteric ischemia (part I) – Incidence, etiologies, and how to improve early diagnosis
Kärkkäinen, J. M., & Acosta, S. (2017) · Best Practice & Research Clinical Gastroenterology · doi:10.1016/j.bpg.2016.10.018 · Cited by 172 · see citing works
Self-citationEndovascular and open surgery for acute occlusion of the superior mesenteric artery
Block, T. A., Acosta, S., & Björck, M. (2010) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2010.05.084 · Cited by 150 · see citing works
Self-citationAcute Mesenteric Ischemia Is a More Common Cause than Expected of Acute Abdomen in the Elderly
Kärkkäinen, J. M., Lehtimäki, T. T., Manninen, H., & Paajanen, H. (2015) · Journal of Gastrointestinal Surgery · doi:10.1007/s11605-015-2830-3 · Cited by 150 · see citing works
Incidence and outcomes of acute mesenteric ischaemia: a systematic review and meta-analysis
Tamme, K., Reintam Blaser, A., Laisaar, K.-T., Mändul, M., Kals, J., Forbes, A., Kiss, O., Acosta, S., Bjørck, M., & Starkopf, J. (2022) · BMJ Open · doi:10.1136/bmjopen-2022-062846 · Cited by 112 · see citing works
Self-citationAcosta, S. (2015) · Current Opinion in Critical Care · doi:10.1097/mcc.0000000000000189 · Cited by 111 · see citing works
Self-citationKoelemay, M. J., Geelkerken, R. H., Kärkkäinen, J., Leone, N., Antoniou, G. A., de Bruin, J. L., Gombert, A., Gottsätter, A., Iborra, E., Ronchey, S., et al. (2025) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2025.06.010 · Cited by 123 · see citing works
Lehtimäki, T. T., Kärkkäinen, J. M., Saari, P., Manninen, H., Paajanen, H., & Vanninen, R. (2015) · European Journal of Radiology · doi:10.1016/j.ejrad.2015.09.006 · Cited by 104 · see citing works
ACR appropriateness criteria® imaging of mesenteric ischemia
Ginsburg, M., Obara, P., Lambert, D. L., Hanley, M., Steigner, M. L., Camacho, M. A., Chandra, A., Chang, K. J., Gage, K. L., Peterson, C. M., et al. (2018) · Journal of the American College of Radiology · doi:10.1016/j.jacr.2018.09.018 · Cited by 99 · see citing works
Mesenteric ischemia: What the radiologist needs to know
Olson, M. C., Fletcher, J. G., Nagpal, P., Froemming, A. T., & Khandelwal, A. (2019) · Cardiovascular Diagnosis and Therapy · doi:10.21037/cdt.2018.09.06 · Cited by 83 · see citing works
Acute mesenteric ischemia: A critical role for the radiologist
Copin, P., Zins, M., Nuzzo, A., Purcell, Y., Beranger-Gibert, S., Maggiori, L., Corcos, O., Vilgrain, V., & Ronot, M. (2018) · Diagnostic and Interventional Imaging · doi:10.1016/j.diii.2018.01.004 · Cited by 73 · see citing works
Diagnostic pitfalls at admission in patients with acute superior mesenteric artery occlusion
Acosta, S., Block, T., Björnsson, S., Resch, T., Björck, M., & Nilsson, T. (2012) · The Journal of Emergency Medicine · doi:10.1016/j.jemermed.2011.03.036 · Cited by 65 · see citing works
Self-citationContrast-Enhanced CT for the Diagnosis of Acute Mesenteric Ischemia
Garzelli, L., Nuzzo, A., Copin, P., Calame, P., Corcos, O., Vilgrain, V., & Ronot, M. (2020) · American Journal of Roentgenology · doi:10.2214/ajr.19.22625 · Cited by 64 · see citing works
Symptomatic Mesenteric Atherosclerotic Disease—Lessons Learned from the Diagnostic Workup
Björnsson, S., Resch, T., & Acosta, S. (2013) · Journal of Gastrointestinal Surgery · doi:10.1007/s11605-013-2139-z · Cited by 65 · see citing works
Self-citationEpidemiology of Acute Mesenteric Ischemia: A Population-Based Investigation
Kase, K., Reintam Blaser, A., Tamme, K., Mändul, M., Forbes, A., Talving, P., & Murruste, M. (2023) · World Journal of Surgery · doi:10.1007/s00268-022-06805-5 · Cited by 56 · see citing works
Normal Lactate and Unenhanced CT-Scan Result in Delayed Diagnosis of Acute Mesenteric Ischemia
Nuzzo, A., Joly, F., Ronot, M., Castier, Y., Huguet, A., Paugam-Burtz, C., Cazals-Hatem, D., Tran-Dinh, A., Becq, A., Panis, Y., et al. (2020) · American Journal of Gastroenterology · doi:10.14309/ajg.0000000000000836 · Cited by 28 · see citing works
Acute mesenteric ischemia in elderly patients
Kärkkäinen, J. M. (2016) · Expert Review of Gastroenterology & Hepatology · doi:10.1080/17474124.2016.1212657 · Cited by 28 · see citing works
Nuzzo, A., Peoc’h, K., Vaittinada Ayar, P., Tran-Dinh, A., Weiss, E., Panis, Y., Ronot, M., Garzelli, L., Eloy, P., Ben Abdallah, I., et al. (2023) · World Journal of Emergency Surgery · doi:10.1186/s13017-023-00505-8 · Cited by 22 · see citing works
- Authors
- Wadman, M., Block, T., Ekberg, O., Syk, I., Elmståhl, S., & Acosta, S.
- Affiliations
- Lund University (SE)
- Uppsala University (SE)
- Skåne University Hospital (SE)
- Corresponding author
- Wadman, Maria
- Venue
- Emergency Radiology
- Published
- 2009-08-06
- Volume
- 17
- Issue
- 3
- Pages
- 171-178
- ISSN
- 1070-3004 (ISSN-L)
- 1438-1435
- OpenAlex
- W2127580273
- Cited by
- 52
- References
- 18
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 2 · 2023: 6 · 2022: 4 · 2021: 1 · 2020: 3 · 2019: 3 · 2018: 3 · 2017: 3 · 2016: 2 · 2015: 6 · 2014: 3 · 2013: 3 · 2012: 3
- FWCI
- 3.03
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Emergency Radiology (publishedVersion)
- PubMed (publishedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Thrombus and Embolism
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Keywords
- superior mesenteric artery occlusion, acute mesenteric ischemia, multidetector computed tomography, intravenous contrast enhancement, in-hospital mortality, intestinal ischemia, intestinal revascularization, endovascular treatment, creatinine, acute abdomen, diagnostic accuracy
- MeSH terms
- Aged, Aged, 80 and over, Contrast Media, Female, Humans, Injections, Intravenous, Male, Mesenteric Vascular Occlusion, Middle Aged, Tomography, X-Ray Computed, Survival Analysis, Mesenteric Artery, Superior
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
