Interpretation of Abdominal CT Findings in Patients Who Develop Acute on Chronic Mesenteric Ischemia
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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While embolism used to be the most common cause of SMA occlusion, there is a shift towards atherosclerotic or thrombotic arterial occlusion in more recent studies.
“While embolism used to be the most common cause of SMA occlusion, there is a shift towards atherosclerotic or thrombotic arterial occlusion in more recent studies.”
AMI may develop on chronic stenosis of the mesenteric arteries, in which case both the CA and SMA are affected by atherosclerotic disease; this condition is referred to as acute on chronic mesenteric ischaemia.
“Moreover, AMI may develop on chronic stenosis of the mesenteric arteries, in which case both the CA and SMA are affected by atherosclerotic disease. This condition is referred to as acute on chronic mesenteric ischaemia.”
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- Authors
- Kärkkäinen, J. M., Saari, P., Kettunen, H.-P., Lehtimäki, T. T., Vanninen, R., Paajanen, H., & Manninen, H.
- Affiliations
- Kuopio University Hospital (FI)
- University of Eastern Finland (FI)
- Corresponding author
- Kärkkäinen, Jussi M.
- Venue
- Journal of Gastrointestinal Surgery
- Publisher
- Elsevier BV
- Published
- 2016-04
- Volume
- 20
- Issue
- 4
- Pages
- 791-802
- ISSN
- 1091-255X (ISSN-L)
- OpenAlex
- W2190682986
- Cited by
- 40
- References
- 1
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 3 · 2023: 3 · 2022: 3 · 2021: 4 · 2020: 8 · 2019: 2 · 2018: 5 · 2017: 2 · 2016: 5
- FWCI
- 4.04
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Gastrointestinal Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Thrombus and Embolism
- Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
- Keywords
- chronic mesenteric ischemia, contrast-enhanced CT findings, bowel wall enhancement, pneumatosis intestinalis, mesenteric thrombosis, mesenteric fat stranding, bowel dilatation, bowel wall thickening, interobserver agreement, intestinal ischemia
- MeSH terms
- Acute Disease, Aged, Aged, 80 and over, Angiography, Chronic Disease, Female, Humans, Intestines, Male, Pneumatosis Cystoides Intestinalis, Retrospective Studies, Thrombosis, Tomography, X-Ray Computed, Observer Variation, Mesenteric Artery, Superior, Atherosclerosis, Mesenteric Ischemia
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