Detecting acute mesenteric ischemia in CT of the acute abdomen is dependent on clinical suspicion: Review of 95 consecutive patients
Abstract
Objectives (1) To evaluate the ability of emergency room radiologists to detect acute mesenteric ischemia (AMI) from computed tomography (CT) images in patients with acute abdominal pain. (2) To identify factors affecting radiologists' performance in the CT interpretation and patient outcome.Materials and methods A retrospective study of 95 consecutive patients treated for 97 AMI events between 2009 and 2013 was carried out. The etiology of AMI was embolism in 24 (25%), atherosclerotic vascular disease (ASVD) in 39 (40%), non-obstructive mesenteric ischemia (NOMI) in 25 (26%), and mesenteric venous thrombosis (MVT) in nine (9%) cases. The protocols, referrals and initial radiology reports of the abdominal CTs were analyzed. The CT studies were further scrutinized for vascular and intestinal findings.Results The referring clinician had suspected AMI in 30 (31%) cases prior to imaging. The crucial findings of AMI had been stated in 97% of the radiology reports if the clinician had mentioned AMI suspicion in the referral; if not, the corresponding rate was 81% (p=0.04). Patients without suspicion of AMI prior to CT were more prone to undergo bowel resection. CT protocol was optimal for AMI (with contrast enhancement in arterial and venous phases) in only 34 (35%) cases. Intestinal findings were more difficult to detect than vascular findings. Vascular findings were retrospectively detectable in 92% of cases with embolism and 100% in ASVD and MVT. Some evidence of intestinal abnormality was retrospectively found in the CT findings in 92%, 100%, 100% and 67% of cases with embolism, ASVD, NOMI and MVT, respectively.Conclusions AMI is underdiagnosed in the CT of the acute abdomen if there is no clinical suspicion.
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In a previous study, an optimal CT-protocol was used only in 35% of cases.
“in a previous study, an optimal CT-protocol was used only in 35% of cases [24].”
From Incidence, diagnosis, management and outcome of acute mesenteric ischaemia: a prospective, multicentre observational study (AMESI Study) (2024) · cites this paper as [24]
An important factor in avoiding delay in diagnosis in this study was when a suspicion of AMI was mentioned in referral requests to radiology.
“An important factor in avoiding delay in diagnosis in this study was when a suspicion of AMI was mentioned in referral requests to radiology, as also suggested by previous observations [17, 24].”
From Incidence, diagnosis, management and outcome of acute mesenteric ischaemia: a prospective, multicentre observational study (AMESI Study) (2024) · cites this paper as [24]
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”
When clinical suspicion of AMI is not evoked, it may be underdiagnosed on CT scans of the abdomen due to inappropriate IV contrast protocol and/or analysis not focusing on mesenteric vessels.
“In addition, when clinical suspicion of AMI is not evoked, it may be underdiagnosed on computed tomography (CT) scans of the abdomen as a result of either an inappropriate IV contrast protocol and/or an analysis that does not focus on the mesenteric vessels [14, 15].”
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 [14]
The discriminative weight of epidemiological and biological factors was insufficient.
“As the discriminative weight of epidemiological and biological factors was insufficient, we suggest the diagnosis be evoked irrespective of the patients’ age, prior cardiovascular history, or laboratory values (such as CRP or l-lactate levels) [14].”
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 [14]
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 [14]
The likelihood of a correct AMI diagnosis is higher if suspicion of AMI is mentioned in the referral to the radiologist.
“Importantly, however, scanning in both arterial and venous phases is necessary to exclude AMI and the likelihood of a correct AMI diagnosis is higher if suspicion of AMI is mentioned in the referral to the radiologist [18].”
From Management of acute mesenteric ischaemia: Results of a worldwide survey (2023) · cites this paper as [18]
Scanning in both arterial and venous phases is necessary to exclude AMI.
“Importantly, however, scanning in both arterial and venous phases is necessary to exclude AMI and the likelihood of a correct AMI diagnosis is higher if suspicion of AMI is mentioned in the referral to the radiologist [18].”
From Management of acute mesenteric ischaemia: Results of a worldwide survey (2023) · cites this paper as [18]
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- Authors
- Lehtimäki, T. T., Kärkkäinen, J. M., Saari, P., Manninen, H., Paajanen, H., & Vanninen, R.
- Affiliations
- Kuopio University Hospital (FI)
- University of Eastern Finland (FI)
- Corresponding author
- Lehtimäki, Tiina T.
- Kärkkäinen, Jussi M.
- Saari, Petri
- Manninen, Hannu
- Paajanen, Hannu
- Vanninen, Ritva
- Venue
- European Journal of Radiology
- Publisher
- Elsevier BV
- Published
- 2015-12
- Volume
- 84
- Issue
- 12
- Pages
- 2444-2453
- ISSN
- 0720-048X (ISSN-L)
- OpenAlex
- W1832028652
- Cited by
- 104
- References
- 26
- Citations by year
- 2026: 3 · 2025: 12 · 2024: 9 · 2023: 12 · 2022: 11 · 2021: 10 · 2020: 16 · 2019: 6 · 2018: 10 · 2017: 11 · 2016: 4
- FWCI
- 8.38
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Radiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Kuopion Yliopistollinen Sairaala
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
- Health Sciences › Medicine › Rheumatology › Omental and Epiploic Conditions
- Keywords
- acute mesenteric ischemia, acute abdomen, clinical suspicion, CT detection, radiology reports, mesenteric embolism, atherosclerosis, mesenteric vein thrombosis, bowel resection, CT protocols
- MeSH terms
- Abdomen, Acute, Acute Disease, Aged, Aged, 80 and over, Female, Humans, Intestines, Male, Middle Aged, Retrospective Studies, Tomography, X-Ray Computed, Reproducibility of Results, Mesenteric Ischemia
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