Influence of clinical suspicion on CT accuracy of acute mesenteric ischemia: Retrospective study of 362 patients
Abstract
Purpose Acute mesenteric ischemia (AMI) may be underdiagnosed when not clinically suspected before CT is performed. We assessed the influence of a clinical suspicion of AMI on the CT accuracy.Method This retrospective single-centre study included patients who underwent CT in 2014-2019 and had clinically suspected AMI and/or confirmed AMI. CT protocols were adapted based on each patient's presentation and on findings from unenhanced images. The CT protocol was considered optimal for AMI when it included arterial and portal venous phases. CT protocols, accuracy of reports, and outcomes were compared between the groups with and without suspected AMI before CT.Results Of the 375 events, 337 (90 %) were suspected AMI and 66 (18 %) were AMI, including 28 (42 %) with and 38 without suspected AMI. These two groups did not differ significantly regarding the medical history, clinical presentation, or laboratory tests. The CT protocol was more often optimal for AMI in the group with suspected AMI (26/28 [93 %] vs. 28/38 [74 %], p = 0.046). Diagnostic accuracy was not different between groups with and without suspected AMI (26/28 [93 %] vs. 34/38 [90 %], p = 1.00). However, it was lower in the group without suspicion of AMI when the CT protocol was not optimal for AMI (27/28 [96 %] vs 7/10 [70 %], p = 0.048).Conclusions The negative influence of not clinically suspecting AMI can be mitigated by using a tailored CT protocol.
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Re-assessment of imaging may detect overlooked radiological findings associated with AMI not reported at the initial reading, especially if the imaging protocol is not optimal.
“It is not unusual that a re-assessment of the imaging may detect overlooked radiological findings associated with AMI not reported at the initial reading, especially if the imaging protocol is not optimal. 143,144”
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 [33]
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- Authors
- Anglaret, S., Dallongeville, A., Beaussier, H., Touloupas, C., Boulay, I., Tardivel, A. M., Béranger, S., Silvera, S., Chatellier, G., Ronot, M., & Zins, M.
- Affiliations
- Hôpital Paris Saint-Joseph (FR)
- Hôpital Beaujon (FR)
- Corresponding author
- Zins, M.
- Venue
- European Journal of Radiology
- Publisher
- Elsevier BV
- Published
- 2021-05
- Volume
- 138
- Pages
- 109652
- ISSN
- 0720-048X (ISSN-L)
- OpenAlex
- W3139368596
- Cited by
- 14
- References
- 35
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 1 · 2023: 4 · 2022: 2
- FWCI
- 1.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- European Journal of Radiology (publishedVersion)
- PubMed (publishedVersion)
- 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, clinical suspicion, CT protocol optimization, diagnostic accuracy, underdiagnosis, mesenteric ischemia
- MeSH terms
- Acute Disease, Arteries, Humans, Ischemia, Portal Vein, Retrospective Studies, Tomography, X-Ray Computed, Mesenteric Ischemia
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