ACR appropriateness criteria® imaging of mesenteric ischemia
Abstract
Mesenteric ischemia is an uncommon condition resulting from decreased blood flow to the small or large bowel in an acute or chronic setting. Acute ischemia is associated with high rates of morbidity and mortality; however, it is difficult to diagnose clinically. Therefore, a high degree of suspicion and prompt imaging evaluation are necessary. Chronic mesenteric ischemia is less common and typically caused by atherosclerotic occlusion or severe stenosis of at least two of the main mesenteric vessels. While several imaging examination options are available for the initial evaluation of both acute and chronic mesenteric ischemia, CTA of the abdomen and pelvis is overall the most appropriate choice for both conditions. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Based on the literature, contrast-enhanced CT-scan has a good accuracy in diagnosing arterial and venous occlusive AMI.
“Based on the literature, contrast-enhanced CT-scan has a good accuracy in diagnosing arterial and venous occlusive AMI [21, 22]”
From Incidence, diagnosis, management and outcome of acute mesenteric ischaemia: a prospective, multicentre observational study (AMESI Study) (2024) · cites this paper as [22]
Omitting the non-contrast CT is unlikely to result in a missed AMI diagnosis.
“Omitting the non-contrast CT is unlikely to result in a missed AMI diagnoses.”
Consensus exists that contrast-enhanced biphasic CT-Angiography with 1-mm slices is the first line imaging modality to diagnose AMI.
“Consensus exists that contrast-enhanced biphasic CT-Angiography with 1-mm slices is the first line imaging modality to diagnose AMI [5].”
From Management of acute mesenteric ischaemia: Results of a worldwide survey (2023) · cites this paper as [5]
In suspected AMI, the common concern about renal function with application of contrast media is clearly outbalanced by the immediate risk of death through AMI.
“Another important point is that if there is a suspicion of AMI, the common concern about the renal function with application of contrast media is clearly outbalanced by the immediate risk of death through AMI [5,19].”
From Management of acute mesenteric ischaemia: Results of a worldwide survey (2023) · cites this paper as [5]
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- Authors
- 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., Ptak, T., Verma, N., Kim, D. H., Carucci, L. R., & Dill, K. E.
- Affiliations
- Centegra Hospital McHenry (US)
- Loyola University Medical Center (US)
- University of Virginia Health System (US)
- Brigham and Women's Hospital (US)
- University of South Florida (US)
- Society for Vascular Surgery (US)
- Newton Wellesley Hospital (US)
- Moffitt Cancer Center (US)
- Emory University (US)
- University of Florida (US)
- University of Wisconsin–Madison (US)
- Virginia Commonwealth University Medical Center (US)
- UMass Memorial Medical Center (US)
- Corresponding author
- Ginsburg, Michael
- ORCID
- Venue
- Journal of the American College of Radiology
- Publisher
- Elsevier BV
- Published
- 2018-11
- Volume
- 15
- Issue
- 11
- Pages
- S332-S340
- ISSN
- 1546-1440 (ISSN-L)
- OpenAlex
- W4250801132
- Cited by
- 99
- References
- 70
- Citations by year
- 2026: 10 · 2025: 18 · 2024: 11 · 2023: 13 · 2022: 19 · 2021: 12 · 2020: 12 · 2019: 1 · 2018: 1
- FWCI
- 6.76
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American College of Radiology (publishedVersion)
- The Journal of the American Medical Association (JAMA) Network (American Medical Association) (submittedVersion)
- 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
- mesenteric ischemia, acute mesenteric ischemia, chronic mesenteric ischemia, abdominal CT angiography, mesenteric artery stenosis, atherosclerotic occlusion, intestinal ischemia, appropriateness of imaging
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 ›
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