The DOI matches its Crossref record; 34 of the 34 references it cites were found in a registry or an index.
Diagnostic Accuracy of the Combination of Clinical Symptoms and CT or MR Angiography in Patients With Chronic Gastrointestinal Ischemia
Abstract
Background: No golden diagnostic standard is available to diagnose chronic gastrointestinal ischemia (CGI). Goals: We aimed to establish an accurate prediction model for CGI, based on clinical symptoms and radiologic evaluation of the amount of stenosis in the celiac artery (CA) and superior mesenteric artery (SMA) by means of computed tomography-angiography or magnetic resonance (MR)-angiography. Study: We prospectively included 436 consecutive patients with clinical suspicion of CGI in a tertiary referral center. Predictors for CGI were obtained by comparing clinical parameters to the diagnosis of CGI. Multivariable logistic regression was used to combine the strongest predictors in a model. A score chart based on the prediction model was provided to calculate the risk of CGI. Results: CGI was present in 171/436 (39%) patients (67 y; range, 54 to 74 y; 27% male). Strongest predictors for CGI were female gender [odds ratio (OR)=1.44; 95% confidence interval (CI), 0.85-2.43], weight loss (OR=1.63, 95% CI, 0.98-2.72), concomitant cardiovascular disease (OR=1.70, 95% CI, 1.04-2.78), duration of symptoms (OR=0.88, 95% CI, 0.79-0.99), and stenosis of CA and SMA (50% to 70% stenosis CA: OR=1.33, 95% CI, 0.56-3.19; >70% stenosis CA: OR=5.79, 95% CI, 3.42-9.81; 50% to 70% stenosis SMA: OR=3.21, 95% CI, 0.81-12.74; >70% stenosis SMA: OR=4.39, 95% CI, 2.30-8.41). A model based on clinical symptoms alone showed limited discriminative ability for diagnosing CGI (c-statistic 0.62). Adding radiologic imaging of the mesenteric arteries improved the discriminative ability (c-statistic 0.79). Conclusions: Clinical symptoms alone are insufficient to predict the risk of CGI. Radiologic evaluation of the mesenteric arteries is essential. This tool may be useful for clinicians to assess the risk of CGI and to decide whether further diagnostic work-up for CGI is needed.
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A cohort of 436 patients suspected of CMI was used to develop a prediction model based on clinical and radiological items.
“A cohort of 436 patients suspected of CMI was used to develop a prediction model based on the abovementioned items. 15”
Having a 50-70% stenosis of multiple mesenteric arteries is associated with a higher risk of CMI.
“Moreover, different studies classifying stenosis grade as < 50%, 50 e 70%, and > 70% demonstrated that having a 50 e 70% stenosis of multiple mesenteric arteries was associated with a higher risk of CMI. 15,16”
The model allows for a low, intermediate, and high probability of CMI up to 21%, 46%, and >79%, respectively.
“This model includes computed tomography angiography (CTA) or magnetic resonance angiography (MRA) of the mesenteric arteries and allows for a low, intermediate, and high probability of CMI up to 21%, 46%, and > 79%, respectively.”
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Metadata
- Authors
- Harki, J., Vergouwe, Y., Spoor, J. A., Mensink, P. B., Bruno, M. J., van Noord, D., Kuipers, E. J., & Tjwa, E. T. T. L.
- Affiliations
- Gastroenterology and Hepatology
- Public Health
- Medisch Spectrum Twente (NL)
- Erasmus MC (NL)
- Radboud University Nijmegen (NL)
- Corresponding author
- Harki, Jihan
- Spoor, Johannes A.
- Mensink, Peter B.
- Bruno, Marco J.
- Kuipers, Ernst J.
- Tjwa, Eric T.T.L.
- Venue
- Journal of Clinical Gastroenterology
- Published
- 2017-07
- Volume
- 51
- Issue
- 6
- Pages
- e39-e47
- ISSN
- 0192-0790 (ISSN-L)
- OpenAlex
- W2490403132
- Cited by
- 23
- References
- 34
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 3 · 2023: 2 · 2022: 2 · 2021: 1 · 2020: 5 · 2019: 1 · 2018: 2 · 2017: 1
- FWCI
- 1.48
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Vascular anomalies and interventions
- Keywords
- mesenteric ischemia, celiac artery stenosis, superior mesenteric artery stenosis, CT angiography, magnetic resonance angiography, diagnostic accuracy, prediction model, clinical risk score, weight loss, cardiovascular disease, diagnostic criteria, female sex as risk factor, symptom duration
- MeSH terms
- Computed Tomography Angiography, Aged, Celiac Artery, Chronic Disease, Female, Gastrointestinal Diseases, Humans, Ischemia, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Multivariate Analysis, Logistic Models, Mesenteric Artery, Superior, Magnetic Resonance Angiography
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