Skip to main content
SpringerLink
Log in

What Is the Most Sensitive and Specific Imaging Study for the Detection of Acute Mesenteric Ischemia? Is MDCT the Gold Standard?

  • Chapter
  • First Online:
Gastrointestinal Emergencies

  • 130 Accesses

Abstract

Angiography has traditionally been considered the gold standard test for diagnosis of acute mesenteric ischemia (AMI). Angiography is not only diagnostic but allows for immediate therapeutic interventions to achieve revascularization. However, computed tomography angiography (CTA) has now replaced angiography as the first-line diagnostic test for AMI. CTA is accurate and has excellent sensitivity and specificity, approaching 100%. It is fast and nearly universally available. Multiple studies and expert guidelines cite CTA as the test of choice for the diagnosis of AMI in the emergency department. Magnetic resonance angiography (MRA) does have a role, but the delay in diagnosis and lack of universal availability make it a less favorable diagnostic tool when compared to CTA.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bradbury AW, Brittenden J, McBride K, Ruckley CV. Mesenteric ischaemia: a multidisciplinary approach. Br J Surg. 1995;82(11):1446–59.

    Article  CAS  Google Scholar 

  2. Kassahun W, Schulz T, Richter O, Hauss J. Unchanged high mortality rates from acute occlusive intestinal ischemia: six year review. Langenbeck's Arch Surg. 2008;393(2):163–71.

    Article  Google Scholar 

  3. Lock G. Acute intestinal ischaemia. Best Pract Res Clin Gastroenterol. 2001;15(1):83–98.

    Article  CAS  Google Scholar 

  4. Cangemi JR. Intestinal ischemia in the elderly. Gastroenterol Clin N Am. 2009;38(3):527–40.

    Article  Google Scholar 

  5. Acosta S, Wadman M, Syk I, Elmståhl S, Ekberg O. Epidemiology and prognostic factors in acute superior mesenteric artery occlusion. J Gastrointest Surg. 2010;14(4):628–35.

    Article  Google Scholar 

  6. Wyers MC. Acute mesenteric ischemia: diagnostic approach and surgical treatment. Semin Vasc Surg. 2010;23(1):9–20.

    Article  Google Scholar 

  7. Oliva I, Davarpanah A, Rybicki F, Desjardins B, Flamm S, Francois C, et al. ACR appropriateness criteria® imaging of mesenteric ischemia. Abdom Imaging. 2013;38(4):714–9.

    Article  Google Scholar 

  8. Aschoff A, Stuber G, Becker B, Hoffmann M, Schmitz B, Schelzig H, et al. Evaluation of acute mesenteric ischemia: accuracy of biphasic mesenteric multi-detector CT angiography. Abdom Imaging. 2009;34(3):345–57.

    Article  CAS  Google Scholar 

  9. Hagspiel K, Flors L, Hanley M, Norton P. Computed tomography angiography and magnetic resonance angiography imaging of the mesenteric vasculature. Tech Vasc Interv Radiol. 2015;18(1):2–13.

    Article  Google Scholar 

  10. Menke J. Diagnostic accuracy of multidetector CT in acute mesenteric ischemia: systematic review and meta-analysis. Radiology. 2010;256(1):93–101.

    Article  Google Scholar 

  11. Kirkpatrick I, Kroeker M, Greenberg H. Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia: initial experience. Radiology. 2003;229(1):91–8.

    Article  Google Scholar 

  12. Bala M, Kashuk J, Moore E, Kluger Y, Biffl W, Gomes C, et al. Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. World J Emerg Surg. 2017;12(38). https://doi.org/10.1186/s13017-017-0150-5

  13. Gaa J, Laub G, Edelman RR, Georgi M. First clinical results of ultrafast, contrast-enhanced 2-phase 3D-angiography of the abdomen. Röfo. 1998;169(2):135–9.

    CAS  PubMed  Google Scholar 

  14. Gilfeather M, Holland GA, Siegelman ES, et al. Gadolinium-enhanced ultrafast three-dimensional spoiled gradient-echo MR imaging of the abdominal aorta and visceral and iliac vessels. Radiographics. 1997;17(2):423–32.

    Article  CAS  Google Scholar 

  15. Holland GA, Dougherty L, Carpenter JP, et al. Breath-hold ultrafast three-dimensional gadolinium-enhanced MR angiography of the aorta and the renal and other visceral abdominal arteries. AJR Am J Roentgenol. 1996;166(4):971–81.

    Article  CAS  Google Scholar 

  16. Meaney JF, Prince MR, Nostrant TT, Stanley JC. Gadolinium-enhanced MR angiography of visceral arteries in patients with suspected chronic mesenteric ischemia. J Magn Reson Imaging. 1997;7(1):171–6.

    Article  CAS  Google Scholar 

  17. Shetty AS, Mellnick VM, Raptis C, Loch R, Owen J, Bhalla S. Limited utility of MRA for acute bowel ischemia after portal venous phase CT. Abdom Imaging. 2015;40(8):3020–8.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Cincinnati College of Medicine, Department of Emergency Medicine, Cincinnati, OH, USA

    Courtney H. McKee & Sarah Ronan-Bentle

Authors
  1. Courtney H. McKee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sarah Ronan-Bentle
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sarah Ronan-Bentle .

Editor information

Editors and Affiliations

  1. Department of Emergency Medicine, MedStar Georgetown University Hospital, Washington, DC, USA

    Autumn Graham

  2. Department of Emergency Medicine, MedStar Georgetown University Hospital, Washington, DC, USA

    David J. Carlberg

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

McKee, C.H., Ronan-Bentle, S. (2019). What Is the Most Sensitive and Specific Imaging Study for the Detection of Acute Mesenteric Ischemia? Is MDCT the Gold Standard?. In: Graham, A., Carlberg, D.J. (eds) Gastrointestinal Emergencies. Springer, Cham. https://doi.org/10.1007/978-3-319-98343-1_29

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-98343-1_29

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-98342-4

  • Online ISBN: 978-3-319-98343-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation