Multi-Slice CT Angiography in Acute Suspected Mesenteric Ischemia: Role in Diagnosis and Differential Diagnosis

Aim of this study is to assess the role of multi-slice CT angiography (MSCTA) in the diagnosis and differential diagnosis of acute mesenteric ischemia (AMI). MSCTA was performed on 27 patients who presented with the clinical suspicion of AMI (16M; 11F, age range: 35-70 years). Reconstructed images using minimum intensity projection, volume rendering and multiplanar volume reconstruction were found to perform better for the detection of vascular abnormalities and improved the diagnostic confidence of both radiologists in the evaluation of bowel and mesenteric abnormalities. Axial and 3D reconstructed images of patients were evaluated independently by two radiologists. AMI was correctly diagnosed in 26/27 patients on MSCTA (97.9% sensitivity and 100% specificity) of whom nine patients underwent surgical exploration. Mesenteric arterial occlusion was seen in 8 patients while one patient had portomesenteric venous thrombosis. A sensitivity of 94%, specificity of 100%, and positive and negative predictive values of 99% and 95%, respectively were achieved for the MSCTA findings of visceral artery occlusion, intestinal pneumatosis, portomesenteric venous gas or bowel wall thickening. Our findings suggest that MSCTA is an effective tool for fast diagnostic work-up of patients with suspected AMI.