CROSS SECTIONAL IMAGING IN ACUTE MESENTERIC ISCHEMIA, WHAT A RADIOLOGIST SHOULD KNOW

Abstract

<strong>Background:</strong> Acute mesenteric ischemia is a rare life-threatening condition that accounts for approximately one in 1000 hospital admissions. The mortality rate is 50%– 69% owing to the absence of specific symptoms and laboratory data, which makes early detection of this condition difficult. If the use of contrast material is possible, biphasic contrast material–enhanced multidetector computed tomography (CT) is the first- line imaging test for early diagnosis of the disease and for differentiation from other causes of acute abdomen. Multidetector CT can depict mesenteric ischemia, its underlying causes, and its severity. Objectives: To discuss about the causes of AMI include arterial embolism, arterial thrombosis, venous thrombosis, and non-occlusive mesenteric ischemia, among which arterial causes are far more common than venous causes.

<strong>Conclusion:</strong> Early diagnosis and prompt management of AMI are mandatory to improve the patient prognosis. For patients with suspected AMI, contrast-enhanced multidetector CT should be the first-line imaging modality for correct diagnosis and to exclude other causes of acute abdomen. Interpretation of CT images should include accurate assessment of the mesenteric arteries and veins, bowel wall thickness, the presence or absence of bowel wall enhancement, patterns of bowel enhancement, abnormalities in the mesentery and peritoneum, and the presence or absence of ascites and extra bowel gas. The severity of the condition and the viability of the bowel should be carefully appreciated with consideration of the underlying cause, as CT findings vary depending on the pathophysiology and the presence of associated complications.