Rutine and dynamic biphasic contrast enhanched abdominal ct examinations in the diagnosis of acute mesenteric ischemia

PurposeThe aim of the study is to evaluate the role of conventional and dynamic biphasic (arterial and venous) CT examinations in the diagnosis of AMI in patients who presented with a prediagnosis of abdominal pain or acute primary mesenteric ischemia, and to assess computed tomographic (CT) findings.Material and methodOf the 55 patients, 22 underwent conventional CT whereas 33 had biphasic computed tomographic angiography (CTA) (single detector spiral). During the conventional CT examination, oral and IV positive contrast materials were administered. Abdominal CT images during arterial and venous phases were obtained by administering IV positive material, and oral and rectal negative materials (water), Mesenteric vascular structures and secondary CT findings of AMI were evaluated through conventional and dynamic CT images. For the diagnosis of AMI, CT findings with ?95% specificity were considered as significant and they were assessed for both conventional CT and dynamic CT separately.ResultsEighteen of the 55 patients enrolled in the study were diagnosed as primary (vascular) AMI. Diagnosis was made surgically in fifteen patients. Three patients were diagnosed with clinical, biochemical and radiological examinations. Twenty-nine of 55 patients underwent surgery. Of the patients who were operated, fifteen were diagnosed as primary AMI and six as secondary AMI.In our study, conventional CT findings with ?95% specificity were regarded as SMA occlusion, SMV occlusion, SMA or portal venous gas and solid organ infarct. Dynamic CT findings with ?95% specificity were regarded as SMA occlusion, SMV occlusion, focal lack of bowel wall enhancement and hypoattenuation of the intestine (bowel) wall. Occlusion of SMA and SMV lumens were determined as CT findings with 100% specificity for both conventional CT and dynamic CTA. In our study, the sensitivity was assessed as 89% and the specificity was assessed as 100% for both conventional CT and dynamic CTA in the diagnosis of AMI.ConclusionThe results of our study suggest that dynamic CTA and conventional CT examinations are of great sensitivity with 80-90% in the diagnosis of AMI. In our study, sensitivity and specificity rates were found to be the same for both conventional CT and dynamic CTA, which may have been due to the small number of the cases.Except for the most reliable CT findings (with 100% specificity) which were SMA and SMV thrombosis, it was found that secondary CT findings overlapped with other pathologies and thus had lower specificity percentages.In spite of these high specificity rates, patients cannot be diagnosed as AMI even with dynamic CTA, possibly, due to the obstruction of marginal and small branches which cannot be shown (imaged) directly. Therefore, it is suggested that patients having negative CT findings but suspected to have AMI through clinical and laboratory findings should be evaluated with complementary methods such as angiography.