Non-occlusive mesenteric ischaemia: CT findings, clinical outcomes and assessment of the diameter of the superior mesenteric artery

Review of the experience of a tertiary care centre for almost 10 years in the CT diagnosis of non-occlusive mesenteric ischaemia (NOMI). Analysis of CT findings, correlation with clinical outcomes and evaluation of the usefulness of measuring the superior mesenteric artery (SMA) diameter for the dia...

Full description

Saved in:

Bibliographic Details
Published in:	British journal of radiology Vol. 91; no. 1081; p. 20170492
Main Authors:	Pérez-García, Carlos, de Miguel Campos, Enrique, Fernández Gonzalo, Adriana, Malfaz, Carlos, Martín Pinacho, Jesus Javier, Fernández Álvarez, Carmen, Herranz Pérez, Raquel
Format:	Journal Article
Language:	English
Published:	England The British Institute of Radiology 01-01-2018
Subjects:	Aged Colon and rectum Diagnostic Radiology Female Humans Intestinal Perforation - diagnostic imaging Intestines - pathology Intestines - surgery Male Mesenteric Artery, Superior - diagnostic imaging Mesenteric Ischemia - diagnosis Mesenteric Ischemia - therapy Necrosis Pneumoperitoneum - diagnostic imaging RADIODIAGNOSIS - Digestive system Retrospective Studies Small intestine Tomography, X-Ray Computed
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Review of the experience of a tertiary care centre for almost 10 years in the CT diagnosis of non-occlusive mesenteric ischaemia (NOMI). Analysis of CT findings, correlation with clinical outcomes and evaluation of the usefulness of measuring the superior mesenteric artery (SMA) diameter for the diagnosis of NOMI. 106 patients were diagnosed with NOMI in a biphasic CT examination from 2008 to 2017 in our hospital. Clinical outcomes and CT findings were reviewed. In 55 patients, the diameter of the SMA was compared with a previous CT scan where NOMI was not the diagnosis, and statistical analysis using paired t-test was performed. 81 patients (76%) had findings consistent with small bowel ischaemia and the ileum was the segment most commonly involved (47%). Lack of wall enhancement, pneumoperitoneum, pneumatosis intestinalis and portal venous gas were all considered signs of bowel necrosis and surgery was performed promptly. 70 patients had signs of vascular narrowing of the SMA branches and in the 55 cases with a previous CT scan, there were statistically significant differences regarding the SMA diameter with a mean reduction of the artery calibre and standard deviation of 1.93 ± 1.1 mm between the NOMI and non-NOMI scans (p < 0.001). Acknowledgment of characteristic bowel necrosis CT findings is crucial for determining the therapeutic attitude and the use of previous CT scans to compare the SMA diameter may help the radiologist to achieve an early diagnosis of NOMI in an often critically ill patient population. Advances in knowledge: Diagnosis of NOMI can be difficult in cases of partial mural ischaemia, thus objective data (diameter of the SMA) should be useful for the radiologist to include NOMI as the first diagnostic option in the differential diagnosis.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0007-1285 1748-880X
DOI:	10.1259/bjr.20170492