Functional versus radiological assessment of chronic intestinal ischaemia.
BACKGROUND
The diagnosis chronic intestinal ischaemia (CII) is based on the clinical symptoms postprandial pain and weight loss combined with abnormal findings during angiography. Despite the well-known poor correlation between symptoms and morphology, physiological tests are rarely performed.


CONCLUSIONS
It is possible to measure the total splanchnic blood flow (SBF) before and after a test meal, and the results supply additional information to the morphologic investigations. To date, no papers have addressed the impact of morphologic changes of the mesenteric arteries on the SBF.


METHODS
Forty-six consecutive patients suspected of CII were investigated. The routine investigation included angiography and measurements of the SBF before and after a test meal. Measurements of the total SBF were performed using the 'Fick principle'. (99m)Technetium-labelled Mebrofenin was used as a tracer. Digital subtraction angiography was performed.


RESULTS
Agreement between SBF and angiography was found in 44 of 46 patients. Mean baseline SBF for all patients was 985 ml/min, total range (525-1932) and within the reported normal range. The mean postprandial increase in SBF was 480 mL min(-1) (-130 to 1353), thus 36 patients were categorized as normal by both angiography and SBF, eight patients were abnormal by both methods and two patients had abnormal SBF but normal angiography.


CONCLUSIONS
In this cohort, SBF detects CII with sensitivity of 1.0, and specificity of 0.95. SBF supplies additional information in patients with convincing symptoms and normal angiography. In these patients, the affection of the intestinal arteries may be too distant or too subtle to be visualized on angiography.
Zacho
Helle D
HD
Department of Clinical Physiology, Viborg Hospital, Viborg, Denmark. helle.damgaard@viborg.RM.dk
Abrahamsen
Jan
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D000814:Aniline Compounds; D001783:Blood Flow Velocity / Q000502:physiology*; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005998:Glycine; D006801:Humans; D007098:Imino Acids; D007422:Intestines / Q000098:blood supply*; D007511:Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008638:Mesenteric Arteries / Q000000981:diagnostic imaging / Q000502:physiology*; D008875:Middle Aged; D015609:Organotechnetium Compounds; D010101:Oxygen Consumption / Q000502:physiology; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D013152:Splanchnic Circulation / Q000502:physiology*
D000814:Aniline Compounds; D007098:Imino Acids; D015609:Organotechnetium Compounds; C034837:technetium Tc 99m mebrofenin; D005998:Glycine