title: Detecting acute mesenteric ischemia in CT of the acute abdomen is dependent on clinical suspicion: Review of 95 consecutive patients.
abstract: OBJECTIVE
  (1) To evaluate the ability of emergency room radiologists to detect acute mesenteric ischemia (AMI) from computed tomography (CT) images in patients with acute abdominal pain. (2) To identify factors affecting radiologists' performance in the CT interpretation and patient outcome.
  
  
  METHODS
  A retrospective study of 95 consecutive patients treated for 97 AMI events between 2009 and 2013 was carried out. The etiology of AMI was embolism in 24 (25%), atherosclerotic vascular disease (ASVD) in 39 (40%), non-obstructive mesenteric ischemia (NOMI) in 25 (26%), and mesenteric venous thrombosis (MVT) in nine (9%) cases. The protocols, referrals and initial radiology reports of the abdominal CTs were analyzed. The CT studies were further scrutinized for vascular and intestinal findings.
  
  
  RESULTS
  The referring clinician had suspected AMI in 30 (31%) cases prior to imaging. The crucial findings of AMI had been stated in 97% of the radiology reports if the clinician had mentioned AMI suspicion in the referral; if not, the corresponding rate was 81% (p=0.04). Patients without suspicion of AMI prior to CT were more prone to undergo bowel resection. CT protocol was optimal for AMI (with contrast enhancement in arterial and venous phases) in only 34 (35%) cases. Intestinal findings were more difficult to detect than vascular findings. Vascular findings were retrospectively detectable in 92% of cases with embolism and 100% in ASVD and MVT. Some evidence of intestinal abnormality was retrospectively found in the CT findings in 92%, 100%, 100% and 67% of cases with embolism, ASVD, NOMI and MVT, respectively.
  
  
  CONCLUSIONS
  AMI is underdiagnosed in the CT of the acute abdomen if there is no clinical suspicion.
authors.affiliation: Department of Clinical Radiology, Kuopio University Hospital, Puijonlaaksontie 2, P.O. Box 100, FI-70029 Kuopio, Finland. Electronic address: tiina.lehtimaki@kuh.fi.
authors.forename: Tiina T
authors.initials: TT
authors.lastname: Lehtimäki
authors.affiliation: Department of Gastrointestinal Surgery, Kuopio University Hospital, Puijonlaaksontie 2, P.O. Box 100, FI-70029 Kuopio, Finland; Heart Center, Kuopio University Hospital, Puijonlaaksontie 2, P.O. Box 100, FI-70029 Kuopio, Finland. Electronic address: jussi.karkkainen@kuh.fi.
authors.forename: Jussi M
authors.initials: JM
authors.lastname: Kärkkäinen
authors.affiliation: Department of Clinical Radiology, Kuopio University Hospital, Puijonlaaksontie 2, P.O. Box 100, FI-70029 Kuopio, Finland. Electronic address: petri.saari@kuh.fi.
authors.forename: Petri
authors.initials: P
authors.lastname: Saari
authors.affiliation: Department of Clinical Radiology, Kuopio University Hospital, Puijonlaaksontie 2, P.O. Box 100, FI-70029 Kuopio, Finland; Unit of Radiology, Department of Clinical Medicine, University of Eastern Finland, Yliopistonranta 1, P.O. Box 1627, FI-70211 Kuopio, Finland. Electronic address: hannu.manninen@kuh.fi.
authors.forename: Hannu
authors.initials: H
authors.lastname: Manninen
authors.affiliation: Department of Gastrointestinal Surgery, Kuopio University Hospital, Puijonlaaksontie 2, P.O. Box 100, FI-70029 Kuopio, Finland; Unit of Surgery, Department of Clinical Medicine, University of Eastern Finland, Yliopistonranta 1, P.O. Box 1627, FI-70211 Kuopio, Finland. Electronic address: hannu.paajanen@kuh.fi.
authors.forename: Hannu
authors.initials: H
authors.lastname: Paajanen
authors.affiliation: Department of Clinical Radiology, Kuopio University Hospital, Puijonlaaksontie 2, P.O. Box 100, FI-70029 Kuopio, Finland; Unit of Radiology, Department of Clinical Medicine, University of Eastern Finland, Yliopistonranta 1, P.O. Box 1627, FI-70211 Kuopio, Finland. Electronic address: ritva.vanninen@kuh.fi.
authors.forename: Ritva
authors.initials: R
authors.lastname: Vanninen
mesh_terms: D000006:Abdomen, Acute / Q000150:complications* / Q000000981:diagnostic imaging*; D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007422:Intestines / Q000000981:diagnostic imaging; D008297:Male; D065666:Mesenteric Ischemia / Q000150:complications* / Q000000981:diagnostic imaging*; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Acute abdominal pain; Acute mesenteric ischemia; Bowel ischemia; CT; Emergency radiology; Superior mesenteric artery occlusion