title: Diagnostic Accuracy of the Combination of Clinical Symptoms and CT or MR Angiography in Patients With Chronic Gastrointestinal Ischemia.
abstract: BACKGROUND
  No golden diagnostic standard is available to diagnose chronic gastrointestinal ischemia (CGI).
  
  
  OBJECTIVE
  We aimed to establish an accurate prediction model for CGI, based on clinical symptoms and radiologic evaluation of the amount of stenosis in the celiac artery (CA) and superior mesenteric artery (SMA) by means of computed tomography-angiography or magnetic resonance (MR)-angiography.
  
  
  METHODS
  We prospectively included 436 consecutive patients with clinical suspicion of CGI in a tertiary referral center. Predictors for CGI were obtained by comparing clinical parameters to the diagnosis of CGI. Multivariable logistic regression was used to combine the strongest predictors in a model. A score chart based on the prediction model was provided to calculate the risk of CGI.
  
  
  RESULTS
  CGI was present in 171/436 (39%) patients (67 y; range, 54 to 74 y; 27% male). Strongest predictors for CGI were female gender [odds ratio (OR)=1.44; 95% confidence interval (CI), 0.85-2.43], weight loss (OR=1.63, 95% CI, 0.98-2.72), concomitant cardiovascular disease (OR=1.70, 95% CI, 1.04-2.78), duration of symptoms (OR=0.88, 95% CI, 0.79-0.99), and stenosis of CA and SMA (50% to 70% stenosis CA: OR=1.33, 95% CI, 0.56-3.19; >70% stenosis CA: OR=5.79, 95% CI, 3.42-9.81; 50% to 70% stenosis SMA: OR=3.21, 95% CI, 0.81-12.74; >70% stenosis SMA: OR=4.39, 95% CI, 2.30-8.41). A model based on clinical symptoms alone showed limited discriminative ability for diagnosing CGI (c-statistic 0.62). Adding radiologic imaging of the mesenteric arteries improved the discriminative ability (c-statistic 0.79).
  
  
  CONCLUSIONS
  Clinical symptoms alone are insufficient to predict the risk of CGI. Radiologic evaluation of the mesenteric arteries is essential. This tool may be useful for clinicians to assess the risk of CGI and to decide whether further diagnostic work-up for CGI is needed.
authors.affiliation: Departments of *Gastroenterology and Hepatology †Public Health §Internal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam ‡Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, The Netherlands.
authors.forename: Jihan
authors.initials: J
authors.lastname: Harki
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Vergouwe
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Spoor
authors.forename: Peter B
authors.initials: PB
authors.lastname: Mensink
authors.forename: Marco J
authors.initials: MJ
authors.lastname: Bruno
authors.forename: Désirée
authors.initials: D
authors.lastname: van Noord
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Kuipers
authors.forename: Eric T T L
authors.initials: ETTL
authors.lastname: Tjwa
mesh_terms: D000368:Aged; D002445:Celiac Artery / Q000000981:diagnostic imaging; D002908:Chronic Disease; D000072226:Computed Tomography Angiography / Q000379:methods*; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007511:Ischemia / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D016015:Logistic Models; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011446:Prospective Studies