Mesenteric ischemia diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Feham Tariq, MD [2]

Overview

The defintive diagnosis of mesenteric ischemia relies mainly on the imaging studies of which the most accurate is high resolution computed tomographic angiography. It demonstrates the site of occluion in the vessels as well as helps determine the choice of treatment opted.

Diagnostic Study of Choice

Gold standard/Study of choice for mesenteric ischemia:

• High resolution computed tomographic angiography (HRCTA) is the gold standard test for the diagnosis of mesenteric ischemia for the following reasons:
  • Confirms the diagnosis
  • Determines the prognosis
  • Identifies collateral circulation
  • Potential sources of inflow
  • Determines the type of occlusion

Acute embolic mesenteric occlusion shows:

Chronic mesenteric ischemia:

• Mesenteric ischemia is primarily a radiological diagnosis.
• The following results of CTA is confirmatory of mesenteric ischemia:

Sensitivity and specificity:

Do	Sensitivity	Specificity
High resolution computed tomographic angiography	94%	95%

✔= The best test based on the feature

Diagnostic results

The following result of computed tomographic angiography is confirmatory of mesenteric ischemia:

Findings
Classic meniscus sign	Seen at the point of occlusion more commonly in acute embolic mesenteric occlusion Proximal jejunal branches are filled quickly whereas distal branches are visualized minimally.
Multiple areas of narrowing and irregularity	More commonly seen in non-occlusive mesenteric ischemia

Sequence of Diagnostic Studies

The [name of investigation] should be performed when:

• The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
• A positive [test] is detected in the patient, to confirm the diagnosis.