How to diagnose Mesentric ischemia, ACR guidelines

The American College of Radiology has released guidelines for the diagnosis of Mesenteric Ischemia which is a life-threatening condition and is difficult to diagnose.

Mesenteric Ischemia is a condition which arises from a sudden decline in blood flow through the mesenteric vessels. Without appropriate and timely treatment, necrosis of the small and large intestine results, leading to sepsis and potentially death. The condition is difficult to diagnose because the symptoms are not specific, and the index of suspicion must be high. But, the rapid progression, the condition is life-threatening if not identified and treated early.

Mortality rates for AMI range between 60% and 80%. AMI is classified as either occlusive or nonocclusive mesenteric ischemia (NOMI). Occlusive mesenteric arterial ischemia (OMI) is subdivided into acute thromboembolism and acute thrombosis. NOM is a critical condition where the patient has several severe comorbidities and is hemodynamically unstable. This condition may arise due to drugs that reduce blood flow (e.g., vasopressors and ergotamines), hypotension from severe medical conditions (e.g., myocardial infarction, sepsis, CHF, and renal disease), and patients that recently received major surgery (e.g., cardiac and abdominal surgery).

The typical thrombotic patient experiences history of postprandial abdominal pain, leading to food avoidance and weight loss. Causes include atheromatous vascular disease (e.g., atherosclerosis, aortic aneurysm, aortic dissection) and decreased cardiac output due to a secondary cause (e.g., dehydration, myocardial infarction, congestive heart failure). Hence, proper diagnosis of Mesenteric Ischemia is imperative.

The American College of Radiology has released guidelines for the diagnosis of Mesenteric Ischemia.

According to the guidelines:

1. CT angiography (CTA) is appropriate to confirm the diagnosis of mesenteric ischemia.


2. CT with contrast in venous timing may be appropriate in conjunction with the CTA to assess the veins and organs, such as the bowel, for signs of tissue death.


3. Catheter-based arteriography may be appropriate in addition to CTA to diagnose a blocked artery, treat the blockage if appropriate, or help plan for surgery.


4. MR angiography (MRA) may be appropriate if CTA is not performed but takes longer and provides less information than CTA.


5. Ultrasound and abdominal radiography (x-ray) have limited use in acute mesenteric ischemia situations.


6. CTA and MRA are the most appropriate diagnostic tools and can be used together to provide complementary views of blood vessels.


7. CTA is the most accurate imaging test for grading the degree of artery blockages.


8. CT with contrast in venous timing may be performed in conjunction with the initial CTA scan to assess the veins and organs, such as the bowel.


9. Catheter-based angiography may be appropriate to guide treatment and determine whether surgery is required.

For further reference, please click on the link: https://acsearch.acr.org/docs/70909/narrative/