Skip to main content
Log in

Accuracy of multidetector row computed tomography for the diagnosis of acute bowel ischemia in a non-selected study population

  • Computer Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

The diagnostic accuracy of multidetector row computed tomography for the prospective diagnosis of acute bowel ischemia in the daily clinical routine was analyzed. Two hundred ninety-one consecutive patients with an acute or subacute abdomen, examined by MDCT over a time period of 5 months, were included in the study. All original CT diagnoses made during the daily routine by radiological generalists were compared to the final diagnoses made by using all available medical information from endoscopies, surgical interventions, autopsies and follow-up. Finally, all CT examinations of patients with an initial CT diagnosis or a final diagnosis of bowel ischemia were reread by a radiologist specialized in abdominal imaging in order to analyze the CT findings and the reasons for initially false negative or false positive CT readings. Twenty-four patients out of 291 (8.2%) had acute bowel ischemia. The age of affected patients ranged from 50 to 94 years (mean age: 75.7 years). Eleven patients were male, and 13 female. Reasons for acute bowel ischemia were: arterio-occlusive (n=11), non-occlusive (n=5), strangulation (n=2), over-distension (n=3) and radiation (n=3). The prospective sensitivity, specificity, PPV and NPV of MDCT for the diagnosis of acute bowel ischemia in the daily routine were 79.17, 98.51, 90.48 and 98.15%. MDCT reaches a similarly high sensitivity in diagnosing acute bowel as angiography. Furthermore, it has the advantage of being helpful in most of its clinical differential diagnoses and of being less invasive with the consecutive possibility of being used earlier in the diagnostic process with all the resulting positive effects on the patients prognosis. Therefore, nowadays MDCT should probably be used as the first step imaging modality of choice in patients with suspected acute bowel ischemia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. Jrven O, Laurika J, Salenius JP, Tarkka M (1994) Acute intestinal ischemia. A review of 214 cases. Ann Chir Gynaecol 83:22–25

    PubMed  Google Scholar 

  2. Bastidas J, Reilly PM, Bulkley GB (1995) Mesenteric vascular insufficiency. In: Yamada T (ed) Textbook of gastroenterology, 2nd edn. Lippincott, Philadelphia, pp 2490–2523

    Google Scholar 

  3. 3. Levine JS, Jacobson ED (1995) Intestinal ischemic disorders. Dig Dis 13:3–24

    CAS  Google Scholar 

  4. Brandt LJ, Boley SJ (1993) Ischemic and vascular lesions of the bowel. In: Sleisenger M, Fordtran J (eds) Gastrointestinal disease, 5th edn, vol 2. Saunders, Philadelphia, pp 1927–1961

    Google Scholar 

  5. Ruotolo RA, Evans SRT (1999) Mesenteric ischemia in the elderly. Gastroenterology 15:527–557

    CAS  Google Scholar 

  6. Klein HM, Lensing R, Klosterhalfen B, Toens C, Guenther RW (1995) Diagnostic imaging of mesenteric infarction. Radiology 197:79–82

    Google Scholar 

  7. Federle MP, Chun G, Jeffrey RB, Rayor R (1984) Computed tomographic findings in bowel infarction. Am J Roentgenol 142:91–95

    CAS  Google Scholar 

  8. Clark RA (1987) Computed tomography of bowel infarction. J Comput Assist Tomogr 11:757

    CAS  PubMed  Google Scholar 

  9. Balthazar EJ, Hulnick D, Megibow AJ, Opulencia JF (1987) Computed tomography of intestinal hemorrhage and bowel ischemia. J Comput Assist Tomogr 11:67–72

    CAS  PubMed  Google Scholar 

  10. Alpern MB, Glazer G, Francis IR (1988) Ischemic or infarcted bowel: CT findings. Radiology 166:149–152

    Google Scholar 

  11. Lund EC, Han SY, Holley HC et al (1988) Intestinal ischemia: comparison of plain radiographic and computed tomographic findings. Radiographics 8:1083

    CAS  PubMed  Google Scholar 

  12. Perez C, Lauger J, Puig J et al (1989) Computed tomographic findings in bowel ischemia. Gastrointest Radiol 14:241

    Google Scholar 

  13. Smerud MJ, Johnson CD, Stephens DH (1990) Diagnosis of bowel infarction: a comparison of plain films and CT scans in 23 cases. Am J Roentgenol 154:99–103

    CAS  Google Scholar 

  14. Taourel PG, Deneuville M, Pradel JA, Regent D, Bruel JM (1996) Acute mesenteric ischemia: diagnosis with contrast enhanced CT. Radiology 199:632–636

    Google Scholar 

  15. Bartnicke BJ, Balfe DM (1994) CT appearance of intstinal ischemia and intramural hemorrhage. Radiol Clin North Am 32:845–860

    CAS  PubMed  Google Scholar 

  16. Ha HK, Rha SE, Kim AY, Auh YH (2000) CT and MR diagnosis of intestinal ischemia. Semin Ultrasound CT MR 21:40–55

    Article  CAS  PubMed  Google Scholar 

  17. Balthazar EJ, Yen BC, Gordon RB (1999) Ischemic colitis: CT evaluation of 54 cases. Radiology 211:381–388

    Google Scholar 

  18. Wiesner W, Khurana B, Ji H, Ros PR (2003) CT of acute bowel ischemia. Radiology. 226:635–650

    Google Scholar 

  19. Wiesner W, Khurana B, Glickman J, Ji H, Ros PR (2002) “Cecal gangrene”: a rare cause of right-sided inferior abdominal quadrant pain, fever and lecokocytosis. Emerg Radiol 9:292–295

    Google Scholar 

  20. Wiesner W, Mortele KJ, Glickman JN, Ji H, Khurana B, Ros PR (2002) CT findings in isolated ischemic proctosigmoiditis. Eur Radiol 12:1762–1767

    Google Scholar 

  21. Wiesner W, Mortele KJ, Glickman J, Ji H, Ros PR (2001) Pneumatosis intestinalis and portomesenteric venous gas in mesenteric ischemia: correlation of CT findings with severity of ischemia and clinical outcome. Am J Roentgenol 177:1319–1323

    CAS  Google Scholar 

  22. Horton KM, Corl FM, Fishman EK (2000) CT evaluation of the colon: inflammatory disease. Radiographics 20:399–418

    CAS  PubMed  Google Scholar 

  23. Zalcman M, Sy M, Donckier V, Closset J, Van Gansbeke D (2000) Helical CT signs in the diagnosis of intestinal ischemia in small bowel obstruction. Am J Roentgenol 175:1601–1607

    CAS  Google Scholar 

  24. Wiesner W, Mortele KJ, Ji H, Ros PR (2002) Normal colonic wall thickness at CT and its relation to colonic distension. J Comput Assist Tomogr 26:102–106

    Article  PubMed  Google Scholar 

  25. Fleischmann (2004) MDCT of renal and mesenteric vessels. Eur Rad 13(Suppl 5):94–1001

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Walter Wiesner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wiesner, W., Hauser, A. & Steinbrich, W. Accuracy of multidetector row computed tomography for the diagnosis of acute bowel ischemia in a non-selected study population. Eur Radiol 14, 2347–2356 (2004). https://doi.org/10.1007/s00330-004-2462-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-004-2462-6

Keywords

Navigation