Acute Mesenteric Ischemia: Pathophysiology-based Approach to Imaging Findings and Diagnosis

Area of Science:

• Radiology
• Gastroenterology
• Abdominal Imaging

Background:

• Acute mesenteric ischemia (AMI) is a critical abdominal emergency with high morbidity and mortality.
• Nonspecific symptoms and lack of biomarkers necessitate advanced imaging for early diagnosis.
• AMI encompasses diverse entities with unique pathophysiology and imaging characteristics.

Purpose of the Study:

• To review the anatomy, pathophysiology, and imaging features of AMI.
• To emphasize a pathophysiology-based approach for accurate diagnosis and management.
• To highlight imaging predictors of transmural bowel necrosis.

Main Methods:

• Review of foundational anatomy and pathophysiology of AMI.
• Analysis of distinct imaging features for various AMI causes.
• Emphasis on up-to-date imaging findings predictive of transmural necrosis.

Main Results:

• Imaging is crucial for diagnosing AMI due to nonspecific clinical presentation.
• Pathophysiology-based interpretation of imaging is superior to a sign-based approach.
• Imaging findings vary significantly based on underlying cause (arterial occlusion, venous occlusion, NOMI).

Conclusions:

• A pathophysiology-based imaging approach is essential for diagnosing AMI and predicting outcomes.
• Identifying transmural necrosis via imaging is critical for patient management.
• Radiologists require a foundational understanding of AMI's diverse presentations for effective interpretation.