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Updated: Jan 29, 2026
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
The Importance of Predicting Bowel Necrosis in Acute Mesenteric Ischemia: Narrative Review
Caterina Giannessi1, Diletta Cozzi1, Ludovica Scalzone1
1Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy.
Abstract:
Acute mesenteric ischemia (AMI) is a clinical condition caused by vascular insufficiency, resulting in intestinal damage. Is often underestimated, if not driven by clinical suspicion, due to the non-specific clinical symptoms (usually represented by acute abdominal pain) and the absence of reliable markers, which results in a poor prognosis and high mortality. We can identify three main forms of AMI: arterial, venous, and non-occlusive. Arterial AMI is the most frequent form, caused by occlusion of the superior mesenteric artery or one of its branches. Venous AMI is the least frequent, caused by thrombosis of the superior mesenteric vein or its branches. Non-occlusive AMI is due to a state of hypovolemia, which is frequent in patients who have undergone surgery. Given the difficulty of diagnosis based on the clinic alone, the radiologist plays a central role in identifying radiological signs of intestinal ischemia and in avoiding misdiagnosis. The radiologist's role is mainly to identify factors predictive of necrosis, which allow us to stratify patients and direct them towards the proper management. The aim of this review is to provide indications for an adequate CT protocol, including an unenhanced phase, an arterial phase, and a venous phase, as well as to underline the features to investigate in the different forms of AMI, in order to increase the diagnostic capacity in this challenging disease.
Insights
Acute mesenteric ischemia (AMI), a condition of reduced blood flow to the intestines, is often missed due to vague symptoms. This review highlights CT imaging protocols to improve diagnosis and patient outcomes.
Area of Science:
- Radiology
- Gastroenterology
- Vascular Surgery
Background:
- Acute mesenteric ischemia (AMI) presents with non-specific abdominal pain and lacks reliable markers, leading to delayed diagnosis and high mortality.
- Understanding the three main forms—arterial, venous, and non-occlusive—is crucial for timely intervention.
- Radiologists are key in identifying subtle signs of intestinal ischemia to prevent misdiagnosis.
Purpose of the Study:
- To outline optimal CT imaging protocols for diagnosing acute mesenteric ischemia.
- To detail radiological features indicative of different AMI types and predict necrosis.
- To enhance diagnostic accuracy and guide patient management strategies.
Main Methods:
- Review of CT imaging protocols for acute mesenteric ischemia.
- Analysis of radiological findings across arterial, venous, and non-occlusive AMI.
- Emphasis on multi-phase CT (unenhanced, arterial, venous) for comprehensive evaluation.
Main Results:
- Specific CT phases are essential for visualizing vascular occlusion and bowel wall changes.
- Radiological signs can predict the extent of ischemia and potential necrosis.
- Accurate interpretation aids in patient stratification and treatment decisions.
Conclusions:
- A standardized CT protocol improves the detection of acute mesenteric ischemia.
- Radiological assessment is vital for differentiating AMI types and guiding management.
- Improved diagnostic capacity through imaging can reduce mortality associated with AMI.
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