Mesenteric Ischemia: 2026 Update-AJR Expert Panel Narrative Review

Area of Science:

• Radiology
• Vascular Imaging
• Gastrointestinal Medicine

Background:

• Mesenteric ischemia (MI) diagnosis is often delayed, significantly impacting patient outcomes.
• Current practices for defining, imaging, and managing MI show considerable variation despite technological advances.

Purpose of the Study:

• To provide radiologists with pragmatic guidance for evaluating mesenteric ischemia using imaging.
• To standardize the definition, imaging protocols, interpretation, and clinical integration of MI diagnosis.

Main Methods:

• A narrative review of the pathophysiologic spectrum, diagnosis, and imaging features of acute mesenteric ischemia (AMI).
• Discussion of CT protocol optimization, including spectral CT, and CT findings indicative of ischemia and necrosis.
• Presentation of a four-phase framework for CT findings in occlusive arterial AMI and consensus statements on image acquisition, interpretation, and reporting.

Main Results:

• Key issues covered include AMI diagnosis, CT optimization, vascular pathologies, ischemia/necrosis indicators, scoring systems, and management strategies.
• A simplified four-phase framework illustrates CT findings progression in occlusive arterial AMI.
• Consensus statements aim to support radiologists in diagnosing and managing MI.

Conclusions:

• Standardized imaging evaluation and reporting are crucial for timely diagnosis and management of mesenteric ischemia.
• Optimized CT protocols and a clear understanding of imaging findings can improve outcomes for patients with MI.
• Radiologists play a pivotal role as first-line decision-makers in the diagnosis and management pathway of mesenteric ischemia.