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Insights into acute mesenteric ischaemia: an up-to-date, evidence-based review from a mesenteric stroke centre unit

Radiologists play a central role in the diagnostic and prognostic evaluation of patients with acute mesenteric ischaemia (AMI). Unfortunately, more than half of AMI patients undergo imaging with no prior suspicion of AMI, making identifying this disease even more difficult. A confirmed diagnosis of...

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Autores principales: Garzelli, Lorenzo, Ben Abdallah, Iannis, Nuzzo, Alexandre, Zappa, Magaly, Corcos, Olivier, Dioguardi Burgio, Marco, Cazals-Hatem, Dominique, Rautou, Pierre-Emmanuel, Vilgrain, Valérie, Calame, Paul, Ronot, Maxime
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The British Institute of Radiology. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10607400/
https://www.ncbi.nlm.nih.gov/pubmed/37493183
http://dx.doi.org/10.1259/bjr.20230232
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author Garzelli, Lorenzo
Ben Abdallah, Iannis
Nuzzo, Alexandre
Zappa, Magaly
Corcos, Olivier
Dioguardi Burgio, Marco
Cazals-Hatem, Dominique
Rautou, Pierre-Emmanuel
Vilgrain, Valérie
Calame, Paul
Ronot, Maxime
author_facet Garzelli, Lorenzo
Ben Abdallah, Iannis
Nuzzo, Alexandre
Zappa, Magaly
Corcos, Olivier
Dioguardi Burgio, Marco
Cazals-Hatem, Dominique
Rautou, Pierre-Emmanuel
Vilgrain, Valérie
Calame, Paul
Ronot, Maxime
author_sort Garzelli, Lorenzo
collection PubMed
description Radiologists play a central role in the diagnostic and prognostic evaluation of patients with acute mesenteric ischaemia (AMI). Unfortunately, more than half of AMI patients undergo imaging with no prior suspicion of AMI, making identifying this disease even more difficult. A confirmed diagnosis of AMI is ideally made with dynamic contrast-enhanced CT but the diagnosis may be made on portal-venous phase images in appropriate clinical settings. AMI is diagnosed on CT based on the identification of vascular impairment and bowel ischaemic injury with no other cause. Moreover, radiologists must evaluate the probability of bowel necrosis, which will influence the treatment options. AMI is usually separated into different entities: arterial, venous, non-occlusive and ischaemic colitis. Arterial AMI can be occlusive or stenotic, the dominant causes being atherothrombosis, embolism and isolated superior mesenteric artery (SMA) dissection. The main finding in the bowel is decreased wall enhancement, and necrosis can be suspected when dilatation >25 mm is identified. Venous AMI is related to superior mesenteric vein (SMV) thrombosis as a result of a thrombophilic state (acquired or inherited), local injury (cancer, inflammation or trauma) or underlying SMV insufficiency. The dominant features in the bowel are hypoattenuating wall thickening with submucosal oedema. Decreased enhancement of the involved bowel suggests necrosis. Non-occlusive mesenteric ischaemia (NOMI) is related to impaired SMA flow following global hypoperfusion associated with low-flow states. There are numerous findings in the bowel characterised by diffuse extension. An absence of bowel enhancement and a thin bowel wall suggest necrosis in NOMI. Finally, ischaemic colitis is a sub-entity of arterial AMI and reflects localised colon ischaemia-reperfusion injury. The main CT finding is a thickened colon wall with fat stranding, which seems to be unrelated to SMA or inferior mesenteric artery lesions. A precise identification and description of vascular lesions, bowel involvement and features associated with transmural necrosis is needed to determine patient treatment and outcome.
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spelling pubmed-106074002023-10-28 Insights into acute mesenteric ischaemia: an up-to-date, evidence-based review from a mesenteric stroke centre unit Garzelli, Lorenzo Ben Abdallah, Iannis Nuzzo, Alexandre Zappa, Magaly Corcos, Olivier Dioguardi Burgio, Marco Cazals-Hatem, Dominique Rautou, Pierre-Emmanuel Vilgrain, Valérie Calame, Paul Ronot, Maxime Br J Radiol Review Article Radiologists play a central role in the diagnostic and prognostic evaluation of patients with acute mesenteric ischaemia (AMI). Unfortunately, more than half of AMI patients undergo imaging with no prior suspicion of AMI, making identifying this disease even more difficult. A confirmed diagnosis of AMI is ideally made with dynamic contrast-enhanced CT but the diagnosis may be made on portal-venous phase images in appropriate clinical settings. AMI is diagnosed on CT based on the identification of vascular impairment and bowel ischaemic injury with no other cause. Moreover, radiologists must evaluate the probability of bowel necrosis, which will influence the treatment options. AMI is usually separated into different entities: arterial, venous, non-occlusive and ischaemic colitis. Arterial AMI can be occlusive or stenotic, the dominant causes being atherothrombosis, embolism and isolated superior mesenteric artery (SMA) dissection. The main finding in the bowel is decreased wall enhancement, and necrosis can be suspected when dilatation >25 mm is identified. Venous AMI is related to superior mesenteric vein (SMV) thrombosis as a result of a thrombophilic state (acquired or inherited), local injury (cancer, inflammation or trauma) or underlying SMV insufficiency. The dominant features in the bowel are hypoattenuating wall thickening with submucosal oedema. Decreased enhancement of the involved bowel suggests necrosis. Non-occlusive mesenteric ischaemia (NOMI) is related to impaired SMA flow following global hypoperfusion associated with low-flow states. There are numerous findings in the bowel characterised by diffuse extension. An absence of bowel enhancement and a thin bowel wall suggest necrosis in NOMI. Finally, ischaemic colitis is a sub-entity of arterial AMI and reflects localised colon ischaemia-reperfusion injury. The main CT finding is a thickened colon wall with fat stranding, which seems to be unrelated to SMA or inferior mesenteric artery lesions. A precise identification and description of vascular lesions, bowel involvement and features associated with transmural necrosis is needed to determine patient treatment and outcome. The British Institute of Radiology. 2023-11 2023-07-26 /pmc/articles/PMC10607400/ /pubmed/37493183 http://dx.doi.org/10.1259/bjr.20230232 Text en © 2023 The Authors. Published by the British Institute of Radiology https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 Unported License http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) , which permits unrestricted non-commercial reuse, provided the original author and source are credited.
spellingShingle Review Article
Garzelli, Lorenzo
Ben Abdallah, Iannis
Nuzzo, Alexandre
Zappa, Magaly
Corcos, Olivier
Dioguardi Burgio, Marco
Cazals-Hatem, Dominique
Rautou, Pierre-Emmanuel
Vilgrain, Valérie
Calame, Paul
Ronot, Maxime
Insights into acute mesenteric ischaemia: an up-to-date, evidence-based review from a mesenteric stroke centre unit
title Insights into acute mesenteric ischaemia: an up-to-date, evidence-based review from a mesenteric stroke centre unit
title_full Insights into acute mesenteric ischaemia: an up-to-date, evidence-based review from a mesenteric stroke centre unit
title_fullStr Insights into acute mesenteric ischaemia: an up-to-date, evidence-based review from a mesenteric stroke centre unit
title_full_unstemmed Insights into acute mesenteric ischaemia: an up-to-date, evidence-based review from a mesenteric stroke centre unit
title_short Insights into acute mesenteric ischaemia: an up-to-date, evidence-based review from a mesenteric stroke centre unit
title_sort insights into acute mesenteric ischaemia: an up-to-date, evidence-based review from a mesenteric stroke centre unit
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10607400/
https://www.ncbi.nlm.nih.gov/pubmed/37493183
http://dx.doi.org/10.1259/bjr.20230232
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