Lehtimäki Tiina T, Kärkkäinen Jussi M, Saari Petri, Manninen Hannu, Paajanen Hannu, Vanninen Ritva
Department of Clinical Radiology, Kuopio University Hospital, Puijonlaaksontie 2, P.O. Box 100, FI-70029 Kuopio, Finland.
Department of Gastrointestinal Surgery, Kuopio University Hospital, Puijonlaaksontie 2, P.O. Box 100, FI-70029 Kuopio, Finland; Heart Center, Kuopio University Hospital, Puijonlaaksontie 2, P.O. Box 100, FI-70029 Kuopio, Finland.
Eur J Radiol. 2015 Dec;84(12):2444-53. doi: 10.1016/j.ejrad.2015.09.006. Epub 2015 Sep 11.
(1) To evaluate the ability of emergency room radiologists to detect acute mesenteric ischemia (AMI) from computed tomography (CT) images in patients with acute abdominal pain. (2) To identify factors affecting radiologists' performance in the CT interpretation and patient outcome.
A retrospective study of 95 consecutive patients treated for 97 AMI events between 2009 and 2013 was carried out. The etiology of AMI was embolism in 24 (25%), atherosclerotic vascular disease (ASVD) in 39 (40%), non-obstructive mesenteric ischemia (NOMI) in 25 (26%), and mesenteric venous thrombosis (MVT) in nine (9%) cases. The protocols, referrals and initial radiology reports of the abdominal CTs were analyzed. The CT studies were further scrutinized for vascular and intestinal findings.
The referring clinician had suspected AMI in 30 (31%) cases prior to imaging. The crucial findings of AMI had been stated in 97% of the radiology reports if the clinician had mentioned AMI suspicion in the referral; if not, the corresponding rate was 81% (p=0.04). Patients without suspicion of AMI prior to CT were more prone to undergo bowel resection. CT protocol was optimal for AMI (with contrast enhancement in arterial and venous phases) in only 34 (35%) cases. Intestinal findings were more difficult to detect than vascular findings. Vascular findings were retrospectively detectable in 92% of cases with embolism and 100% in ASVD and MVT. Some evidence of intestinal abnormality was retrospectively found in the CT findings in 92%, 100%, 100% and 67% of cases with embolism, ASVD, NOMI and MVT, respectively.
AMI is underdiagnosed in the CT of the acute abdomen if there is no clinical suspicion.
（1）评估急诊室放射科医生从急性腹痛患者的计算机断层扫描（CT）图像中检测急性肠系膜缺血（AMI）的能力。（2）确定影响放射科医生CT解读表现及患者预后的因素。
对2009年至2013年间连续治疗的95例患者的97次AMI事件进行回顾性研究。AMI的病因包括栓塞24例（25%）、动脉粥样硬化性血管疾病（ASVD）39例（40%）、非阻塞性肠系膜缺血（NOMI）25例（26%）和肠系膜静脉血栓形成（MVT）9例（9%）。分析腹部CT的检查方案、转诊情况及初始放射学报告。对CT研究进一步仔细检查血管和肠道表现。
在成像前，转诊医生怀疑有AMI的病例有30例（31%）。如果临床医生在转诊中提及怀疑AMI，97%的放射学报告中陈述了AMI关键表现；如果未提及，相应比例为81%（p = 0.04）。CT检查前未怀疑有AMI的患者更倾向于接受肠切除术。仅34例（35%）病例的CT检查方案对AMI是最佳的（动脉期和静脉期有对比增强）。肠道表现比血管表现更难检测。栓塞病例中92%的血管表现可通过回顾性检测发现，ASVD和MVT病例中为100%。分别在栓塞、ASVD、NOMI和MVT病例的CT表现中回顾性发现肠道异常证据的比例为92%、100%、100%和67%。
如果没有临床怀疑，急性腹部CT对AMI的诊断不足。
