A diagnostic imaging test that uses X-rays and computer technology to create detailed images of the body.
Feasibility/Equipment: Transportation of patient to specific room is needed. Radiation dose is relevant (many times higher than with abdominal x-ray). Contrast media used for contrast-enhanced CT is associated with risks in patients with allergy and renal insufficiency.
Scoring information: none
Cost: high costs related to equipment and personnel
Evidence: Abdominal CT-scan has high accuracy in diagnosing many GI and vascular pathologies and has become a diagnostic method of choice in trauma and most of abdominal pathologies [1]. Assessment of GI motility with CT-scan is static. However, enteral application of contrast media allows some estimation of the passage, whereas increased diameter of bowels and changes (e.g. thickening/thinning) in the bowel wall may be indirect indications of dysmotility. Biphasic contrast CT allows accurate diagnosis of arterial and venous mesenteric ischaemia, with bowel wall enhancement, mesenteric stranding and pneumatosis intestinalis possibly adding additional value on presence and progression of ischaemia [2]. CT-angiography is a method of choice in diagnosing mesenteric ischaemia [3].
Accuracy / measurement properties: Unenhanced CT scan in patients with abdominal pain was 30% less accurate regarding diagnosis than contrast-enhanced CT scan [4]. Diagnostic accuracy of the CT-angiography with optimal protocol is above 90% in diagnosing occlusive acute mesenteric ischaemia [5]. For diagnosis of NOMI multidetector CT-scan is reported to have sensitivity of 96% but specificity only of 33-60% [6].
References
- ACR–SABI–SAR–SPR practice parameter for the performance of computed tomography (ct) of the abdomen and computed tomography (ct) of the pelvis https://www.acr.org/-/media/ACR/Files/Practice-Parameters/ct-abd-pel.pdf
- Nakamura Y, Kondo S, Narita K, Maeda S, Fonseca D, Honda Y, Tani C, Fukumoto W, Mitani H, Ishibashi M, Chosa K, Tatsugami F, Awai K. Understanding CT imaging findings based on the underlying pathophysiology in patients with small bowel ischemia. Jpn J Radiol. 2023 Apr;41(4):353-366. doi: 10.1007/s11604-022-01367-x
- ACR Appropriateness Criteria® Imaging of Mesenteric Ischemia 2018 https://acsearch.acr.org/docs/70909/Narrative/
- Shaish H, Ream J, Huang C, Troost J, Gaur S, Chung R, Kim S, Patel H, Newhouse JH, Khalatbari S, Davenport MS. Diagnostic Accuracy of Unenhanced Computed Tomography for Evaluation of Acute Abdominal Pain in the Emergency Department. JAMA Surg. 2023 Jul 1;158(7):e231112. doi: 10.1001/jamasurg.2023.1112.
- Anglaret S, Dallongeville A, Beaussier H, Touloupas C, Boulay I, Tardivel AM, Béranger S, Silvera S, Chatellier G, Ronot M, Zins M. Influence of clinical suspicion on CT accuracy of acute mesenteric ischemia: Retrospective study of 362 patients. Eur J Radiol. 2021 May;138:109652. doi: 10.1016/j.ejrad.2021.109652.
- Kwok HC, Dirkzwager I, Duncan DS, Gillham MJ, Milne DG. The accuracy of multidetector computed tomography in the diagnosis of non-occlusive mesenteric ischaemia in patients after cardiovascular surgery. Crit Care Resusc. 2014 Jun;16(2):90-5.