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Impact of MDCT with intravenous contrast on the survival in patients with acute superior mesenteric artery occlusion.

Wadman, Maria LU ; Block, T; Ekberg, O; Syk, Ingvar LU ; Elmståhl, Sölve LU and Acosta, S (2010) In Emergency Radiology Aug 6.
Abstract
Acute thromboembolic occlusion in the superior mesenteric artery (SMA) is a condition with high mortality and morbidity. Multi-detector computerised tomography with intravenous contrast enhancement (MDCTiv) may improve diagnostic accuracy and survival. Patients with acute SMA occlusion were identified between 2004 and 2008 at Malmö University Hospital, Sweden. Medical records were analysed. Each MDCTiv was re-evaluated. A total of 67 patients were identified with SMA occlusion, of which 36 were examined with MDCTiv and ten with plain MDCT without intravenous contrast. In all, 24 (67%) of the 36 patients were correctly diagnosed by MDCTiv at first evaluation. Clinical suspicion of intestinal ischemia followed by a distinct inquiry for... (More)
Acute thromboembolic occlusion in the superior mesenteric artery (SMA) is a condition with high mortality and morbidity. Multi-detector computerised tomography with intravenous contrast enhancement (MDCTiv) may improve diagnostic accuracy and survival. Patients with acute SMA occlusion were identified between 2004 and 2008 at Malmö University Hospital, Sweden. Medical records were analysed. Each MDCTiv was re-evaluated. A total of 67 patients were identified with SMA occlusion, of which 36 were examined with MDCTiv and ten with plain MDCT without intravenous contrast. In all, 24 (67%) of the 36 patients were correctly diagnosed by MDCTiv at first evaluation. Clinical suspicion of intestinal ischemia followed by a distinct inquiry for intestinal ischemia was associated with trend for a higher rate of correct radiological diagnosis, 18 of 23 (78%), at first evaluation (0.06) but without affecting in-hospital survival (p = 0.27). At re-evaluation, SMA occlusion was found in all cases with MDCTiv, whereas intestinal findings were present in half. In-hospital mortality rate was 42% for patients who underwent MDCTiv, which was significantly lower compared to 90% for the ten patients examined with plain MDCT (p = 0.007) and 71% for patients not examined with MDCTiv or plain MDCT (p = 0.031). Patients that underwent plain MDCT had higher levels of creatinine compared to those examined with MDCTiv (p = 0.005). Patients who underwent intestinal revascularisation, endovascular or open, had higher survival rate (p = 0.001). Examination with MDCTiv in patients with acute SMA occlusion was associated with survival benefit. Hence, MDCTiv seems to be the method of choice in the workup phase. Radiologists should routinely describe the mesenteric vessels in patients with acute abdomen even when the diagnosis is not asked for. Patients with high creatinine levels are at risk to be examined without intravenous contrast, and survival in these patients is poor. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
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in
Emergency Radiology
volume
Aug 6
publisher
Springer
external identifiers
  • PMID:19657684
  • Scopus:77952242902
ISSN
1438-1435
DOI
10.1007/s10140-009-0828-4
language
English
LU publication?
yes
id
40381bec-8d90-4933-836f-8283478dc890 (old id 1469972)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/19657684?dopt=Abstract
date added to LUP
2009-09-07 10:34:11
date last changed
2016-10-13 04:35:49
@misc{40381bec-8d90-4933-836f-8283478dc890,
  abstract     = {Acute thromboembolic occlusion in the superior mesenteric artery (SMA) is a condition with high mortality and morbidity. Multi-detector computerised tomography with intravenous contrast enhancement (MDCTiv) may improve diagnostic accuracy and survival. Patients with acute SMA occlusion were identified between 2004 and 2008 at Malmö University Hospital, Sweden. Medical records were analysed. Each MDCTiv was re-evaluated. A total of 67 patients were identified with SMA occlusion, of which 36 were examined with MDCTiv and ten with plain MDCT without intravenous contrast. In all, 24 (67%) of the 36 patients were correctly diagnosed by MDCTiv at first evaluation. Clinical suspicion of intestinal ischemia followed by a distinct inquiry for intestinal ischemia was associated with trend for a higher rate of correct radiological diagnosis, 18 of 23 (78%), at first evaluation (0.06) but without affecting in-hospital survival (p = 0.27). At re-evaluation, SMA occlusion was found in all cases with MDCTiv, whereas intestinal findings were present in half. In-hospital mortality rate was 42% for patients who underwent MDCTiv, which was significantly lower compared to 90% for the ten patients examined with plain MDCT (p = 0.007) and 71% for patients not examined with MDCTiv or plain MDCT (p = 0.031). Patients that underwent plain MDCT had higher levels of creatinine compared to those examined with MDCTiv (p = 0.005). Patients who underwent intestinal revascularisation, endovascular or open, had higher survival rate (p = 0.001). Examination with MDCTiv in patients with acute SMA occlusion was associated with survival benefit. Hence, MDCTiv seems to be the method of choice in the workup phase. Radiologists should routinely describe the mesenteric vessels in patients with acute abdomen even when the diagnosis is not asked for. Patients with high creatinine levels are at risk to be examined without intravenous contrast, and survival in these patients is poor.},
  author       = {Wadman, Maria and Block, T and Ekberg, O and Syk, Ingvar and Elmståhl, Sölve and Acosta, S},
  issn         = {1438-1435},
  language     = {eng},
  publisher    = {ARRAY(0xd92b000)},
  series       = {Emergency Radiology},
  title        = {Impact of MDCT with intravenous contrast on the survival in patients with acute superior mesenteric artery occlusion.},
  url          = {http://dx.doi.org/10.1007/s10140-009-0828-4},
  volume       = {Aug 6},
  year         = {2010},
}