Radiography Abdomen Radiography has little to no role in the diagnosis of chronic mesenteric ischemia because these patients have not yet developed bowel necrosis, and therefore the radiograph will likely be normal or demonstrate nonspecific findings. A negative radiograph also does not exclude the diagnosis of chronic mesenteric ischemia [19,57,68]. CTA Abdomen and Pelvis CTA of the abdomen and pelvis has been shown to provide best accuracy and inter-reader agreement for grading mesenteric vessel stenosis compared to MRA and US, with sensitivity and specificity of 95% to 100% using DSA as a reference standard [29]. Moreover, CTA is an accurate diagnosing tool for detecting median arcuate ligament syndrome as a potential cause of chronic ischemia [7]. CTA can also accurately exclude other causes of chronic abdominal pain. CT Abdomen and Pelvis CT of the abdomen and pelvis with IV contrast performed during the venous phase appears to provide satisfactory evaluation of major vascular pathology, such as atherosclerotic plaques and occlusions, although this has not been well studied [69]. There is a paucity of data regarding performance of CT without IV contrast for suspected chronic mesenteric ischemia. Although able to assess the extent calcified atherosclerotic plaque affects the mesenteric vasculature, CT without IV contrast is limited in its ability to evaluate noncalcified plaque and is therefore likely to underestimate the degree of stenosis. Additionally, calcified atherosclerotic plaque in the mesenteric vasculature is a common incidental finding in the elderly population and cannot be relied upon for accurate diagnosis of chronic mesenteric ischemia [24,26,33]. CT without and with IV contrast is not indicated in the evaluation of suspected chronic mesenteric ischemia.
Imaging of Mesenteric Ischemia. Radiography Abdomen Radiography has little to no role in the diagnosis of chronic mesenteric ischemia because these patients have not yet developed bowel necrosis, and therefore the radiograph will likely be normal or demonstrate nonspecific findings. A negative radiograph also does not exclude the diagnosis of chronic mesenteric ischemia [19,57,68]. CTA Abdomen and Pelvis CTA of the abdomen and pelvis has been shown to provide best accuracy and inter-reader agreement for grading mesenteric vessel stenosis compared to MRA and US, with sensitivity and specificity of 95% to 100% using DSA as a reference standard [29]. Moreover, CTA is an accurate diagnosing tool for detecting median arcuate ligament syndrome as a potential cause of chronic ischemia [7]. CTA can also accurately exclude other causes of chronic abdominal pain. CT Abdomen and Pelvis CT of the abdomen and pelvis with IV contrast performed during the venous phase appears to provide satisfactory evaluation of major vascular pathology, such as atherosclerotic plaques and occlusions, although this has not been well studied [69]. There is a paucity of data regarding performance of CT without IV contrast for suspected chronic mesenteric ischemia. Although able to assess the extent calcified atherosclerotic plaque affects the mesenteric vasculature, CT without IV contrast is limited in its ability to evaluate noncalcified plaque and is therefore likely to underestimate the degree of stenosis. Additionally, calcified atherosclerotic plaque in the mesenteric vasculature is a common incidental finding in the elderly population and cannot be relied upon for accurate diagnosis of chronic mesenteric ischemia [24,26,33]. CT without and with IV contrast is not indicated in the evaluation of suspected chronic mesenteric ischemia.