Computed tomography in acute mesenteric ischemia: diagnostic possibilities, limitations and the future
Authors:   I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Kuznetsov M.R. , Chernookov A.I. ,   BIOTECH University, Moscow, Atayan A.A. ,   I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Belykh E.N. ,   I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Kanadashvili O.V. ,   I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Ramazanov A.A. ,   Clinical Center for Restorative Medicine and Rehabilitation, Moscow, Ivanova M.I. ,   N.E. Bauman City Clinical Hospital No. 29, Moscow, Tsedinov S.O. ,   I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow
Published: January 2025

Acute mesenteric ischemia (AMI) represents a severe and potentially life-threatening condition caused by an abrupt reduction in intestinal blood
flow. This ischemic event, if not promptly addressed, leads to intestinal necrosis. The clinical presentation of AMI is commonly nonspecific and
variable, complicating early diagnosis. Without timely detection and intervention, AMI can progress to devastating complications including
intestinal necrosis, sepsis, multiple organ dysfunction syndrome (MODS), or short bowel syndrome secondary to extensive bowel resection.
Early identification is therefore paramount to optimizing treatment and reducing both morbidity and mortality associated with this condition.
This review explores the pivotal role of computed tomography (CT) in the diagnosis of AMI, evaluates the diagnostic accuracy of CT in
comparison with alternative imaging modalities, and discusses future advancements aimed at enhancing CT-based diagnostic capabilities.
A comprehensive review of the existing literature was conducted, focusing on studies investigating the utility of CT and other imaging
techniques in the evaluation of AMI. Relevant diagnostic parameters were analyzed, including bowel wall thickening, pneumatosis intestinalis,
and damage within the superior mesenteric artery (SMA) and its branches. The role of CT angiography was also assessed in diagnosing
abnormalities of the mesenteric arterial and venous systems. The findings underscore that CT is a highly effective diagnostic tool for AMI,
offering superior sensitivity and specificity compared to other imaging technologies such as X-ray, ultrasound, and magnetic resonance imaging (MRI). However, certain limitations — such as suboptimal image quality in specific patient populations, the risks associated with
ionizing radiation, and adverse reactions to contrast agents — must be acknowledged and addressed. Despite these challenges, CT has
emerged as a cornerstone in the early detection and management of AMI, facilitating rapid and accurate assessments that are critical to
improving patient outcomes. Advances in CT technology and integration of artificial intelligence and machine learning algorithms into CT
imaging workflows could refine diagnostic accuracy and reduce time-to-diagnosis. A multidisciplinary approach that combines CT imaging
with other diagnostic modalities may further optimize the patient management of with AMI.
Keywords: acute mesenteric ischemia, mesenteric circulation disorder, computed tomography, CT angiography, early diagnosis, intestinal
ischemia, superior mesenteric artery, artificial intelligence, machine learning, multidisciplinary approach.
For citation: Kuznetsov M.R., Chernookov A.I., Atayan A.A., Belykh E.N., Kanadashvili O.V., Ramazanov A.A., Ivanova M.I., Tsedinov S.O.
Computed tomography in acute mesenteric ischemia: diagnostic possibilities, limitations and the future. RMJ. 2024;10:23–26. DOI:
10.32364/2225-2282-2024-10-4