Imaging of Bowel Ischemia

Acute bowel ischemia is a broad category of disease that includes acute mesenteric ischemia and acute colonic ischemia. These two entities differ in their pathogenesis but result in hypoxic injury that presents with nonspecific clinical findings and a wide range of imaging appearances. Multi-row detector computed tomography (CT) and computed tomography angiography (CTA) have supplanted conventional angiography as the test of choice for acute mesenteric ischemia. Routine portal venous CT is typically adequate for colonic ischemia as it is most commonly nonocclusive in etiology. Dual-energy computed tomography is a more recent advancement that can potentially offer improved conspicuity of differential bowel wall enhancement compared to conventional CT. Magnetic resonance angiography may be used as a secondary option to CTA in acute mesenteric ischemia in stable patients for whom iodinated contrast and ionizing radiation are a primary concern.