Table 1 Summary of findings on accuracy of radiological diagnosis (Forest plots available in Figs. 2, 3, 4, 5 and 6 and supplemental figures S1-S9). Not all results were available in all studies (e.g. Only sensitivity for some, Only odds ratio for some).

From: Radiological diagnosis of acute mesenteric ischemia in adult patients: a systematic review and meta-analysis

Variable

Number of studies (patients)

Sensitivity (95% confidence interval)

\(\:{I}^{2}\)

Specificity (95% confidence interval)

\(\:{I}^{2}\)

Adjusted odds ratio (95% confidence interval) [N of studies]5

Composite diagnosis of AMI1

242 (3391)

85.5 (78.1–90.6)

78%

96.1 (91.0–98.3)

88%

 

AMI any stage with CTA

12 (2028)

92.0 (86.3–95.5)

45%

98.8 (95.1–99.8)

79%

NA

Excluding SBO

10 (1107)

92.5 (85.6–96.2)

49%

98.5 (90.8–99.79)

72%

NA

Including SBO

2 (921)

89.8 (84.8–93.4)

0%

99.5 (98.7–99.8)

0%

NA

AMI any stage with any CT modality (including CTA)

8 (1363)

75.8 (63.3–85.1)

83%

90.5 (78.8–96.1)

88%

7.4 (2.3–24.0) [1]

Excluding SBO

6 (352)

74.9 (51.0–89.5)

83%

69.3 (48.4–84.5)

79%

7.4 (2.3–24.0) [1]

Including SBO

2 (429)

65.9 (44.5–82.3)

75%

97.2 (81.7–99.6)

90%

NA

Transmural ischaemia in SBO

5 (582)

80.4 (63.6–90.6)

88%

95.2 (92.3–97.1)

0%

NA

Bowel wall characteristics

Reduced/absent enhancement of the bowel wall

37 (3840)

57.9 (50.4–65.1)

85%

90.8 (85.5–94.4)

83%

14.3 (6.4–31.2) [3]

AMI vs. no AMI

14 (1484)

46.1 (34.3–58.3)

83%

95.9 (90.1–98.4)

71%

22.9 (7.9–66.2) [1]

Transmural vs. no transmural

23 (2402)

64.7 (56.7–72.4)

83%

86.9 (79.0–92.1)

85%

8.1 (2.5–26.1) [2]

Thickening of the bowel wall

47 (5238)

56.4 (50.4–62.2)

79%

63.4 (53.7–71.8)

90%

3.1 (1.1–8.5) [1]

AMI vs. no AMI

18 (1855)

61.0 (50.4–72.0)

84%

67.0 (46.9–82.4)

73%

NA

Transmural vs. no transmural

29 (3393)

53.3 (46.4–60.1)

70%

61.8 (50.6–71.8)

93%

3.1 (1.1–8.5) [1]

Pneumatosis intestinalis4

41 (4103)

32.9 (22.2–45.7)

77%

95.2 (82.4–98.8)

62%

2.36 (1.1–5.1) [2]

AMI vs. no AMI

20 (2043)

27.0 (20.3–35.0)

75%

98.2 (93.3–99.5)

68%

NA

Transmural vs. no transmural

21 (2070)

44.8 (20.7–71.6)

79%

84.1 (37.6–97.9)

57%

2.36 (1.1–5.1) [2]

Bowel wall thinning3

8 (617)

30.5 (21.4–41.5)

74%

97.9 (88.6–99.7)

48%

NA

AMI vs. no AMI

2 (193)

22.0 (7.6–49.1)

93%

97.5 (62.4–99.9)

0%

NA

Transmural vs. no transmural

6 (434)

33.6 (25.4–42.9)

43%

98.0 (85.3–99.8)

65%

NA

Unenhanced hyperattenuation

7 (571)

22.8 (12.7–37.4)

86%

99.8 (53.8–100.0)

0%

NA

AMI vs. no AMI

3 (178)

18.2 (6.1–43.3)

89%

100.0 (0.0–100.0)

0%

NA

Transmural vs. no transmural

4 (393)

26.2 (13.7–44.3)

84%

99.1 (56.1–100.0)

0%

NA

Hyperenhancement

12 (1163)

18.8 (10.6–31.1)

86%

82.3 (65.2–92.0)

93%

NA

AMI vs. no AMI

7 (620)

26.4 (12.7–47.0)

89%

89.0 (60.4–97.7)

95%

NA

Transmural vs. no transmural

5 (553)

12.8 (7.8–20.2)

27%

75.4 (60.4–86.0)

80%

NA

Other non-vascular features

Mesenteric stranding/ edema

31 (3487)

77.4 (66.0–85.8)

87%

47.5 (36.4–58.9)

93%

3.7 (1.2–10.3) [2]

AMI vs. no AMI

14 (1562)

63.5 (45.0–78.7)

90%

59.3 (46.7–70.7)

82%

NA

Transmural vs. no transmural

17 (1971)

85.9 (74.2–92.8)

82%

39.4 (25.3–55.4)

95%

3.7 (1.2–10.3) [2]

Ascites

46 (4888)

66.5 (57.1–74.8)

86%

62.0 (50.8–71.9)

67%

5.3 (2.6–10.4) [2]

AMI vs. no AMI

18 (1715)

53.7 (42.0–64.9)

85%

60.3 (33.2–82.3)

92%

NA

Transmural vs. no transmural

28 (3183)

74.6 (62.6–83.8)

87%

63.2 (51.9–73.2)

89%

5.3 (2.6–10.4) [2]

Bowel dilatation3

31 (3062)

59.6 (54.3–64.7)

71%

69.0 (60.9–76.1)

84%

4.8 (2.1–10.7) [1]

AMI vs. no AMI

18 (1743)

56.4 (50.4–62.2)

65%

68.8 (57.9–77.9)

84%

4.8 (2.1–10.7) [1]

Transmural vs. no transmural

13 (1319)

63.4 (54.4–71.6)

73%

69.4 (56.8–79.7)

85%

NA

Portomesenteric venous gas4

29 (3000)

18.9 (13.7–25.6)

82%

99.0 (95.6–99.8)

49%

NA

AMI vs. no AMI

18 (1937)

16.9 (10.8–25.5)

87%

99.6 (99.6–99.6)

61%

NA

Transmural vs. no transmural

11 (1063)

22.6 (14.9–32.8)

65%

96.3 (89.0–98.8)

24%

NA

Solid organ infarction 2

9 (742)

21.2 (11.3–36.4)

82%

88.7 (48.3–98.5)

93%

NA

AMI vs. no AMI

9 (742)

21.2 (11.3–36.4)

82%

88.7 (48.3–98.5)

93%

NA

  1. Legend: AMI- acute mesenteric ischemia; CT – computed tomography; CTA – computed tomography angiography; SBO – strangulating bowel obstruction.
  2. Transmural vs. no transmural – transmural bowel ischemia vs. no transmural ischemia (may include no ischemia).
  3. Highlighted in bold for subgroup analyses: sensitivity > 90% and specificity > 95% for the composite diagnosis and sensitivity > 60% and specificity > 90% for specific features.
  4. 1 in studies on SBO only transmural ischemia was considered as AMI.
  5. 2 one study reported results for CTA and CT separately.
  6. 3 studies assessing only patients with SBO were not included, as bowel dilatation (potentially leading to bowel wall thinning) is a sign of SBO. Studies including patients with SBO among AMI were included, results are presented separately in Supplemental Figures S1 and S2.
  7. 4 some studies included only patients with pneumatosis intestinalis (PI) and distinguished between patients with and without AMI, therefore specificity in these studies is always 0.
  8. 5 adjusted odds ratios as reported in individual studies. Number of studies is reported in square brackets. Result of a meta-analysis is presented if several studies reported adjusted OR.
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