Jan Menke, MD
Purpose: To use meta-analysis to determine the diagnostic accuracy of contrast agent-enhanced multidetector computed tomography (CT) in primary acute mesenteric ischemia (AMI).
Materials and methods: The PubMed search engine and five other electronic databases were searched for "mesenteric ischemia," "computed tomography," and related terms in articles published between January 1996 and September 2009, without language restrictions. Reference lists of retrieved articles were also searched. Two reviewers independently selected six studies that reported 2×2 contingency data on the diagnostic accuracy of multidetector CT in primary AMI in at least 10 patients with disease and 10 patients without disease and that used surgery or clinical outcome as the reference standard. Study data were independently extracted by the two reviewers, and disagreement was resolved by consensus. The study quality was assessed by using items from the Quality Assessment of Diagnostic Accuracy Studies tool. The primary 2×2 count data were investigated with a bivariate random-effects meta-analysis of sensitivity and specificity.
Results: Three studies were prospective, and three were retrospective. All studies were of high quality. The CT scanners used in the included studies had between four and 40 rows. The between-study heterogeneity was low to moderate. Overall, AMI was found in 142 of 619 studied cases. The meta-analysis showed a pooled sensitivity of 93.3% (95% confidence interval: 82.8%, 97.6%) and a pooled specificity of 95.9% (95% confidence interval: 91.2%, 98.2%).
Conclusion: On the basis of a thorough clinical examination, contrast-enhanced multidetector CT allows the diagnosis of primary AMI with high sensitivity and specificity. Thus, it may be used as the first-line imaging method.