Clinical Surgery-International
The correlation of the D-dimer test and biphasic
computed tomography with mesenteric computed
tomography angiography in the diagnosis of acute
mesenteric ischemia
Hizir Akyildiz, M.D.
a,
*, Alper Akcan, M.D.
a
, Ahmet Oztürk, Ph.D.
b
,
Erdogan Sozuer, M.D.
a
, Can Kucuk, M.D.
a
, Ibrahim Karahan, M.D.
c
a
Department of General Surgery, School of Medicine, Erciyes University, 38039 Kayseri, Turkey;
b
Department of
Biostatistics, School of Medicine, Erciyes University, Kayseri, Turkey;
c
Department of Radiology, School of Medicine,
Erciyes University, Kayseri, Turkey
Abstract
BACKGROUND: Early diagnosis is the main factor to improve the outcome of acute mesenteric
ischemia (AMI). The goal of this study was to assess the correlation of the D-dimer test and biphasic
computed tomography (CT) with mesenteric CT angiography for the diagnosis of AMI.
METHODS: Selected consecutive patients with a clinical suspicion of AMI were admitted to the
study. Blood samples were taken before biphasic CT with mesenteric CT angiography examination.
RESULTS: The sensitivity and specificity values of biphasic CT with mesenteric CT angiography
were 92.9% and 89.5%, respectively. The sensitivity and specificity of D-dimer testing for the diagnosis
of AMI were 94.7% and 78.6%, respectively. D-dimer levels higher than 3.17 g fibrinogen equivalent
units/mL were more specific (P .0001) and acted similarly to the biphasic CT with mesenteric CT
angiography in the diagnosis of AMI.
CONCLUSIONS: In the setting of early diagnosis of AMI, the D-dimer test may improve our ability
to diagnose patients in whom we cannot use multidetector row CT with CT angiography.
© 2009 Elsevier Inc. All rights reserved.
KEYWORDS:
Acute mesenteric
ischemia;
Biphasic computed
tomography (CT) with
mesenteric CT
angiography;
D-dimer
Acute mesenteric vascular disorders are life-threatening
conditions with high mortality rates.
1,2
With the increase of
average life expectancy and the increasing prevalence of
cardiovascular diseases in the Western world, acute bowel
ischemia is becoming more and more common.
3
Many
studies have shown that the only factor that may influence
the prognosis of affected patients is early, correct diagnosis
and therapy.
1–4
Catheter angiography and computed tomography (CT)
have been the main diagnostic tests for acute mesenteric
ischemia (AMI). Although considered the gold standard for
decades, angiography is an invasive procedure that is not
universally available and that may take time to arrange and
perform. In addition, it can only provide assessment of the
mesenteric vessels.
3,5
On the other hand, CT is more widely
available, less invasive, and can be performed quickly. It
can provide further information on not only the mesenteric
vessels, but also the bowel, abdominal organs, and sur-
* Corresponding author. Tel.: +90 5334613605; fax: +903524374912.
E-mail address: hyakyildiz@gmail.com
Manuscript received January 10, 2008; revised manuscript February
14, 2008
0002-9610/$ - see front matter © 2009 Elsevier Inc. All rights reserved.
doi:10.1016/j.amjsurg.2008.02.011
The American Journal of Surgery (2009) 197, 429 – 433