American College of Radiology
ACR Appropriateness Criteria®

Imaging of Mesenteric Ischemia

Variant 1: Suspected acute mesenteric ischemia. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CTA abdomen and pelvis with IV contrast Usually appropriate ☢☢☢☢☢ 30-100 mSv 9 9 0 0 0 0 0 0 0 1 13
CT abdomen and pelvis with IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 1 6 6 1 0 0
Arteriography abdomen May be appropriate (Disagreement) ☢☢☢ 1-10 mSv 5 3 0 1 9 1 1 0 0 2 0
MRA abdomen and pelvis without and with IV contrast May be appropriate (Disagreement) O 0 mSv O 0 mSv [ped] 5 5 0 0 2 2 4 4 2 0 0
Radiography abdomen May be appropriate ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 5 5 3 0 2 2 5 1 1 0 0
US duplex Doppler abdomen May be appropriate O 0 mSv O 0 mSv [ped] 4 4 1 1 1 6 3 2 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 0 2 7 3 1 1 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 3 4 5 2 0 0 0 0 0
MRA abdomen and pelvis without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 0 4 10 0 0 0 0 0 0
Variant 2: Suspected chronic mesenteric ischemia. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CTA abdomen and pelvis with IV contrast Usually appropriate ☢☢☢☢☢ 30-100 mSv 9 9 0 0 0 0 0 0 0 1 13
MRA abdomen and pelvis without and with IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 8 8 0 0 0 1 1 1 4 7 0
CT abdomen and pelvis with IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 2 8 3 1 0 0
Arteriography abdomen May be appropriate (Disagreement) ☢☢☢ 1-10 mSv 5 3 0 3 6 1 1 0 2 1 0
MRA abdomen and pelvis without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 5 5 0 0 3 3 6 2 0 0 0
US duplex Doppler abdomen May be appropriate O 0 mSv O 0 mSv [ped] 5 5 0 0 1 2 5 2 5 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 0 5 5 4 0 0 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 3 3 5 0 3 0 0 0 0
Radiography abdomen Usually not appropriate ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 2 2 4 5 4 1 0 0 0 0 0
Please refer to the supporting documentation for a more complete discussion of the concepts and their definitions below.
Final Tabulations:
A histogram of the number of panel members who rated the recommendation as noted in the column heading (ie, 1, 2, 3, …etc.)
Disagree:
The variation of the individual ratings from the median rating indicates panel disagreement on the final recommendation.
References:
Lists the references associated with the recommendation
SQ:
Study Quality (1, 2, 3, 4, Good M or Inadequate M) of the references listed.
RRL:
Information on the Relative Radiation Level (RRL) designations can be found here.